Local resistance to the global eradication of polio: newspaper coverage of the 2003-2004 vaccination stoppage in northern Nigeria

Acceptability and Feasibility of Human Papillomavirus Vaccine Introduction in Cameroon: A Mixed-Methods Study

INTRODUCTION

Human papillomaviruses (HPV) are responsible for sexually transmitted infections, and some of these viruses have oncogenic potential. The HPV vaccine is due to be introduced in Cameroon in September 2019. Our study looked at the knowledge, perceptions, and attitudes of the population and healthcare professionals regarding cervical cancer and its vaccine prevention. This approach provides a solid basis for, among other things, developing a clear communication strategy for the introduction of the vaccine.

OBJECTIVE

This study aimed to assess the feasibility and acceptability of introducing the HPV vaccine in Cameroon among key stakeholders including health workers and parents.

METHODS

From March to May 2019, we conducted a qualitative and quantitative descriptive study in six health districts in the Centre Region. A total of 257 study participants were recruited, including 168 parents and 89 health professionals; 60 interviews were also conducted, 30 with parents and 30 with health professionals. The quantitative data collected were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States); for the qualitative analysis, we carried out repeated readings of the transcribed interviews. This work enabled us to identify the significant themes emerging from the interviewees' discourse.

RESULTS

The vast majority of healthcare professionals claim to be aware of cervical cancer (93.3%), but only 15.7% of female healthcare professionals claim to have ever carried out a screening test. A significant proportion of these professionals have actual experience of cervical cancer. Among parents, knowledge of this cancer also appears to be relatively high for a lay audience (54.2%), with a low screening rate (7.1%). Awareness of the HPV vaccine as a cervical cancer prevention tool was very low: 14.9% among parents and 44.9% among healthcare professionals. In addition, we found that information about the existence of an HPV vaccine was still very low among parents (83.9% had never heard of it); 43.8% of healthcare professionals had been informed about the vaccine at their training school. As regards acceptance of the HPV vaccine, the quantitative and qualitative results point in the same direction. The majority of parents are in favor of a campaign and access to this new vaccine via the Expanded Program on Immunization (EPI). However, many of them (94.6%) explained that they wanted more information before making a decision.

CONCLUSION

Informing and raising public awareness of cervical cancer, the HPV vaccine, and vaccine safety are essential measures to encourage public support for the HPV vaccination campaign.

A structural equation modelling approach to understanding the determinants of childhood vaccination in Nigeria, Uganda and Guinea

Vaccines have contributed to reductions in morbidity and mortality from preventable diseases globally, but low demand for vaccination threatens to reverse these gains. Explorations of the determinants of vaccination uptake may rely on proxy variables to describe complex phenomena and construct models without reference to underlying theories of vaccine demand. This study aimed to use the results of a formative qualitative study (described elsewhere) to construct and test a model to explain the determinants of vaccination uptake. Using the results of a survey among more than 3,000 primary caregivers of young children in Nigeria, Uganda and Guinea, factor analysis produced six explanatory factors. We then estimated the effects of each of these factors on uptake of immunization using a structural equation model. The results showed that the probability that a child is fully vaccinated increases if a caregiver has support from others to vaccinate them (B = 0.33, β = 0.21, p<0.001) and if caregivers had poor experiences with the healthcare system (B = 0.09, β = 0.09, p = 0.007). Conversely, the probability of full vaccination decreases if the caregiver's husband exerts control over her decision-making ability (B = -0.29, β = -0.20, p<0.001), or if the caregiver perceives vaccines to be of low importance (B = -0.37, β = -0.27, p<0.001). Belief in religious protection (B = -0.07, β = -0.05, p = 0.118) and a belief that vaccines are harmful (B = -0.12, β = -0.04, p = 0.320) did not have an observed effect on vaccination status. This research suggests that interventions may benefit from that including entire families and communities in their design.

The Excluded Voices from Africa's Sahel: Alternative Meanings of Health in Narratives of Resistance to the Global Polio Eradication Initiative in Northern Nigeria

Although previous inquiry into resistance to the polio vaccines in northern Nigeria has been launched from several disciplines, inquiry has been limited to the 2003 revolt and has rarely been informed by theory. This study drew on the culture-centered approach to health communication to argue that the exclusion of marginalized communities from decision-making by the Global Polio Eradication Initiative (GPEI) resulted in a vaccine resistance which found expression in health activism that engaged the local news media. To recover the excluded voices, this study examined community members' narratives of resistance to the vaccines in Nigerian news from 2012 to 2018. Upon providing a backdrop for these narratives through a chronology of GPEI milestones in northern Nigeria developed from Nigerian newspapers, the study then engaged with 168 speech acts of resistance in Nigerian news to co-construct alternative meanings of health. Drawing on a local cultural meaning of the vaccines as covertly carrying out a Western family-planning agenda, narrators negligibly associated "family planning" with health. Narrators further articulated health as access to foods and as religious practice. These findings have implications for the inclusion of voices from sub-Saharan Africa in GPEI decision-making.

