Polio Eradication Campaign Research Articles

Use of a fractional dose of inactivated polio vaccine (fIPV) to increase IPV coverage among children under 5 years of age in Somalia

BackgroundGlobal efforts reduced incidence of polio cases from 350,000 in 1988 to 22 cases in 2022 globally. There have been no wild poliovirus (WPV) cases seen in Somalia since August 2014. However, in 2017, there was a surge in the number of cases of circulating vaccine-derived poliovirus type 2 (cVDPV2), even with different intervention responses using monovalent oral polio vaccine type 2 (mOPV2). This study aimed to assess the use of fractional inactivated polio vaccine (fIPV), a smaller dose of the polio vaccine, equal to 1/5 of a standard dose, as an innovative polio vaccination delivery model, and identify the main opportunities for and challenges to the use of fIPV in the future for vaccinations.MethodsThe study used two designs: a quasi-experimental design used to pilot fIPV in five districts and a cross-sectional study using both quantitative and qualitative approaches to collect primary data. A simple random sampling method was used to select 2 out of the 5 pilot districts for household surveys to study 768 participants. Key informant interviews and focus-group discussions were used to collect data from key frontline health workers and health/immunization officials involved in the campaigns. Secondary data from the pilot campaigns were analysed, such as administrative pilot data, lot quality assurance sampling (LQAS) and post-campaign communication assessments.ResultsA total of 131,789 children aged 4–59 months were included for the pilot. Among these, 126,659 (96.1%) and 126,063 (95.6%) children were vaccinated in rounds 1 and 2, respectively. Out of the 768 households assessed, 99.9% had their children vaccinated. Nearly half of the few children who were not vaccinated were reported to be due to the parent of the child not being at home (48%). Ninety-seven percent of the qualitative study interviewees were satisfied with fIPV injection and recommended its use for routine immunization.ConclusionsThe study findings are promising in the use of fIPV in mass campaigns to realize better coverage and global polio eradication. fIPV will potentially be used by policymakers in the design of polio eradication campaigns that integrate the fIPV vaccine into routine or supplementary immunization.

Combating Polio Vaccine Hesitancy: An Evaluation of Mediated Polio Eradication Campaigns in Pakistan

Health campaign initiatives are especially tailored to the needs of their target audience and encourage vaccination adoption for polio eradication. Vaccination resistance, however, remains a serious barrier in Pakistan. The content analysis method was used to examine message appeals and message characteristics used in Pakistan's Polio National Immunization Campaigns from 2020 to 2022. Polio advertisements were obtained from the Pakistan Polio Eradication Program's internet archives. Advertisements range in duration from 40 to 60 seconds on average. The quantitative results provided to a deeper understanding of the message characteristics (credibility of message presenters, appeals, style, slogan, language) used in anti-polio advertisements broadcasted via cable and television channels during the Polio National Immunization Campaigns. It was evident that attempts were made to effectively engage the target audience via the employment of 31% knowledgeable speakers, a range of message appeals 34%, and a diversity of communication styles 72%. The necessity for ongoing evaluation and improvement of campaign message techniques was highlighted by variations in the use of slogans and regional languages. Keywords: Mediated Polio Immunization Campaigns, Message Appeals, Polio Vaccination, Polio vaccine hesitancy

FROM COLONIAL PAST TO PRESENT: THE NEXUS OF SMALLPOX AND POLIO VACCINATION REJECTION IN NORTH-WESTERN NIGERIA

This paper presents some historical precedents that provide a critical framework for interpreting the rejection of polio vaccination in North-western Nigeria. In this paper, qualitative content analysis of written and oral data is used to explore the genealogy of the suspicion that cloud both smallpox and polio vaccinations in the area. The main objective of the paper is to provide a critical analysis of the politics of smallpox vaccination that reveals mistrust that persists to the present. The paper observed that the people’s perception of colonial medicine and mistrust of colonial officers geared their apathy to smallpox vaccination in the zone. Traditional institutions and legislation were used to ensure the acceptance of the vaccination and this increased the suspicion when people perceived the strategy as a control mechanism than a genuine attempt to improve their public health. These memories of smallpox vaccinations have a direct impact on the contemporary polio eradication campaign. People perceived polio vaccination as a continuation of the surreptitious Western agenda. The findings of the study present that perceived mistrust of the West stands to be the significant challenge for polio eradication campaigns as it did during smallpox vaccination in the colonial era.

