Skip navigation

morry.chris's blog

Recently Featured Resources

Here are a few resources that were recently featured on the UNICEF/CI Children and Equity theme site that may be of interest. We hope some of them are useful to your work and also that they spur some of you to share resources you think would be of use to others.

Interpersonal Communication Can Work in Child Survival Programmes

This research brief describing the effectiveness of interpersonal communication (IPC) approaches in child survival programmes was prepared by The Health Communication Capacity Collaborative (HC3) at Johns Hopkins Bloomberg School of Public Health Center for Communication Programs in collaboration with Management Sciences for Health, NetHope, Population Services International, Ogilvy PR, and Internews.

The Voice of Children in the Global Arena

Starting next April, children and youth around the world will, like Malala, be able to denounce the violation of their rights before a special United Nations body. This will be possible thanks to the enactment of the third Facultative Protocol of the Convention of the Rights of the Child, which was approved by the UN General Assembly. This instrument will enter into force because it has been ratified by ten UN Member States, two of which - Bolivia and Costa Rica - ratified the protocol just a few days ago.

Every Child Counts

For many years The State of the World’s Children report has been considered the quintessential gauge of the progress being made around the world toward ensuring the quality of life for children and protecting their rights.

First general forum entry.

Made by Chris Feb 17 2014.

Notes from the field - Nigeria December 2013

Entry 3 of this trip from Chris Morry

It has been very busy since we left Afghanistan for Nigeria. So busy in fact that it was 24 hours before I learned of Nelson Mandela's death. His passing is a moment for reflection not only on the impact of a single person who came to represent the best elements of one of the most powerful social justice movements of our time but also on what brings us together to create large scale societal change. Warren Feek recently posted a blog containing his reflections on the man, the movement and the dangers of thinking that major social transformations can be accomplished by technocratic management or policy makers alone. Immersed as I have been for the past few weeks in the polio programme, it is useful to be reminded of this, and it led me to reflect on the nature of 'demand' in the GPEI and the sources of its power for change.

Certainly, the eradication of a disease that has been killing and disabling children for thousands of years is no small feat, nor is it the kind of thing that can be accomplished without the mobilization of states and communities, money and time, courage and dedication. In this sense, it has some of the attributes of a social movement, a great global effort to remove forever, the burden on humanity of a single disease. But it is also (and needs to be) an intensely technocratic endeavour driven by epidemiology and supported by well-planned large-scale communication programmes.

Notes from the field - Afghanistan December 2013

Entry 2 for this trip from Chris Morry

As I left for Afghanistan, Robert Steinglass sent me a commentary he recently wrote on routine immunization (RI) titled "Routine Immunization: An essential but wobbly platform". In it, he argues for a re-balancing of immunization direction and investment and offers a critique of long standing approaches and thinking within programmes like the Global Polio Eradication Initiative (GPEI). His arguments echo the discussions that are now (and many would say very belatedly) going on within the GPEI itself. Click here for a summary of his commentary and a link to the original.

As polio eradication gets closer, reaching the virus in its remaining reservoirs has become increasingly complex and expensive. At the same time, the increasing energy and resources required to eradicate polio in those areas where it remains endemic have been diluted by the need to respond to outbreaks in other areas where very poor RI, conflict, or both leave children unimmunized.

If we look at two regions in Afghanistan, the impact of poor RI coverage on the polio programme becomes clear. Southern Afghanistan is presently a success story where after years of transmission there has not seen a single wild polio case for over twelve months. But any sense of success has to be tempered by the knowledge that RI is almost non-existent in provinces like Kandahar, and the risk of re-importation, therefore, is extremely high. The short term response is continuous door-to-door rounds until the risk of importation is gone, but this is not, of course, a viable long-term strategy.

In Eastern Afghanistan, RI is much better, and this has served as a defence against the outbreaks just across the border in Pakistan.

