Preserving gains, rebuilding trust: Togo takes no chances with polio

When Angèle, a 28-year-old vendor and single mother in Togo, heard that her 5-year-old child had been vaccinated against poliomyelitis (polio) at school in February, she immediately went to express her discontent.

"On my way home from the market I learned that my child had been vaccinated against polio without my consent," she screamed, very upset, before threatening: "I warn you. If anything happens to him, I will pursue you until the end of my life."

The young woman's protest was so dramatic that the scene was filmed by a witness and shared on social media, where the video went viral.

The reason for her outburst? A catch-up vaccination campaign against polio organized in February 2022 by the Government of Togo for children aged 3 to 6 years in response to new cases of the wild poliovirus in 2021.

Prior to this upsurge in cases, the country had been declared free of this particular form of poliovirus in 2007—a major advance that was made possible by vaccination against polio, a serious and highly contagious disease that can cause paralysis of the lower limbs and respiratory muscles, leading either to death or to heavy, irreversible aftereffects.

Aware of the danger, another woman, Habiba, 30, brought her 5-year-old son to the vaccination centre last February.

"It is important that he gets all his vaccines. Since he was born, I have been trying to take him to all the mandatory vaccination appointments and he didn't die from any of them. So, I think vaccines are useful," she explained, before describing a man in her village who often sits outside, in the street. "Our parents say that he was normal as a little boy and that it was polio [that did that to him]. I don't want that for my son."

How misinformation about vaccines could endanger children's health

Many parents in Togo, as elsewhere, do not always find it important to get their children vaccinated against polio.

Like other vaccines that have been used for decades – such as the ones against tetanus, diphtheria, measles, pertussis, or yellow fever - the polio vaccine is adversely affected by the growing mistrust over COVID-19 vaccines over the past year or so.

Although the polio vaccine was proven safe and effective for decades, and saved millions of lives across the world, many parents in Togo and beyond now question its safety and even doubt its benefits—and these questions extend to other "classic" vaccines. People's reactions are sometimes visceral, like Angèle's, reflecting a fear that, although real, is scientifically unfounded and stands to overshadow the well-documented risks unvaccinated children are exposed to.

Are they safe? Will they have long-term adverse effects? Are they really indispensable? Can we not protect our children using natural procedures? Are there other substances in the vaccines?  Parents in Togo, like in other countries, sometimes struggle to find clear, definitive and credible answers to these types of questions.

Distrust of health authorities and the media

There are several reasons for this distrust, depending on the geographical, political and social context.

There is a growing mistrust in many countries towards public officials and health authorities in particular. In countries where institutions guarantee the right to information and freedom of the press, mainstream media, whether public or private, are increasingly being questioned.

In countries where legislation on the right to information is non-existent or not fully implemented, citizens sometimes feel that they don't have full access to information. In both cases, they increasingly rely on the Internet, especially social media, to get the information they seek.

Social media has become an alternative conveyor of information. It compensates for a lack of access to or trust in information sources like mainstream media. However, it also allows anyone to take on the role of a “journalist” and potentially spread rumors, beliefs, myths, and even fake news that can have harmful effects on individuals, potentially on a large scale.

Fake news is not a new phenomenon. It preceded the advent of the information society—but the Internet  amplified it to unprecedented proportions.

In 2018, UNESCO  published a handbook, "Journalism, fake news & disinformation: handbook for journalism education and training", that addresses, among other issues, the pitfalls of contemporary disinformation and the self-regulation of social media.

The COVID-19 "infodemic" and people's mistrust of "classic" vaccines

In the specific context of the COVID-19 pandemic - the first pandemic since the advent of social media - WHO has called the spread of fake news an "infodemic", and the United Nations as a whole launched the global Verified campaign to counter this phenomenon. The COVID-19 infodemic has led a large number of people around the world to mistrust COVID-19 vaccines, a mistrust that also affected trust in "classic" vaccines to such an extent that routine vaccination campaigns, especially in sub-Saharan African countries, are often equated with COVID-19 vaccine drives.

Elias, a health worker in his thirties who participated in the polio catch-up vaccination campaign in Togo, knows this problem well.

"With the current COVID crisis and the controversy surrounding the vaccination campaigns, it is not easy to carry out this campaign [...]. But we need to convince the parents in order to prevent children from becoming disabled tomorrow as a result of this polio outbreak," he said.

Concerned by many parents' resistance or refusal to get their children vaccinated, UNICEF's Deputy Resident Representative in Togo, Ms. Fosca Giulidori, urged parents whose children had not been immunized against polio to use the February catch-up vaccination campaign to take the leap for their children's own good. "When we have the opportunity to protect our children from a vaccine-preventable disease, let us not hesitate," she said.

For her part, Dr Diallo Fatoumata Binta Tidiane, WHO's Representative in Togo, said: "This vaccination campaign aims to completely eradicate polio in Togo and around the world. We can therefore reassure you about the efficacy of this vaccine and all other WHO-approved vaccines."

The COVID-19 infodemic has also disrupted other polio vaccination campaigns across the world. To tackle this challenge, health authorities make significant education and communication efforts to preserve immunization gains and rebuild people's confidence in life-saving vaccines such as the polio vacccine. United Nations entities continue to stand with Togo to help the country achieve these goals.

Like previous routine vaccination campaigns, the February 2022 catch-up campaign was led by the Togolese Government with the support of WHO, UNICEF and Gavi, the Vaccine Alliance. 599,735 children were vaccinated in the process. The campaign was implemented as part of the 2022-2026 Strategy of the Global Polio Eradication Initiative, thanks to which the world has never been closer to eradicating polio. Despite tremendous progress made, continuous vigilance is required as no child is safe when the poliovirus circulates again within a community.

Originally written in French by the United Nations Development Coordination Office (UN DCO) with inputs from the UN Country Team in Togo and WHO’s Office in Togo. Translated into English by UN DCO. To learn more about UN's work in Togo, please visit Togo.UN.org.