Communication and Social Mobilisation for a Nationwide (Lebanese) Polio Vaccination Campaign 2013

This national information, education, and communication (IEC) campaign involved communicating the following messages, designed to build trust and encourage parental compliance with the need to vaccinate:

• "All vaccines have been provided by the Ministry of Health through procurement from UNICEF with the highest international standards free of charge. They are of excellent quality and they have been provided from outside.
• Centres will be opened and the government mobilized to protect children's lives.
• In the difficult economic situation you are going through; get the vaccine free of charge, fresh and reliable.
• There is no vaccine that can cause a disease.
• The child may have fever after vaccination but this is very normal. Just give your child a simple medicine to reduce it.
• We will go everywhere to reach you and protect your children."

Strategies for communicating these messages included:

• A person-to person approach - Community, social, and health workers went door to door to informal tented settlements and collective shelters to provide the vaccine for every child. "[A]t the Basal collective shelter for Syrian refugees, families came out to greet the four-person vaccination team. Mothers encouraged the children to take the two drops of polio vaccine by telling them it is 'assir' - juice." Both verbally and in the form of printed brochures (separate 2-page leaflets for families and leaflets for social workers), the overriding message was to "spread the word for our children and a polio-free Lebanon"). Simplified key messages included information such as this: "The vaccine is extremely safe and effective, and the best protection for children against polio. It is important to vaccinate EVERY CHILD, even on the first day of life. Sick children and children who are already vaccinated must also get the vaccine. Every dose strengthens the child." The family brochure featured simple language with drawings and images to be accessible even to illiterate mothers.
• Posters for parents and general public that were placed on a nationwide scale at locales such as schools, shops, supermarkets, primary health care (PHC) centres, hairdressers, municipalities, pharmacies, NGOs, mosques, and churches.
• A 30-second TV spot, broadcast on all stations at prime time.
• A 30-second radio spot about the campaign, distributed to all radio stations.
• A media outreach campaign - The polio campaign story was pitched to local, regional, and international media organisation in addition to UNICEF's own production of video and photo materials. A social media pack was also produced to engage followers on UNICEF Lebanon's social media platforms, in addition to mobilising media on the importance of vaccination through sharing and circulating posts and photos on UNICEF Lebanon's official Twitter and Facebook accounts.

Immunisation and Vaccines.

Lebanon, which has been polio-free since 2001, hosts the largest number of families displaced by the Syrian crisis, with more than 727,300 registered refugees, over half of whom are children, many living in informal tent settlements with little or no access to basic services. According to the World Health Organization (WHO), the first cases of polio in Syria were reported in October 2013 in the eastern province of Deir al-Zour, 14 years after Syria was declared free of the disease. A December 2013 WHO update says that 17 cases of polio have been confirmed in Syria - 15 of them in Deir al-Zour, one in rural Damascus, and one in Aleppo. (Source: BBC News)

One of the major difficulties faced in informal tented settlements is first, the high number of locations all over Lebanon coupled with significant geographic dispersion and population movements. It is estimated that there are more than 100,000 registered refugees residing in nearly 400 informal tented settlements across Lebanon. In addition, there are many more refugees who are unable or unwilling to register their presence in the country. UNICEF estimates that by the end of 2013, there were 385,000 registered and non-registered refugees residing in informal tented settlements. So as to make sure all children were reached in the most marginalised areas, UNICEF partnered with national NGO Beyond to specifically hone in on only informal tented settlements and collective shelters. The NGO had to ascertain that all the members of the family were present and had, in some cases, to return several times to ensure everyone was reached.

In 2008, UNICEF commissioned a quantitative and qualitative study to determine some of the knowledge, attitudes, and practices Lebanese have on child health in general. 60% of the women surveyed stated that children may get the disease if vaccine was administered or the child may get sick. However, there was a wide consensus on the importance of vaccination as a protective measure against disease. One of the major problems is the lack of trust people have in government services. When asked as to the reasons why they choose private physicians:

• Over 40% of the sample said that they do not trust the work of the MOPH centres and those of the Ministry of Social Affairs.
• One-third of the adults surveyed believed that the governmental centres may provide expired vaccines.
• In some areas, especially in Akkar, people complained that the Ministry of Public Health centres are open only few hours a week.
• Many people also believe that the government centres are very mediocre, with poor-quality services, lack of consistency and follow-up, and corruption.

Over a 5-day period, UNICEF, in collaboration with the Ministry of Public Health and local NGOs, provided 1.5 million vaccination shots to reach 750,000 children in Lebanon, regardless of nationality. Vaccination teams visited homes, health centres, and around 390 informal tented settlements where Syrian refugee families live. Vaccination stations were also set up at 4 official border points to ensure all children coming into the country are vaccinated.