Asian Journal of Social Sciences & Humanities Vol. 12, Jan-Dec 2023__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________BELIEFS AND PRACTICES INFLUENCING POLIOVACCINATION COVERAGE IN CAMERRON SINCE THE
ADVENT OF COVID-19 VACCINE
Fosso Simun REINE
Department of Social Studies, National Centre for Education, Ministry of Scientific
Research and Innovations, CAMERON.
reinesimun208@gmail.com

ABSTRACT
Since the outbreak of the COVID-19 pandemic, there has been a lot of controversy
over the different types of vaccines produced by different pharmaceutical companies
worldwide and this has made many people indifferent about their effectiveness insolving the health challenges created by the pandemic. This paper seeks to portray
how other vaccination campaigns especially those administered to children have been
affected by the emergence of the COVID-19 vaccine in Cameroon. This study is basedon the recent poliomyelitis outbreak in Kousseri in 2021, According to Mbu (2014),
Cameroon has been polio-free for three consecutive years (2010-2012). In 2013, four
wild polioviruses type 1 were detected in Cameroon linked to the WPV1 last detected
in Chad in 2011. Also in 2014, three cases were detected (cVDPV) type 2 cases linked
to circulation in Chad. In 2014, the government of Cameroon recognized that thepolio epidemic was a global health issue, in this light, there was a need to free
Cameroonians from this pandemic with the objective to make the polio curve bent
downward by July 2014, keeping the number of unvaccinated children to less than 5%.
Since the advent of Covid-19, people’s perceptions and practices toward vaccination
have been affected especially the poliomyelitis vaccine. In order to have a clear
understanding of this aspect, qualitative research was carried out. Data was gotten
from the respondent with the help of different techniques such as interviews andobservation. Purposeful sampling was done to get participants for the study. Data
collected on the field was analyzed and interpreted. Cameroon’s objective to freepolio outbreak has not been attained with the recent outbreak in 2021, coupled with
the Covid-19 outburst and the institution of the COVID-19 vaccine, the majority ofpeople have been hesitant toward this vaccine and have doubted the authenticity ofother vaccination campaigns like that of poliomyelitis.
Keywords: Poliomyelitis, Covid-19, Vaccination, Hesitance, Influence
INTRODUCTION
Poliomyelitis has been a serious public health challenge between children of 0-5 years of age,with recurrent outbreaks in different countries worldwide. The collaborative efforts of the
Global Polio Eradication Initiative, Centre for Disease Control and Prevention and World
Health Organisation with other parties successfully eradicated poliovirus using surveillance,awareness campaigns and massive immunization in most parts of the world (Shafique et al2021).Since January 2020-June 2021, there were 38 Vaccine Derive Poliovirus (cVDPV2)
emergences in active transmission in 34 countries, of which 28 of these countries are in
Africa. It was also reported that 15 of the 26 emergences in active transmission in Africancountries were detected, either in patients with Acute Flaccid Paralysis (AFP) or throughCopyright © 2023

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Asian Journal of Social Sciences & Humanities Vol. 12, Jan-Dec 2023__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

