WEBVTT

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HUMAYRA BINTE
ANWAR: Principle 1,

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understand and leverage social
perception norms and beliefs

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related to polio and
polio vaccination.

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Step one is understanding
social perception and norms.

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Before you try to change
people's ideas and norms,

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it is first extremely
important to understand them.

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Let's see an example from India.

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India's suffered setbacks
when the number of polio cases

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increased between 2002 and 2007.

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80% of the cases
were concentrated

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in Uttar Pradesh, where
polio disproportionately

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affected the poorest, hardest
to reach underserved community.

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Typically, Polio cases
were among children

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aged less than two years,
who lived in mostly

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poor Muslim communities.

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Poor Muslim population in
the state of Uttar, Pradesh

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often felt threatened
by the government.

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The fear led parents
to hide their children

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or even attack the vaccinators.

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Misconception about
OPV and suspicion

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about motivation
behind the campaign

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emerged, especially in the
light of other visible problems,

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like understaffed clinics,
poor roads, other diseases.

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Misconception included OPV
caused illness in children.

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It was ineffective,
caused infertility

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and was part of the plan to
curb the growth of Muslims

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and [INAUDIBLE].

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Misconception resulted in
residents to polio vaccination

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amongst a significant
number of caregivers.

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[INAUDIBLE] and a
massive polio outbreak

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that paralyzed 1,600 children
focused the Indian government

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and the Global Polio
Eradication Leadership

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into a crisis of confidence.

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This is a case of
vaccine hesitancy.

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So it was rightly
say that, "there

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is no vaccine against
resistance or refusals

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that are rooted in
cultural, religious,

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and political context.

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No supply chain
can overcome issues

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or gender-based
decision-making in households.

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Medical approaches alone cannot
address surging community

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concerns.

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This challenges demand
effective communication action."

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Now I would like you
to think about what

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are the root causes of vaccine
hesitancy in Uttar, Pradesh?

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According to the root
cause identification tool,

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they should find the
causes of the problem

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and then keep digging
farther for the root causes.

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Here the problem is vaccine
hesitancy among the poorer

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Muslim communities in UP.

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If they ask why, the
answer would be those

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felt threatened
by the government.

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If we go further,
then it will come out

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that they my thought
OPV causes infertility

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and was part of the plan
to cut growth of Muslims.

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So the root causes might be the
misconception, lack of trust,

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et cetera.

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But how information should be
collected to really understand

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what causes?

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Common approaches in public
health to get more information

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include formal surveys,
which is a great way

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to understand perception.

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Here the figure shows in
the [INAUDIBLE] province

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of Pakistan, only
26% of caregiver

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trusted the health
worker compared

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to 61% in the rest
of the country.

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Also, in [INAUDIBLE] from
districts of Afghanistan,

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only 40% of caregivers
trusted health workers.

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We could get deeper
understanding

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of some of these issues through
conducting interviews and focus

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groups with parents
and key stakeholders,

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but really a lot of
the best understanding

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of social perception and norms
come not only or even primarily

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from these formal methods.

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They come from the health
workers and supervisors, who

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take the time to talk with
and understand the perception

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and need of the
people they serve.

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Step two, leveraging social
perception and norms.

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Note that here it
does not say changing.

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Sometimes you must try
to change the perception,

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but this can be
difficult. Often,

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working with existing norms
and perception is the best way

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to forward.

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So I would like you
to think about what

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were some of the strategies
that were used in Pradesh.

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Did these strategies
address any of the root

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causes you identified, and how?

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It was realized that
polio could be curtailed

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by engaging with the communities
in a more effective manner.

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UNICEF focused its
communication intervention

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to counter the numerous
myth and misconception

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about the resident communities.

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All communication was meant to
change the opinion, attitude,

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and behavior of families
from residents to acceptance.

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These interventions were
clubbed under the umbrella term

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underserved strategy,
that is USS.

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It was predicted that religious
leader could be drawn in,

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since they are
well-respected and accepted

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in their communities.

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They were a trusted source
to whom people can turn to

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for other personal
matters, including

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decision about health,
education, and livelihoods.

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Religious leaders had
well-established networks

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of volunteers and
community groups.

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They had the potential to
bring about positive changes

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in society.

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The ladies there [INAUDIBLE].

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Regular meeting
was done with them.

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and they were
constantly involved

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in the planning and
implementation of the program

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to build a sense of ownership.

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Through this initiative,
trust was successfully

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created among the
religious leader first.

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And the procession of
the ladies were changed

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towards polio eradication.

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As a result, they themselves
evolved innovative ways

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and used different religious
functions as opportunities

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to disseminate the information.

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For an example, the time
for [? namaz ?] or prayer

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became an opportunity to
communicate the masses

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about polio.

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The result was [INAUDIBLE].

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The resistant-household
declined 86%

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