The Drum Beat 797 - Pakistan Polio Learning

• 1.Building Trust
  Most Pakistanis willingly vaccinate their children with the oral polio vaccine (OPV). However, trust varies over time, across the country, and amongst different groups. It can be lost easily. Key lessons that emerged from (i) a 2003 boycott of polio vaccine in Nigeria and (ii) misinformation that led influencers in India to discourage vaccination participation include the fact that rebuilding trust requires a multi-layered and sustained approach, often involving extensive dialogue with key influencers at all levels led by trusted people. Going forward, the programme's framework for communication will shift from a health belief model that emphasises risk perception to one that focuses on building social norms that reinforce and encourage polio vaccination. Community empowerment approaches are to be used in high-risk local areas implemented in a 5-step process: Inform, Consult, Involve, Collaborate, Empower. This will be done through long-term social and behaviour change communication (SBCC) interventions, with differentiated local strategies tailored to high-risk underserved communities.
   
• A few relevant CI summaries:
  * Trust and Confidence in Vaccines: Tales of Three Vaccines, Lessons for Others
  * Measuring Trust in Vaccination: A Systematic Review
  
• * For more, try a search of "trust" on The CI's polio network, yielding nearly 700 results that can be filtered to help you find what you seek.
  

• 2.Participatory Design and Community Engagement
  When in April 2019 an anti-polio vaccine video went viral, causing violent public protest and leading to OPV campaign stoppages and spikes in refusals, it became clear that it would take nothing short of a major transformation to cultivate the kind of local-level knowledge and engagement required to rebuild trust. One aspect of this transformation was the development of a participatory approach focused on the highest-risk groups, especially the Pashtun, that encompasses research, knowledge gathering, and deeper engagement with influential people and structures in those communities. Lessons are included from the volunteer community mobiliser (VCM) model in Northeast Nigeria, which built community trust, reduced noncompliance, countered rumours, and increased routine immunisation, and from Afghanistan, where the Immunization Communication Network (ICN) fostered local connection, provided high-priority services to underserved communities, and engaged caregivers in dialogue. As part of its transformation plans, Pakistan has developed an integrated approach to strengthen communication strategies through the introduction of participatory approaches to community engagement, programme design, planning, and research.
   
• A few relevant CI summaries:
  * The CORE Group Partners Project in North East Nigeria: Community Engagement Strategies to Combat Skepticism and Build Trust for Vaccine Acceptance
  * Lessons Learnt from the Polio Program Communication Activities in Eastern Afghanistan
  
• * For more, try a search of the custom keyword "community participation" on The CI's polio network, yielding over 700 results that can be filtered to help you find what you seek.
  

• 3.Understanding High-Priority Populations
  Transformation of Pakistan's programme will require a much better understanding of high-risk and therefore high-priority populations - e.g., Pashtun speakers and mobile populations. Lessons from research in India, Pakistan, Nigeria, and Afghanistan into why groups of households and communities resist vaccination reveal rational foundations to resistance that are often based in specific local realities that need to be understood, respected, and responded to. The 2021 National Emergency Action Plan (NEAP)'s 4 pillars for engaging priority communities are: (i) conducting operational research to develop a deeper understanding of the specific challenges in priority communities; (ii) building strong, sustainable alliances between priority communities and the polio programme; (iii) using integrated service delivery to create an enabling environment by meeting critical community health needs; and (iv) developing tailored operational delivery to address specific challenges.
   
• A few relevant CI summaries:
  * Role of Social Mobilization (Network) in Polio Eradication in India
  * National Emergency Action Plan for Polio Eradication 2020 [Pakistan]
  
• * For more, try a search of "high-risk" and/or "Pashtun" on The CI's polio network, together yielding approximately 400 results that can be filtered to help you find what you seek.
  

