New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 1 For every child Health, Education, Equality, Protection ADVANCE HUMANITY Naseem-Ur-Rehman Chief, Communication & Information AEFI Communication: Bangladesh Experience UNICEF BANGLADESH

New Delhi 10 August 2004 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

New Delhi 10 August 2004 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

New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 4 Brief on EPI EPI initiated in 1979 First NIDs in 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

New Delhi 10 August 2004 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.

New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 6 Examples of campaigns Dhaka City Mayor’s call

New Delhi 10 August 2004 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

New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 8 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 Overview of AEFI cases in Bangladesh

New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 9 Overview continued… deaths in Jamalpur (Dhaka division) after measles vaccination Six more fell ill, later recovered All deceased were 10-month old Two girls, one boy

New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 10 Actors’ responses: factual, mitigation, damage control Agency 1. GOB 2. UNICEF 3. WHO SEARO Team National Health Ministry Line Director Representative Chief, H&N Chief, C&I Prog.Off. H&N National Professional Officer, EPI Surveillance District Civil Surgeon Divisional Chief Sub-district Upazila Health Officer UPC

New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 11 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 GOB response mechanisms

New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 12 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. UNICEF response

New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 13 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 UNICEF communication response

New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 14 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 Role of WHO

New Delhi 10 August 2004 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

New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 16 Media and AEFI: excerpts from Bangladesh press

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New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 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

New Delhi 10 August 2004 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

New Delhi 10 August 2004 AEFI Communication: Bangladesh Experience 24 Thank You