Taliban decree deepens Afghanistan’s health crisis

Ban on female NGO staff hampers critical aid work and jeopardizes polio eradication campaign.

Polio amidst COVID-19 in Pakistan: Ongoing efforts, challenges, and recommendations.

Poliomyelitis is a crippling viral disease caused by poliovirus, a positive‐stranded RNA virus that is a serotype of Enterovirus C. Pakistan remains one of the countries in the world where poliomyelitis is still prevalent, posing an obstacle to global poliomyelitis eradication. With the commencement of the COVID‐19 pandemic, polio eradication campaigns have proven less feasible, resulting in an increase in polio cases across the country. Pakistan's healthcare system and socio‐economic framework are incapable of dealing with two deadly viruses at the same time. As a result, effective measures for combating the destruction caused by the spread of the poliovirus are required.

Evaluating nongovernmental organization–led community mobilizers in health promotion, immunization campaigns, and acute flaccid paralysis surveillance: a systematic review of the evidence

Community mobilization, partnership, and surveillance are regarded as key elements in various polio eradication activities. Several nongovernmental organizations have led community mobilizers (CMs) in different aspects of the polio eradication campaigns, and their effectiveness shows mixed findings. This study systematically reviewed the literature on the role of CMs in polio eradication activities. Literature searches were conducted using a combination of key words to find relevant published studies up to 30 November 2020. The 27-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist addressing the various components of systematic review was adhered to. A total of 1627 articles were identified by the search, with 65 articles passing the title/abstract and full text reviews, and with four additional articles obtained from references of articles included (making a total of 69 articles). Of these 69 articles involved in the review, 24 (five reviews and 19 original articles) focused largely and explicitly on CMs and were included in the full review. The rest (45) discussed CMs in a broader context, hence they were summarized based on part 1 of the data extraction form only.The findings of the review indicated that although CMs’ instrumental role in health promotion and supporting immunization is consistent for all the reviewed studies, their role in acute flaccid paralysis (AFP) case detection is limited. The role of CMs, other actors in community-based surveillance, and health education needs to be further strengthened, particularly in high-risk communities where routine immunization and AFP surveillance are much needed.

Coverage and factors associated with receiving campaign polio vaccines in an urban population in Guinea-Bissau

BackgroundPolio eradication campaigns are intended to complement routine immunization. Studies addressing factors associated with campaign coverage are warranted to identify children missed by campaigns. MethodsBandim Health Project runs demographic surveillance with registration of routine immunization and campaign participation data in urban Guinea-Bissau. We assessed coverage and factors associated with receiving campaign polio vaccines in children aged 0–35 months in two polio eradication campaigns conducted in 2017 and 2018 using univariate and multivariate regression models. ResultsCampaign coverage reached 84% in 2017 and 88% in 2018. We found lower coverage among children of young and not formally educated mothers in univariate analyses; Children <9 months and Fula children had lower campaign coverage in both univariate and multivariate analyses. ConclusionsTo increase campaign coverage in urban Guinea-Bissau attention may be directed at informing young mothers, mothers of young children, mothers without formal education, and the Fula ethnic group about campaigns.

