New Delhi

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AEFI Communication Bangladesh Experience
Naseem-Ur-Rehman Chief, Communication
Information
UNICEF BANGLADESH
For every child Health, Education, Equality,
Protection ADVANCE HUMANITY
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Bangladeshs 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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Bangladeshs 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 Mayors 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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Overview of AEFI cases in Bangladesh

• 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

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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, HN Chief, CI Prog.Off. HN National Professional Officer, EPI Surveillance District Civil Surgeon Divisional Chief Sub-district Upazila Health Officer UPC
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GOB response mechanisms

• 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

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UNICEF response

• 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.

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UNICEF communication response

• Subtle investigative media work
• Comprehend medias 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

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Role of WHO

• Factual/ scientific position
• Position on efficacy, storage, distribution,/admin
  istration of vaccines
• Appraise GOB on situation
• Joint field investigation
• Technical advise on testing samples
• Monitor situation

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Communitys 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