Intimate partner violence and the spatial pattern of maternal healthcare services utilization among parous married women in northern Nigeria

The low uptake of maternal healthcare services (MHS) in Nigeria is implicated in the country’s poor maternal health outcomes. In northern Nigeria where these outcomes are poorest, not much is known about the contribution of violence within unions on married women’s uptake of MHS. Using data on antenatal care (ANC) utilisation and place of delivery, and their sociodemographic confounders from the Nigerian Demographic and Health Survey, this study investigates this relationship. Results of univariate, bivariate and multivariate analyses show that 46.4% and 22.1% of the women had at least four ANC sessions and had health facility delivery respectively. At the subregional level however, the North-Central zone had the highest utilisation rates while the North-West zone had the lowest. The prevalence of intimate partner violence (IPV) ranged from 8.2% (sexual violence) to 16.7% (physical violence) and 35.8% (emotional violence). Subregional analysis of IPV shows that the North-West zone had the lowest prevalence rates. Contrary to some literature evidence, women who experienced IPV in the study area had higher odds of utilising MHS (P < 0.001). When the sociodemographic characteristics of the women were adjusted for, the relationship became statistically insignificant however. The association between the women’s socioeconomic characteristics and their MHS uptake suggests that attention be paid to the wealth and educational status of the population because of their propensity for sustaining the higher uptake recorded. The role of religion in the outcomes further suggests that it be used as a tool to promote the uptake of MHS in the region.

Overview of Tools and Measures Investigating Vaccine Hesitancy in a Ten Year Period: A Scoping Review

The challenge of vaccine hesitancy, a growing global concern in the last decade, has been aggravated by the COVID-19 pandemic. The need for monitoring vaccine sentiments and early detection of vaccine hesitancy in a population recommended by the WHO calls for the availability of contextually relevant tools and measures. This scoping review covers a ten year-period from 2010–2019 which included the first nine years of the decade of vaccines and aims to give a broad overview of tools and measures, and present a summary of their nature, similarities, and differences. We conducted the review using the framework for scoping reviews by Arksey and O’Malley (2005) and reported it following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews’ guidelines. Of the 26 studies included, only one was conducted in the WHO African Region. Measures for routine childhood vaccines were found to be the most preponderant in the reviewed literature. The need for validated, contextually relevant tools in the WHO Africa Region is essential, and made more so by the scourge of the ongoing pandemic in which vaccination is critical for curtailment.

Media Data and Vaccine Hesitancy: Scoping Review

Background

Media studies are important for vaccine hesitancy research, as they analyze how the media shapes risk perceptions and vaccine uptake. Despite the growth in studies in this field owing to advances in computing and language processing and an expanding social media landscape, no study has consolidated the methodological approaches used to study vaccine hesitancy. Synthesizing this information can better structure and set a precedent for this growing subfield of digital epidemiology.

Objective

This review aimed to identify and illustrate the media platforms and methods used to study vaccine hesitancy and how they build or contribute to the study of the media's influence on vaccine hesitancy and public health.

Methods

This study followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A search was conducted on PubMed and Scopus for any studies that used media data (social media or traditional media), had an outcome related to vaccine sentiment (opinion, uptake, hesitancy, acceptance, or stance), were written in English, and were published after 2010. Studies were screened by only 1 reviewer and extracted for media platform, analysis method, the theoretical models used, and outcomes.

Results

In total, 125 studies were included, of which 71 (56.8%) used traditional research methods and 54 (43.2%) used computational methods. Of the traditional methods, most used content analysis (43/71, 61%) and sentiment analysis (21/71, 30%) to analyze the texts. The most common platforms were newspapers, print media, and web-based news. The computational methods mostly used sentiment analysis (31/54, 57%), topic modeling (18/54, 33%), and network analysis (17/54, 31%). Fewer studies used projections (2/54, 4%) and feature extraction (1/54, 2%). The most common platforms were Twitter and Facebook. Theoretically, most studies were weak. The following five major categories of studies arose: antivaccination themes centered on the distrust of institutions, civil liberties, misinformation, conspiracy theories, and vaccine-specific concerns; provaccination themes centered on ensuring vaccine safety using scientific literature; framing being important and health professionals and personal stories having the largest impact on shaping vaccine opinion; the coverage of vaccination-related data mostly identifying negative vaccine content and revealing deeply fractured vaccine communities and echo chambers; and the public reacting to and focusing on certain signals-in particular cases, deaths, and scandals-which suggests a more volatile period for the spread of information.

