A CRITIQUE OF THE RESEARCH EVEDENCE ON ERADICATION OF POLIO IN PAKISTAN & INDIA

Contents Abstract 3 Introduction 4 Challenges that were faced 6 The impact of Social mobilization 9 Making the influencers a part of the programm 10 The role of media 11 Conclusion 11 References 12

Abstract
Ever since the year 1988, there has been a challenge going on to eradicate polio. This has been possible because of the Global Polio Eradication Programme. This initiative has used various media resources to make people aware of the ill effects of polio thereby allowing immunization to take place all over the world so that this harmful disease can be combated. However one of the most challenging tasks that were faced during this initiative was to reach the far flung places which were poor in economy and had very little access to health facilities so that polio could be completely eradicated. The program used various strategies combined with research and innovation so that they could gain access to populations that had been unreached (Adedeji, Marquez, Moore & Gonzalez, 2007).
Here in this analysis we shall be reviewing the challenges that came while conquering the polio battle in both India and Pakistan during the years of 2000 up to 2007. This case study will delve upon the following points: 1. The epidemiological aspect of polio 2. The data analysis 3. Strategies of communication used to make people more conscious
It also deals about how findings are based on research projects and communication with the people via media formats such as the television, radio and newspapers and social mobilization. These forms of communication with the common people have helped to drastically cut down the occurrence of Polio in both the countries (Peek, 2000).
Communication campaigns that include social networking, listening to what the people have to say, learning about their demands, facing stigmas based on gender discrimination, not allowing their child to be vaccinated have been given utmost importance. The analysis will also conclude with numerous studies that have further elaborated the need for communication while eradicating polio along with the impact that it has both globally and locally upon the interventions concerning Public Health. The reason of selecting this topic is that India and Pakistan are two countries that lack basic health care services and eradicating polio will help both the countries to have a better future for its children along with being disease free.

Introduction

With the help of the Global Polio Eradication Programme since 1988, the world has been immensely close to eradicating this menace of Polio. For this initiative to be a success communicating with the people has played a very pivotal role. The World Health Organization created this program along with collaboration from the Centres for Disease Control and Prevention and the UNICEF (Paul, 2009). There have been several nongovernmental organisations such as the Bill and the Melinda Gates foundations that have been an imperative part of this program. Countries that have been severely stricken by Polio also are a part of the initiative (WHO. 2014). With the help of vaccination drives the numbers of cases suffering from Polio were brought down drastically. With the numbers being 350000 during the year 1988 and only 1643 in the year 2009 so we can say that ever since the program started it has certainly worked towards wiping polio off from the face of the earth. Communication programs have mainly helped in ensuring that these community immunization campaigns are a grand success but the issue of polio persisting in India and Pakistan still remains (Paul, 2007). They are some of the most hardest to reach countries with poor medical facilities thereby making them polio free has become a huge challenge that needs to be overcome in the coming times by utilizing modern research techniques and communicating plans and strategies.
Here we will be delving into the years 2000 – 2007(Afzal & Rai, 2009) and see the efforts that have been made to eradicate polio along with understanding about the strategies that have lead to a rise towards immunization of the disease especially to those populations that are very difficult to reach out to. There have been campaigns going on from quite some time in both India and Pakistan to combat polio and the time duration that has been analysed in this case study states the new techniques of using the epidemiological data and ideas of communicating so that people could understand the need of eradicating polio. The reason why I have chosen to lay emphasis on only India and Pakistan is because of the following reasons: 1. The both are countries that are very difficult to reach out to 2. People are not very well educated to understand the graveness of the situation 3. Needs a more plan oriented approach to deal with the problem 4. Communication interventions need to be monitored in both countries in order to ensure that the campaign is a success.

Reviews about the communication of Polio have been conducted at both national and international levels further these reviews have been conducted at the sub nation level as well, thereby helping immensely towards the collection of the data, its analysis and how it helps towards creating initiatives that can help to communicate with the people. It also includes getting help for expert analysts from the advisory groups that specialise in eradication of Polio programs (2015). In this assignment I will also highlight how data collected can be based on evidence study, the need of communication interventions along with the usage of social mobilisation have helped both India and Pakistan to address the problems related to Polio that both countries have faced. In the conclusion I will also state the observations that have been made that deal with the last stages of eradicating polio and what effects it has on the health communication modules (Oshinsky, 2005). The exact definition of public health communication is based on the application of communication intervention that include the following a) Social mobilization b) Communicating interpersonally c) Mass media d) Local medical
These following methods need to be extensively used so that all the objectives pertaining to public health can be achieved. The entire concept of social mobilization is based on attaining a goal by using efforts that are self reliant in nature which sometimes can include using help from different organisations and media resources.