Role of Mass Media and Interpersonal Communication in Polio Eradication Campaign

Health communication characterizes the boundary between communication and health and is progressively documented as essential for everyday well-being. Mass media, especially electronic media, is the need of the time, especially during the outbreaks like Polio in Pakistan. People get information from mass media, up-grade their knowledge, and their attitudes are formed, and ultimate change in practices becomes forth. By keeping in view the widely witnessed role of mass median healthcare communication, this article also examines Pakistan regarding Polio eradication. We executed a descriptive quantitative method and gathered data from n= 300 respondents. Results revealed that Mass Media and Interpersonal communication have a significant role in delivering the proper knowledge about the Polio disease. Through Mass Media and Interpersonal Communication, the masses may know the harmful consequences of Polio disease and the influential role of the vaccine inuring this disease. Thus, we concluded that media help eradicate misconceptions about the vaccine, resulting in the complete wipe out of Polio from Pakistan. Further, we have discussed the results and highlighted the recommendations accordingly.

Impact and effect mechanisms of mass campaigns in resource-constrained health systems: quasi-experimental evidence from polio eradication in Nigeria

BackgroundMass campaigns are a key strategy for delivering life-saving interventions under Global Health Initiatives, especially in weak health system contexts. They are frequently designed parallel to the health system to...

The COVID-19 vaccines rush: participatory community engagement matters more than ever

The COVID-19 vaccines rush: participatory community engagement matters more than ever

Disease Surveillance Investments and Administration: Limits to Information Value in Pakistan Polio Eradication.

In Pakistan, annual poliovirus investment decisions drive quantities of supplemental immunization campaigns districts receive. In this article, we assess whether increased spending on poliovirus surveillance is associated with greater likelihood of correctly identifying districts at high risk of polio with assignment of an elevated “risk ranking.” We reviewed programmatic documents from Pakistan for the period from 2012–2017, recording whether districts had been classified as “high risk” or “low risk” in each year. Through document review, we developed a decision tree to describe the ranking decisions. Then, integrating data from the World Health Organization and Global Polio Eradication Initiative, we constructed a Bayesian decision network reflecting investments in polio surveillance and immunization campaigns, surveillance metrics, disease incidence, immunization rates, and occurrence of polio cases. We test these factors for statistical association with the outcome of interest—a change in risk rank between the beginning and the end of the one‐year time period. We simulate different spending scenarios and predict their impact on district risk ranking in future time periods. We find that per district spending increases are associated with increased identification of cases of acute flaccid paralysis (AFP). However, the low specificity of AFP investment and the largely invariant ranking of district risk means that even large increases in surveillance spending are unlikely to promote major changes in risk rankings at the current stage of the Pakistan polio eradication campaign.

Mass vaccination against COVID-19 may require replays of the polio vaccination drives.

Mass vaccination against COVID-19 may require replays of the polio vaccination drives.

Multiplex PCR-Based Neutralization (MPBN) Assay for Titers Determination of the Three Types of Anti-Poliovirus Neutralizing-Antibodies.

Determination of poliovirus-neutralizing antibodies is an important part of clinical studies of poliovirus vaccines, epidemiological surveillance and seroprevalence studies that are crucial for global polio eradication campaigns. The conventional neutralization test is based on inhibition of cytopathic effect caused by poliovirus by serial dilutions of test serum. It is laborious, time-consuming and not suitable for large scale analysis. To overcome these limitations, a multiplex PCR-based neutralization (MPBN) assay was developed to measure the neutralizing antibody titers of anti-poliovirus sera against three serotypes of the virus in the same reaction and in shorter time. All three anti-poliovirus sera types were analyzed in a single assay. The MPBN assay was reproducible, robust and sensitive. Its lower limits of titration for the three anti-poliovirus sera types were within range of 0.76–1.64 per mL. Different anti-poliovirus sera were tested with conventional and MPBN assays; the results obtained by both methods correlated well and generated similar results. The MPBN is the first neutralization assay that specifically titrates anti-poliovirus antibodies against the three serotypes of the virus in the same reaction; it can be completed in two to three days instead of ten days for the conventional assay and can be automated for high-throughput implementation.

