Importance of Public Health Education: Polio Immunization in West Africa

The first annual African Science Academy Development Initiative (ASADI) conference was held in Nairobi in November 2005. The theme of the two-day conference revolved around harnessing the scientific and technological capacity of African science academies in order to aid government leaders across the continent in fulfilling their commitments to the United Nations' Millennium Development Goals. Amongst the areas of focus were maternal and child health, disease prevention, and the eradication of extreme poverty and hunger.

This presentation was featured during the ASADI conference and described the comprehensive public-health education strategy that was critical to rebuilding public trust and increasing advocacy for polio immunisation in West Africa, following a 12-month period during which Nigerian officials were refusing to administer the vaccine. It discussed the immediate impact of negative communication through national and international media channels, evident in the decreased acceptance of polio vaccine and then in the subsequent rise in poliovirus cases. Additionally, the spread of these negative messages and importation of the virus from Nigeria to neighbouring countries (such as Mali, Cameroon, Sudan and Burkina Faso) was diagrammed.

In order to regain trust in polio vaccination programmes, the public health education strategy focused on sustaining engagement of traditional and religious leaders, attaining high political commitment, and increasing media visibility. Additional components included deploying community mobilisers in high-risk areas and leveraging community and family centered activities. The key community elements for building support for immunisation in West Africa were outlined as:

1. Grassroots Involvement
2. Policy Change
3. Media and Public Awareness

Intensified advocacy and partnership activities were launched as part of this strategy, and included high-level visits to governors and religious leaders, as well as increased involvement of the private sector (such as cell phone companies). Engagement of traditional networks and nomadic groups were also seen as an important part of this advocacy strategy.

The strategy underlined the need to strengthen the focus on community education through the aforementioned activities, as well as through visits to non-compliant households and involvement of traditional media. The use of media in behaviour change was highlighted in this presentation, and the following activities were initiated to promote vaccine-seeking behaviour:

• Human interest stories generated in the media to stimulate adoption of positive behaviours
• Dialogue stimulated through folk media (including town criers)
• Mobile cinema shows and Theatre for Development performances followed by community dialogue

The results of these interventions indicated a drastic decrease in the number of non-compliant cases in Nigeria from February to May of 2005. Additionally, following the deployment of community mobilisers in late 2004, an increase in the number of districts reporting >90% polio vaccination coverage was witnessed (data shown from May 2005). The increased demands for polio vaccine and increased coverage during vaccination campaigns reported during this period led public health officials to declare that the polio safety controversy in Nigeria had come to an end.

The presenters concluded that these results reflect the importance of public health education, and that the above interventions led to an increased public understanding about the importance of immunisation. In addition, they had the effect of increasing support for immunisation activities amongst key stakeholders.