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AEFI Communication: Bangladesh Experience Naseem-Ur-Rehman Chief, Communication & Information UNICEF BANGLADESH For every child Health, Education, Equality, Protection New Delhi AEFI Communication: ADVANCE HUMANITY 10 August 2004 Bangladesh Experience 1 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 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 2 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 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 3 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 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 4 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. New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 5 Examples of campaigns Dhaka City Mayor’s call New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 6 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 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 7 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 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 8 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 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 9 Actors’ responses: factual, mitigation, damage control Agency 1. GOB National Health Ministry Line Director District Civil Surgeon Sub-district Upazila Health Officer 2. UNICEF Representative Chief, H&N Chief, C&I Prog.Off. H&N Divisional Chief UPC 3. WHO SEARO Team National Professional Officer, EPI Surveillance New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 10 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 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 11 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. New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 12 UNICEF communication response • • • • • • • • • • • 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 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 13 Role of WHO • 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 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 14 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 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 15 Media and AEFI: excerpts from Bangladesh press New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 16 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 17 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 18 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 19 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 20 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 21 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 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 22 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 New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 23 Thank You New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 24