Combating Polio Vaccine Hesitancy: An Evaluation of Mediated Polio Eradication Campaigns in Pakistan

"These results highlighted the necessity of focused initiatives to enhance the visibility and promotion of polio vaccination messages, particularly during prime-time television transmission, in order to successfully raise awareness and resolve challenges related to polio vaccine refusals."

Pakistan is currently one of just two countries in the world that has not entirely eradicated polio. In many parts of the country, parents are hesitant to vaccinate their children against polio. There might be multiple reasons for their polio resistance. This study was conducted to evaluate the message characteristics and message appeals used in polio campaigns to identify what factors contribute to parental resistance to polio vaccination in Pakistan.

The content analysis method was used to examine message appeals and message characteristics used in Pakistan's Polio National Immunization Campaigns from 2020 to 2022. A total of 239 polio advertisements from 13 different national campaigns created by the government in partnership with the United Nations Children's Fund (UNICEF) as part of the Global Polio Eradication Initiative (GPEI) and broadcast on national and local cable television channels from February 2020 to November 2022 were examined. These advertisements were obtained from the Pakistan Polio Eradication Program's internet archives, and they range in duration from 40 to 60 seconds on average. The polio messages were the unit of analysis for this study, and the message appeals (fear, rational) and message characteristics (credibility of message presenters, style, slogan, language) were the units of observation.

One of the main outcomes of the content analysis was the relatively low frequency of polio awareness advertising during the research period. In 2020, n=75 (31%) of polio ads were shown, which suggests that polio advertising was less prevalent then than in 2021 - i.e., n=114 (48%). One factor contributing to this lower number was the shift of resources by the GPEI to battle the COVID-19 pandemic. In 2022, n=50 (21%) polio advertisements were broadcast through cable and television channels during three polio national immunisation campaigns. The reduced frequency of polio campaign advertisement in 2022 could be because of factors like political instability, floods in various parts of Pakistan, and public perceptions of immunisation campaign.

Public officials consistently appeared as prominent message presenters over the course of the three years, accounting for n=58 (24%) of the total count. The second-most common message presenters were experts, who accounted for (n=36, 15%) of the total. Their significant appearance in polio advertisements suggests that disseminating accurate and reliable information to the public is a top concern. Religious scholars, on the contrary, appeared in n=30 (13%) of the anti-polio ads, highlighting their importance in raising awareness regarding polio vaccination. Also, community leaders made an active appearance, making up (n=19, 8%) of the Polio ads. Famous personalities, including celebrities, cricketers, and anchor persons, etc. appeared less frequently - i.e., n=10 (4%). Parents, polio sufferers, and polio workers working to eradicate the disease all made up 4-7% of the overall polio advertisements and were less prevalent. Overall, the findings emphasised the deliberate choice of message presenters in polio ads to maximise campaign efficacy.

A substantial number of message presenters were identified for being "knowledgeable" in anti-polio advertisements. In 2020, n=26 (35%) of the message presenters were characterised as knowledgeable, followed by n=35 (31%) in 2021 and n=14 (28%) in 2022. In contrast, a minor percentage of message presenters were classified as "empathetic": n=5 (7%) in 2020, n=10 (9%) in 2021, and n=5 (10%) in 2022.

"Rational appeals" were the most prevalent message appeal utilised in anti-polio advertisements over the course of three years. In 2020, the advertising used n=23 (31%) of the rational appeals. This percentage increased to n=48 (42%) in 2021 and n=10 (20%) in 2022. These findings imply that rational and evidence-based arguments were frequently used to persuade the audience of the need for polio prevention.

Negative and positive emotional appeals accounted for n=31 (13%) and n=44 (18%) of total polio advertisements, respectively. One type of approach based on negative emotions is fear-based appeals, which rose significantly from n=4 (5%) in 2020 and n=5 (4%) in 2021 to n=8 (16%) in 2022. The use of combination appeals in anti-polio advertisements received the second-highest percentage n=59 (25%) in total, which shows that a variety of message appeals were used to involve the public in the fight against polio.

The most prominent style of messaging used in the ads was conversational, accounting for n=56 (75%) in 2020, n=82 (72%) in 2021, and n=33 (66%) in 2022. With a casual and interactive tone, this style was employed to build a personal connection with the audience. Narrative and dramatic message styles accounted for n=18 (8%) and n=7 (3%) of the total, indicating efforts to convey personal stories of parents to evoke emotional effects. The use of visuals/music style and combination styles accounted for n=17 (7%) and n=26 (11%), respectively, indicating a focus on improving the visual and aural components to increase engagement.

Slogans can help raise awareness, encourage immunisation, and mobilise community support in the efforts to eliminate polio. The findings revealed that the use of slogans was inconsistent across all national polio campaigns televised in the years 2020-2022. Slogans used in national vaccination campaigns frequently repeated the same old slogans. Furthermore, 59% of adverts were shown without slogans.

The results indicate a substantial preference for using Urdu, the national language of Pakistan, as the main language in the ads, making up n=182 (76%). Regional languages were used to a lesser extent, with the category of combination demonstrating a mix of languages, with n=15 (6%) - indicating that some effort was made to cater to specific linguistic preferences. "Understanding the target audience's diverse linguistic needs is crucial for effective communication in polio campaigns."

"In conclusion, the quantitative findings help in a better understanding of the message characteristics employed in anti-polio advertising broadcasted through cable and television channels during Polio national immunization campaigns of 2020-2022. The use of credible speakers, a variety of message appeals, and a diversity of message styles show that efforts were taken to effectively connect with the target audience. Variations in the usage of slogans and regional languages highlight the need for constant assessment and refinement in campaign message strategies. This emphasizes how crucial it is to do constant research and analysis to determine the best...strategies for promoting polio prevention."