UNICEF Experience in Supporting Communication in the Introduction of Novel Oral Polio Vaccine Type 2 (nOPV2)

"Deploying nOPV2 in the COVID context would require extraordinary communication and social mobilization support."

Outside the two countries where wild poliovirus remains endemic (Afghanistan and Pakistan), the major threat to achieving polio eradication is outbreaks of circulating vaccine-derived poliovirus (cVDPV), especially type 2. To better address existing cVDPV transmission and to prevent future outbreaks, governments and Global Polio Eradication Initiative (GPEI) partners, including the United Nations Children's Fund (UNICEF), are working to deploy the novel oral polio vaccine type 2 (nOPV2), which is less likely to revert to neurovirulence or seed new cVDPV events than monovalent OPV type 2 (mOPV2). This case study documents UNICEF's efforts related to communication for development (C4D) to support the introduction of nOPV2. It covers global-level preparations and guidance, strategic communications, and messaging around the new vaccine, as well as country-level training and on-the-ground support for vaccine introduction. In addition, the document features the communication experiences of UNICEF Nigeria, UNICEF Liberia, and UNICEF Republic of the Congo in executing their first nOPV2 campaigns.

From January through March 2020, UNICEF began preparing to introduce nOPV2 by conducting research around perceptions of a new polio vaccine. The organisation understood that a new vaccine might generate novel barriers in people's perceptions that influence whether they accept vaccination. The risk of potential barriers might be especially likely at a time when communities globally are highly tuned in to information and misinformation on vaccines in general, due to the COVID-19 pandemic and the simultaneous introduction of COVID-19 vaccines worldwide.

Specifically, UNICEF supported a rapid qualitative assessment of perceptions and attitudes around a new polio vaccine in the Republic of the Congo, Kenya, and Nigeria. Through focus group discussions and individual interviews, researchers heard from caregivers, frontline workers (FLWs), health practitioners, and social influencers (e.g. community leaders, religious leaders, journalists) about their perceptions around the polio vaccine generally, their awareness and understanding of cVDPV, and their anticipated questions and concerns around a new vaccine. UNICEF applied the research findings to build communication strategies, content, and messaging around nOPV2 that were designed to be responsive to community concerns and based on trusted information sources.

GPEI developed a readiness process and tools to help countries prepare to use nOPV2 and meet readiness requirements. In terms of advocacy, communication, and social mobilisation (ACSM), each country wishing to use nOPV2 needed to develop and provide four documents to regional and global verification teams: an advocacy plan, a behaviour strategy, a crisis communications strategy, and a vaccine-related event (VRE) plan. UNICEF provided global guidance and templates to support countries in developing the first three required ACSM plans, while the United States Centers for Disease Control and Prevention (CDC) led development of the VRE plan. The case study describes the support UNICEF provided for each strategic document.

In addition, UNICEF enlisted McCann Global Health to devise a launch plan tool to help determine how to communicate to audiences about nOPV2. Communication teams in countries preparing for nOPV2 could use this toolkit and adapt the guidance to their local context to build country-specific communication strategies and materials that would engage audiences and support nOPV2 introduction.

Working with the GPEI nOPV2 Working Group, UNICEF led the development of a training module for FLWs on nOPV2 introduction [PDF] and designed a facilitators' guide for use during training of trainer events. The manual also promoted vaccinator and social mobiliser capacity-building and focused on interpersonal communication skills (IPC) - e.g., the need for campaigns to have the personal credibility of the messenger/source of information and feature messages to help people understand outbreaks and key messages on COVID-19.

Examples of other types of UNICEF support included:

• From July to August 2020, UNICEF enlisted the Matter Group and Common Thread to design and facilitate a series of virtual workshops to engage with countries about how they should conceptualise their behavioural strategy and the positioning of nOPV2 in their local context.
• From October 2020 to January 2021, C4D and communication specialists in UNICEF's West and Central Africa Regional Office (WCARO) polio Rapid Response Team (RRT) and UNICEF headquarters (HQ) Polio Eradication Programme deployed to Liberia, Republic of the Congo, and Sierra Leone to provide hands-on technical support. For example, in Liberia, UNICEF HQ members supported the development of the strategic communication plan and ensured the country was ready for all communication components of the nOPV2 introduction.
• UNICEF HQ and regional office (RO) staff led a series of virtual, multi-day, country-level trainings to prepare countries for the communication elements of nOPV2 introduction. These trainings covered topics such as the nOPV2 verification process, nOPV2 positioning and key messages, vaccine management, IPC, misinformation, and rumours.
• UNICEF HQ misinformation experts facilitated two-day, online misinformation management workshops in over 14 countries, and online social listening dashboards were created in each country.
• With GPEI's Global Communications Group (GCG), UNICEF developed a template for crisis communications planning and supported the GCG's development of "Recommendations for Reporting on Poliovirus Outbreaks", a media guide for journalists writing about cVDPVs and polio eradication, along with nOPV2 Frequently Asked Questions (FAQs). Relatedly, UNICEF's external communications and C4D teams worked to plan media stories and products so that communities received timely and accurate information to combat misinformation and reinforce healthy, positive behaviours. External communications looked at all community media products that influence mothers and fathers.

