COMMUNICATION and the POLIO ENDGAME
The detection of two polio cases in Nigeria in August 2016 after two years of no cases being seen in the country is a reminder of how fragile progress against this disease can be. But with polio endemic in only two countries, and just 21 cases of polio seen in those countries in the first eight months of 2016, it looks as if this crippling disease will soon be relegated to history.
The story of the rocky road polio eradication is one of science – of vaccine development, supply chains and lab tests. But it is also a story of communication. Where attention has been paid to ambitious and localised communication strategies in support of polio vaccination, great successes have been seen. But where the communication by those opposed to vaccination has been more compelling than that of the public health community, eradication efforts have at times been brought to their knees.
In terms of the positive contribution communication can make, much has been learnt from India. When polio cases soared between 2005 and 2007, it was only by using locally owned, data-driven communication strategies to reach the poor and isolated communities where cases clustered that the disease was brought under control. A vast network of trained health workers and communicators fanned out across vast geographies to talk with families, household by household. These conversations convinced parents of the need for repeated rounds of vaccination and helped overcome suspicions that the polio vaccine didn't work, made children ill and/or caused infertility. The support of religious and community leaders and the broadcast of public service announcements also helped to build trust in the vaccine and encourage families to vaccinate their children. These efforts played a major part in India being declared polio-free in 2014.
Such was the success of the India programme, and so clear was the role that communication and social mobilisation played, that these strategies became central to global polio eradication policy. The Global Polio Eradication Initiative’s most recent strategy sets out plans for locally tailored communication efforts to build support for vaccination among the most sceptical.
But communication around this disease can also cut the other way, allowing the virus to thrive. In Nigeria in 2012, messages disseminated by anti-polio vaccination campaigners via video and radio claimed that the polio vaccine was part of a deliberate Western plot to sterilise Muslims and to spread AIDS, cancer and polio itself. Rumour spread like wildfire in the north of the country and the number of polio cases soared, reaching 122 by the end of the year. Violence and intimidation followed and, in 2013, 13 vaccinators in Kano and Borno states were murdered.
That year, a report of the global Independent Monitoring Board (IMB), charged with overseeing the Global Polio Eradication Initiative, demanded an explanation of how these devastating setbacks had happened. How could it be that those who sought to damage the polio programme in Nigeria were more effective communicators than the programme itself? Why were parents who refused the polio vaccine still lacking the information that they needed to answer basic questions about polio? The IMB report noted that the overall global polio programme faced a “deep threat” caused by a “crippling under-emphasis on social mobilisation and communication".
Understanding how this situation arose in Nigeria is vital if lessons are to be learnt about how to effectively deploy communication in public health. Michel Zaffran, the Head of Polio Eradication at the World Health Organisation (WHO), provides an interesting analysis. In recent correspondence, Zaffran explained that while global polio eradication programme has long recognised the importance of communication, epidemiologists often like to focus on quantifiable, known variables like where the virus is circulating in the environment, how many children have been paralysed and how many more have been missed by vaccination teams. In contrast, he notes, “understanding people's attitudes, perceptions, and the complex interaction between behaviour, culture and social context, is often a lot more difficult … to communicate – and act upon – particularly in emergency contexts when quick decisions and results need to be demonstrated".
However complex these factors may be, acting on them is absolutely central to improving health. And that’s precisely what’s happening now. After the devastating events in Nigeria, UNICEF increased the size of their teams working to lead work on polio communication and formed long-term partnerships with 25 organisations across the world (among them, BBC Media Action) to enable the quick turnaround of professional communication work on the ground. According to data obtained from UNICEF, the number of grassroots social mobilisers in polio-endemic countries rose from about 12,000 in 2013 to over 35,000 in 2016. Emergency Operation Centres leading the fight against polio in Nigeria, Afghanistan and Pakistan now have dedicated cells for social mobilisation and communication, where health communication experts work closely alongside epidemiologists and clinicians.
These investments have paid off. Dr Reza Hossaini, Head of Polio at Unicef, argues: “We’ve eradicated polio in nearly every country in the world because communities have come together and decided that their children will no longer be crippled by polio. This has been the invaluable contribution of communications and social mobilization…”