Documenting the Community Mobilization Efforts in the IPV Study

"Communication interventions have played a consistently central role in the Polio Eradication programme. Mass media and information dissemination approaches used in immunization efforts worldwide have contributed to its success. The central components of the India communication strategy continue to be political advocacy, social mobilization and behaviour change communication."

This report details a study conducted to explore an alternative to efforts being undertaken at the time (2009) to eradicate polio in India. At the time of the study, the eradication strategy used only Oral Polio Vaccine (OPV), but - according to research cited here - "[t]he efficacy of OPV in inducing mucosal immunity in the gut of Indian children in Western Uttar Pradesh is challenged by a combination of factors such as diarrheal disease, poor sanitation, population density etc." To provide the programme with other complementary vaccination options, in May 2008, the India Expert Advisory Group (IEAG) on Polio Eradication recommended a multi-armed trial to inform decisions on potential use of Inactivated Polio Vaccine (IPV).

The purpose of this study was to compare the immunogenicity of different doses and methods of administration of IPV and Monovalent Oral Polio Vaccine 1 (mOPV1) in children with high risk of poliovirus infection. While the scope of this documentation did not cover any learnings that could be applicable to mass-scale IPV implementation, "it does provide insights into community's fears and anxieties that could be pre-addressed through messages." That is, the communication element comes into play with regard to the involvement of India's Social Mobilization Network (SM Net), which works in high-risk areas, emphasising involvement of the underserved community through a three-tier network of mobilisers aiming to sustain the changed behaviour of the intended audience.

As detailed here, the World Health Organization (WHO) team located 10 study sites across Moradabad district in the state of Uttar Pradesh. The study design involved vaccination and blood sample in 3 visits (at 0, 7, and 28 days) among healthy infants 6-9 months of age who were resident in high-risk areas of Moradabad. SM Net, consisting of the CORE Group Polio Project and the United Nations Children's Fund (UNICEF), mobilised families of children in the above-mentioned age group. Because of the reluctance in these communities to vaccinate their children and the complexity of the study that required 3 visits to a health facility by the study candidates and their parent/s and 3 blood draws, the drop-out of less than 13% was a surprise; the drop-out rate was anticipated to be 50%. The present document looks at the processes retrospectively, especially the mobilisation efforts, that led to this achievement.

An excerpt from the report follows:
"The enrolment of children in the IPV Study was a result of meticulous planning and its execution was done through seamless coordination between NPSP [National Polio Surveillance Project] and the SM Net.

Three key factors at the planning level that proved useful in ultimately mobilizing community and averting much resistance due to negligence were:

• Involvement of SM Net gave a headstart to the Study by utilizing the strengths of CMCs [Community Mobilization Coordinators] who are known to be reliable and considered to be one of their own by the community.
• Implementation protocols were made for each cadre across partner organizations and then shared. While these designated clear role and responsibilities, a common thread that bound them all together was that the Study had to succeed.
• The various aspects of the existing AEFI [Adverse Events Following Immunisation] strategy were strengthened so that nothing fell through the crack, like each child had a doctor designated to follow-up, referral centers were identified and all the cost incurred were borne by the Study partner.

The implementation of the Study had an unprecedented precision and team work. All the factors that mobilized families and sustained their participation worked in conjunction with each other and may not have worked if executed in isolation. These were:

• Messages created need for the vaccine and were built to stress its exclusivity. These were also meant to rekindle their role in polio eradication in general. The communication approach that was adopted by all partners throughout the study period while dealing with parents was cautious, clear and non-conflicting.
• Incentives and compensations created a facilitative environment but also ended up raising unmet demands among the rest who were not part of the Study.
• Community concerns mainly revolved around the safety of their children and were resolved through counseling and demonstration at site, for example, of blood collection vials.
• Influencers were oriented about the Study and their support was solicited prior to initiating it. Their presence and pro-active support often helped mediate processes between the community and the Study.
• Follow-up visits and helpline numbers [through which parents were reassured that their child would be safe and they could contact any study staff in case of any query or child's illness] together helped build confidence among parents and reassured them that what was promised was delivered.

In brief, clear roles and responsibilities were delineated to all cadres who at different stages of contact with the families delivered clear, non-conflicting, specific messages to persuade and sustain families' participation. Whatever was promised in terms of direct incentives or indirect benefits like follow-up was given out to the families. The SM Net, being in direct contact with the community, became a potent route of communication regarding IPV, allaying concerns about the vaccine."

Click here for the 41-page report in PDF format.