Conclusions

The heterogeneity in the use of media to study vaccines can be better consolidated through theoretical grounding. Areas of suggested research include understanding how trust in institutions is associated with vaccine uptake, how misinformation and information signaling influence vaccine uptake, and the evaluation of government communications on vaccine rollouts and vaccine-related events. The review ends with a statement that media data analyses, though groundbreaking in approach, should supplement-not supplant-current practices in public health research.

Social media use for health, cultural characteristics, and demographics: A survey of Pakistani millennials

Objective

Over the last 10 years, an extensive body of literature has been produced to investigate the role of social media in health. However, little is known about the impact of cultural characteristics (e.g. masculinity, collectivism, and uncertainty avoidance) on social media use regarding health-related information, especially in developing countries like Pakistan. The present study employed Hofstede’s cultural characteristics framework and uses and gratification theory to examine how Pakistani millennials’ demographic attributes and cultural characteristics are associated with their social media use for health-related information.

Method

An online survey of 722 people aged 18–35 living in Pakistan was conducted in spring 2020 to examine the intensity and frequency of social media use, health-related use of social media, cultural characteristics, and demographic attributes.

Results

Results showed that cultural characteristics—masculinity, collectivism, and uncertainty avoidance—are strongly related with their perceptions of social media importance, usefulness, and perceived ease of access for health-related information even when controlling for demographic characteristics. Age and gender are also significantly associated with their perspectives on social media for health.

Conclusions

We found that communicating and sharing information is the most important motivation for Pakistani millennials to use social media in the area of health with WhatsApp and YouTube being most preferred social media sites for health-related issues.

Estimating Vaccine Confidence Levels among Healthcare Staff and Students of a Tertiary Institution in South Africa

Healthcare workers were the first group scheduled to receive COVID-19 vaccines when they became available in South Africa. Therefore, estimating vaccine confidence levels and intention to receive COVID-19 vaccines among healthcare workers ahead of the national vaccination roll-out was imperative. We conducted an online survey from 4 February to 7 March 2021, to assess vaccine sentiments and COVID-19 vaccine intentions among healthcare staff and students at a tertiary institution in South Africa. We enrolled 1015 participants (74.7% female). Among the participants, 89.5% (confidence interval (CI) 87.2-91.4) were willing to accept a COVID-19 vaccine, 95.4% (CI 93.9-96.6) agreed that vaccines are important for them, 95.4% (CI 93.8-96.6) that vaccines are safe, 97.4% (CI 96.2-98.3) that vaccines are effective, and 96.1% (CI 94.6-97.2) that vaccines are compatible with religion. Log binomial regression revealed statistically significant positive associations between COVID-19 vaccine acceptance and the belief that vaccines are safe (relative risk (RR) 32.2, CI 4.67-221.89), effective (RR 21.4, CI 3.16-145.82), important for children (RR 3.5, CI 1.78-6.99), important for self (RR 18.5, CI 4.78-71.12), or compatible with religion (RR 2.2, CI 1.46-3.78). The vaccine confidence levels of the study respondents were highly positive. Nevertheless, this could be further enhanced by targeted interventions.

Point-of-care vaccinators' perceptions of vaccine hesitancy drivers: A qualitative study from the cape metropolitan district, South Africa

BACKGROUND

Vaccination coverage remains suboptimal in many parts of the world, especially in low-and middle-income countries (LMICs), including South Africa. Vaccine hesitancy, a recognized factor contributing to low vaccination uptake in many parts of the world, is suspect in the suboptimal vaccination coverage level in South Africa, particularly in the Western Cape Province. We aimed to investigate vaccine hesitancy and to describe point-of-care vaccinators' perceptions of the drivers of vaccine hesitancy in the Cape Metropolitan District, South Africa (Cape Metro). We conducted in-depth interviews with 19 point-of-care vaccinators in 16 purposively selected healthcare facilities in the Cape Metro between September and November 2019. Participants were sampled purposively as 'rich cases' who had been delivering vaccination services for at least five years post-qualification. We organized the data thematically in ATLAS.ti and report findings thematically by the types of reasons participants reported for vaccine hesitancy amongst clients.