Method of research
A wide range of data was collected that was segregated into primary and secondary data, this data contained the research along with the reports that were made from the technical departments and the papers that had documented all the efforts that were being taken to eradicate polio in both the countries. An examination of the data was done in a very random format over the reports that were collected from the surveys that were held in some regions of India and Pakistan (Ahmad, 2003); interviews of people from various polio vaccination camps and some surveys that were conducted by the Technical Advisory Group were also studied. Apart from this all the data that was collected from various meeting of the advisory groups and campaigns was also taken into account. All these provided significant data pertaining to polio eradication in India and in Pakistan also measures that were taken by different countries to deal with polio were taken into account (Obregón et al., 2009). The findings of the research are backed by quantitative and qualitative data that has been collected in the time span of 7 years for this research.
Challenges that were faced

There was a huge challenge that was faced in the form of coordination of the a logistics that were available, the number of health workers that were a part of the program , the people who volunteered at the booth for polio vaccinations and those who were part of teams conducting house visits. India certainly has taken steps and has show immense progress in reducing the numbers of polio since the year 1995. By the year 2005, nearly 170 million of the population of children had been immunized by the oral poliomyelitis vaccine when the days for national immunization were held and more than 100 million were immunised when sub national days of immunization were held. Also the percentage of children that were immunised went up from 86% to 96% (Ansari et al., 2014) in the years 2000 to 2007. Here the children were given a minimum of two doses of the oral poliomyelitis vaccine. Apart from this the polio eradication drive in Pakistan commenced in the year 1995 and their numbers also reduced from 3000 cases to a mere 156 cases that were primarily of wild polio. There has been a certain downfall in the occurrence of polio till the recent years (Nair, 2002).

Fig 1. Cases of wild polio in Pakistan from 1998 -2007
The massive camps that were held in the formative years have contributed significantly for the decrement of cases of polio that lead most of the people to believe that eradicating polio was of utmost importance. However a major setback in these numbers was seen in India during the year 2001- 2002 when the numbers increased from 268 to 1600. (Seen in Figure 2.) And this rise went on to 66 cases in the year 2005 to nearly 875 in the year 2007. 80%(Athar Ansari, Khan & Khan, 2007) of the polio cases were from the state of Uttar Pradesh in India where the most affected were people who belong to the lowliest economic strata of the society that had no access to health services. There was a rise in the number of cases in Pakistan as well with the maximum rise was witnessed during 2003 to 2006, which led to believing that more stringent actions needed to be taken so that this increment could be dealt with so that all the people could have access to the vaccine for Polio so that its transmission could be stopped.

Fig 2. Cases of Wild Polio in India.
Mostly the cases of Polio that were reported were of children who were 2 years of age and were a part of Muslim communities that were very poor and basic sanitation was not available to them. They also missed most of the oral polio vaccine campaigns and thus had received a lesser number of the doses of the vaccine. Thus the question that arises is why did the children miss out on the OPV drives? ('Polio Eradication Plan', 2004) A large percentage of the parents were aware of the importance of polio drops so that their children could be protected from the disease while some simply failed to understand the need to give so many doses of the vaccine to their children.
Numerous doubts pertaining to the vaccines and some people were even suspicious of the agenda behind these campaigns. Hence they were pulled out and it was seen that the basic problems were clinics that had lack of staff, the connectivity via mode of transport was poor and prevalence of other diseases. Some misconceptions that surrounded the vaccine were that it caused unknown illness in the children who were given the dose; it was not very effective, gave way to infertility and mainly was a huge campaign that was started so that the Muslim population could be curbed and the Hindu population could have an upper hand (Bagchi, 2007). In the mean while Pakistan also had its own share of misconceptions surrounding the Oral polio vaccine. Very few children were brought by their parents for the vaccine, people were not comfortable of a team comprising of only males who visited their homes as a part of the campaigns. The people who volunteered to be a part of the program were fed up of the endless questions that were related to the OPV and the scenario was worsened further when a news channel stated that sub standard OPV were used. Hence a large number of families resisted the vaccine and thus their children did not get immunized. However in countries like Nigeria the campaign faced the same kind of resistance because of similar misconceptions. The most pivotal challenges that both the countries faced was reaching out to the population that lived in far flung areas of India and Pakistan and had a very low form of immunity so that cases of Wild Polio could be curbed because the environment that these people lived in was very conducive for the spread of polio. Therefore reaching out to the population that are undeserved has become one of the most important agendas of the initiative as their communication interventions were not enough to bring about a reform in the people so that they would be open to the vaccine(Brown, 2001). Thus a challenge has been set that deals with convincing the parents and the care givers of the children to understand the numerous benefits of immunizing their children and to further educate those people whose children have already been vaccinated so that they do not stop the doses in the coming times.