Mandatory vaccination: understanding the common good in the midst of the global polio eradication campaign

BackgroundThe detection of wild poliovirus in Israeli sewage in May 2013 led the health authorities to vaccinate children with OPV (Oral Polio Vaccine). Shelly Kamin-Friedman explored the legal and ethical dimensions of this policy. This commentary makes three claims: (1) Mandatory vaccination is a valid exercise of the state’s police powers to protect the common good. (2) A disease eradication campaign is a sufficient ground for the exercise of those powers. (3) The state is obliged to use the least restrictive/invasive measure to achieve community-wide vaccine coverage, but need not use less effective measures; further, determining which measure is most effective is a fact-specific determination.GoalsThis commentary offers grounds to support state powers to protect the public’s health and safety. It shows why governments have both the duty and power to safeguard the collective good. State powers also have limits, whose boundaries are determined by the public health necessity. If the state is reasonably using the least restrictive intervention to achieve an important public health objective, it is well within the limits of its authority.MethodThe commentary uses legal and ethical norms and evidence to support its conclusions.Main findings and conclusionGovernments have a duty and power to achieve population-based vaccine coverage sufficient to stem the spread of infectious diseases, including in isolated geographical areas with high numbers of individuals claiming religious and/or conscientious exemptions to vaccine requirements. Governments are obliged to reasonably seek the least restrictive/invasive measure to achieve valid public health objectives; and governments are not obliged to use less effective measures simply because they are voluntary or less invasive. Finding the most effective, least invasive intervention is fact-specific. The essence of public health law is to recognize the state’s power and duty to safeguard the public’s health and safety, and to establish and enforce limits on those powers when the government overreaches—that is, adopts a measure more invasive/restrictive than needed to achieve a valid public health objective.

Challenges to Polio Campaign: A Case Study of Gujar Khan

Pakistan is among the group of four nations in the world which are categorized as endemic because of the prevalence of Polio. In the past few years, Pakistan took some big steps to curb the disease through polio eradication campaigns but it met numerous obstacles. The major objective of this research work was to shed light on the main challenges and associated factors faced by the polio staff directly related to the limited effectiveness of Oral Poliovirus Vaccine (OPV) in the populated and non-populated areas of Tehsil Gujar Khan in District Rawalpindi. Pakistan approach towards Polio extermination is subjected to the issues .in the current system, socio-cultural, and ethical perspective. By enhancing safety, confidentiality, respect, community resilience and autonomy of Polio staff in a society based on ethical values, outcomes of the campaigns can be increased. A descriptive approach was followed. Random sampling method was applied. Questionnaire was used as a tool.

POLIO VACCINE;

Objectives: To assess knowledge and attitude of young doctors serving in Tertiarycare Hospitals regarding the IPV intervention and polio eradication campaign. Study Design:A cross sectional descriptive study. Setting: Five Tertiary Care Hospitals in Rawalpindi andIslamabad. Period: Oct 2015-Nov 2015. Methods: Proportionate random sampling techniquewas used to select a sample of 100 doctors working in pediatrics wards and out patientsdepartments (OPD). After taking informed consent the data was collected using a standardizedQuestionnaire to measure level of awareness among this cohort of Health care providers. Datawere entered and analyzed using SPSS version 21. Baseline distinctiveness (demographic)was summarized by descriptive statistics. The statistical inference was drawn using Chi squaretest, p value of ≤ 0.05 was considered as significant. Results The study sample comprised of47 males and 53 females. Mean age of participants was 29.8 ± 5.7. There were 15% HouseOfficers, 45% Post Graduate Trainees, 30% Medical Officers and 10% consultants in thesample. Majority of doctors (65%) expressed disinterest and doubt about polio immunizationwhile 40% suggested focus on sanitation and health promotion before immunization. Amongthe participants only 29% had attended polio surveillance training workshop in last 2 years andparticipated in polio National Immunization days. There was no significant association betweenknowledge about IPV and years of experience(x2 =2.68, p= 0.433). Conclusion: This studysuggests that there was inadequate knowledge of doctors in tertiary care hospitals regardingIPV and polio eradication efforts in Pakistan.

