In Jan. 2004, the workshop "Why Invest in Communication for Immunization?" was held in Washington, DC, USA. Organised by the Health Communication Partnership (HCP) and the United Nations Children's Fund (UNICEF), this 2-day workshop brought together specialists, practitioners, advocates, and funders who use communication to address immunisation issues at local, regional, national, and global levels.

This issue of the Drum Beat highlights key themes emerging from 7 key presentations at this workshop. Please click on the links provided for a more detailed summary. Please see the Communication Initiative's Immunisation and Vaccines window for additional resources.

1. Lessons Learned from 5 Country Studies of Communication Support for Polio Eradication and Routine Immunization - Michael Favin, CHANGE Project, AED, mfavin@smtp.aed.org

In 1999, communication specialists from major international organisations carried out studies in Mozambique, Zambia, Democratic Republic of the Congo, Mali, and Nigeria on communication support for polio eradication and routine immunisation. Highlights of these findings include:

• Polio activities tended to be successful, while routine coverage remained stagnant or fell.
• A wide array of partners carried out mobilisation and communication efforts for polio National Immunization Days, but minimal efforts (e.g., health talks and posters) were conducted for routine immunisation/surveillance.
• There was limited promotion of routine immunisation in polio communications; some efforts made actually caused confusion.
• Centralised, top-down planning and execution resulted in some materials being inappropriate, and some being distributed late or not at all.

What worked well:

• emphasising interpersonal communication and involving local leaders and networks
• fostering interagency and intersectoral collaboration
• engaging public officials and the media in partnerships
• using a mix of media

Areas needing improvement:

• carrying out and using research for programme and materials design
• making communications more strategic (systematically defining desired behaviours; analysing and addressing barriers)
• ensuring local involvement in communications planning
• allowing more lead time (funding)
• supervising, monitoring, and evaluating communications
• funding, managing, and ensuring quality of routine immunisation services
• interacting more closely with families (health staff)

Conclusions:

• Research-based national strategies can provide basic technical content and message consistency while supporting local adaptation and planning
• Routine immunisation programmes can draw on ideas that worked in polio eradication.

Click here for a more detailed summary

2. Integrating and Supporting Expanded Program on Immunization (EPI) Communication - Lora Shimp, BASICS, lshimp@jsi.com

Country immunisation programmes, commonly referred to as the Expanded Programme on Immunization (EPI), are supported by national Ministries of Health as well as various donor and partner organisations. Lora Shimp's presentation focuses on the recommendations and strategies implemented by the Communication Advisory Group (CAG) for immunisation, which works with EPI partners and the Task Force for Immunization in Africa (TFI) to develop communication and advocacy support for efforts such as the "reaching every district" (RED) approach. Efforts to reduce drop-out (i.e., infants who begin their vaccination schedule but do not complete the series) are part of RED, in which communication plays a key role. Areas of focus have included use of existing community networks to mobilize and engage their support and utilisation of immunisation services, provision of information through mass media, and use of interpersonal channels (e.g., vaccination cards used by health workers and mobilisers to track vaccination status and provide information to caregivers, stressing the importance of return visits to complete the immunisation schedule).

At a Nov. 2004 meeting, the CAG recommended the following to the TFI:

• Increased financing and support for communication as a component of routine EPI to enable more effective community linkages, advocacy support, and social mobilisation for immunisation
• Funding for communication positions at global, regional, and national levels
• Technical support and capacity building for and within countries, including strengthening service delivery and improving communication linkages at district and community levels (e.g., enhancing health worker and caregiver interpersonal communication, linking health centres with communities and local leaders, and increasing use of media for advocacy).

Click here for a more detailed summary

3. Communication lessons learned in polio eradication - Silvio Waisbord, CHANGE Project, AED, silviowaisbord@hotmail.com

Silvio Waisbord discusses specific communication goals in support of polio eradication, with a focus on capacity building in terms of personnel, technical, and organisational aspects:

• Large-scale media (television, radio) have raised awareness about polio vaccines
  
  
  • different media is appropriate in rural and in urban areas
  • local and minority media is particularly relevant
  • print media (posters, newspapers) have had a limited impact

• Interpersonal communication is important - whether between health workers and caretakers, or with traditional and religious institutions and leaders
• If not addressed quickly, rumours can turn into organised political resistance

What could have been done better?

• Explaining and conveying information about oral polio virus and other immunisation programmes
• Using local forms of communication and culture (e.g., popular theatre or community radio) strategically
• Designing focused strategies for specific populations
• Maintaining continuity of communication activities
• Show linkages between communication interventions and coverage rates

Waisbord urges that capacity building in communication for immunisation be institutionalised, that communication plans be improved, and that technical expertise in communication be maintained. He also suggests fine-tuning communication strategies for hard-to-reach communities, which have irregular access to health services, insufficient or no access to mass media, are highly mobile, and are marginalised.

