“Polio can be stopped when countries combine the right elements: political will, quality immunization campaigns and an entire nation’s determination. We must build on this historic moment and ensure that India’s polio program continues to move full-steam ahead until eradication is achieved.” – Bill Gates
Image credit: Gates Foundation, Flickr
Earlier this year, the global health community was witness to a huge achievement, which involved overcoming one of the world’s historic public health challenges. This past January, India recorded a full year without a new case of polio, moving it one step closer to being officially removed from the list of four countries where the disease remains endemic. The other three countries are Nigeria, Afghanistan, and Pakistan. As a Pakistani-American and with a family member who has a form of polio, I am personally fascinated by this public health success and the lessons that we, as social marketers and public health communicators, can glean from this monumental effort.
Polio is a highly infectious viral disease, mainly affects children under five years of age, and leads to irreversible paralysis. While it cannot be cured, it can be prevented through drops of oral polio vaccine given to children under five years of age. As long as a single child remains infected, children in all countries are at risk of contracting polio.
In 1988, at a time when the virus was paralyzing 1,000 children around the world every day, half of them in India, the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention, and the United Nations Children’s Fund launched the global campaign to eradicate polio. In 1995, after garnering political will, support and manpower, India began its mass vaccination campaign, but volunteers were faced with skeptics and rampant rumors that the polio vaccine caused illness and infertility and that the vaccination campaign was a Western conspiracy to curb the growth of Muslims. Thus began a massive public education and advocacy campaign that focused on building confidence and credibility in the polio eradication initiative.
Early on in the initiative, it became clear that information alone is not sufficient to encourage behavior and social change. A paper in the Bulletin of the World Health Organization outlines key strategies and lessons learned from polio eradication efforts in India and Pakistan, which continue to tackle deep rooted religious, socio-cultural and political resistance to eradication:
- Engage influencers as spokespeople. The polio campaign gained the support of religious and community leaders, who became strong community allies and were able to convert their communities. Messaging was infused into religious sermons and mosque announcements to reach community members, and Imams (religious leaders) welcomed families to vaccination booths.
- Carefully segment the target audience and reach them through interpersonal communication. With the backing of community leaders, the campaign targeted women and female caregivers, the primary decisionmakers on child health. Trained female health workers were able to convey the safety, efficacy and benefits of the vaccine.
- Location, location, location. Take the product to the audience.
In addition to a house-to-house strategy, vaccination booths were set up across the country. Taking into account constant migration, booths were also set up at train and bus stations and border posts to ensure that hard-to-reach children, including those of migrant workers, were vaccinated.
- Constantly monitor and track data. A disease surveillance system facilitates case reporting and enables swift responses if a case is found. Volunteers set out every day to examine babies and collect stool samples for testing. Health centers, doctors and even spiritual healers are trained to report the first sign of symptoms that might indicate polio.
The routine monitoring of epidemiological data and disease surveillance is especially important to ensure full eradication of the virus. India will not be certified completely polio-free until it goes at least three full years without a case. On the race to wipe out a fatal disease ingrained in the country’s history, it is nearly at the finish line.
Although the campaign has been successful — testament to its strategic and synergistic communication efforts — it has also been controversial. Some argue that the campaign is narrow-minded; that it is only focused on eradicating polio, to the detriment of other pressing public health issues in the region, such as malaria, malnutrition, and maternal health.
Still, India’s success serves as a blueprint for other countries, motivating them to use the same model to tackle other critical public health challenges. The world awaits for Nigeria, Afghanistan and Pakistan to follow in India’s footsteps and achieve a similarly successful outcome.
What are your thoughts on this global health communication effort? What other lessons can we learn?