Lichinga, Mozambique – It is the last day of polio vaccination campaign in Niassa, a province in northern Mozambique, and a mobile vaccination team headed by health worker Celina Miguel is going house-to-house in a small village.

The team has just come up against a refusal.

“They want to give my child an illness, an illness to kill her!” says the young mother who turned down the Oral Polio Vaccine for her daughter.

Miguel tries to speak to the parent, but she is not hopeful, “I’m not from this area so I think she doesn’t trust me,” she says.

While it is recommended that vaccinators are from the community where they work, it is not always possible due to scarcity of skilled personnel.

Approximately 16 000 vaccinators and community mobilizers were deployed in Mozambique's third round of the polio campaign. Their efforts to overcome vaccine hesitancy are essential to reaching high immunisation rates to eradicate polio.

Miguel, who carries her young baby on her back, says this is not the first time she meets someone who refuses the vaccine. “Some parents are not sure. But I talk to them and usually manage to convince them,” she says

Miguel has been well prepared.

In Niassa, the Ministry of Health and the World Health Organization (WHO) are working to combat vaccine hesitancy through pre-campaign training and collaboration between health workers and community leaders. 

In partnership with WHO and UNICEF, the health ministry ran trainings for vaccinators and community mobilizers during the campaign preparation phase. Hesitancy is a key topic alongside technical knowledge about polio and the vaccine.

Trainers use role-playing techniques such as staged refusals. These rehearsals support health workers to respond effectively in real life.

An estimated 90% of caregivers were well prepared for the campaign during the second round thanks to vaccinators and social mobilizers’ capacity building. Vaccine refusals were maintained below one percent as a result.

“A successful campaign is all about communication,” says Maria da Glória Moreira, Health Information and Promotion Officer at WHO Mozambique.

“Managerial shortfalls, political biases, culture and religion, fear or mistrust. The roots of disinformation and misinformation about the vaccine are many,'' says Moreira. “But there is nothing that can’t be resolved through discussion,” she adds.

“If a team encounters hesitancy, they should listen carefully to the family's reasons and try to convince them about its benefits,” says Moreira. “How you communicate is just as important as what you communicate. Respect, active listening and the use of simple language are essential to good relationships with parents.

“As a mother, I tell parents we are here to help their babies not to harm them,” says Miguel.

For polio, a parents' decision to vaccinate is influenced by several key factors. Knowledge about the campaign such as its dates, where and how the vaccine will be given are a major driver. Others include community perceptions of the polio vaccine and of health care providers themselves.

Along with building the communication skills of frontline health workers, involving a community’s influential actors has proven essential to challenging parents’ preconceptions.

In Lichinga, vaccination teams set up outside churches to reach children after Sunday sermon. Health workers are encouraged to build connections with religious and traditional leaders so they can work together to promote campaigns and combat hesitancy.

As part of WHO’s health promotion strategy, Moreira runs advocacy events with traditional leaders, priests and imams so they can better inform their communities about polio. Over the past two rounds, 4720 leaders were involved in the campaign’s training.

“A few years ago, in one village, it took me two weeks to convince a local leader to let our teams in. Some groups refuse health services altogether. So I tell leaders: ‘You look after the spirit, we’ll look after the body!’ We are complimentary and we must work hand in hand. The key is perseverance”.

Chief Chingomadje, who took part in Moreira’s pre-campaign event, enjoyed working with leaders across all faiths towards a common goal. His local vaccination team now notifies him as soon as there is a refusal. “When they can’t convince families, I talk to them in person. I phoned a parent earlier today to ensure they take their baby to get vaccinated during the campaign’s mop-up day”.

Back with Miguel’s team, discussion is still underway on the mother’s doorstep.

The atmosphere lifts when Miguel’s colleague Assiato appears and starts talking to the mother in her local dialect. It is not long before they open the cooler and vaccinate her daughter. Full of laughter and visibly reassured, the mother says: “I know this woman, Assiato is like family. If she tells me to do it, I will.”