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AEFI Communication:
Bangladesh Experience
Naseem-Ur-Rehman
Chief, Communication & Information
UNICEF BANGLADESH
For every child
Health, Education, Equality, Protection
New Delhi
AEFI Communication:
ADVANCE HUMANITY
10 August 2004
Bangladesh Experience
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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
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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
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10 August 2004
AEFI Communication:
Bangladesh Experience
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Brief on EPI
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EPI initiated in 1979
First NIDs in 1995
12 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
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10 August 2004
AEFI Communication:
Bangladesh Experience
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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.
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10 August 2004
AEFI Communication:
Bangladesh Experience
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Examples of campaigns
Dhaka City Mayor’s call
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10 August 2004
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Bangladesh Experience
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NID campaign modalities
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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
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Overview of AEFI cases in Bangladesh
• 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
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10 August 2004
AEFI Communication:
Bangladesh Experience
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Overview continued…
• 2003
• 3 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
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Actors’ responses: factual, mitigation,
damage control
Agency
1. GOB
National
Health Ministry
Line Director
District
Civil Surgeon
Sub-district
Upazila Health
Officer
2. UNICEF
Representative
Chief, H&N
Chief, C&I
Prog.Off. H&N
Divisional Chief
UPC
3. WHO
SEARO Team
National
Professional
Officer, EPI
Surveillance
New Delhi
10 August 2004
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Bangladesh Experience
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GOB response mechanisms
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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
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10 August 2004
AEFI Communication:
Bangladesh Experience
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UNICEF response
• 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.
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10 August 2004
AEFI Communication:
Bangladesh Experience
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UNICEF communication response
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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
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10 August 2004
AEFI Communication:
Bangladesh Experience
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Role of WHO
• 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
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10 August 2004
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Bangladesh Experience
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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
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10 August 2004
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Bangladesh Experience
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Media and AEFI: excerpts from
Bangladesh press
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Bangladesh Experience
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Bangladesh Experience
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Bangladesh Experience
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Bangladesh Experience
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Bangladesh Experience
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Bangladesh Experience
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Impact on routine immunization
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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
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Bangladesh Experience
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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
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10 August 2004
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Bangladesh Experience
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Thank You
New Delhi
10 August 2004
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Bangladesh Experience
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