English

Objectives: To assess knowledge and attitude of young doctors serving in Tertiarycare Hospitals regarding the IPV intervention and polio eradication campaign. Study Design:A cross sectional descriptive study. Setting: Five Tertiary Care Hospitals in Rawalpindi andIslamabad. Period: Oct 2015-Nov 2015. Methods: Proportionate random sampling techniquewas used to select a sample of 100 doctors working in pediatrics wards and out patientsdepartments (OPD). After taking informed consent the data was collected using a standardizedQuestionnaire to measure level of awareness among this cohort of Health care providers. Datawere entered and analyzed using SPSS version 21. Baseline distinctiveness (demographic)was summarized by descriptive statistics. The statistical inference was drawn using Chi squaretest, p value of ≤ 0.05 was considered as significant. Results The study sample comprised of47 males and 53 females. Mean age of participants was 29.8 ± 5.7. There were 15% HouseOfficers, 45% Post Graduate Trainees, 30% Medical Officers and 10% consultants in thesample. Majority of doctors (65%) expressed disinterest and doubt about polio immunizationwhile 40% suggested focus on sanitation and health promotion before immunization. Amongthe participants only 29% had attended polio surveillance training workshop in last 2 years andparticipated in polio National Immunization days. There was no significant association betweenknowledge about IPV and years of experience(x2 =2.68, p= 0.433). Conclusion: This studysuggests that there was inadequate knowledge of doctors in tertiary care hospitals regardingIPV and polio eradication efforts in Pakistan.

Polio Eradication and Health Systems in Karachi: Vaccine Refusals in Context

ABSTRACTCommunity and health worker engagement will be key to polio eradication in Karachi, Pakistan. In this study, the authors conducted participant observation, interviews, and a document review in SITE Town, Karachi, an area that in recent years has harbored poliovirus. SITE’s diverse population includes large numbers of internally displaced persons who are disproportionately affected by polio and are more likely than other populations to refuse the polio vaccine. Vaccine acceptance and worker motivation in SITE Town were shaped by the discrepancy in funding and attention for polio eradication campaigns as compared with routine services. Parental vaccine refusals stemmed from a distrust of government and international actors that provided few services but administered polio vaccine door-to-door every month. Addressing this discrepancy could therefore be key to eliminating polio. The authors suggest short-term improvements to routine immunization and sanitation in key polio endemic areas, coupled with ...

The Impact of Polio Eradication on Routine Immunization and Primary Health Care: A Mixed-Methods Study

Background. After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).Methods. Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.Results. Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year.Conclusions. Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts.

PARALLEL DILEMMAS: POLIO TRANSMISSION AND POLITICAL VIOLENCE IN NORTHERN NIGERIA

ABSTRACTNigeria is one of three countries where polio continues to be endemic. In northern Nigeria, areas with low levels of polio immunization due to persistent parental opposition as well as implementation and infrastructural problems have contributed to wild poliovirus transmission. Furthermore, political violence associated with Islamic groups opposed to the federal government has also hampered the conclusion of the Global Polio Eradication Initiative (GPEI) efforts. This violence, which began in Borno State and has spread to other parts of northern Nigeria, occurs precisely where poliovirus transmission continues. These two related aspects – parallel dilemmas of low immunization and political violence – confound the conclusion of GPEI efforts in Nigeria. This situation also raises ethical questions both about the final stages of eradication efforts and about military actions to contain ongoing violence. The Nigerian government's attempts to suppress opposition to the polio eradication campaign by threatening non-compliant parents with arrest and by closing down media outlets may frighten some parents into compliance but can also breed resentment and resistance, just as military and police activities, such as house-to-house sweeps and widespread arrests, may encourage sympathy for Islamic insurgents. This situation suggests that the possible solution of one problem – the ending of wild poliovirus transmission – depends upon a solution of the other, i.e. the cessation of violent anti-government activities.