Managing public acceptance of vaccination during polio outbreaks in conflict-affected areas of Syria, 2017

Summary:

In June 2017, an outbreak of vaccine-derived polio virus type 2 was confirmed in territory held by the Islamic State in Eastern Syria, eventually resulting in 74 childhood cases of paralysis. This prompted a response consisting of three vaccination rounds using the monovalent oral vaccine type 2 (mOPV2) and one round of inactivated polio vaccine (IPV). The communications effort faced serious challenges including widespread mistrust of the campaigns; destruction of telecommunications; and lack of security affecting mass gatherings and the movement of campaign workers. This paper details the communication strategies and solutions that were developed to overcome these challenges to ensure successful C4D response: with a focus on interpersonal communications by known individuals to build trust in the community. These strategies included conducting an initial pre-vaccination survey to gauge the level of vaccine hesitancy; identifying, and addressing vaccine refusal prior to the vaccination campaigns by deploying community mobilizers, community leaders and other influencers to conduct home visits and group meetings to promote vaccination and respond to people's concerns; and on-going collection of social data to monitor public attitudes and identify areas of resistance throughout the outbreak response. Refusal rates declined sharply once the campaigns began; vaccination coverage, as measured through independent monitoring, ranging from 77%-90% in the governorate that was the epicenter of the outbreak. This experience holds lessons that can be applied in other conflict settings experiencing outbreaks of polio or other vaccine-preventable diseases.

Background/Objectives:

1. Review possible strategies to design and implement communication for development activities work in conflict areas. 
2. Review simple tools to collect social data in conflict settings 
3. Outline different tactics to monitor and report on activities. 
4. Specifically discuss how to address vaccine hesitancy in conflict scenarios.

Description of Intervention and/or Methods/Design:

This paper details the communication strategies and innovative solutions that were developed to overcome these challenges and ensure a successful outbreak response :with a focus on interpersonal communications by known individuals to build trust in the community. These strategies included conducting an initial pre-vaccination survey to gauge the level of vaccine hesitancy and reasons for refusing vaccination and tailoring key messages to address these concerns; identifying, monitoring and addressing vaccine refusal prior to the vaccination campaigns by deploying community mobilizers, community leaders and other influencers to conduct home visits and group meetings to promote vaccination and respond to people's concerns; using a variety of methods to raise awareness of the campaigns, including announcements at mosques and the distribution of leaflets in bread bags; and on-going collection of social data to monitor public attitudes and identify areas of resistance throughout the outbreak response.

Results/Lessons Learned:

Awareness regarding the campaign and in-spite of all the faced challenges was above 95%. Vaccination coverage, as measured through independent monitoring, increased from 77%-90% in the governorate that was the epicenter of the outbreak. Reasons for refusals especially as related to fear of side effects or unknown source of the vaccine also declined sharply by the end of round three from 23% to below 10% in some governorates / districts.

Discussion/Implications for the Field:

This experience holds lessons that can be applied in other conflict settings experiencing outbreaks of polio or other vaccine-preventable diseases.

Abstract submitted by:

Sahar Hegazi - UNICEF
Ibrahim Elsheikh - UNICEF
Fazal Ather - UNICEF
Tamara Abu Sham - UNICEF
Denise DeRoeck - Independent Consultant