Report on the Meeting of the Technical Advisory Group (TAG) on Polio Eradication in Pakistan [August 2019]

"The increased cases and positive environmental samples are symptoms of a programme in crisis. There are serious problems in coordination and implementation and to-date unresolved issues with campaign quality, monitoring, accountability and community engagement."

This report summarises the discussions of the Technical Advisory Group (TAG) on Poliomyelitis Eradication in Pakistan, August 29-30 2019 in Islamabad. The TAG was convened at a critical juncture of the Pakistan Polio Programme: At the time of the meeting, Pakistan had reported 58 cases of wild poliovirus (WPV), representing 80% of the global case count, and there was widespread virus circulation across the country. (Also in 2019, there was an incident in Peshawar in April, in which a single rumour of vaccinated children falling sick in a village school triggered panic and violence nationwide.) In this context, the TAG reviewed eradication efforts, analysed the key challenges and risks to eradication, and provided strategic technical guidance to help pave the way forward. The present summary focuses on the communication elements of the meeting/report.

Overall, the TAG considers the communication component of the national programme to be unduly focused on vaccine refusal and "resistance". There has been lesser and inadequate emphasis on continuous strategic efforts to build positive engagement at community level as the basis for enabling better reception of oral polio vaccine (OPV) during supplementary immunisation activities (SIAs), as well as build a stronger understanding of and demand for Essential Immunization (EI) services.

Based on communication reviews that have been conducted, the TAG reports that communication has developed as a standalone programme, operationalised primarily around campaigns, with poor delivery of interpersonal communication (IPC) at the doorstep and the absence of a broader integrated community engagement strategy. There is clarity following the Peshawar incident that community trust in the Pakistan Polio Programme is very low. The surge of negative social media leading up to this incident was a new challenge for the programme. Community trust building went unsupported by strategic alliances/coalitions that might counter political co-option and help rebuild trust.

In terms of progress in the communication realm, the TAG recognised a more responsive social media management effort during recent campaigns - an important lesson learned from the Peshawar incident. Furthermore, alongside on-the-ground efforts to re-establish communication and dialogue with communities, the national programme is entering into a strategic process of perception management (PM). The TAG considers this focus to be legitimate, but cautions that PM is complex - in particular, when conducted through the ungoverned space of social media - and is at best a complementary strategy to the core work of engaging with communities in meaningful and authentic ways that by nature has to be done at the local level by local trusted actors.

Recommendations specific to communication include:

• Prioritise community engagement (CE) using structured, evaluatable approaches adapted for local context, ensuring integrated management of all relevant CE actors.
• Continue to monitor and manage online content to support positive public messaging and mitigate rumours.
• Focus the mass media strategy should focus on enhancing public confidence in the Polio Eradication Initiative (PEI) and OPV.
• Take care when developing PM and alliance building interventions, ensuring review of initiatives by a group of communication and media experts, monitoring content, and advising on adjustments.
• Execute all communication activities with coherence, ensuring consistency of content and messaging across all platforms.

Other recommendations:

• Capitalise on the strong commitment from national and provincial leaders and the military leadership.
• Develop a unified strategy led by a reconstructed "One Team" approach at all levels: "Trust among institutions and individuals must be rebuilt, focusing on the core goal of eradication and not using the polio programme as a political football. The Government and its polio partners throughout all levels must be united in purpose and implementation. They must have an operating culture that can identify challenges and collectively develop and implement solutions."
• Implement plans for "transformation" focused on SIA quality and CE by simplifying management structures, simplifying processes, and simplifying operations.
• Concentrate on building community trust as a programme priority, garnering public support from government and civil society actors beyond the polio programme, and introducing sustained and evidence-based CE activities, especially in Super High-Risk Union Councils (SHRUCs). "Changes must be made to the management structure at District and UC [Union Council] level to ensure that communication staff are dedicated to communication activities, including ensuring time for such activities to be planned and implemented effectively, and developing strategic responses to political and anti-vaccination disinformation."

Click here for the 29-page report in PDF format.
Click here for a 23-slide PowerPoint presentation in PDF format featuring feedback from the TAG.