Polio Eradication in Egypt: What Triggered the Change?

Presentation to the Executive Board

of the International Union for Health Promotion

and Education (IUHPE)

Cairo, Egypt - June 4, 2008

By: Farag Elkamel, PhD

Senior Communication Adviser, Unicef

Dean, Faculty of Mass Communication,

Ahram Canadian University

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This is a hieroglyph of the 18th dynasty,

dating between 1580 – 1350 B.C

Scientists discovered the first vaccine against

poliovirus in 1955. The vaccine was in the form

of an injection until 1961, when an oral route of

administration was discovered.

In 1988, when the Global Polio Eradication

Initiative began, polio paralyzed more than

1000 children worldwide every day.

Since the global eradication effort began in

Egypt, Polio cases kept declining.

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Even though reported polio cases were

decreasing,

by 2002 Egypt was unfortunately

one of only a handful of countries

in the world

where polio still existed

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Number of Confirmed Cases of

Poliomyelitis in Egypt: 1996-2002

• 1996 100

• 1997 14

• 1998 35

• 1999 9

• 2000 4

• 2001 5

• 2002 7

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The remaining wild polio virus

in Egypt was circulating in

the environment in densely

populated and slum areas,

where it was more difficult

to reach and vaccinate all

children.

There was some panic

because of an upward

trend (4 cases in 2000, 5 in 2001, and 7 in 2002)

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New Strategic Directions

After 2002

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• An assessment of the May 2003 campaign was

carried out by Dr. Farag Elkamel who was

contracted by Unicef, Egypt as their Senior

Communication Adviser.

• Based on a study he designed a new strategy for

Communication and Social Mobilization was

among his recommendations to Unicef and the

government for future polio campaigns in Egypt.

• Dr. Elkamel developed the new strategy and

provided technical assistance to Unicef and the

government to ensure its implementation

between 2003 and 2006.

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1. The assessment utilized a field study that was

sponsored by Unicef, Egypt and was designed,

directed, and analyzed by Dr. Farag Elkamel

after the first of three rounds of National

Immunization Days (NIDs) which took place in

May 2003.

2. The study used a condensed cluster sample of

204 participants was distributed as follow: 1. Cairo (52)

2. Giza (53)

3. Zagazig (50)

4. Assiut (49

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MAIN FINDINGS

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1. STATE OF IMMUNIZATION

• In the 204 homes visited, there were 289

children who were five years old or less

• All but 11 children were immunized during

the 2003 campaign. They were:

8 in Cairo

2 in Giza

1 in Zagazig

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1.A. REASONS FOR MISSING

IMMUNIZATION

Of all the children in the sample, 11 weren't

immunized for the following reasons:

4 weren't immunized because they were at their

school or nursery,

3 were not immunized because their parents

were not at home even though the children were

there, and

2 weren't immunized because of fear of infection

1 wasn’t immunized due to travel of the family

during the campaign

1 unknown reason

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2. INFORMATION SOURCES

Parents found out about the 2003 campaign from the

following sources:

• TV: 88%

• Outdoor signs and balloons: 22%

• Megaphones: 19%

• Other family members: 19%

• Radio: 16%

• Newspapers: 9%

• Mosque or Church sermons: 5%,

• Schools/nurseries: 2.5%.

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3. THE SCHOOL NETWORK

In 47% of the households visited there were

other siblings who were enrolled in school. Only

29% of the parents of these siblings said that

their children were told at school about the

campaign.

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4. OTHER UNDER-USED CHANNELS

When asked to exclude radio and television and think of the

most effective community mobilization channels,

respondents specified the following:

– Outdoors 21.6

– Megaphones 20.6

– Mosque sermon and megaphone 19.1

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5. POSITIVE INDICATORS

Attitudes and Intentions towards immunization are overwhelmingly positive:

Only five persons (2.5%) of the total sample expressed a negative intention towards future immunization

Only six persons (3%) believe that immunization has health hazards.

