The Mozambique Response to the WPV and cVDPV Outbreaks [Presentation from the Sharing Learning from Polio SBC Side Event at the 2022 SBCC Summit]

"...it was the first time that while polio case has been discovered after such a long time....[W]e were concerned whether there would be questions from the communities. So we were prepared to answer these as part of the social mobilization and the pre campaign door to door preparation of the communities, which had to be done."

On May 15 2022, a case of wild poliovirus type 1 (WPV1) was reported in Mozambique - the first in that country since 1993. Mozambique was also affected in 2022 by a concurrent outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2). These troubling outbreaks are the focus of this presentation, delivered at the Sharing Learning from Polio SBC: Misinformation, Social Data and Conflict side event at the 2022 International SBCC Summit.

Ketan Chitnis characterises the response in 2022 as data informed, with an eye to addressing misinformation and ensuring acceptance of the oral polio vaccine (OPV) and trust in the polio programme. For instance:

• UNICEF strongly supports the Ministry of Health (MoH) in the implementation of a multi-layered social and behaviour change (SBC) programme to reach and engage caregivers and influencers.
• Independent monitoring (IM)/lot quality assurance sampling (LQAS) data from the 5 polio campaigns in 2022 reported that more than 95% of caregivers have knowledge and willingness to vaccinate; cases of refusal were maintained at less than 1%.
• Data from social investigation of the polio cases, complemented by pre- and post-vaccination campaign (IM and LQAs) evaluations, constitute the foundation of the SBC strategy, ensuring interventions are tailored to caregivers and targeted as per the community context.
• Polio campaigns are intense and rely on continuous dialogue with communities to track possible rumours and misinformation that may affect vaccination acceptance.
• The strategy has relied on investment in generating evidence for decision-making for SBC and the leveraging of human resources/SBC officers in priority provinces using community dialogue and supervision.

UNICEF Mozambique has learned the following about data, trust, and acceptance of the vaccine:

• Religious leaders and community radio have a substantial effect on promoting demand for and acceptance of vaccines.
• The mobilisation of communities in urban areas is challenging and lacks robust communication interventions due to greater mobility and access to multiple platforms; paediatricians represent a strategic voice of trust to encourage vaccination in big cities.
• While communities are easily engaged, the effective engagement of high-level leaders and decision makers is needed to increase risk perception and prioritise the polio agenda in the country.

Recommendations on ensuring demand considerations are based on evidence and not on perceptions among planners include:

• Active community listening and dialogue is essential to create trust in polio response interventions. While communities have multiple priorities, when they are consulted, engaged in respectful conversations, have their questions clarified, and are provided with communication that is socially acceptable, levels of demand for OPV and vaccination behaviour are high. Work, timing, and schooling are major factors when children are missed. Context and environment are critical.
• Routine data on vaccine acceptance, layered with in-depth analysis when there is some hesitancy or resistance (e.g., religious reasons), are challenging to gather but are needed. Sharing such data with planners and decision makers is an important step towards evidence-based SBC. IM and LQS data helped to demonstrate that trust is solid among communities.

Chitnis' reflections on novel OPV (nOPV) and having cVDPV and WPV outbreak at the same time include:

• Mozambique's experience of using bivalent OPV (bOPV) and nOPV vaccine during different campaigns did not create a problem for demand. Communities were not told about the difference in the composition of the vaccine and why each is needed. There were no questions, even from the media, so science communication was not required either.
• Vaccine-derived and wild polio found during surveillance and campaigns also did not pose challenges for vaccine acceptance or questions from communities.

Chitnis concludes his presentation by stating that, in Mozambique, there is good demand for routine immunisation (RI), which perhaps made it easier for the polio campaign in 2022 to be successful. Yet, during the polio campaign, gaps in RI were identified, which will be addressed in 2023 and beyond, including through intensive SBC.

In response to an audience member's question about the extent to which religious leaders seek detailed scientific information about polio transmission and vaccination, Chitnis discussed a guide UNICEF has created for these leaders that focuses on promoting health-seeking behaviours but that does not include highly technical information.

Click here, and then click on the Part 1 video recording, to locate and watch Chitnis' presentation (beginning at approx. 1 hour and 11 minutes into that recording).