FINDINGS

Of the 19 interviewees, 11 (59%) reported having encountered vaccine-hesitant clients at some point in their careers. Reasons reported for vaccine hesitancy by clients included: (a) religion, (b) internet misinformation, (c) concern over causing the child pain, (d) natural immunity development, and (e) concern about possible adverse effect following immunization. Vaccine hesitancy in the Cape Metro cuts across all socio-economic classes. Also, some communities perceived to be vaccine-hesitant were mentioned by the participants in this study.

CONCLUSIONS

Attitude towards vaccination are generally positive in the Cape Metro. However, vaccine hesitancy is present. The issues of vaccine hesitancy at the reported levels can still be mitigated by continuous health education in the clinics and communities, as well as stakeholder engagement as suggested by the point-of-care vaccinators in the Cape Metro.

Nigeria experience on the use of polio assets for the 2017/18 measles vaccination campaign follow-up

BACKGROUND

The global polio eradication initiative has made giant stride by achieving a 99% reduction in Wild poliovirus (WPV) cases, with Nigeria on the verge of being declared polio-free following over 36 months without a WPV. The initiative has provided multiple resources, assets and lessons learnt that could be transitioned to other public health challenges, including improving the quality and vaccination coverage of measles campaigns in order to reduce the incidences of measles in Nigeria. We documented the polio legacy and assets used to support the national measles campaign in 2017/2018.

METHODS

We documented the integration of the measles campaign coordination with the Polio Emergency Operation Centre (EOC) at national and state levels for planning and implementing the measles SIA. Specific polio strategies and assets, such as the EOC incident command framework and facilities, human resource surge capacity, polio GIS resource These strategies were adapted and adopted for the MVC implementation overcome challenges and improve vaccination coverage. We evaluated the performance through a set process and outcome indicators.

RESULTS

All the 36 states and Federal Capital Territory used the structure and resources in Nigeria and provided counterpart financing for the MVC 2017/ 2018. The 11 polio high-risk states deployed the use of GIS for microplanning process, while daily call-in data were tracked in 99.7% of the LGAs and 70,846 reports were submitted real-time by supervisors using Open data kit (ODK). The national coverage achieved was 87.5% by the post-campaign survey with 65% of states reporting higher coverage in 2018 compared to 2015.

CONCLUSION

Polio eradication assets and lessons learned can be applied to measles elimination efforts as the eradication and elimination efforts have similar strategies and programme implementation infrastructure needs. Leveraging these strategies and resources to support MVC planning and implementation resulted in more realistic planning, improved accountability and availability of human and fiscal resources. This approach may have resulted in better MVC outcomes and contributed to Nigeria's efforts in measles control and elimination.

Vaccine hesitancy among mobile pastoralists in Chad: a qualitative study

BACKGROUND

Demand side barriers to vaccination among rural and hard-to-reach populations in Chad are not yet well understood. Although innovative approaches such as linking human and animal vaccination increase vaccination uptake among mobile pastoralist communities, vaccination coverage in these communities is still lower than for rural settled populations. We hypothesize that mobile pastoralists' communities in Chad face specific demand side barriers to access vaccination services. Understanding the factors that caregivers in these communities consider, explicitly or implicitly, in order to decide whether or not to vaccinate a child, in addition to understanding the provider's perspectives, are essential elements to tailor vaccination programmes towards increasing vaccination acceptance and uptake.

METHODS

We conducted a qualitative study in a rural health district in southern Chad in April 2016 with 12 key informant in-depth interviews and four focus group discussions (FGDs) including 35 male and female participants. Participants in the study included caregivers, traditional chiefs, local and religious leaders from mobile pastoralist communities, and health officials and staff. We conducted a content analysis using a pre-defined set of categories for vaccine hesitancy covering issues on harmful effects of vaccination, mistrust with vaccination programmes/services, issues with the health system and other issues.

RESULTS

The groups of demand side barriers reported most frequently in focus group discussions were mistrust on the expanded programme on immunization (EPI) and polio vaccination outreach services (53%, n = 94), followed by health system issues (34%, n = 94), and concerns related to potential harm of vaccines (13%, n = 94). Concerns identified by caregivers, health professionals and community leaders followed a similar pattern with issues on programme mistrust being most frequently reported and issues with harm least frequently reported. None of the health professionals reported concerns about vaccinations being potentially harmful.

CONCLUSION

Mobile pastoralist communities face specific demand side barriers to vaccination. Understanding these barriers is essential to reduce vaccine hesitancy and increase vaccination uptake. Local health systems must plan for the periodic presence of pastoralist communities in their zones of responsibility and create more mutual trust.

