Independent Monitoring Board of the Global Polio Eradication Initiative: Ninth Report - May 2014

"Eradicating polio requires that millions of parents allow their children to be given dose after dose of polio vaccine. Properly engaging them is key to success."

The above insight is one of those shared in the ninth report following from the tenth meeting of the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI), held in London, United Kingdom (UK), from May 6-8 2014.

Context: "For the last 14 years, we have been witnessing the excruciatingly long tail of completing global eradication. The 'last 1%', a phrase that only three years ago was an inspiring rallying call to finish the job, is becoming an open goal for eye-rolling cynics." The IMB affirms that optimism for the GPEI was running high as 2012 drew to a close. Polio transmission in India had been interrupted, and the 3 remaining endemic countries (Pakistan, Nigeria, and Afghanistan) had made "significant programmatic improvements". However, this optimism "quickly unwound", due to tragedies such as the targeted killing of polio vaccinators in Pakistan and the exportation of the Nigeria polio virus to southern Somalia, where it infected a population unprotected against polio because of an al-Shabab ban on vaccination that remains in place (as of May 2014). As part of these and other setbacks, in 2012, there were 223 polio cases in 5 countries; in 2013, there were 407 cases in 8 countries. In response, "much hard work has been undertaken by infected countries and their global partners to try to reverse the negative eradication trend that became established in 2013." Despite this, "Pakistan's situation is dire. Its program is years behind the other endemic countries." And, in Nigeria: "The crisis of the kidnapped schoolchildren in Borno has heightened tension and danger in a key polio-affected area, strained relationships between national and local structures and unleashed hostility to government amongst communities and families."

Subsequent sections of the report explore in detail the situation with regard to polio and vaccine-related communication in Pakistan, Nigeria, and Afghanistan, as well as the outbreak response in the Horn of Africa, the Middle East, and Central Africa. Outbreak prevention strategies are explored; for example: "[T]he global program needs to communicate much more clearly with countries about what is expected of them to close their immunity gaps - and on what time scale."

The report next looks at areas of cross-cutting importance across the global polio eradication programme, examining issues that point to the centrality of communication and coordination. For example, in the section "Families and communities: a question of trust", the IMB recommends that the World Health Organization (WHO), one of the GPEI partners, "relax its grip on the training of vaccinators and their supervisors, allowing UNICEF [the United Nations Children's Fund], CDC [the Centers for Disease Control and Prevention] and other partners to contribute, particularly to enhance the interpersonal communication skills of vaccinators." Specific improvement aims include refining the metrics that the GPEI uses to monitor the quality of social mobilisers' work and enhancing vaccinators' interpersonal skills to equip them for sometimes-difficult negotiations with reluctant parents. "It is important that there is a multi-agency approach to training vaccinators. It should not solely be the domain of WHO to lead this vital task." The IMB calls on the core GPEI partners to meet in person to address these areas as well as the fact that "we [the IMB] were struck by the fact that the potential transformational value of social mobilization work was not accepted by all in the partnership....The skeptics need to better engage with those who believe in the promise of social mobilisation. We would predict two benefits of this engagement. The skeptics would see evidence of social mobilisation's impact. And the believers, in response to the skeptics' challenge, would make a more persuasive and focused case for where precisely investment in social mobilization can help."

The IMB makes 11 recommendations. Two communication-centred items that suggest the importance of advocacy strategies include:

• "We recommend that the heads of the Global Polio Eradication Initiative core partner agencies meet urgently with the President and Prime Minister of Pakistan to support their essential leadership of the Pakistan polio eradication program, and to offer every possible assistance in establishing the new EOC [Emergency Operations Center] as a strong national body with the power, resources and capacity to drive transformative action.
• We recommend that the President of Nigeria galvanizes action to gain the pledge of all national, state and local candidates in the forthcoming election, together with traditional and religious leaders, to protect the polio eradication program from disruption and politicization, returning it to its humanitarian role in saving the lives of Nigerian children."