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6. THE MAIN COMMUNICATION

OBSTACLE: MISINFORMATION

There is a relatively large minority of

parents who are misinformed. For

example, 14% of parents in the sample

stated that a child should not be

immunized if he/she was sick, which is

contrary to the basic polio campaign

message.

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Summary of Main Obstacles

Identified by Research

• Lack of adequate public information on certain

important immunization facts

• Too many children are missed by the NIDs,

specially in slum areas

• Poor community awareness and social

mobilization because MOHP lacks expertise

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CONCLUSIONS & RECOMMENDATIONS

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CONCLUSION & RECOMMENDATION-1

REVISE CAMPAIGN STRATEGY:

CHANNELS

The Communication campaign should be

revised and divided into two main

components: A national Campaign that

covers the country and a community

mobilization one that has a more targeted

focus.

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CONCLUSION & RECOMMENDATION-1A

The national component of the

communication campaign should mainly

utilize TV and radio,

since they virtually reach everyone, with

much less expenditures on other means

because of their comparatively limited reach

and the limited campaign budget

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CONCLUSION & ECOMMENDATION-1B

The community mobilization campaign should

focus on harder to reach areas as well as all

areas where the last cases of polio were

reported

This campaign should focus on 5 community

outreach channels: 1. The megaphone

2. Schools & Nurseries

3. Outdoors/businesses/NGOs, etc.

4. Megaphones: street and mosques

5. Mosque & Church sermons

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CONCLUSION & RECOMMENDATION-2:

REVISE MESSAGE STRATEGY

Campaign messages should focus on:

a. Correcting existing misinformation

b. Offering needed knowledge and practical

advice to make sure that a child gets

immunized

c. Appealing to parents’ sense of responsibility

d. less emphasis on attitude-change messages,

since attitudes are already very positive

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CONCLUSION & RECOMMENDATION 3:

STRENGTHENING MOHP COMMUNITY

MOBILIZATION CAPABILITIES

Developing Planning tools for Organizing community awareness campaigns

Building MOHP capacities for planning and implementing community social mobilization activities (training, TOT, manuals)

Institutionalizing community social mobilization within the MOHP micro planning process

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Tools and Activities for Enhancing the

MOHP Capacities

Four Training Programs:

1. Communication Skills

2. Vaccination and Registration Skills

3. Supervision and Training Skills

4. Community Mobilization Skills

Activities:

1. Training Curricula

2. TOT

3. Training plans

4. Audio-Visuals

5. Evaluation & Monitoring system & tools

Trainees:

• 2550 close supervisors in 51 workshops

• 775 administrative supervisors in 24 workshops

• More than 6000 volunteers (vaccinators) 26

Community mobilization used local channels of communication to

reach families in target areas, including mosques, churches,

schools, megaphones, health centers and local businesses.

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How Community Mobilization

Made a Difference?

• Tackling the issue of missed children with targeted reach and messages

• Combating rumors in local communities

• Penetrating slums and hard-to-reach areas

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IMPACT OF REVISED STRATEGY

Mass media (mainly TV)

combined with community mobilization

(2003-2005)

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Attitude Towards Immunization Remained

Very Highly Positive

97.3 99.2

20

40

60

80

100

Important to receive routine & NID doses

2002 2005

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Significant Information Gains

Due to Revised Approach & Message Strategy

94.5

73 77.1

45.6

64

98.5 90 98 91.1

96.6

0

20

40

60

80

100

120

Take routine

+ NID

Vaccine has

no side effect

Max age 5 y Min. age is

one day

No harm of

extra doses

2002 2005

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THE EFFECT

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Confirmed Cases of Polio

started to decline by the end of 2003,

and completely disappeared

in 2005

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Number of Confirmed Cases of

Poliomyelitis in Egypt: 2003-2008

(as of 15 May 2008)

• 2003 1

• 2004 1

• 2005 0

• 2006 0

• 2007 0

• 2008 0

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THE OUTCOME

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Egypt was declared polio free by the Egyptian MOHP on August 29,

2005, and by UNICEF/WHO on February 1, 2006.

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