How is communication of vaccines in traditional media: a systematic review

AIM:

Taking into account that a key determinant in public approval of vaccinations is how the media constructs and frames messages about vaccination programmes, our aim is to review communication studies exploring media coverage of vaccines within traditional media venues.

METHODS:

Using a registered protocol (PROSPERO: 42017072849), a systematic review was conducted that searched in three international electronic databases (PubMed, Scopus, and the International Bibliography of Social Science) for articles published between 2007 and 2017 following content-analysis methods. The characteristics and outcomes were systematically identified and described. The search yielded 24 eligible studies that were further analysed in the review.

RESULTS:

Media coverage of vaccines has been largely studied during the last decade. Findings revealed that 62% ( n = 15) of studies analysed the human papillomavirus vaccine, 87% ( n = 21) examined newspapers, and 62% ( n = 15) examined North American media. In relation to media content analyses, 75% found negative messages on vaccines and 83% identified a lack of accurate information.

CONCLUSIONS:

This systematic review suggests an agenda for further research. There is a significant need to analyse other types of traditional media beyond newspapers. Future studies should focus on other geographical areas such as low-income countries and on analysing visual materials and digital media. We found that negative messages and inaccurate information are common in media coverage on vaccines; therefore, further research focusing on these topics is needed. Officials in public health organizations should develop a close collaboration with the media to improve public communication on vaccines.

Using best-worst scaling to rank factors affecting vaccination demand in northern Nigeria

BACKGROUND

Understanding and ranking the reasons for low vaccination uptake among parents in northern Nigeria is critical to implement effective policies to save lives and prevent illnesses. This study applies best-worst scaling (BWS) to rank various factors affecting parents' demand for routine childhood immunization.

METHODS

We conducted a household survey in Nahuche, Zamfara State in northern Nigeria. Nearly two hundred parents with children under age five were asked about their views on 16 factors using a BWS technique. These factors focused on known attributes that influence the demand for childhood immunization, which were identified from a literature review and reviewed by a local advisory board. The survey systematically presented parents with subsets of six factors and asked them to choose which they think are the most and least important in decisions to vaccinate children. We used a sequential best-worst analysis with conditional logistic regression to rank factors.

RESULTS

The perception that vaccinating a child makes one a good parent was the most important motivation for parents in northern Nigeria to vaccinate children. Statements related to trust and social norms were ranked higher in importance compared to those that highlighted perceived benefits and risks, healthcare service, vaccine information, or opportunity costs. Fathers ranked trust in the media and views of their leaders to be of greatest importance, whereas mothers placed greater importance on social perceptions and norms. Parents of children without routine immunization ranked their trust in local leaders about vaccines higher in considerations, and the media's views lower, compared to parents with children who received routine immunization.

CONCLUSIONS

Framing immunization messages in the context of good parenting and hearing these messages from trusted information sources may motivate parental uptake of childhood vaccines. These results are useful to policymakers to prioritize resources in order to increase awareness and demand for childhood immunization.

Validation of the vaccine conspiracy beliefs scale

BACKGROUND

Parents' vaccine attitudes influence their decision regarding child vaccination. To date, no study has evaluated the impact of vaccine conspiracy beliefs on human papillomavirus vaccine acceptance. The authors assessed the validity of a Vaccine Conspiracy Beliefs Scale (VCBS) and determined whether this scale was associated with parents' willingness to vaccinate their son with the HPV vaccine.

METHODS

Canadian parents completed a 24-min online survey in 2014. Measures included socio-demographic variables, HPV knowledge, health care provider recommendation, Conspiracy Mentality Questionnaire (CMQ), the seven-item VCBS, and parents' willingness to vaccinate their son at two price points.

RESULTS

A total of 1427 Canadian parents completed the survey in English (61.2%) or French (38.8%). A Factor Analysis revealed the VCBS is one-dimensional and has high internal consistency (α=0.937). The construct validity of the VCBS was supported by a moderate relationship with the CMQ (r=0.44, p<0.001). Hierarchical regression analyses found the VCBS is negatively related to parents' willingness to vaccinate their son with the HPV vaccine at both price points ('free' or '$300') after controlling for gender, age, household income, education level, HPV knowledge, and health care provider recommendation.

CONCLUSIONS

The VCBS is a brief, valid scale that will be useful in further elucidating the correlates of vaccine hesitancy. Future research could use the VCBS to evaluate the impact of vaccine conspiracies beliefs on vaccine uptake and how concerns about vaccination may be challenged and reversed.

