The Drum Beat 808 - What Have We Learned from Polio Eradication So Far?

• 1.The Untold Story of Community Mobilizers Re-engaging a Disengaged Community During the Endemic Era of India's Polio Eradication Program
  by Roma Solomon
  Although India's polio eradication programme began in earnest in 1995, the community gradually disengaged from the programme as misinformation about the oral polio vaccine (OPV) spread. In states like Uttar Pradesh, vaccinators were met with refusals, sometimes accompanied by physical aggression. This article examines what caused this break in communication and how the CORE Group Polio Project (CGPP)'s social mobilisers delved deep to uncover why communities had become suspicious of government intentions in offering OPV. "How the war against polio in India was won needs to be told so that lessons can be used for other community health interventions." [Mar 2021]
  
   
• 2.Lessons from the Elimination of Poliomyelitis in Africa
  by Abdulaziz Mohammed, Oyewale Tomori, and John N. Nkengasong
  In August 2020, Africa was declared free of wild poliovirus (WPV) after a 32-year effort. This article chronicles the global, continental, national, and community actions taken by diverse stakeholders that led to this achievement. It discusses the challenges encountered, exploring the lessons learned and their potential applicability to future public health interventions in Africa and elsewhere. For example, in northern Nigeria, WPV transmission was largely due to a combination of socio-economic determinants of health and community resistance to immunisation. In response, the United Nations Children's Fund (UNICEF) and partners supported thousands of voluntary community mobilisers in northern states of Nigeria, whose work included engagement of community influencers to ensure community buy-in. As a result of these and other efforts, hundreds of thousands of households reversed their decision to refuse vaccination. [Oct 2021]
  
   
• 3.Community Action Groups (CAGs): A Polio Best Practice
  In 2020, CGPP India institutionalised the voluntary efforts of its informal network of polio influencers to form Community Action Groups (CAGs) that address immunisation and other issues arising during the COVID-19 pandemic. CGPP staff recognised that COVID-19-affected people suffered from stigma and community shunning, as well as fear of using health services (including immunisation), and they identified many similarities to what the project and influencers had dealt with in their polio efforts. Seizing the opportunity, the CAGs mobilised to actively combat fear and stigma related to COVID-19, to inform and educate the community about COVID-19 and other health issues, and to provide support through tangible local actions.
  
   
• 4.Evaluating Nongovernmental Organization-led Community Mobilizers in Health Promotion, Immunization Campaigns, and Acute Flaccid Paralysis Surveillance: A Systematic Review of the Evidence
  by Muktar A. Gadanya, Chihurumnanya Alo, Amina A. Umar, et al.
  In the years following the Global Polio Eradication Initiative (GPEI)'s inauguration at the World Health Assembly (WHA) in 1988, the WHA urged polio-endemic states to engage local leadership and members of the community to foster acceptance of polio eradication interventions, including vaccination. This systematic literature review explores the effectiveness of non-governmental organisation (NGO)-led community mobilisers (CMs) to spread health messages, to promote immunisation campaign participation, and to improve acute flaccid paralysis case detection. One recommendation from the review is that CMs be provided with adequate supervision and support. The findings "can have an impact outside of polio eradication campaigns, indicating how to best engage with these communities to improve health outcomes." [Dec 2021]
  
   
• See also:
  cVDPV2 Outbreak Response in the Midst of COVID-19 in Ghana: Key Lessons Learned from Communication and Social Mobilisation Strategies and Activities
  

• 5.Evidence Review: Religious Marginality and COVID-19 Vaccination - Access & Hesitancy
  by Mariz Tadros and Claire Thomas
  Experience, including from the polio eradication effort, shows that being situated on the margins due to religious affiliation shapes experiences of vaccine access and uptake. This Social Science in Humanitarian Action Platform brief presents key considerations for addressing differentials in access to and willingness to undergo vaccinations that are linked to religious minority status, experiences, authorities, or doctrine. It also explores ways in which religious marginality intersects with other identity markers. Finally, the brief outlines practical, socio-religiously sensitive approaches to community health engagement - including specific ways to engage with religious leaders - that are designed to enhance vaccination confidence and combat hesitancy. [Nov 2021]
  
   
• 6.Strategic Engagement of Religious Leaders in COVID-19 Vaccination Webinar
  Co-hosted by World Vision International and Christian Connections for International Health, this webinar brought together a panel to discuss how faith leaders influence vaccination uptake and how to engage them for greater impact. For example, Ellyn W. Ogden of the United States Agency for International Development (USAID), a GPEI partner, shared her experience in engaging faith leaders to encourage uptake of the OPV in the context of the 2003 Nigerian OPV boycott. Ogden detailed the GPEI's organisation of a religious leaders' forum for polio eradication out of the office of the Sultan, describing the experience as "a turning point in building vaccine confidence where there had been great hesitancy." [Oct 2021]
  
