I’m often asked how the largest-ever public health movement – to end polio – has boosted the world’s ability to fight other deadly infectious diseases.
When I flew into Sierra Leone on 22 October to help tackle Ebola, I got to see for myself. Polio and Ebola are very different viruses that call for different responses, yet both have a disproportionate impact on the poorest and most vulnerable children. Both are stark reminders that we must strengthen fragile health systems. And for both, building trust and changing people’s behavior are at the very heart of a successful response.
Here are five ways the battle against polio is boosting the Ebola response:
1. Hunting the virus
Something we learned to do really well with polio, especially in India and Nigeria, is how to track the virus. You hunt the virus every day: where it’s going, where it’s coming from, and who it’s impacting.
To beat Ebola – just like polio – you need to understand the specific behaviors of people locally. Who is most vulnerable to infection? What are their behaviors? What’s driving these behaviours? By having the answers to these questions you can pinpoint the most strategic actions; cutting off the virus at its knees before it has the chance to run.
In Sierra Leone and other Ebola-affected countries, this has meant re-tasking the monitoring systems that were developed to make sure every child is reached with the polio vaccine – to track the impact of actions to fight Ebola. Systems that were developed to track acceptance and refusal of the polio vaccine are now helping gauge the speed and effectiveness of behavior change against Ebola.
2. Communication front and center
For Ebola, there’s no vaccine and no cure. Basically, the only way to prevent more cases is to change how people care for the sick and how they bury those who have died. Communication and engagement are critical to ending the outbreak.
It is no easy task but the mechanisms developed for polio have meant that we can bring rigor to UNICEF’s lead role in this area. Rapid data on knowledge and perceptions around Ebola, for example, has allowed UNICEF to fine-tune SMS and other messaging by demographic, to reach the right members of the public with the right messages.
Religion is also important. Mapping and engaging religious influencers have been crucial to ending polio, and is now proving invaluable in the Ebola outbreak, where burial practices are contributing to very high levels of infection. Religious leaders are not only a voice for behavior change, but they also participate in many parts of the Ebola response. They may accompany burial teams or work in a prayer room at a community Ebola care center. This is similar to polio, where religious leaders don’t just influence people from a mosque, or send out fatwas in favor of the polio vaccine. They walk with the vaccination teams like they did in India. Or they’re at the local mosque, bringing children in to be vaccinated.
3. The “War Room”
In Nigeria, Ebola was brought under control so quickly in part due to the replication of an Emergency Operations Centre (EOC) set up in 2012 to fight polio. An EOC is like a war room, where your strategy is determined minute by minute. All the data flows through there. All the work streams are coordinated there. It goes hand-in-hand with tracking the virus where it is – and moving coordination and management systems to where the virus is most deadly. So you have all the real-time information, all the knowledge, all the resources right there.
4. Trust can make or break the response
Trust is crucial to ending the Ebola outbreak as it is for polio. Drawing on polio’s framework of trust, we’ve tried to apply a similar approach to the Ebola response:
- Do people trust the health workers in the community care centers?
- Are they perceived to be playing a protective role in a community?
- When people bring a sick loved one to the center, do they feel that it’s a safe place? Or does it seem like a foreign structure where people fear they may not see their loved ones again?
- Is there a channel of communication between communities and services to make sure care centers incorporate their cultural beliefs?
It’s a continuous process of engagement, very much like it is with polio. We’re fighting this disease hand-in-hand with communities until it’s done.
Polio eradication represents hope. With strong leadership, innovation and persistence, we’re proving it’s possible to identify and reach every last child in the world, to influence closely-held community beliefs – and to stop a deadly virus in its tracks forever. Liberia, Sierra Leone and Guinea have all eradicated polio against great odds. With our support, they can end the Ebola outbreak too.
Sherine Guirguis is Senior Communications Manager for UNICEF’s Global Polio Programme.