environmental surveillance, outside of the country of first isolation of genetically linked virus(Alleman et all 2021).
Like other countries, Cameroon has been struggling to eradicate this virus from it healthsystem by using the above mentioned methods. That is why for three consecutive years, thecountry had been free from poliomyelitis that is since 2010- 2012. In 2013, four wild polio
viruses type 1 (WPV1) were detected in Cameroon linked to WPV1 last detected in Chad in2011 (Mbu, 2014). In 2014, three cases were detected (cVDPV2) and were linked tocirculation in Chad. This continues outbreak made the government of Cameroon to recognisethat, polio epidemic was a global health challenge and in this light, they have been putting ineffort to free infants from this epidemic, with the objective to make the polio curve bent
downward by July 2014, and keeping the number of unvaccinated children to less than 5%(Mbu, 2014).
Ever since the first detection of the cVDPV 2 in 2018 in Nigeria, this genetically linked virus
has been circulating in 17 West and Central African countries and during the reporting period,
circulation was documented in 16 countries excluding Cameroon (Alleman et all 2021). Thisimplies that poliomyelitis had actually been eradicated from Cameroon. This statement failed
to be sustained due to the detection of two cases of (cVDPV type 2 in October 2021 in two
different health districts in Nigeria. The third case was found in the Fotokol health district inExtreme North with the same genetic strain like those discovered in Nigeria and also in thesame month of October. Another case was detected in the kousseri health district inNovember 2021 (Expanded Programme on immunization 2022). All these detections weredone during the second phase of the COVID-19 outbreak. Despite all the efforts put in placeby the government of Cameroon in combination with some international partners to fight thisepidemic, Poliomyelitis is still being detected in some parts of the country. That is why thegovernment has taken upon itself to carry out routine vaccination of children between theages of 0-5 years.
Like COVID-19, poliomyelitis is a disease of hygienic concern. The spread of the disease isthrough fecal oral route and is rapid in areas with poor sanitation, however, the reasons for it
being highly communicable is due to the spreading of the virus in feces (Mehndiratta et al,2014). Similar to covid-19, majority of patients are asymptomatic, during this time, the virus
sheds in the stool of humans and can be isolated from throat swabs also, but stool samples of
the infected persons are the primary sample sources (Mehndiratta et al). According toJonathan et al 2022, Poliomyelitis can present in stages, such as the acute stage, recovery
stage, and residual-paralysis stage. The acute stage is mainly comprised of features, such as
fever, neck stiffness, profound muscular weakness, paralyses, and autonomic dysfunction. In
the convalescent or recovery stage, the acute features disappear, and the recovery ofparalyzed muscles begins. This stage can last up to two years. In the last stage, the patient isleft with residual paralysis, imbalance of muscle power, and poor posture.
Vaccinations campaigns have always been routinely organized by the state to redress the
problem of poliomyelitis especially in children but since the outbreak of COVID-19, and theinstitution of COVID-19 vaccine, many families have been very skeptical about it
authenticity and have refused to vaccinate their children during national vaccination
campaigns. In this light, we will wish to understand how the institution of the COVID-19
vaccine has influenced poliomyelitis vaccination campaign coverage in Cameroon? How has
the perception of COVID-19 vaccine affected people’s belief about the virus? What measures
have been put in place by the government to see that children are vaccinated irrespective of
the hesitance expressed by parents and care givers?