Click here for a more detailed summary

4. The Rotavirus Vaccine Program - Evan Simpson, Program for Appropriate Technology in Health (PATH), RVPinfo@path.org

PATH's Rotavirus Vaccine Program was created in 2003 to reduce child morbidity and mortality from childhood diahrroeal disease by accelerating the availability of rotavirus vaccines appropriate for use in developing countries. Strategies include:

• Vaccine demand: providing potential vaccine purchasers at global, national, and local levels with information about disease burden estimates, safety and efficacy; financing and economic data; and immunisation policy analysis.
• Vaccine supply: collecting data needed to conduct demand forecasts and market surveys, and information related to international supply requirements. "The aim is to overcome demand uncertainty, which has been a significant barrier to ensuring vaccine availability in developing countries."

Click here for a more detailed summary

5. Immunisation Communication, the Media and the Public - Dr. David Salisbury CB FRCP FRCPCH FFPHM, Department of Health, London UK, David.Salisbury@doh.gsi.gov.uk

David Salisbury begins by exploring "the new role" of the media in reporting on vaccination issues. He claims that "the science element" lends an "aura of mystique" to the issue of vaccination for those exposed to media reports. A key communication challenge is that often what is feared is not the communicable disease itself but, rather, the vaccine. Anti-vaccine groups sometimes use scare tactics to galvanise the media for their cause, communicating vaccination risks (perhaps unsubstantiated) to both children and adults. The media can exacerbate the problem by reporting findings as scientific truths, while failing to report findings that contradict earlier false claims.

Salisbury reviews some research that gauges the vaccination-related communication needs and preferences of UK mothers. These women have indicated that they want information from people who communicate in a clear, consistent, and open manner. In short, they desire an evidence-based approach, and want to be empowered to find that evidence for themselves.

Click here for a more detailed summary

6. Advocacy for Financial Sustainability - Dana Faulkner & Rebecca Fields, CHANGE Project, AED, rfields@aed.org

Faulkner and Fields begin by describing the requirement, introduced in 2002, that Financial Sustainability Plans be submitted to The Global Alliance for Vaccines and Immunization (GAVI)'s board for grant reporting. This requirement, they say, has highlighted a few key challenges:

• The money doesn't reach where it is needed
• The programme doesn't do as much as it could with the money
• There is not enough money to meet programme objectives

To address these challenges, an advocacy framework/tool (in the form of a CD-ROM) has been developed to build awareness about the value of immunisation. This tool first focuses on the finance-related strategic objectives already selected by the country, then poses a series of questions to clarify needed actions. It defines the specific actors who can carry out these actions. This framework includes a series of short problem statements that link to frameworks for analysis and planning, existing manuals, country examples, and resource materials. 50 such CD-ROMs have been sent to GAVI's Financing Task Force (FTF) for field testing; the contents of the CD-ROM are posted on the FTF website.

Conclusions:

• Advocacy is highly culture-bound and situational: Outsiders can only pose good questions - the answers require insider savvy
• Advocacy activities targeted at specific, politically sensitive issues (like budget allocations) can be a risky activity for EPI programme managers
• Country health officials tell us they need more than messages that say "immunisation is good" - if they are to successfully advocate for immunisation programmes relative to other priorities
• Successful advocacy for immunisation by country programmes has the potential to affect the power dynamic between and among country managers and external funders - funders may feel that their priorities are challenged.

Click here for a more detailed summary

7. Repositioning Vaccines: A New Global Advocacy Strategy - Tommy Bruce; for more info, contact Chlopak, Leonard, Schechter & Associates, vaccines@clsdc.com

Advanced in 1998, the Healthy People 2010 Objectives articulate more than 500 national objectives for improving the health of Americans by 2010. One of them holds that full immunisation coverage should be guaranteed to at least 90% of USA children, with at least 80% coverage in every district. To support this effort, Chlopak, Leonard, Schechter & Associates engaged in a research project with UNICEF in 2003. The study found that, while vaccines are appreciated within the public health field, there is general reticence toward pro-vaccine advocacy.

Tommy Bruce urges that a campaign be undertaken to engage policy makers and the media, rebuild public trust in vaccines, generate political and financial support for immunisation, and create a sense of urgency. Bruce suggests that messages emphasise specific child survival goals. Media outreach approaches might include:

• Identifying and engaging top journalists covering immunisation
• Providing a steady flow of information
• Sustaining a positive message in front of key audiences
• Countering negative stories
• Publicising achievements and success stories
• Promoting media responsibility through, for example, a campaign that would feature one "hot spot" per month (e.g., Hepatitis in Peru). An Internet portal could make information about vaccines accessible, organise and unify existing resources, establish links to partner organisations' websites, create a virtual forum for partners and allies to exchange ideas, and constitute a rapid response mechanism to broadcast problems and correct false rumours.

Click here for a more detailed summary

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