2018 Nigeria Polio Eradication Emergency Plan

"Above all, achieving these gains were a result of carefully planned and implemented mobilization and engagement meetings which resulted in strong political support and collaborative implementing of innovative strategies across the county."

From Nigeria's National Primary Health Care Development Agency (NPHCDA), this report reviews progress made to date to meet the 2017 National Polio Eradication Emergency Plan (NPEEP) and sets forth intentions for 2018 with regard to Nigeria's polio eradication programme. To put it simply, 2018 involves looking toward interruption of polio virus transmission; during 2017, Nigeria did not record any wild polio virus type 1 (WPV1) or circulating vaccine-derived polio virus type 2 (cVDPV2) from cases or the environment.

After describing the context of the programme and sharing relevant data, the report examines activities implemented in 2017. On the communication-related front, the Presidential Task Force for Polio Eradication, which provides overall stewardship and leadership of the programme, met twice in 2017. As detailed here, the National and State Emergency Operations Centers (EOCs) continued to drive the programme, ensuring strong coordination of Government and partner efforts at all levels and strategic technical support to the programme, including close monitoring of performance. At the international level, the programme was well represented at meetings such as Independent Monitoring Board (IMB) meetings. The programme also met with polio high-risk Local Government Areas (LGAs), the Northern Traditional Leaders Committee on Polio and PHC (NTLC), and the Nigerian military - all aimed at consolidating gains and expanding strategic linkages for the good of the programme. Furthermore, during supplemental immunisation activities (SIAs), inter-border synchronisation meetings are held and attended by officials from neighbouring countries, and these meetings culminate in joint plans and synchronisation of vaccination sessions by teams from both countries.

The major challenge faced in 2017 was lack of access to remaining children in completely inaccessible areas in Borno, especially Abadam, Marte and some islands on the Lake Chad. Other challenges for focus in 2018 are outlined, such as the risk of complacency: The prolonged duration of non-detection of WPV in several states (outside Borno) has created a sense that "the job is finished", resulting in wavering political support, reduced counterpart funding, and "fatigue". In addition, there was a surge in resistance to vaccination in the fourth quarter of 2017 following rumours that linked a monkey pox outbreak to vaccination. The rumours started in the south east zone and spread to the rest of the country. Several states were affected negatively, including some high-risk states like Borno, Yobe, and Adamawa, as evidenced by independent monitoring results of the polio Immunization Plus Days (IPDs) in October and November 2017. A study was conducted to assess the impact of the rumours, after which some strategies were proposed, including:

• Provide technical support but allow the government to take the lead.
• Institute/reactivate crisis management to tackle rumours around disease outbreaks, especially VDPD outbreaks.
• Investigate vaccine-related rumours; they could have a negative impact on vaccination or could result in a disease outbreak.
• Issue an immediate press release by the highest authority in the health system to debunk rumours.
• Remember that every opportunity of engagement - whether on media or face to face - promotes immunisation.
• Involve ethnic, religious, and political minorities in information activities.
• Prepare packages on frequently asked questions (FAQs) for all health workers, especially before vaccination campaigns or introduction of new vaccines.
• Disseminate a single set of messages through the same channels as those used by the rumour-mongers.
• Do not raise the rumour-mongers' profile by identifying and denouncing them.
• Monitor vaccinations in areas reached by rumours. Do not overreact where there is no decline in vaccinations. Quantify impacts. Do your vaccination tally sheets tell a different story from what you anticipated? Do not respond to a decline in vaccinations that does not, in the event, materialise.
• Meet with your opponents as well as your friends.
• Combat ignorance with knowledge, not with coercion.
• Pay particular attention to health workers. (Coverage surveys and interviews conducted for the anti-rumour study confirm that mothers cite the health worker as the single most important source of information on vaccinations.
• Use African Vaccination Week to organise activities to debunk rumours.

As outlined here, the strategic priorities for 2018 as identified by the National EOC and after due consultation with immunisation partners and local stakeholders to include: (1) Sustaining resilience; (2) Enhancing SIA quality in prioritised vulnerable areas; (3) Increasing access to vaccination in security-challenged areas and among internally displaced persons, or IDPs (particularly in Borno, Yobe, and Lake Chad islands); (4) Ensuring robust outbreak response across all states; (5) Enhancing routine immunisation (RI) in polio high-risk LGAs; (6) Intensifying surveillance; (7) Strengthening cross-border collaboration; (8) Improving and strengthening quality assurance of all polio data; and (9) polio transition planning.

Several communication elements are pivotal to these strategies. Here are some examples, related to sustaining resilience:

• Communication and advocacy efforts for 2018 will entail a clear narrative approach in communicating to Nigerians that the country is still susceptible to poliovirus reinfection, emphasising on the benefits and values of immunisation and the risk of non-vaccination, especially for under-5 children.
• A robust engagement of key traditional and religious leaders in the South to complement the efforts of the northern traditional and religious leaders to secure regular public pronouncements will be undertaken to check rumours and ensure that every eligible child is immunised during SIAs and through RI services.
• A comprehensive interpersonal communication (IPC) skills training will be conducted for all frontline workers, especially in polio high-risk and RI low performing LGAs. The training will be complemented with a national performance and award system to be rolled out in 2018 to motivate service providers and mobilisers.
• Social mobilisation networks (such as the volunteer community mobiliser (VCM) network) will be evaluated to ensure that only high-impact structures and those adaptable to support mobilisation of households and communities for RI services are retained and scaled up to the south. Redistribution of VCMs within States in line with the 2018 high-risk algorithm will be undertaken. This means that the VCM network will be further empowered to support active case search for acute flacid paralysis (AFP) and undertake other surveillance activities.
• Evidence-based communication and advocacy efforts will be sustained, with more timely analysis and dissemination of social data after every SIA to all stakeholders, particularly political and traditional leaders. The peer data quality review that started in 2017 will be sustained and scaled up to further improve social data quality. More concerted effort will be made to further probe the reasons for "child absent" through special investigations and regular polling surveys on knowledge, attitudes, and practices (KAP). The results of such investigations, and surveys will disseminated and used to guide interventions.
• The concept of placing polio within the broader health context of child survival in messaging that was started in 2016 will be sustained in 2018 with support to the National Emergency Routine Immunization Coordination Centre (NERICC) in launching an intensive advocacy and communication campaign highlighting the under-5 deaths in Nigeria due to low RI coverage. Also, household and community mobilisers will continue to play a pivotal role in delivering integrated messages at the household level to increase the risk perception of caregivers and build trust for immunisation. The Northern Traditional Leaders Committee (NTLC), the Federation of Muslim Women Associations in Nigeria (FOMWAN), the Catholic Women Organization (CWO), the Pentecostal Women Fellowship, the Da'awah Coordination Council of Nigeria (DCCN), the Christian Association of Nigeria (CAN), and other community–based organisations (CBOs) will be further sensitised on the need to support RI efforts.
• As the country is gradually closing out polio, effort will be made to formally document all programme strategies, innovations, standard operating procedures (SOPs), events, and any other documents that may be required by the national polio emergency operations centre.

Specific communication-centred planned activities are outlined to support these aims in the areas of: reducing chronically missed children, enhancing demand for RI, motivating frontline health workers, ensuring strong political support for immunisation, strengthening engagement with donors, and documenting process and progress. Corresponding targets, milestones, and indicators are also delineated - e.g., intensive Expanded Programme on Immunization (EPI) advocacy and communication campaign (including social media campaign) in collaboration with NERICC launched by end April 2018, and new entertainment-education packages in English and the main Nigerian languages in place by June 2018.