Part 2 of the case study explores three country experiences in introducing nOPV2, covering: context/activities, major achievements, problems and challenges, interventions and solutions, results, and lessons learned. For example, in the case of UNICEF Republic of the Congo, round 1 (R1) of the first nOPV2 campaign took place from May 27-29 2021, two months after the start of COVID-19 vaccine campaigns in the country; R2 was held August 20-22 2021. Engaging professional associations in advocacy meetings to support the introduction of the vaccine ahead of the campaign was a new initiative. As a result, representatives of the Congolese Paediatric Society and the Alliance of the Private Health Sector of Congo talked to the media about the response and the importance of polio vaccination. UNICEF and partners briefed community media online about the campaign and organised workshops and briefings during which they provided the media with a press kit containing policy messages on the campaign. A national-level Misinformation Management Committee was set up in February 2021 to track rumours online and offline in the community. UNICEF also engaged and trained young bloggers who carried out online monitoring and provided accurate information. Teams worked with leaders and influencers in areas where refusals and reluctance were registered due to misinformation. To address misinformation, UNICEF involved supervisors in refusal mapping and management. Engagement of political and traditional leaders was effective in some areas, and they got involved in addressing refusals. Meetings were organised with traditional leaders to provide them with guidelines. When FLWs registered a refusal in the community, traditional leaders were approached and reminded about the guidelines so they could support parents in accepting vaccination.

Despite those efforts, during R1, issues occurred with campaign activities, in part due to COVID-19 activities. For instance, the same health district managers and FLWs (including social mobilisers and traditional and religious leaders) involved in sensitising the community about the COVID-19 vaccine were involved in reaching out to communities about the polio vaccine, which caused confusion in the community and created difficulties in terms of vaccine hesitancy and refusal. For various reasons, the allotted time for communication and sensitising the community was inadequate. After analysing R1 results, UNICEF Congo created a plan to address the issues of vaccine refusal and low campaign awareness. For instance, at the community level, groups mapped as refusals in R1 were engaged in community dialogue in many parts of the country. Plans also included increased engagement of leaders and influencers - for example, by mapping leaders and influencers and working with celebrities (e.g., artists, musicians, comedians) to draw more attention to the polio campaign. Community engagement occurred well in advance of R2. Caravans (a flatbed truck or tractor with musicians on board, along with individuals with megaphones to mobilise people, and others walking behind with banners) were used to intensify mass communication. Advocacy with religious leaders secured their commitment to support polio and immunisation in general and address refusals on religious grounds. To reinforce this process, the programme identified bloggers, young volunteers, celebrities and other digital mobilisation influencers to inform and educate the community and to track and manage rumours. Also, the programme held community dialogues before the campaign and involved community leaders.

Reflecting on the experience in these countries, UNICEF asserts that, "While campaign quality in each of them could have been better, it can be noted that a gradual improvement of campaign quality and communication efforts between R1 and R2 was seen in each country. Initial campaigns in the three countries occurred without facing a crisis scenario. However, it was felt important to strengthen the crisis communication capacity on the ground by ensuring that teams, clear protocols and rumour-tracking processes were in place....Apart from some misinformation about nOPV2 in Liberia, no major misinformation was detected about nOPV2. Misinformation surrounding the COVID-19 vaccine, on the other hand, is becoming increasingly common, and it is sometimes confused with the polio vaccine."

Going forward, the end of nOPV's initial use period (as of October 11 2021) means that more countries will be eligible to use the vaccine under the World Health Organization (WHO) Emergency Use Listing (EUL) recommendation, once verified for use and as supply allows. "UNICEF and GPEI partners will continue to provide guidance and support to meet the remaining special use requirements, including any specific support for communication preparation."