Did the call for boycott by the Catholic bishops affect the polio vaccination coverage in Kenya in 2015? A cross-sectional study

INTRODUCTION

Polio eradication is now feasible after removal of Nigeria from the list of endemic countries and global reduction of cases of wild polio virus in 2015 by more than 80%. However, all countries must remain focused to achieve eradication. In August 2015, the Catholic bishops in Kenya called for boycott of a polio vaccination campaign citing safety concerns with the polio vaccine. We conducted a survey to establish if the coverage was affected by the boycott.

METHODS

A cross sectional survey was conducted in all the 32 counties that participated in the campaign. A total of 90,157 children and 37,732 parents/guardians were sampled to determine the vaccination coverage and reasons for missed vaccination.

RESULTS

The national vaccination coverage was 93% compared to 94% in the November 2014 campaign. The proportion of parents/guardians that belonged to Catholic Church was 31% compared to 7% of the children who were missed. Reasons for missed vaccination included house not being visited (44%), children not being at home at time of visit (38%), refusal by parents (12%), children being as leep (1%), and various other reasons (5%). Compared to the November 2014 campaign, the proportion of children who were not vaccinated due to parent's refusal significantly increased from 6% to 12% in August 2015.

CONCLUSION

The call for boycott did not affect the campaign significantly. However, if the call for boycott is repeated in future it could have some significant negative implication to polio eradication. It is therefore important to ensure that any vaccine safety issues are addressed accordingly.

Youth Group Engagement in Noncompliant Communities During Supplemental Immunization Activities in Kaduna, Nigeria, in 2014

INTRODUCTION

One of the major challenges being faced in the Global Polio Eradication Initiative program is persistent refusal of oral polio vaccine (OPV) and harassment of vaccination team members by youths. The objective of the study was to describe the strategy of collaborating with recognized youth groups to reduce team harassment during vaccination campaigns and improve vaccination coverage in noncompliant communities.

METHODS

We assessed data from polio vaccination activities in OPV-refusing communities in the Igabi and Zaria local government areas (LGAs) of Kaduna State in Nigeria. We evaluated the following factors to determine trends: enhanced independent monitoring data on the proportion of children missed by vaccination activities (hereafter, "missed children"), lot quality assurance surveys, and vaccination team harassment.

RESULTS

The proportion of missed children decreased in both LGAs after the intervention. In Igabi LGA and Zaria LGA, the lowest proportions of missed children before and after the intervention decreased from 7% to 2% and from 5% to 1%, respectively. Lot quality assurance survey trends showed an improvement in immunization coverage 1 year after youth groups' engagement in both LGAs.

CONCLUSIONS

Systematic engagement of youth groups has a great future in polio interruption as we approach the endgame strategy for polio eradication. It promises to be a veritable innovation in reaching chronically missed children in OPV-refusing communities.

Political will and international collaborative frameworks in infectious diseases

The last few decades have been marked by a rapid expansion in the world?s population, along with an increasingly dynamic mobility of individuals. This accelerated global inter-connectedness enabled microorganisms to reach virtually any location worldwide more rapidly and efficiently than ever before, reshaping the global dynamics of pathogens. As a result, a local infectious disease outbreak anywhere in the world may almost instantaneously assume global dimensions, and should therefore be considered a global priority. The history of several infectious diseases illustrates that in addition to prophylactic and therapeutic medical interventions, the interplay of social, economic, and political factors makes a fundamental contribution to the outcome of infectious disease outbreaks. Furthermore, this multi- and cross-disciplinary interconnectedness is a key determinant of the outcome of efforts to eradicate vaccine-preventable infectious diseases. A combined framework that incorporates teachings provided by previous outbreaks, and integrates medical and biomedical interventions with contributions made by social, economic, and political factors, emerges as vital requirement of successful global public health initiatives.

Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications

Despite being recognized as one of the most successful public health measures, vaccination is perceived as unsafe and unnecessary by a growing number of parents. Anti-vaccination movements have been implicated in lowered vaccine acceptance rates and in the increase in vaccine-preventable disease outbreaks and epidemics. In this review, we will look at determinants of parental decision-making about vaccination and provide an overview of the history of anti-vaccination movements and its clinical impact.

Progress toward poliomyelitis eradication in Nigeria

BACKGROUND

Transmission of wild poliovirus (WPV) has never been interrupted in Afghanistan, Pakistan, and Nigeria. Since 2003, infections with WPV of Nigerian origin have been detected in 25 polio-free countries. In 2012, the Nigerian government created an emergency operations center and implemented a national emergency action plan to eradicate polio. The 2013 revision of this plan prioritized (1) improving the quality of supplemental immunization activities (SIAs), (2) implementing strategies to reach underserved populations, (3) adopting special approaches in security-compromised areas, (4) improving outbreak response, (5) enhancing routine immunization and activities implemented between SIAs, and (6) strengthening surveillance. This report summarizes implementation of these activities during a period of unprecedented insecurity and violence, including the killing of health workers and the onset of a state of emergency in the northeast zone.

