AEFI CASE STUDIES

Kiran Negi

Advocacy & Partnership Officer

UNICEF Office for West Bengal & Assam

Field Office, Kolkata © 2003 - 2004

Field Office, Kolkata © 2003 - 2004

Case Study I Vitamin A Campaign, Assam

– Government of Assam with UNICEF support launched a state wide Pulse Vitamin A Campaign on 11 November 2001. During the week following the campaign the media reported alleged side effects and resultant deaths of children – Media inflated the figures and misreported. Some articles quoted the programme as a Polio campaign; said children died as the drug was not as per the set standards; inadequate training of health workers – Caused mass hysteria in the public with parents rushing children to the hospital – Picked up by International media Field Office, Kolkata © 2003 - 2004

Communications Response

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GOVERNMENTS RESPONSE

• GoA ordered an inquiry into the deaths, headed by Chief Secretary • GoA sent samples to the National Testing Laboratory – the drugs met all standards • Almost all reported deaths went for postmortem and Vitamin A was not reported as the case of death • GoI set up a high level committee to review the situation and make recommendations on further Vitamin A strategies •

UNICEF’S RESPONSE

• Issued press release • Sent a fact finding team with Deputy Director of National Institute of Nutrition (Hyderabad) and WHO representative • Report was prepared and presented to GoA • UNICEF sent samples to Australia – the drugs met all standards Field Office, Kolkata © 2003 - 2004

Impact

• The Vitamin A coverage very low in the state of Assam • Impacted all health campaigns in the State • Pulse Polio campaign in particular has been affected – ‘Pulse’ • Avoided media in the State ever since – The issue never got addressed • Prior to every Polio campaign the media would carry articles on the alleged Vitamin A deaths and UNICEF’s role • In the process, the biggest losers became the children of Assam

February 2004 UNICEF conducted a media workshop in Guwahati, Assam on Polio Eradication campaign with GoA and WHO and appealed to the media to move on in the interest of the children of Assam

Field Office, Kolkata © 2003 - 2004

Case Study II Polio NID/SID, West Bengal

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KEY PERCEPTIONS OF THE COMMUNITY THAT THE MEDIA REFLECTS

MISCONCEPTION • “Causes infertility - it is a ploy on the part of the Govt. to make the children infertile, and hence is so adamant on giving Polio drops again & again.” • • • “Children fall sick post taking Polio drops” “Polio drops are ineffective - after the drops children still get Polio.” “None of my earlier children had taken the drop & never contracted the disease. Why should I take the chance this time by giving the drop?” CONSIDER IT A TOP DOWN APPROACH • There are other diseases like measles and diarrhoea that kill our children. Why is the government pushing Polio drops? Not a single child in our village has Polio.

FATIGUE SET IN • For 1-2% of the children who get left out we have to take our children 8 times for the drops. We are not going to do this any more DEVELOPMENT: • Use polio as a bargaining chip with the government – If you build a bridge for our village over the river we will give our children the Polio drops, else not.

Field Office, Kolkata © 2003 - 2004

Communications Response

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GOVERNMENTS RESPONSE

• Partners in all UNICEF media activities •

UNICEF’S RESPONCE

• Regular Media monitoring to track the stories on Polio • Misconception – Address with the media on a one-one-one basis • Development - Conduct media workshop. Try and facilitate between the Government and the Media. Articles in the press and Government apathy affects UNICEF’s work • Share media feedback with Government, working on collective solutions – Media Cell • WHO partners with UNICEF in all Media activities Field Office, Kolkata © 2003 - 2004

Negative Influence for Immunization Quacks are an unsolved problem!

They influence Public Trust

Field Office, Kolkata © 2003 - 2004

Impact

• Development issues continue to be primary • A boycott in one area also sometimes motivates other areas to use Polio as a bargaining tool • Have managed to address scientifically inaccurate stories

Field Office, Kolkata © 2003 - 2004

Case Study III Intake of Iron tablets, West Bengal

– On 22 July 2004, in the Nalanda Vidyapith School, Balurghat, Dakhin Dinajpur iron-folic acid tablets were distributed to the adolescent girl-students under a Government anaemia control programme supported by UNICEF – 3-girls were reported with nausea and vomiting after consumption of iron tablets – Hysteria broke out and other girls too started to complain Field Office, Kolkata © 2003 - 2004

Communications Response

• GOVERNMENT-UNICEF RESPONSE – District administration and UNICEF worked in tandem – Set-up committee to examine the causes – The expiry date checked and sent for testing – District Magistrate and Chief Medical Officer sent all 114 girls to the hospital, and were relieved within 2 hours, post a complete check-up – The DM and CMOH met with the parents of the girls after school hours to reassure them – As the Media picked up the story, the DM in consultation with UNICEF took the decision to call a Media briefing and address the issue in a holistic manner, the following day – UNICEF remained low key since it was a Government programme, and it was decided that the DM and the CMOH would address the Media – Media briefing held on 23 July 2004 – Media told about the programme and the need to undertake it in the district – Request made to the Media to not sensationalise the news to protect against any adverse impact to the programme Field Office, Kolkata © 2003 - 2004

Impact

• The incidence was reported by the electronic media on July 22 and 2-3 key publications the next day • On July 23, after the briefing, the story was carried by all local media; in national media only NDTV picked up a ticker with no mention of UNICEF • There has been close interaction with the District with continuous media monitoring • No coverage on the issue has appeared post July 23 rd • District Administration and UNICEF looking at more effective communications strategy with Teachers, Parents and the Media

Has not affected the Anaemia Programme in any other schools in the District and on the state

Field Office, Kolkata © 2003 - 2004

Areas of Improvement

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MEDIA

– Partner with the media to make the campaign a success: • Highlight the state/district scenario explaining the need for the campaign • Highlight the advantages to the target group • Touch upon effects of the drug on the target group Field Office, Kolkata © 2003 - 2004

Cont…

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MEDICAL FRATERNITY

- Involve the physicians in the medical collages, private practitioners and the government - About the possible side effects and treatments •

GOVERNMENT

- Involve all concerned state Government departments informed – Nodal Department, Health Department, Panchayat and Rural Department, District Administration, Directorate of Information and Cultural Affairs - Keep the GoI informed through the country office Field Office, Kolkata © 2003 - 2004

Cont…

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THINK LONG TERM – STRATEGY

- Avoid single day campaign, as it takes a lot of energy, is a very large exercise to control and hence stretches resources - Also it does not strengthen Routine Immunization, infact it weakens it Field Office, Kolkata © 2003 - 2004

Thank You

Field Office, Kolkata © 2003 - 2004