For every child Health, Education, Equality, Protection ADVANCE HUMANITY

1. AEFI Communication: Bangladesh Experience Naseem-Ur-Rehman Chief, Communication & Information UNICEF BANGLADESH For every child Health, Education, Equality, Protection ADVANCE HUMANITY AEFI Communication: Bangladesh Experience

2. Bangladesh’s Poliomyelitis Eradication Progress • 1988, Bangladesh set the goal of polio eradication by 2000 • Four strategies: • 1). 1) three doses of oral poliovirus vaccine (OPV3) among infants under one year; • 2) National Immunization Days (NIDs) • 3) surveillance of polio cases • 4) "mopping-up" campaigns to eliminate the wild virus AEFI Communication: Bangladesh Experience

3. Bangladesh’s immunization picture • Remarkable success in increasing immunization coverage from 2% in the mid-1980s to 95% by 2004 • No clinically confirmed polio case since 2001 • No case with isolation of wild poliovirus since 2001 AEFI Communication: Bangladesh Experience

4. Brief on EPI • EPI initiated in 1979 • First NIDs in 1995 • 12 NIDs till date • Massive social mobilization efforts • More than 22 million children under five in each NID • More than 50,000 health and family planning workers and 600,000 volunteers • Multiple partners: UNICEF, Government of Japan, WHO, CDC Atlanta, USAID, IOCH, DFID, Rotary, Royal Government of Netherlands AEFI Communication: Bangladesh Experience

5. EPI Communication in Bangladesh • Message: ‘give your child vaccination’ • Message: ‘ we look for every child’ • Vitamin A drop during National Immunization Days. • EPI coverage has been stable 87%-98% • Independent surveys indicate that actual OPV3 coverage ranged from 60%-74% since 1991. AEFI Communication: Bangladesh Experience

6. Examples of campaigns Dhaka City Mayor’s call AEFI Communication: Bangladesh Experience

7. NID campaign modalities • Curtain-raiser • Radio and TV count downs • Newspapers stories/supplements/features • Health minister briefs the media • Media splash and high visibility • Special PSAs, motivational messages • Little reference to possible adverse reactions AEFI Communication: Bangladesh Experience

8. Overview of AEFI cases in Bangladesh • AEFI not restricted to far-away, remote or inaccessible places • Almost a national representative sample • 2004 Four cases so far • Three suspected polio cases. In Rangpur (Rajshahi division) , Khulna (Khulna division) and Bandarban (Chittagong division) districts) • One death of boy aged six in Khulna (Khulna Division) • One boy dies after administration of Vitamin-A capsule in Munshiganj (Dhaka division) during NID AEFI Communication: Bangladesh Experience

9. Overview continued… • 2003 • 3 deaths in Jamalpur (Dhaka division) after measles vaccination • Six more fell ill, later recovered • All deceased were 10-month old • Two girls, one boy AEFI Communication: Bangladesh Experience

10. Actors’ responses: factual, mitigation, damage control AEFI Communication: Bangladesh Experience

11. GOB response mechanisms • Report from the field • Joint GOB-WHO-UNICEF team leaves for field • Collection of samples (autopsy report, viscera) • Tests at government's central laboratory/ Geneva • Formation of probe body • Submission of report • Departmental action in case of negligence by officials/ front-line functionaries • Withdrawal of vaccine if it is old and replace with new supply AEFI Communication: Bangladesh Experience

12. UNICEF response • Exchange notes with team/field staff • Alert MOH, Partners • Joint fact finding mission • Joint assessment with GOB and WHO • Technical advise to GOB • Monitor situation • Procure new vaccine, if required. AEFI Communication: Bangladesh Experience

13. UNICEF communication response • Subtle investigative media work • Comprehend media’s reaction/treatment • Counter negative press • Closely follow-up, scan/monitor media reports • Establish system of reply to media queries • Press clippings/summaries shared with field colleagues • Translation of local language editorials/reports • Personalized briefings with key reporters • Identify trends in media reporting • Prepared Q & A for possible media queries • Media management AEFI Communication: Bangladesh Experience

14. Role of WHO • Factual/ scientific position • Position on efficacy, storage, distribution,/administration of vaccines • Appraise GOB on situation • Joint field investigation • Technical advise on testing samples • Monitor situation AEFI Communication: Bangladesh Experience

15. Community’s perception and reaction • When programme designed to save lives ends in death: • Grief, anger, panic, pessimism pervades • Knowledge, attitude, perception clash • Fixing responsibilities/accepting reality • Some withdrawal tendency • Return to normalcy after some time • Lack of ability to handle complications • Programme opponents ( quacks, hakims, conservatives) grab the opportunity • Rumour, negative message resurface • Issues of quality, handling and training emerges AEFI Communication: Bangladesh Experience

16. Media and AEFI: excerpts from Bangladesh press AEFI Communication: Bangladesh Experience

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22. Impact on routine immunization • Word of mouth spreads fast • Huge damages to programme acceleration • Lack of follow-up in different areas • Poor strategy to neutralize negative messages • No planning for rebuilding the confidence, winning back community support AEFI Communication: Bangladesh Experience

23. What worked well • Coordinated response by all actors • Proactive role of all What could have been done better • If report of the investigation was made public • Test report made available from Geneva • Actions taken as per recommendations of the report • Strengthen communication to allay fear, if any. • Media training on AFP/AEFI and other complications AEFI Communication: Bangladesh Experience

24. Thank You AEFI Communication: Bangladesh Experience