The impact of Social mobilization

There are various campaigns that are being held and are being advertised on various social media platforms, however these media advertisements are visible only at the national level and those people who are a part of the underserved populations do not have an access to these communication campaigns hence it’s imperative that an intervention pertaining to social mobilization is brought into order('WHO is to add a monovalent oral poliomyelitis vaccine to its existing polio eradication regimen in India,', 2006). In India alone only health workers have been pulled up so that the deal with the issue directly so that they can work along with the health workers at the local level, the district level and the community level can educate the population about the various benefits of the OPV (Chaturvedi, 2008). They thus coordinated with the teams so that they could conduct a follow up at several time intervals to check with the families of the children. Also a significant rise was seen in the number of activities that the campaign held communicating interpersonally was spiked up in the form of house visits and making use of influencing people of the society and religious leaders such as the doctors and the priests of that area.
Studies have shown that these rises in the activities has led to a reduction in the number of polio cases. Places where there was lack of awareness before these social mobilization initiatives have seen a rise in number of people who attended the vaccine both in comparison to those families who did not partake in these activities. In nearly 4 districts of Uttar Pradesh which were at high risk saw a drop in the number of wild polio cases and there was an increment in the number of polio booths that were set up as well. The percentage rose from 50% to 57% during the period of 2000- 2007(Closser, 2010).
Pakistan also saw its own share of changes and a series of social mobilization campaigns were set into motion and more than 95% of the people agreed to the fact that polio was indeed a grave issue that needed to be eradicated while only 83% people who did not have these activities believed in the importance of eradicating polio. In districts where these activities were increased saw a rise in people who believed that the OPV was the solution to eradicating polio (Mail, 2002). The polio eradication drive that Pakistan started revised its plans pertaining to communicating plans so that they could focus completely on those people who had high chances of accepting the oral polio vaccine. By the year 2005 nearly 98% of the people were aware of the polio initiative and more than 50% (Coates, Waisbord, Awale, Solomon & Dey, 2013) of the people said that they discussed the benefits of the oral polio vaccine with their family and friends. Thus these findings led the campaign to lay more emphasis on educating women as they were the primary care givers to their children.
Hence this communication plan now focused solely on making women aware of the benefits of the oral polio vaccine (Silk, 2007). Women were trained as health workers which led to intensification of the communication plans. They thus helped to influence women in families about the importance of OPV, support was provided to them from religious leaders and doctors from the neighbouring areas.
Making the influencers a part of the program

The most imperative challenge that has been faced by the program is reaching out to the far flung population, which includes large number of the Muslim community. Which led to the form a strategy that focused only on educating the people about the wild polio cases and the lack of sanitation that was available to the people? Famous institutions like the Aligarh Muslim University along with doctors and religious leaders were made a part of the initiative so that the people could be motivated. Nearly 87% increment as seen because of this program. A similar change was seen in Pakistan a rise as well. As per data collected in the year 2007 an increment was seen from 37% to 50 %('Polio Eradication Plan', 2004) for immunization of children as well. Hence including religious leaders and celebrities indeed worked like a charm to educate the people.

The role of media Media has had a very crucial role to play when it comes to eradicating polio. Most people stated that they had heard about polio booths and immunization days either on the television or on the radio. The percentage went up to 89 %( John, 2009) in the year 2007. Thus we can state that communication in the form of social media does influence peoples thinking’s to a large extent thus leading to a larger turn out of people to the various polio booths.
Lessons learnt from improving communication include the following: 1. Using interventions that are based on communication that can monitor the data on the underserved populations. 2. Excessive utilisation of social mobilization at all levels so that the overall efficiency of the polio eradication initiative can be increased. 3. Using influencers such as leaders and building relationship with the families along with the caregivers who are resistant towards the oral polio vaccine. 4. Using doctors and celebrities as spokespersons for campaigns to reach out to the people. 5. Conduct more house visits for administering polio drops 6. Work at the grass root level so that people can become aware of the implications of polio and understand the dire need for immunization. Conclusion
Communication in the past few years for eradicating polio has been based mainly on the information that has been provided by the health care sector, through various media platforms which have all worked with one goal that is to increase the rise for the vaccines of polio mostly in those areas that have complete access to immunization booths and services. But the cases of polio in India and Pakistan (Kew, 2012) have given rise to a complete new set of challenges which are based mostly on having the need for interventions which are mainly helpful in dealing with epidemic along with immunization of the children. The two countries have come up with various plans and initiatives that can improve the problem of immunizing children in far flung areas (Durante & Dal Poz, 2014). The data that has been collected by the epidemiology state that interventions in the form of communication methods are the best approach to follow. Therefore setting up various programs that deal with eradication, increasing the demand for vaccines, improving the attendance for the polio booths, making more efforts to advertise about the immunization days and working over the resistant areas of the population.
Even though there have been numerous setbacks when it came to eradicating polio both the countries of India and Pakistan has certainly made progress in eliminating the diseases. The strategies of communication have made a significant contribution to change the perspective of the people towards OPV('India “number one” polio eradication priority, says WHO', 2003), overcoming the resistance towards the vaccine, gender obstacles and most imperative of all reaching out to the undeserved population have been done. They thus need to continue with all these initiatives so that polio can be eliminated completely with not a trace left behind (Salgado, 2003).
This case stud hence shows the complete contribution of communication so that a wide network of support can be built while addressing the population that is far flung and resists the vaccine. The problem lies mainly in the social stigma against the vaccine and no vaccine can cure it, it can only be cured by educating the masses and making them aware of the implication of not vaccinating their children. Doctors cannot do the job alone as it needs to be addressed at the grass root levels (Islam & Rizwan, 2014). This is why polio drops are being provided at the doorstep. Hence these problems need to be based solely on communication strategies. All the lessons that have been learned by this program need to be collaborated so that further issues can be dealt with in a more stream lined manner.

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