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Polio vaccination programs face challenges in high-conflict areas
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The path to polio eradication, especially in high-conflict areas such as Pakistan and Nigeria, is blocked by operational challenges, limited disease awareness and negative caregiver attitudes toward vaccination, according to research conducted at Harvard University.
“These findings suggest that polio eradication efforts might need to develop communications and outreach efforts that address caregiver attitudes and knowledge,” Gillian K. SteelFisher, PhD, research scientist and deputy director of the Harvard Opinion Research Program, and colleagues wrote in The Lancet Infectious Diseases. “Moreover, programs could address local priorities more directly to enhance community-level trust.”
The researchers designed and analyzed questionnaires regarding caregivers’ awareness, knowledge and attitudes about polio and the oral polio vaccine (OPV) as well as their trust in vaccination efforts in specific regions of Pakistan and Nigeria. The caregivers were typically parents of children aged younger than 5 years, although some were adults other than parents who were responsible for a child’s health. All were living in Pakistan and Nigeria, areas at high risk for polio transmission.
Gillian K. SteelFisher
Local interviewers were sent only to areas that were deemed accessible, but included “higher-conflict” and “lower-conflict” locations, based on the Security Level System established by the U.N. Department of Safety and Security.
In Pakistan, 3,396 caregivers were polled; 997 were from Federally Administered Tribal Areas (FATA) — or higher-conflict areas. Local interviewers were unable to reach 20% of caregivers, either because they were not home or refused to participate, the researchers wrote.
In Nigeria, 2,629 caregivers were included, 388 of whom were from Borno (higher-conflict areas). Four percent of caregivers were not included because they also were not home or refused to participate.
The reported vaccination coverage was 70% in FATA and 67% in Borno during the most recent vaccination campaign that the caregivers could recall, “thus, a third of caregivers in these regions were unable to confirm that their child received OPV,” the researchers said.
This was not the case in lower-conflict areas, however, with 1% of caregivers in Pakistan and 8% in Nigeria unable to confirm that their child received OPV.
The primary obstacle for vaccine efforts appeared to be operational: either vaccinators did not visit the home or the caregiver could not recall such a visit.
In FATA, polio awareness was an issue, with 12% of caregivers reporting that they were unfamiliar with the disease. Only 3% of caregivers reported this in Borno. Also, 12% of caregivers in Borno reported that although vaccinators visited their homes, the child was not vaccinated.
Caregivers in higher-conflict areas of both countries had more negative views of OPV, had less positive views of vaccine campaign efforts and were less trusting of vaccinators compared with caregivers in lower-conflict areas.
“Polio vaccination programs might need to address underlying attitudes of caregivers through communications and the selection and training of vaccinators,” SteelFisher and colleagues wrote. – by Colleen Owens
Disclosure: SteelFisher reports grants from Robert Wood Johnson Foundation to the Harvard T.H. Chan School of Public Health (HCS) and a cooperative agreement between the CDC and HCS. In addition, SteelFisher’s husband has done consulting work for Eli Lilly in the past 3 years. Please see the full study for a list of all other authors’ relevant financial disclosures.
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