Building confidence in the COVID-19 vaccine in a polio-endemic country: strategic communication lessons from Pakistan.

In a health emergency, governments rely on public trust in their policy, and anticipate its compliance to protect health and save lives. Vaccine hesitancy compromises this process when an emergency involves infections. The prevailing discourse on vaccine hesitancy often describes it as a static phenomenon, ignoring its expanse and complexity, and neglecting the exploration of tools to address it. This article diverges from the conventional perspective by explaining the case of Pakistan and its communication strategy for the COVID-19 vaccine. Decades of polio vaccine hesitancy, rooted in the country's fight against terrorism, constitute its history. On the other hand, the first-ever launch of typhoid conjugate vaccine involving 35 million kids during 2019-2021 was a success. Against this backdrop, the country considered vaccine hesitancy as a dynamic phenomenon, interwoven with the social ecology and the responsiveness of the healthcare system. Its communication strategy facilitated those willing to receive the vaccine, while being responsive to the information needs of those still in the decision-making process. In the face of both hesitancy and a scarcity of vaccine doses, the country successfully inoculated nearly 70% (160 million) of its population in just over 1 year. People's perceptions about the COVID-19 vaccine also improved over time. This achievement offers valuable insights and tools for policymakers and strategists focused on the demand side of vaccine programmes. The lessons can significantly contribute to the global discourse on improving vaccine confidence and bolstering global health security.

Health system barriers and levers in implementation of the Expanded Program on Immunization (EPI) in Pakistan: an evidence informed situation analysis.

BACKGROUND: In Pakistan, immunization coverage has been quite low since the program's inception, and the 2012-2013 population-based survey recorded it at 54%. Much has been written about the issues, challenges, and constraints in the implementation of Pakistan's immunization program. However, there is a need to better understand the health system barriers as well as levers that influence progress. This review aims to bridge the information gaps on system-level barriers that currently impede the optimal delivery and uptake of immunization services to the children of Pakistan through the Expanded Program on Immunization (EPI). METHODS: We conducted a comprehensive literature review, using PubMed and Google Scholar to find peer-reviewed literature, and also reviewed EPI-related international and national reports. Additionally, we consulted government reports, surveys, and publications on the health system. Employing the basic tenets of WHO's health systems framework for health system strengthening, and a socio-ecological model, this study cataloged the service delivery and the demand side perspective on various pillars of Pakistan's immunization program. RESULTS: Themes generated from the literature review included financing, governance, service delivery, human resources, information systems, and supplies and vaccines. Findings suggest that certain areas in the larger health system need to be improved for a more coordinated implementation of EPI in Pakistan. Moreover, it is imperative to understand community behaviors and perceptions as well as demand side issues in order to achieve the desired results. CONCLUSION: For better immunization coverage and ultimately a reduction in child mortality due to preventable diseases, EPI operations and performance must be improved. Further systematic implementation research could help to develop an even finer understanding of the system-wide bottlenecks encumbering the coverage and efficiency of the program.

Distressed setting and profound challenges: Pandemic influenza preparedness plans in the Eastern Mediterranean Region.

BACKGROUND: Influenza pandemics are unpredictable and can have severe health and economic implications. Preparedness for pandemic influenza as advised by the World Health Organization (WHO) is key in minimizing the potential impacts. Pandemic Influenza Preparedness (PIP) Framework is a global public-private initiative to strengthen the preparedness. A total of 43 countries receive funds through Partnership Contribution (PC) component of PIP Framework to enhance preparedness; seven of these fall in the WHO's Eastern Mediterranean Region. We report findings of a desk review of preparedness plans of six such countries from the Region. METHODS: The assessment was done using a standardized checklist containing five criteria and 68 indicators. The checklist was developed using the latest WHO guidelines, in consultation with influenza experts from the Region. The criteria included preparation, surveillance, prevention and containment, case investigation and treatment, and risk communication. Two evaluators independently examined and scored the plans. RESULTS: Pandemic preparedness plan of only one country scored above 70% on aggregate and above 50% on all individual criteria. Plans from rest of the countries scored below satisfactory on aggregate, as well as on individual preparedness criteria. Among the individual criteria, prevention and containment scored highest while case investigation and treatment, the lowest for majority of the countries. In general, surveillance also scored low while it was absent altogether, in one of the plans. CONCLUSIONS: This was a desk review of the plans and not the actual assessment of the influenza preparedness. Moreover, only plans of countries facilitated through funds provided under the PC implementation plan were included. The preparedness scores of majority of reviewed plans were not satisfactory. This warrants a larger study of a representative sample from the Region and also calls for immediate policy action to improve the pandemic influenza preparedness plans and thereby enhance pandemic preparedness in the Region.

Case Study: Effects of a Media Campaign on Breastfeeding Behaviors in Sindh Province, Pakistan.

A 2013-2014 media campaign in Sindh Province, Pakistan, promoted healthy breastfeeding practices. According to data from annual household surveys, 26.7% of mothers saw one television spot and 19.4% saw another. The proportion of mothers who received breastfeeding information via television increased from 8.3% to 29.4% after the campaign (p≤0.05) and the percentage receiving information from doctors, mothers-in-law and relatives/friends nearly doubled (p≤0.05). However, no improvements in breastfeeding practices were reported. The experience in Sindh suggests that, in order to change breastfeeding practices, mass media interventions should be linked with other interventions, such as provider counseling, that involve influential family members in addition to mothers.

Understanding care and feeding practices: building blocks for a sustainable intervention in India and Pakistan.

Undernutrition and inadequate stimulation both negatively influence child health and development and have a long-term impact on school attainment and income. This paper reports data from India and Pakistan looking at how families interact, play with, and feed children; their expectations of growth and development; and the perceived benefits, consequences, opportunities, and barriers of adopting recommended feeding and developmental behaviors. These data were collected as part of formative research for the Sustainable Program Incorporating Nutrition and Games (SPRING) trial. This trial aims to deliver an innovative, feasible, affordable, and sustainable intervention that can achieve delivery at a scale of known effective interventions that maximize child development, growth, and survival and improve maternal psychosocial well-being in rural India and Pakistan.

Using TV talk show for public health media advocacy: a case study.

OBJECTIVES: Much of the focus of public health communication has been on bringing about individual change with relatively little attention to changing public policy through mass media. We conceptualized using TV talk shows as a tool to influence district level health policy. METHODS: A series of TV talk shows was recorded to present the maternal and newborn health situation and promises of public representatives and health officials from 10 project districts. The shows were aired on national circuit. Panellists were interviewed after the airing to know how much were they influenced by this advocacy intervention. RESULTS: Both public representatives and health officials remembered the issue of maternal and newborn health, the project and their participation in the show. Two third of the participants felt more accountable after having given on-camera commitments while half of them informed there were policy discussions or progress in implementation of decisions to improve maternal and newborn health after attending the show. The participants felt a sense of accountability after appearing on TV screen to make pledges on improving the health situation in their district. They appreciated this advocacy initiative and expressed their desire to participate in such shows in future as well. The cost of production and airing of the show was $1800 per episode. CONCLUSION: TV talk show is an effective media intervention having low costs, and can be used for public health advocacy in developing countries.