Notes from the field - Pakistan December 2013

Entry 1 for this trip from Chris Morry

A few days ago, I finished being part of Polio Technical Advisory Group (TAG) meetings for Pakistan and Afghanistan, respectively, and am now in Nigeria, the other remaining polio endemic country. The following notes flow from a few reflections during this travel but let's start with Pakistan.

It has been a difficult year for Pakistan's polio programme. I was last here in mid-December 2012 just before the horrific and targeted killings of polio vaccinators. At the time, Pakistan was talking about the 'last low season' and hoping that the first 6 months of 2013 would see it interrupt polio transmission and set it on the road towards eradication. Due to: those killings; the resulting cancellation, delayed and/or lower quality vaccination campaigns; the transitional upsets of the election of a new government; and a ban on vaccination campaigns in areas of North and South Waziristan in FATA , that 'last low season' was not to be.

Pakistan is now at the start of another low season and finds itself in the unenviable position of being the worst performing of the three remaining endemic countries. It hopes to do better this time, and there are a few reasons to be optimistic. Its programme is stronger than it was last year, its new government more settled and very supportive of eradicating polio, and attacks on polio workers reduced (though still far too high). However, the ban in the Waziristans continues, leaving many thousands of children unimmunized and vulnerable to getting and spreading the virus; polio workers must travel with police escorts in many places (known as a 'protected' campaign, though those police escorts are also being targeted and killed); and campaign quality continues to be substandard in too many places.

Notes from the field entry 5 - India/Afghanistan, October 2013

Entry 5 from Chris Morry.

It's all about borders...

The team came back together in Kabul on October 28, after splitting into two groups, one travelling to the south in Kandahar, the other to Jalalabad in the east. These are two parts of Afghanistan that tell different yet similar polio stories. Two years ago, the south was in the grips of a large polio outbreak, while eastern Afghanistan was polio free. Since then, the tables have turned, and the south is now free of wild polio virus, while the east has 8 cases so far this year, with a high potential for more before the end of December.

Why has this happened? On the one hand, it is a story of the south gaining access to areas not controlled by government, where, in some cases, for years, anti-government elements (AGE) had refused to allow vaccination teams to enter. At the same time, significantly improved polio campaigns in both quality and number led to a decrease in the number of un- and under-immunised children in the region. On the other hand, it is a story of the east, where better overall immunisation coverage and campaign quality had allowed it to stay polio free in spite of a major and growing outbreak in Pakistan along its borders. Eventually, the pressure of the high virus circulation in Pakistan, the million or so people who travel from Pakistan to eastern Afghanistan through the Torkam border each year, and a deteriorating security situation in eastern provinces like Kunar, resulting in chronically inaccessible areas containing 10s of thousands of children, allowed the virus to establish itself in the east.

Notes from the field entry 4 - India/Afghanistan October 2013

Entry 4 from Chris Morry

Hi Again

Much better internet here than I had expected.

I am in the east and therefore haven't been able to look closely at what's behind the much improved polio numbers in the south. I expect the other half of our team will have much to say about Permanent Polio Teams (PPTs), improved access, and the extent to which the quality of campaigns has improved.

What I can say based on what I've seen so far and from previous reviews is that there has been continuing improvement in accessibility in the south which is no doubt due to dialogue, letters of support from a range of political and religious leaders, and positive behind the scenes action from community leaders at many levels. However, it is also important to remember that, at the end of 2012, the main issue was (as it always is) too many missed children! And 80% of the children missed were in accessible areas. While the hard and often dangerous work of negotiating access to the other 20% should not be underestimated, it's difficult to imagine getting to where we are today without significant improvements in campaign quality - accountability, management, social mobilization, and communication. Improvements that allowed the programme to reach more children in accessible areas also ensured that children in areas that became accessible actually got immunised when the opportunity arose.

None of the above means the issues in the south are solved. Serious gaps remain, pockets of under-immunised children remain vulnerable to infection, the virus may still be circulating at low levels, and the risk across the border has not gone away.

Notes from the field entry 3 - India/Afghanistan October 2013

Entry 3 from Chris Morry

It is good to hear from some you - I want to particularly address Wendy’s question: "What do you think accounts for the decrease in cases in Afghanistan?"

