Summary Report on the Technical Advisory Group Meeting on Poliomyelitis Eradication for Afghanistan [June 2015]

"While the [polio eradication] programme has gained information as to why these children have remained unvaccinated, it has yet to fully elaborate on how it will address the causes of persistently missed children, and thus reduce their numbers to a minimum."

Held from June 1-2 2015 in Islamabad, Pakistan, this meeting of the Technical Advisory Group on Polio Eradication (TAG) in Afghanistan had the purpose of reviewing progress towards interrupting wild poliovirus (WPV) transmission in Afghanistan and making recommendations to improve technical and managerial aspects of the programme - including communication elements - in order to achieve interruption of poliovirus transmission in the country and, by extension, worldwide.

Until the date of this review, 3 cases due to WPV type 1 had been reported in this country in 2015 (2 from Farah province and 1 from Helmand province). "The on-again, off-again ability to vaccinate in Helmand remains a problem."

An excerpt from the Conclusions section of the report, with a focus on communication strategies, follows:

"The TAG recognizes and applauds the government on its commitment to neutrality of the polio programme. However, it notes that these positive developments are recent and that programme oversight has been impacted by the long political transition. This transition has led to the need for the government to create a new coordination mechanism that is not yet fully articulated and a National Emergency Action Plan that is insufficiently detailed to drive the work planning from June 2015....

The TAG would like to recognize the complexity of the access situation across the country and praise the constant efforts required at local levels to obtain and sustain access....It notes that “Not available” continues to be the major reason for children not being vaccinated, and recognizes that there can be a number of reasons for this from the quality of vaccinator interaction with care givers at the door to a form of soft refusal. The TAG notes with some concern, particularly as it pertains to the highest risk areas, that the second major reason for nonvaccination of children is outright 'Refusal'.

With enthusiasm, the TAG would like to recognize the innovative use of geographic information system (GIS) information in the mapping survey of Nahrisaraj, Helmand province. This has resulted in the identification of four villages not included in microplans and is a great example of the level of microscopic detail that will be required of the programme in going forward to reach its ultimate goal of polio eradication.

The TAG notes that media plans have been developed, including TV and radio public service announcements, BBC and VOA [Voice of America] radio, and bulk SMSs [text messages], along with plans to revise information, education and communication materials. The programme is starting to review the structure and role of the Immunization Communication Network to optimize its impact on reduction of missed children and toincrease female mobilizers. The TAG acknowledges the recently available data collected through the knowledge, attitudes and practices survey. These data confirm overall high awareness levels in the selected low performing districts but also very low levels of knowledge and risk perception. Both the post-campaign assessment and the knowledge, attitudes and practices survey confirm stagnation in changing attitudes around missed children, including refusals, especially those due to 'sleeping, sick and newborn'. The TAG recommends that the programme quickly develop a clear communication and mobilization strategy focused on reducing the rates of missed children during supplementary immunization activities."

The report offers a number of recommendations, such as expediting the development and roll-out of a revised training curriculum for vaccinators and mobilisers to improve the quality of activities and reduce the number of missed children. "Data from the recent knowledge, attitudes and practices study should be incorporated into the training materials and curriculum. This should be prioritized and rolled out in the low performing districts by the end of August, 2015."

Click here for the 17-page document in PDF format.