METHODS

This report reviews management strategies, innovations, trends in case counts, vaccination and social mobilization activities, and surveillance and monitoring data to assess progress in polio eradication in Nigeria.

RESULTS

Nigeria has made significant improvements in the management of polio eradication initiative (pei) activities with marked improvement in the quality of SIAs, as measured by lot quality assurance sampling (LQAS). Comparing results from February 2012 with results from December 2013, the proportion of local government areas (LGAs) conducting LQAS in the 11 high-risk states at the ≥90% pass/fail threshold increased from 7% to 42%, and the proportion at the 80%-89% threshold increased from 9% to 30%. During January-December 2013, 53 polio cases were reported from 26 LGAs in 9 states in Nigeria, compared with 122 cases reported from 13 states in 2012. No cases of WPV type 3 infection have been reported since November 2012. In 2013, no polio cases due to any poliovirus type were detected in the northwest sanctuaries of Nigeria. In the second half of 2013, WPV transmission was restricted to Kano, Borno, Bauchi, and Taraba states. Despite considerable progress, 24 LGAs in 2012 and 7 LGAs in 2013 reported ≥2 cases, and WPV continued to circulate in 8 LGAs that had cases in 2012. Campaign activities were negatively impacted by insecurity and violence in Borno and Kano states.

CONCLUSIONS

Efforts to interrupt transmission remain impeded by poor SIA implementation in localized areas, anti-polio vaccine sentiment, and limited access to vaccinate children because of insecurity. Sustained improvement in SIA quality, surveillance, and outbreak response and special strategies in security-compromised areas are needed to interrupt WPV transmission in 2014.

Trends and patterns of under-5 vaccination in Nigeria, 1990-2008: what manner of progress?

BACKGROUND

Despite efforts towards reducing childhood morbidity and mortality, Nigeria ranks among countries with the highest rates of vaccine-preventable diseases including tuberculosis, poliomyelitis, measles, diphtheria, pertussis and tetanus. These efforts include regular rounds of immunization days and routine exercises. The government of Nigeria periodically undertakes National Demographic and Health (NDH) surveys, which tap information on various health indices including vaccination coverage. Limited studies have used the NDHS data to examine the trends in vaccination coverage for the assessment of successes or failures of the immunization efforts.

METHODS

This study used four NDH Surveys datasets between 1990 and 2008, which generated child health information including the proportion that had had any or all basic childhood vaccines. A combined total of 44,071 (weighted) children were involved in the study. The trend and pattern of vaccination over 18 years were examined while selected factors were regressed to obtain predictors of child vaccinations in Nigeria.

RESULTS

The most recent survey (2008) reported more complete vaccination apart from 1990, which was said to be inaccurate. In all surveys, children from mothers with higher education, who were delivered in hospitals, lived in urban areas, and whose mothers work outside the home had significantly higher proportions of completed basic vaccination. A lower level of childhood vaccination is observed in the northern parts, while higher rates are observed in the southern parts. More complete vaccination coverage was reported in the 1990 survey, followed by 2008, 1999 and 2003. In addition, children from mothers with higher levels of education, who were delivered in hospitals, who lived in urban areas, and whose mothers work outside the home had significantly higher proportions of completed basic vaccination.

CONCLUSION

Much more work needs to be done if more children are to be covered and thus reduce vaccine-preventable diseases.

Survey of poliovirus antibodies in Kano, Northern Nigeria

INTRODUCTION

In 1988, the World Health Assembly resolved to eradicate poliomyelitis. Since then, much progress towards this goal has been made, but three countries including Nigeria remain polio-endemic as of end 2012. To assess the immunity level against poliomyelitis in young children in Northern Nigeria, we conducted a seroprevalence survey in the Kano Metropolitan Area (KMA) in May 2011.

METHODS

Parents or guardians of infants aged 6-9months or children aged 36-47months presenting to the outpatient department of Murtala Mohammad Specialist Hospital were approached for participation, screened for eligibility and were asked to provide informed consent. After that, a questionnaire was administered and blood was collected for neutralization assay.