   
• 7.The Excluded Voices from Africa's Sahel: Alternative Meanings of Health in Narratives of Resistance to the Global Polio Eradication Initiative in Northern Nigeria
  by James O. Olufowote and Dalaki J. Livingston
  This study draws on a culture-centred approach in order to unearth marginalised voices that were excluded from various sites of decision-making in northern Nigeria over the period 2012 to 2018. It does so by examining community members' narrative of resistance to the polio vaccines in Nigerian news media and grounding the resultant analysis in health communication theory. Among the practical implications: The GPEI and other health initiatives may benefit from pursuing an equal partnership with marginalised communities, such as by engaging religious and traditional leaders and fathers/grandfathers (who often influence child vaccination decisions in sub-Saharan Africa), in dialogue. [Mar 2021]
  
   
• 8.Establishment and Use of Polio Communication Network in Response to Polio in Outbreak Countries of the Horn of Africa: 2013-2014
  by Rustam Haydarov, Obianuju Igweonu, Saumya Anand, et al.
  Between 2013 and 2014, the Horn of Africa countries experienced a severe WPV outbreak that prompted the creation of the Polio Communication Network (PCN). This paper documents the establishment and contributions of the PCN in Somalia, Kenya, and Ethiopia from 2013 to 2015. For example, given the influential role of faith-based organisations (FBOs) in opinion and behaviour formation, as well as their capacity to reach the people in great numbers (including pastoralists), relevant FBOs were engaged to develop and reinforce messages on polio and child survival, drawing on religious teachings from the Quran or the Bible. Cascaded trainings were conducted on programme interventions and messages to build the capacities of FBO leaders. Representatives of the FBOs participated in the planning, implementation, and evaluation of polio supplementary immunisation activities as part of the effort to enhance community awareness of, demand for, and uptake of polio vaccination. [Nov 2020]
  
   
• See also:
  Vaccines: Religio-Cultural Arguments from an Islamic Perspective
  

• 9.Mobile Nudges and Financial Incentives to Improve Coverage of Timely Neonatal Vaccination in Rural Areas (GEVaP Trial): A 3-Armed Cluster Randomized Controlled Trial in Northern Ghana
  by Gillian Levine, Amadu Salifu, Issah Mohammed, and Günther Fink
  This cluster randomised controlled trial (RCT) assessed if mobile-phone-based reminders and incentives for health workers and caregivers could increase timely neonatal vaccination in rural Karaga District in Ghana's Northern Region. The RCT included 3 arms in 15 communities: a voice call reminder intervention; a community health volunteer (CHV) intervention with small monetary incentives; and a control arm. The proportion of infants vaccinated on time in the CHV plus incentives arm during the intervention period was 49.5 percentage points larger than in the control arm, and timely OPV coverage was 48.8 percentage points higher in the CHV plus incentives than in the control arm. The approach used in this trial could be considered in other settings, as it engaged local community members previously trained in health promotion to undertake "activities to increase demand for and utilization of vaccination services..." [May 2021]
  
   
• 10.Impacts of Supportive Feedback and Nonmonetary Incentives on Child Immunisation in Ethiopia
  by Abebual Demilew, Mesay Girma, Elizabeth McElwee, et al.
  Zerihun Associates, in partnership with Marie Stopes International Ethiopia and ideas42, identified bottlenecks to immunisation in the Oromia region in Ethiopia and then created and implemented an intervention using behaviourally informed feedback to mobilise health extension workers around improving immunisation rates and to create a positive reinforcement loop for those improvements using non-monetary rewards. Among the lessons learned: Providing feedback that enables individuals or communities to benchmark their own performance against that of an appropriate peer group can be an effective spur to action, especially when it primes and leverages a sense of pride in one's group identity and is combined with recognition for improvement. [Jun 2021]
  
   
• 11.Mobile Phone-Delivered Reminders and Incentives to Improve Childhood Immunisation Coverage and Timeliness in Kenya (M-SIMU): A Cluster Randomised Controlled Trial
  by Dustin G. Gibson, Benard Ochieng, E. Wangeci Kagucia, et al.
  Conducted in rural western Kenya, the Mobile Solutions for Immunization cluster RCT aimed to assess whether short message service (SMS), or text message, reminders, either with or without mobile-money incentives, could improve the proportion of children fully immunised by their first birthday. The 4 study groups included: control, SMS reminders only (SMS only), SMS reminders plus a 75 Kenyan shillings (KES) incentive, and SMS reminders plus a 200 KES incentive. Children in the SMS plus 200 KES group were significantly more likely to achieve full immunisation at 12 months of age (relative risk (RR) 1.09, 95% confidence interval (CI) 1.02-1.16, p=0.014) than children in the control group. The secondary outcome of achieving timely full immunisation was significantly higher in all 3 intervention groups compared with the control group. [Apr 2017]
  