• Like Water is for Fish - The Power of Story in our Lives
  Taking a cue from this Drum Beat's theme about the value of looking outside the polio world to glean lessons from other development work, you may be interested in a book by Dr. Garth Japhet, who is the co-founder of Soul City and Heartlines. The Soul City and Soul Buddyz series integrated health topics into compelling storylines on TV, radio, and in print to both entertain and inform, and Heartlines' programmes and films provide witness to the transformative power of story. This book describes Dr. Japhet's journey to the understanding that story, in its multiple forms, is as essential for our lives as water is for fish...
   

• 4.Social Media: Building Positive Narratives by Social Listening
  The polio programme has established an online presence, learned how to create engaging digital content, built relationships with significant digital influencers, and started responding to rumours and misinformation, but these capacities and tools need to continue to evolve in line with the development of social media as a force in Pakistan society. Lessons from a study in Ukraine looking at how to research the impact of social media on attitudes towards polio vaccination include the importance of understanding the natural spaces people are using to share and access information on vaccination and identifying ways to engage with those spaces through content sharing and dialogue. Research exploring how Australian organisations promoting vaccination responded to multiple social media challenges reveals that many anti-vaccination rumours are global or share similar attributes, meaning that successful responses can be transferable. Going forward, the programme will need to pay careful attention to its listening networks and rumour tracking with the support of a growing group of digital influencers willing to share positive content with communities who trust them.
   
• A few relevant CI summaries:
  * Natural Social Spaces: How Do We Research Social Media and Development Trends, Dynamics, and Impact? Learning from a Polio and Routine Immunization and Social Media Research Initiative in Ukraine
  * How Organisations Promoting Vaccination Respond to Misinformation on Social Media: A Qualitative Investigation
  
• * For more, try a search of "social media", for example, on The CI's polio network, yielding nearly 350 results that can be filtered to help you find what you seek.
  

• 5.Helplines: Connecting People to the Programme
  Pakistan's Sehat Tahaffuz 1166 helpline was established in February 2020 to provide accurate information about polio and other vaccines and a space for the public to report missed children, clarify doubts about vaccines, and lodge complaints when they feel polio services are not optimal. It was expanded quickly to also support health communication during the COVID-19 pandemic. Lessons on helplines around (i) measuring outcomes and (ii) the importance of the interaction between the caller and the call centre include, for example, that the quality of communication during the call (or in the case of WhatsApp, the text or voice message exchange) determines users' experience and impacts on how they perceive the information they receive and consequently their actions after the call. Critical to the success of this interaction is the co-creation of solutions between the call centre and the caller.
   
• A relevant CI summary:
  * Pakistan Polio Eradication Initiative Support to the COVID-19 Response
  
• * For more, try a search of "helpline" on The CI's polio network.
  

• 6.Engaging Adolescents and Children
  Initiatives that inform and engage adolescents and children in healthy behaviours and encourage them to promote these behaviours in their homes and communities could be a useful tool for changing and sustaining attitudes to vaccination. Though not all parents, especially members of the most vulnerable and highest-risk communities, will support this type of approach, it has been used with considerable success in other endemic countries. In Nigeria, youth groups from communities with high refusal rates teamed up with polio campaign teams, and India's Pulse Polio Programme engaged school children to act as "messengers of change" to encourage parents to vaccinate their younger siblings. There are plans for a formative research project with a subsequent intervention component in Karachi, through which UNICEF hopes to better understand how adolescents can be engaged to shift the attitudes and decisions of vaccine-hesitant caregivers - ultimately increasing the uptake of essential immunisation (EI) in their families and communities. One point to consider: Engaging adolescents needs to be seen as a long-term investment in the future, offering the next generation of parents a better understanding of healthy behaviours, the importance of vaccination, and the value of giving back to their communities.
   
• A few relevant CI summaries:
  * Youth Group Engagement in Noncompliant Communities During Supplemental Immunization Activities in Kaduna, Nigeria, in 2014
  * Messengers of Change: Involving Children in Polio Awareness
  
• * For more, try searches such as a combination of the custom keywords "children" and "community participation" and/or "youth" and "community participation" on The CI's polio network, together yielding nearly 300 results that can be filtered to help you find what you seek.
  

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