Engaging Communities in Preparation for Third Round of Polio Vaccination Campaign

UNICEF, WHO, the Ministry of Health, and Rotary organised various awareness and social mobilisation events to engage the community, journalists, governors, educators, and health workers at different levels (from nurses to heads of clinics and oblast coordinators), in order to increase vaccination rates and decrease refusals. This was through working on raising the public understanding of polio and honing the media and medical doctors' capacity to address public concerns. In every event, audience participation was very important (i.e. making participants feel they can voice their concerns), as was the presence of experts to provide answers to debunk any rumours.

For example, WHO works closely with vulnerable populations, such as Roma, to ensure that children of these communities receive polio vaccines. At a training session for Roma health mediators in Kyiv, WHO explained how to approach communities on polio vaccination and asked the mediators to explain their experience on communicating about polio, including challenges they face, and provide tips to others. Roma health mediators are members of the Roma community who are trained to liaise between the community and the health system. "When I visit parents in Roma settlements, I need to have a good understanding of the polio vaccine myself so I can answer their questions and explain the importance of protecting their children," says Valentina, a Roma health mediator. WHO also invited experts to address false rumours the mediators were not yet clear on.

Similarly, UNICEF media events targeted journalists through trainings and roundtables with editors, and invited WHO experts and the Ministry of Health senior officials to answer media questions about polio and current health topics. Local government officials and/or representatives from the health and education sector also sometimes participate. Short videos about polio have been well received because they really help the public to understand the disease and the importance of the vaccine.

To help foster understanding of polio and communication strategies for improving uptake of OPV, UNICEF has created a number of information, education, and communication (IEC) materials for use in the trainings - in both English and Ukrainian - including a fact sheet on polio, "Ten Things to Know about Polio", a poster on polio with diagrams and figures, key messages for the media, and flyers to be distributed to special audiences. For instance, a parents’ leaflet titled "Useful Information for Parents" reminds parents that "We, parents, were all protected from polio by vaccination. Remember the two pink drops that we received when we were children? Today we do not see people living with consequences of polio around us, thanks to vaccination. But if we ask grandparents, they will remember how many people were maimed and killed by polio before the mass vaccination in Ukraine. Let us not refuse the right to protection from this disease to our children!....Pay attention and adhere to the national immunization calendar for your child. Follow the announcements in media and your doctor's advice with regards to the next National Immunization Days schedule, and the age of children that should be given the polio vaccine. LOVE, PROTECT, VACCINATE!"

Moreover, as studies in Ukraine showed parents' most trusted health sources, especially on vaccination, were doctors, nurses, and paramedics, an information package (info-kit) was designed to help physicians communicate with parents about response to the outbreak in Ukraine. The info-kit provides information about the most frequently asked questions by parents about the disease and the vaccine. It also shares simple and effective tips on interpersonal communication designed to help convince parents vaccinate their children. For instance, in order to encourage dialogue, physicians should ask parents open-ended questions, not only questions that require a "yes / no" answer so that the physician can get a better sense about their thoughts and concerns. The importance of careful and active listening is stressed; physicians should use gestures to show parents that they understand and should not interrupt parents when they speak (nor should they be distracted by phone calls, for example). The physician should clearly and explicitly show parents that he or she respects and appreciates them. Providing information systematically and in a way that parents can easily learn and remember is key; using visual and printed materials can be helpful. The physician should check to be sure that the parents have perceived and understood the information, asking parents to repeat key points and encouraging parents to ask any additional questions. After encouraging parents to follow the recommendations of health professionals - motivating parents to bring the child during each round, the physician should notify parents of the next steps, reminding parents about the dates of upcoming rounds.

The Global Polio Eradication Initiative partners in Ukraine continue to work together to reach the remaining children and to immunise all in the target group with 3 doses of vaccine.

Immunisation and vaccines

In Ukraine, less than 50% of children were un- or under-immunised in 2014, and in 2015 the level of immunisation against polio among children under 1 year of age dropped further - to 14%. On September 1 2015, the Ministry of Health of Ukraine announced that 2 cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) had been confirmed by the WHO regional reference laboratory and experts from the Centers for Disease Control and Prevention (CDC). The virus was found in stool samples from two children from Zakarpatskaya region in Ukraine. The 2 children, one aged 4 years and the other 10 months, were not vaccinated against polio and became temporarily paralysed after contracting the virus. They have since recovered mobility.

All 24 oblasts plus Kyiv city are to be included in outbreak response planning, implementation, and monitoring. The first round of vaccination reached less than 65% coverage. The second, reaching 75%, albeit a slight improvement from the first, remains far below the global standards (WHO standard operating procedures following an outbreak is 95%).

According to organisers, OPV is the most effective means of stopping the spread of poliovirus and ensuring collective immunity. Vaccines for the third round were procured by UNICEF with funds donated by the European Union Humanitarian Aid and Civil Protection department (ECHO) and made in France. They were delivered to Ukraine in strict accordance with WHO standards for packaging, shipping, and storage, including monitoring and assessing temperature fluctuations. As an extra safety precaution, each bottle of vaccine is equipped with a vaccine vial monitor, which registers cumulative heat exposure over time and indicates whether it was ever stored improperly.