   
• 12.Vaccine Hesitancy and Refusal: Behavioral Evidence from Rural Northern Nigeria
  by Ryoko Sato and Yoshito Takasaki
  The field experiment reported in this paper was explicitly designed to measure vaccine hesitancy behaviourally by offering free tetanus vaccines on the doorstep to women of childbearing age in rural Nigeria. The implication is that a simple intervention, such as a door-to-door vaccination campaign that makes the cost of vaccination low enough, may be effective for floating refusers. In contrast, to induce behavioural change among absolute refusers, policies first need to lower the barriers directly associated with vaccines, such as misperception and distrust of vaccines. [Sep 2021]
  
   
• See also:
  Improving Immunisation Coverage in Rural India: Clustered Randomised Controlled Evaluation of Immunisation Campaigns with and without Incentives
  

• 13.Ensuring Sustainability of Polio Immunization in Health System Transition: Lessons from the Polio Eradication Initiative in Indonesia
  by Luthfi Azizatunnisa', Utsamani Cintyamena, Yodi Mahendradhata, and Riris Andono Ahmad
  Indonesia introduced polio immunisation into the routine immunisation programme in 1981, followed by initiation of a polio eradication initiative called Erapo (Eradikasi Polio) in 1991. The government had a strong commitment to implement this policy, which resulted in polio elimination in 1995. However, the immunisation programme faced challenges in maintaining its performance during political and governmental reform in 1998. Potential approaches to improve prioritisation in a decentralised health system explored here include: (i) engage with sub-national governments as advocacy partners regarding immunisation financing; (ii) support research to analyse how current centre-local relationships exist; and (iii) promote ongoing policy and practice dialogues. [Sep 2021]
  
   
• 14.Nigeria Experience on the Use of Polio Assets for the 2017/18 Measles Vaccination Campaign Follow-up
  by Avuwa Joseph Oteri, Usman Adamu, Boubacar Dieng, et al.
  Nigeria attained WPV-free status on August 25 2020. This paper documents the polio legacy and assets used to support Nigeria's national measles campaign in 2017/2018. For example, the advocacy, social mobilisation, and communication strategy leveraged strategies and tactics used by the polio eradication initiative, especially those related to demand creation and for reaching vulnerable populations in security-threatened areas. Strategic advocacy of high government officials at national and sub-national levels, including the engagement of the Nigeria Governors' Forum with a signed agreement to support the measles vaccination campaign, reportedly led to the ownership of the programme and participation by government officials. [May 2021]
  
   
• 15.Delivering on the Promise of a Polio-free World: Polio Eradication Strategy 2022-2026
  As the world adjusted to a new global health threat in COVID-19, the GPEI launched a review to identify remaining obstacles to polio eradication and to develop a new strategy to deliver on the promise of a polio-free world. One of the five strategic objectives centres on political advocacy. As the GPEI works to generate collective urgency, engagement in, and accountability for polio eradication, it faces challenges such as difficulty in achieving and maintaining political will, due in part to inadequate approaches to securing ownership of the eradication effort by the governments of polio-impacted countries. The plan outlines the role of increased political will at all levels of government and with all local actors - among other actions - in meeting 2 major goals: (i) to permanently interrupt all WPV transmission in endemic countries; and (ii) to stop circulating vaccine-derived poliovirus transmission and prevent outbreaks in non-endemic countries. [Jun 2021]
  
   
• See also:
  Advocacy for Stronger Immunization Programs
  

• 16.The Synthesis and Translation of Research and Innovations in Polio Eradication (STRIPE) project seeks to map, synthesise, and disseminate knowledge from the polio eradication initiative using an implementation science lens. Here are some CI summaries from this project:
  
  * Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE): Initial Findings from a Global Mixed Methods Study
  * Lessons Learned from the Polio Eradication Initiative in the Democratic Republic of Congo and Ethiopia: Analysis of Implementation Barriers and Strategies
  * Conflict, Community, and Collaboration: Shared Implementation Barriers and Strategies in Two Polio Endemic Countries
  * A Multi-Pronged Scoping Review Approach to Understanding the Evolving Implementation of the Smallpox and Polio Eradication Programs: What Can Other Global Health Initiatives Learn?
  * Evaluating the Process of Partnership and Research in Global Health: Reflections from the STRIPE Project
  * Translating Implementation Experiences and Lessons Learned From Polio Eradication Into a Global Health Course: Insights From an International Consortium
  * Assessing Community Engagement in Nigeria Polio Eradication Initiative: Application of the Consolidated Framework for Implementation Research
  
   
• See also:
  Some Lessons for Malaria from the Global Polio Eradication Initiative
  

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