Middle East Outbreak Response Review

"The humanitarian situation...remains of grave concern and, as the conflict enters its fourth year, insecurity, and violence continue to force the people of Syria to seek safety and protection elsewhere. Disruption of health services and infrastructure, low levels of routine immunisation and prolonged wild poliovirus circulation places the region at high risk of further outbreaks..."

In November 2013, a strategic plan was created in response to the circulation of wild poliovirus (WPV) in Syria in October 2013 after a 15-year absence with the goal of interrupting WPV transmission in Syria and surrounding countries by the end of March 2014. This report reviews the strategic plan, which was developed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) in collaboration with the ministries of health and other humanitarian aid and United Nations (UN) partners across the Syrian Arab Republic, Iraq, Jordan, Lebanon, Turkey, Egypt, and the West Bank and Gaza Strip. The review of the plan sought to: collate and analyse all available secondary data, consult with key partners at country and international levels, and carry out targeted field visits for primary data collection.

As detailed here, the regional communication for development (C4D) strategy that was developed had the aim of ensuring that more than 90% of caretakers with children under 5 years of age had appropriate knowledge of polio vaccination. This included knowledge of campaign dates, the importance of repeated doses, routine immunisation, vaccine safety, risk of non-compliance, and ensuring that children are immunised during supplementary immunisation activities (SIAs). The regional external communication strategy emphasised the risk of polio returning to the region and the importance of a coordinated regional response, advocating for health system strengthening and maintaining a political commitment.

Particular challenges to communications and social mobilisation that affected the strategy in the region include: a lack of engagement of local communications actors, particularly in hard-to-reach areas and amongst underserved populations; poor focus on community-level interventions during immunisation campaigns; and a lack of diversified media outlets that can reach a wider audience.

According to the report, although high household awareness of polio campaigns has been achieved across the region, low awareness rates are still prevalent in high-risk areas of unvaccinated children. Post-campaign monitoring in Syria, Lebanon, and Jordan indicated that 70% of missed children are located in areas with low-risk perception, unawareness of campaign, and fear of oral polio vaccine (OPV). (Further information on communications and social mobilisation can be found in the individual Country Assessments in Annex 1.)

Recommendations include: Develop a high-level advocacy plan to ensure regional commitment to polio eradication; develop country- and regional-level media strategies for polio; diversify local strategies and media channels to respond to the local social context and different implementation approaches; develop high quality messages to address parental concerns, create demand, and mitigate fatigue following repeated campaigns; and strengthen social skills of health workers to address safety concerns and low risk perception among communities.