RESULTS

A total of 327 subjects were enrolled. Of these, 313 (96%) met the study requirements and were analyzed (161 [51%] aged 6-9months and 152 [49%] aged 36-47months). Among subjects aged 6-9months, seroprevalence was 81% (95% confidence interval [CI] 75-87%) to poliovirus type 1, 76% (95% CI 68-81%) to poliovirus type 2, and 73% (95% CI 67-80%) to poliovirus type 3. Among subjects aged 36-47months, the seroprevalence was 91% (95% CI 86-95%) to poliovirus type 1, 87% (95% CI 82-92%) for poliovirus type 2, and 86% (95% CI 80-91%) to poliovirus type 3. Seroprevalence was associated with history of oral poliovirus vaccine (OPV) doses, maternal education and gender.

CONCLUSIONS

Seroprevalence is lower than required levels for poliovirus interruption in the KMA. Persistence of immunity gaps in the 36-47months group is a big concern. Since higher number of vaccine doses is associated with higher seroprevalence, it implies that failure-to-vaccinate and not vaccine failure accounts for the suboptimal seroprevalence. Intensified efforts are necessary to administer polio vaccines to all target children and surpass the threshold levels for herd immunity.

Breaking community barriers to polio vaccination in Northern Nigeria: the impact of a grass roots mobilization campaign (Majigi)

This paper examines the impact of a community-based intervention on the trends in the uptake of polio vaccination following a community mobilization campaign for polio eradication in northern Nigeria. Uptake of polio vaccination in high-risk communities in this region has been considerably low despite routine and supplemental vaccination activities. Large numbers of children are left unvaccinated because of community misconceptions and distrust regarding the cause of the disease and the safety of the polio vaccine. The Majigi polio campaign was initiated in 2008 as a pilot trial in Gezawa, a local council with very low uptake of polio vaccination. The average monthly increase in the number of vaccinated children over the subsequent six months after the pilot trial was 1,047 [95% confidence interval (CI): 647-2045, P = 0·001]. An increasing trend in uptake of polio vaccination was also evident (P = 0·001). The outcome was consistent with a decrease or no trend in the detection of children with zero doses. The average monthly decrease in the number of children with zero doses was 6·2 (95% CI: -21 to 24, P = 0·353). Overall, there was a relative increase of approximately 310% in the polio vaccination uptake and a net reduction of 29% of never vaccinated children. The findings of this pilot test show that polio vaccination uptake can be enhanced by programs like Majigi that promote effective communication with the community.

The science in social science

A recent poll showed that most people think of science as technology and engineering--life-saving drugs, computers, space exploration, and so on. This was, in fact, the promise of the founders of modern science in the 17th century. It is less commonly understood that social and behavioral sciences have also produced technologies and engineering that dominate our everyday lives. These include polling, marketing, management, insurance, and public health programs.

Interruption of poliovirus transmission in Ghana: molecular epidemiology of wild-type 1 poliovirus isolated from 1995 to 2008

Described in detail is the molecular epidemiology of wild-type 1 poliovirus circulation in Ghana between 1995-2008, following the implementation of a surveillance system for cases of acute flaccid paralysis and poliovirus infection. Molecular phylogenetic analysis combined with a detailed evaluation of epidemiological indicators revealed that the geographical and temporal circulation of wild-type poliovirus in Ghana was determined by the quality of the implementation of global eradication strategies. The transmission of "indigenous" wild-type 1 poliovirus was eliminated in 1999. However, a drastic reduction in national immunization campaigns resulted in the importation in 2003 and 2008 of wild-type 1 poliovirus from neighboring countries. Both outbreaks were promptly interrupted following resumption of immunization activities. The results detailed here provide scientific evidence that supports the feasibility of polio eradication in Central West Africa, one of the remaining endemic areas for the disease, provided that comprehensive immunization campaigns and sensitive surveillance systems are in place.

Global health in conflict. Understanding opposition to vitamin A supplementation in India

Vitamin A supplementation is a public health intervention that clinical trials have suggested can significantly improve child survival in the developing world. Yet, prominent scientists in India have questioned its scientific validity, opposed its implementation, and accused its advocates of corruption and greed. It is ironic that these opponents were among the pioneers of populationwide vitamin A supplementation for ocular health. Historically, complex interests have shaped vitamin A supplementation resistance in India. Local social and nutritional revolutions and shifting international paradigms of global health have played a role. Other resistance movements in Indian history, such as those in response to campaigns for bacillus Calmette-Guérin and novel vaccines, have been structured around similar themes. Public health resistance is shaped by the cultural and political context in which it develops. Armed with knowledge of the history of a region and patterns of past resistance, public health practitioners can better understand how to negotiate global health conflicts.