Community Feedback and Response Mechanisms: Pakistan Experience [Presentation from the Sharing Learning from Polio SBC Side Event at the 2022 SBCC Summit]

"...there's distrust with the government, but we have learned that the only way to reach the people in the best way is probably through the people themselves..."

In Pakistan, one of the remaining polio-endemic countries, vaccine hesitancy is high, and the amount of false information is concerning. In this presentation, one member of the team at UNICEF Pakistan describes the work the organisation is doing to combat misinformation through community feedback and response mechanisms. It was delivered at the Sharing Learning from Polio SBC: Misinformation, Social Data and Conflict side event at the 2022 International SBCC Summit.

Julianne Birungi begins by providing context, including refusals (e.g., of oral polio vaccine - OPV) based on religious beliefs, information/disinformation, concerns about vaccine efficacy/safety, and/or Western conspiracy theories (e.g., that OPV is part of a plot to sterilise Muslims). Of note is the April 22 2019 Peshawar Incident, in which the fake news that 500 children got sick after vaccination spread like wildfire and led to a venerable tsunami of misinformation on social and mainstream media. The ripple effect included panic, protests, and a stalled OPV campaign.

In response to a baseline environment and crisis situation, an 11-member social media team at the National Emergency Operation Center (NEOC) in Pakistan (supported by UNICEF as part of the Global Polio Eradication Initiative partnership) now engage in social listening 24/7. As part of their human-centred design framework, they put the community at the centre to be able to address concerns about vaccination. The team looks at Facebook and WhatsApp, producing reports every day. They also have a partnership with Meta. Some of the lessons learned through this work include:

• The intensity and complexity of the polio programme caused fatigue and resistance in the lead-up to the Peshawar Incident.
• Synergy between online and real-world "brick and mortar" communication is important, as can be seen in UNICEF's integrated communication strategy with a specific geographic focus.
• It is necessary to create systems of resilience to "inoculate" the public online and off-line against rumours and misinformation. Efforts to build trust are also key.

The polio programme's digital engagement model for polio eradication can be understood through this acronym: D (define - objectives and audiences); I (include - social listening and community sentiment); G (give - demand generation and risk perception information); I (inform - people about vaccination campaign dates and required actions); T (talk - to the community to address rumours, misinformation, and information gaps); A (activate - digital social mobilisers and online influencers); and L (leverage - data to monitor and evaluate digital communication).

In pursuing digital engagement, the polio programme seeks to build a bridge that connects parents/caregivers/people, providing real-time information. Some of the specific tools UNICEF Pakistan has developed to conduct this work (also described at Related Summaries, below) include:

• The Polio/Sehat Tahaffuz 1166 toll-free helpline, which received an average of 3,000 calls during campaigns;
• Monitoring of, and responding to, misinformation on social media platforms, which entailed reporting 52 negative links (January - October 2022); and
• The dedicated WhatsApp polio helpline, which responded to 183,483 messages, about 10% of which were misinformation (January - October 2022). Frontline workers connected through WhatsApp at the provincial levels work as the "eyes and ears" of the polio programme.

The polio programme's social listening happens through different channels, including broadcast media (e.g., radio, television) and the real world: What is happening out there, what are people saying? What does that mean? Who are they - are they Pashtuns? Are they speaking in Urdu? Are they female? Are they male? Are they religious leaders? Armed with these data, Birungi says: "...we're engaging, we give back the correct information to the community health worker. Remember, we know where the missing information is. We know which community it is. We know which tribe it is, we know which influencers are there. We all this information is there. So we go back to those people and tell them and then they try to address some of those issues..."

Recommendations for others undertaking similar work include:

• Put in place a responsive system - e.g., a dedicated digital media cell.
• Ensure effective social listening through different mechanisms - from the community to the national level.
• Carry out timely response and engagement.
• Identify designated spokespersons at provincial and national levels.
• Establish an effective crisis communication strategy, with standard operating principles (SOPs).
• Create safe spaces to encourage audience dialogue.
• Foster community partnerships.
• Engage a wide range of polio champion/influencers to share content on their channels.
• Build partnerships - e.g., with Meta.

Birungi engaged with an audience member whose question concerned movement of people (and polio) between Afghanistan and Pakistan and the fact that there are still cases in Pakistan, noting that "you can't also believe the amount of work that is being put into that." It's an ongoing challenge trying to track the people who are coming from Afghanistan into the country and to ensure the children are vaccinated (that is, that their parents accept OPV for them). "[Y]ou can visit a household 10 times and the people don't change, but it doesn't mean that you haven't visited and therefore what are the indicators of what is working and what is not working?"

Click here, and then click on the Part 2 video recording, to locate and watch Birungi's presentation (beginning at approx. 13 minutes and 31 seconds into that Part 2 recording).