Sustaining the Gains of Polio Eradication: Addressing Vaccine Refusals in Northeast Nigeria [Presentation from the Sharing Learning from Polio SBC Side Event at the 2022 SBCC Summit]

"[P]eople were displaced, which increased the huge risk for...the spread of polio and requires strong social mobilization and household level demand generation..."

In this presentation at the Sharing Learning from Polio SBC: Misinformation, Social Data and Conflict side event at the 2022 International SBCC Summit, Elizabeth Onitolo discusses UNICEF Nigeria's work to address vaccine refusals in conflict-affected northeast (NE) Nigeria, which has been affected by insurgency in the last 12 years. The rising cases of missed children due to vaccine refusals pose a huge risk for sustaining Nigeria's gains in securing its status as a wild-polio-free country in August 2020.

In most cases where UNICEF Nigeria encounters caregivers who are refusing vaccine, the issue is that there have been too many rounds of polio vaccination or because of their religious beliefs. Onitolo describes UNICEF Nigeria's efforts to respond, such as by:

• Classifying settlements based on accessibility;
• Strengthening and leveraging community networks (e.g., traditional and religious leaders' platforms) to build trust for vaccines;
• Deepening community engagements through volunteer community mobilisers (VCMs) prioritising households refusing vaccines (1,207,342 caregivers reached to date);
• Training rapid response teams (RRTs), which are made up of trained community members who are responsible for quick and timely resolution of refusals (over 93% of cases resolved by RRTs);
• Improving service design and integrated services to boost coverage (more routine immunisation (RI), COVID-19 and yellow fever vaccination, birth registrations, etc.), showing families they care about them and their children beyond just giving them polio vaccine;
• Building partnerships and collaborations (e.g., with the Nigerian military, local vigilantes, and community informants) to improve coverage for uptake of vaccines - in part by training and provision of information, education, and communication (IEC) materials;
• Deploying a "hit and run" strategy, which involves going quickly into a community that is normally inaccessible (a safe, open window of time) to vaccinate children, establish some contacts there, and leave some information;
• Increasing access to health services for mobile population and other underserved groups (i.e., nomads); and
• Using data to drive the design and implementation of programmes and activities.

As a result of these concerted efforts, NE Nigeria is consistently showing a reduction in vaccine refusal rates compared to other zones in the same region. Seven percent (170 of 2,496) of the non-compliance cases identified during the Borno campaign in NE Nigeria remained unresolved.

Key learnings from this work include:

• The VCM network is the "game changer" that strengthened community engagement.
• Building partnerships and leveraging trusted multiple platforms, such as the military, traditional and religious leaders, women, and youth groups, is key.
• Timely data gathering and use, such as satellite imagery and other data sources, was important for focused interventions.
• It can be useful to take notice of competing priorities and to leverage polio structures for COVID-19, cholera, and other response needs.

Recommendations include:

• Leverage multiple community platforms and local networks to implement suitable community engagement interventions, such as community dialogues and house-to-house visits.
• Engage existing partners to reach underserved groups such as internally displaced persons (IDPs), nomads, and trapped populations.
• Reach out to female religious leaders; they are the ones who can reach the women who are carrying babies the polio programme wants to vaccinate.
• Establish a data-gathering mechanism, and ensure that data guide interventions.

In responding to audience member questions, Onitolo elaborates on UNICEF's work engaging with religious leaders and the northern traditional leaders councils, with whom UNICEF "actually sell[s] the health of the child, not just polio vaccination....We want people, the religious leaders, to look at vaccine in a positive light and we keep reinforcing that message. And that way, even the person who is a naysayer [will] jump on board at the end of the day."

Click here, and then click on the Part 2 video recording, to locate and watch Onitolo's presentation (beginning at approx. 1 hour and 33 minutes into that Part 2 recording and then, following an interruption, continuing at approx. 1 hour and 53 minutes in).