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For every childHealth, Education, Equality, ProtectionADVANCE HUMANITY
Naseem-Ur-RehmanChief, Communication & Information
AEFI Communication:Bangladesh Experience
UNICEF BANGLADESH
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Bangladesh’s Poliomyelitis Eradication Progress
• 1988, Bangladesh set the goal of polio eradication by 2000
• Four strategies:– 1). 1) three doses of oral poliovirus vaccine
(OPV3) among infants under one year; – 2) National Immunization Days (NIDs) – 3) surveillance of polio cases – 4) "mopping-up" campaigns to eliminate the
wild virus
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Bangladesh’s immunization picture• Remarkable success in increasing
immunization coverage from 2% in the mid-1980s to 95% by 2004
• No clinically confirmed polio case since 2001
• No case with isolation of wild poliovirus since 2001
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Brief on EPI• EPI initiated in 1979 • First NIDs in 1995 • 12 NIDs till date• Massive social mobilization efforts• More than 22 million children under five in each
NID• More than 50,000 health and family planning
workers and 600,000 volunteers• Multiple partners: UNICEF, Government of
Japan, WHO, CDC Atlanta, USAID, IOCH, DFID, Rotary, Royal Government of Netherlands
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EPI Communication in Bangladesh
• Message: ‘give your child vaccination’• Message: ‘ we look for every child’ • Vitamin A drop during National Immunization
Days. • EPI coverage has been stable 87%-98%• Independent surveys indicate that actual
OPV3 coverage ranged from 60%-74% since 1991.
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Examples of campaigns
Dhaka City Mayor’s call
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NID campaign modalities• Curtain-raiser
• Radio and TV count downs
• Newspapers stories/supplements/features
• Health minister briefs the media
• Media splash and high visibility
• Special PSAs, motivational messages
• Little reference to possible adverse reactions
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• AEFI not restricted to far-away, remote or inaccessible places
• Almost a national representative sample• 2004 Four cases so far• Three suspected polio cases. In Rangpur
(Rajshahi division) , Khulna (Khulna division) and Bandarban (Chittagong division) districts)
• One death of boy aged six in Khulna (Khulna Division) – One boy dies after administration of Vitamin-A
capsule in Munshiganj (Dhaka division) during NID
Overview of AEFI cases in Bangladesh
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Overview continued…
• 2003
• 3 deaths in Jamalpur (Dhaka division) after measles vaccination
• Six more fell ill, later recovered
• All deceased were 10-month old
• Two girls, one boy
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Actors’ responses: factual, mitigation, damage control
Agency
1. GOB
2. UNICEF
3. WHO
SEARO Team
National
Health Ministry
Line Director
Representative
Chief, H&N
Chief, C&I
Prog.Off. H&N
National Professional Officer, EPI Surveillance
District
Civil Surgeon
Divisional Chief
Sub-district
Upazila Health Officer
UPC
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• Report from the field• Joint GOB-WHO-UNICEF team leaves for field• Collection of samples (autopsy report, viscera)• Tests at government's central laboratory/
Geneva• Formation of probe body• Submission of report• Departmental action in case of negligence by
officials/ front-line functionaries• Withdrawal of vaccine if it is old and replace with
new supply
GOB response mechanisms
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• Exchange notes with team/field staff
• Alert MOH, Partners
• Joint fact finding mission
• Joint assessment with GOB and WHO
• Technical advise to GOB
• Monitor situation
• Procure new vaccine, if required.
UNICEF response
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• Subtle investigative media work• Comprehend media’s reaction/treatment• Counter negative press• Closely follow-up, scan/monitor media reports• Establish system of reply to media queries• Press clippings/summaries shared with field
colleagues• Translation of local language editorials/reports• Personalized briefings with key reporters• Identify trends in media reporting• Prepared Q & A for possible media queries• Media management
UNICEF communication response
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• Factual/ scientific position
• Position on efficacy, storage, distribution,/administration of vaccines
• Appraise GOB on situation
• Joint field investigation
• Technical advise on testing samples
• Monitor situation
Role of WHO
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Community’s perception and reaction
• When programme designed to save lives ends in death:
• Grief, anger, panic, pessimism pervades• Knowledge, attitude, perception clash• Fixing responsibilities/accepting reality• Some withdrawal tendency• Return to normalcy after some time• Lack of ability to handle complications• Programme opponents ( quacks, hakims,
conservatives) grab the opportunity• Rumour, negative message resurface• Issues of quality, handling and training emerges
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Media and AEFI: excerpts from Bangladesh press
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Impact on routine immunization
• Word of mouth spreads fast
• Huge damages to programme acceleration
• Lack of follow-up in different areas
• Poor strategy to neutralize negative messages
• No planning for rebuilding the confidence, winning back community support
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What worked well• Coordinated response by all actors• Proactive role of all
What could have been done better
• If report of the investigation was made public• Test report made available from Geneva• Actions taken as per recommendations of the
report • Strengthen communication to allay fear, if any.• Media training on AFP/AEFI and other
complications
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Thank You