The question you ask is a good one. We have yet to get a chance to look closely at all that’s happened but it is true that there has been no case of wild polio in southern Afghanistan this year.

I think there is a need to see this as an opportunity, while being cautious. We are coming to the low season and not having had a case in almost a year is a good place to be right now. The programme itself remains optimistic but also healthily sceptical. Reviews are about to start to make sure the surveillance system hasn’t missed cases, and environmental sampling is to be expanded to see if the virus is circulating in the sewage. However, there is every reason to believe that the main reason children have been spared polio for so long in this region is the improved quality of the immunisation campaigns coupled with fewer inaccessible areas and a lot of hard work through repeated rounds.

This provides an opportunity to continue to build immunity in the region through the low season. Of course, there remain serious gaps in programme coverage in the south; the danger of cases coming from Pakistan is high; the south east is threatened by the bans on vaccination in North and South Waziristan in Pakistan; and 8 cases are now confirmed in the east, also along the Pakistan border. There is much to remain concerned about!

Notes from the field entry 2 - India/Afghanistan October 2013

Entry 2 from Chris Morry

Not much to say about Afghanistan as I am still in India. We have had some logistical difficulties getting visas for some of the international panellists because of Eid al-Adha. So we have moved the dates a little to make sure we are all able to participate.

Logistically, it is worth noting that these reviews have to be organised with flexibility and some thought towards Plans B and C, as they occur in difficult and unpredictable regions.

The last three endemic countries, Afghanistan, Pakistan, and Nigeria, remain endemic for a range of inter-related, complex reasons - conflict; extremely high rates of poverty; poor nutrition; lack of infrastructure, especially in areas effecting health and access, such as sanitation, drinking water, and roads; gender inequality; lack of education; the denial of immunisation access to populations for political reasons; and the list goes on. All of this creates the opportunity for the virus to flourish in pockets and then occasionally to leap out, as new pockets of under-immunised and vulnerable children emerge.

We have seen this recently in Somalia, Kenya, and Ethiopia; we have watched Israel worry about the virus appearing in its sewage even if there have been no cases as of yet; and, just today, we heard the news that polio may be appearing in the midst of the chaos of Syria’s civil war.

Amongst all this, Afghanistan has only had 7 wild-polio-virus-derived cases - this compared to 26 cases for the same period last year and none of these cases is in the south where the majority of cases usually occur. This may be interpreted as good news, though the increase in polio cases in the east along the Pakistan border speaks to the ever present danger of the virus travelling from one vulnerable area to another - Pakistan and Afghanistan being a single transmission zone sharing the same genetic type of polio virus.

Notes from the field entry 1 - India/Afghanistan, October 2013

Entry 1 from Chris Morry.

Warm greetings to all on the eve of my departure. I'll be flying to Kabul for a polio communication review and then on to India for some quick meetings with UNICEF and the CORE India polio project. I plan to post brief messages as regularly as I can as a way of capturing some of the process and issues faced by a review team once on the ground. I'm hoping some of this will be of use and interest to some of you.

Our objective in this review (I am joining a panel focused on the review upon arrival) is to look at several areas of priority for the programme, but the main objectives are to advise on how to 1) improve access to children and 2) create demand at caregiver and community level.

First some notes on logistics: the panel will break into several teams travelling to Kandahar and Jalalabad. Each team has a series of questions to explore which will be done via key informant interviews and the review of documents.

My team will focus on the impact of mass communication, on the one hand, and the utilisation of interpersonal communication (IPC) strategies at the local level, on the other. These will be linked together with an evaluation of both local level planning and also the communication network which now operates in Afghanistan.

We have a few days to explore all of this and will then report back with recommendations to UNICEF, polio partners, and the Government of Afghanistan. My flight leaves today, so look for more to come once I am actually in the field.

Posting again soon....

Chris Morry
Programme Director
The Communication Initiative

If you wish to comment, please click reply if you receive this note via email or log in and comment here:

Polio Networks