India is polio free, but the challenges of fighting polio were numerous

In January 2014, India has been officially recognised as being polio free by the World Health Organization. What were the factors that contributed to this historic outcome?

For one, the country’s Polio Eradication Programme was the result of a strong partnership between the Ministry of Health and Family Welfare, the World Health Organization, UNICEF, Rotary International, and the U.S. Centers for Disease Control.

The polio eradication campaign involved well known public figures like former President of India Pratibha Patil (Photo: WFS)

It began in 1995 as the Intensive Pulse Polio Immunisation programme under which children up to the age of five years were given additional doses of Oral Polio Vaccine (OPV) irrespective of their immunisation status at the time.

In early days, ‘communication’ was used in a very limited way because the entire effort of administering polio drops to babies and children was being addressed by public sector immunisation teams. However, it was soon realised that effective communication was certainly the most powerful ‘vaccine’ that could prevent communities from various dreaded diseases, including polio.

A planned communication strategy then came into the picture and has now been identified as a major factor in the final outcome.

It can be said that in India, evidence-based communication strategies - including through interpersonal communication and through social channels - made a marked difference in delivering effective health communication for the polio eradication programme.

These efforts included participation of community organisations as well as government at the national, state and local levels, along with professional organisations and the media.

Mass media campaigns combined with sustained political will contributed to reducing the incidence of the disease, which in turn led to a stage where no fresh cases of wild-polio virus infections were spotted since Jan 11, 2011.

However, while the medical experts/immunisation specialists have adjudged the health communication for polio eradication as very effective, many communication scientists point to the limitations of the current approach and the “communication-content”.

They argue that the use of communication for polio eradication has not been strategic. While it was widely used to promote the polio vaccine drops, the factors responsible for the spread of the polio virus - like low rates of routine immunisation, poor sanitation and lack of clean drinking water - were not publicised through behaviour change tools.

This remains a gap, because even now a large number of communities have very little knowledge about the causes behind polio transmission.

The polio programme faced many challenges. The first was to identify those children aged less than two years, who lived in the densely populated neighbourhoods of marginalised communities, which lacked basic sanitary and health care facilities, and who had missed out in OPV rounds resulting in their getting fewer doses.

Another major hurdle was to make parents aware of the need for repeated doses of polio drops to protect their children. Misconceptions about OPV and suspicions about the motive behind this repeated campaign were also issues that needed to be taken on board.

Many imagined that the OPV vaccine itself was the cause of the illnesses their children suffered from, and there was even the view that such vaccines would cause infertility in children when they grew up into adults.

But the most persistent rumour of all was that the vaccine was part of a plan to curb population growth. Therefore, reaching this critical group became a significant strategy and a turning point in the formulation and implementation of communication interventions.

The most underserved and vulnerable groups were also the most hard to reach, and included nomads, tribals and migratory populations that resided for short spells of time in the sub-urban clusters of towns and cities across India.

Social mobilisation was, therefore, included in the overall communication approach and became a crucial component of the programme. The evolving strategy included reaching out to, and connecting with, women as a community through inter-personal communication methods.

The entire process of evolving a more effective system of communication for polio eradication included mass media campaigns to attract national visibility and general public awareness.

It included “brand” and “basic message promotion”, especially using sound-bites from well-known celebrities like Amitabh Bachchan (“Do boond zindagi ki”, two drops of life). In this way, interpersonal communication and social mobilisation piggy-backed on the mass-media and that proved invaluable in reaching the unreached.

In the apparent absence of a dedicated, trained communication cadre with the government to carry this momentum forward across India, a huge social network was created with the local health personnel of the districts.

Local health authorities coordinated the work at different levels, from the district and block to the village and they even made house-to-house visits and brought community and religious leaders on to a single platform.

In support of its ‘Underserved Community/Hard-to-reach’ activities, the polio programme proactively engaged with influential Muslim institutions and other select institutions to build confidence in the programme among minority communities.

It was also found that folk media was very useful in increasing community awareness and enhanced attendance. Mass-media campaigns involving movie and cricket stars and important regional and national level political figures that focused on exposing the hollowness of rumours and encouraged people to bring children for vaccination were run.

There is documented evidence to suggest that puppet and theatre shows, folk media and video vans, which travelled to more than 3,500 villages in Uttar Pradesh, contributed to a 20 per cent increase in booth attendance.

It showed the power of synergistic communication activities. Integrated social mobilisation, interpersonal communication, gender and culturally-sensitive interventions, mass/folk media and political advocacy together greatly contributed to the overall success of the polio programme. Clearly, such a model could also be adopted for other public health programmes and initiatives.

However, it also needs to be reiterated that the current polio communication content is largely based on promoting the OPV. Therefore, a scientific campaign in promoting behavioural change with regard to sanitation, safe drinking water, routine immunisation and good nutrition is now the need of the hour.

(Deepak Gupta is a senior expert in Strategic Communication & Programmes in Asia and a Research Scholar and Anusha Agarwal is a C4D & Youth-Development Practitioner & Researcher.) - Women's Feature Service