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Asian Journal of Social Sciences & Humanities Vol. 12, Jan-Dec 2023__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________METHODOLOGY
Study design
This study depended on a qualitative research design and focused on ethnographic approachwith high lights on interviews and observations as the main techniques for data collection.
Population for the study
The populations for the study were parents of children less than five years of age, nursery andprimary school instructors, vaccination campaign team and medical practitioners involved in
the vaccination of children.
Population size and sample
The study was carried out in the Biyem-Assi District area particularly at the Bisquitery healtharea. The populations considered for the study were children of less than five years of age,
their parents and caregiver, 6 health workers were stationed at the different health post and
two were send out for door to door administration of the polio vaccine. A snowball sampling
was done, were a team was sent to the field to identify household with children of less than
five years and also to indicate the number of children per house on the gate or at the door post,
they identified other households by asking parents to indicate other houses with children ofless than five years of age. In the second phase that started on the 3rd of July 2022, a Global
positioning system method was used to localize the areas that had not been covered by thevaccination team on the field.
Data sources
Different types of data were collected for this study. Firstly, secondary data was gotten frombooks and journal articles while primary data was collected from parents, nursery andprimary school instructors and medical personnel
Data collection techniques
In-depth interview
In-depth interviews were carried out with the chief of post at the health center and with thehealth workers who administered the polio vaccine on the field. Also, parents wereinterviewed to get their opinion on the ongoing vaccination campaign against polio in theadvent of the COVID-19 vaccine.
Observation
This technique helped us to get information on the manner parents behaved toward the healthworkers who moved from door to door administering the vaccine and how the health workers
were able to convince parents of the importance and safety of the polio vaccine administered
to their children.
Data analysis
A thematic data analysis was used. Data gotten through verbal communication andobservation were coded into various categories and summarised under themes and subthemes. Direct quotes were also used and the respondents were given pseudonyms to protect
their identity.
Theoretical approach
The theoretical approach for this study is Ethno medicine. This approach enabled us tounderstand people’s attitude towards polio and how health care seeking processes are
influenced by other social and cultural factors.
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Asian Journal of Social Sciences & Humanities Vol. 12, Jan-Dec 2023__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________RESULTSPERCEPTION OF POLIOMYELITIS OUTBREAKS
Continuation of outbreaks requires improvements in the timeliness and quality of outbreak
response so that any ongoing transmission in mOPV2 response zones is stopped (WHO,2020). However it is believed that the sharp increase in cVDPV2 outbreaks is possibly as aresult of population movement of recently vaccinated children into areas with low population
immunity or wayward use of mOPV2 outside of response zones (WHO, 2020). This ismostly equated to the movement of infected children from Nigeria and Tchad to Cameroon.
Though poliomyelitis is an infectious disease, the numbers of infected children are notusually as many as the cases of other infectious diseases like malaria, typhoid and respiratory
tract infections. This has always influenced perceptions about it existence and attitude toward
prevention. During interview with some parents, they said that, since the outbreak ofpoliomyelitis is usually detected in the North and far North regions of Cameroon, with justone or two cases found, they believe the virus cannot meet them because of distance andbecause of the limited number of infected cases. Such believes go a long way to stop parents
from preventing their children during moments of outbreak, thinking that they are not part of
the narrative.
“Since I started hearing about polio, I have never seen a child suffering from it
except on television, I really wonder whether the disease actually exist”(female,
10 am, 2022, Yaounde).
When people live with this type of notions, they will not actually put any effort to support the
government in its effort to eradicate the disease.
COMPONENT OF POLIO VACCINE AND ADMINISTRATION
In order to eradicate polio in Cameroon, a circulating vaccine-derived poliovirus (cVDPV)VDPV demonstrating person-to-person transmission in the community, based on evidence
from human and/or environmental detections of related viruses was produced (WHO, 2020).
Also, Mebendazole and Vitamine A were also provided. Vitamin A and polio oral wasadministered to children between 5months to 5years old while Mebendazole wasadministered to children of nine months and above for deworming. Children eligible fordeworming were given one tablet of Mebendazole to chew while one doze of vitamin A and
two drops of polio oral vaccine was administered to the children through their mouths. Not
any of these drugs were given through injections even though polio vaccines do exist in
injectable forms. The vaccination team used this to convinced some parents, by insistingthat COVID-19 vaccines were not in tablet form and were not taken orally they were
injected in the body. With this, some parents became convinced and accepted that the vaccine
should be administered to their children. Actually, the polio vaccination campaign was tofight the type 2 polio virus while the routine vaccination given at the hospital is to fight thetype 1 polio virus. Children who received the vaccine where identified with a mark on theirsmall finger. This was to prevent repetition and a number was written on their door to showthat their homes have been visited. In the second phase, telephones were used to localisechildren that had not been vaccinated. This was to enable the team to reach as many children
as possible.

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Asian Journal of Social Sciences & Humanities Vol. 12, Jan-Dec 2023__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________THE EFFECT OF SURVELLANCE DISRUPTION ON FOLLOW UP OF POLIO
According to Zomahoun et al 2021, Precautions taken to mitigate the spread of COVID-19
might have affected the ability of surveillance officers to conduct routine surveillance
activities, which would have had an impact on the number of AFP cases reported. When
WHO declared a global pandemic on 11 March 2020, the Global Polio Eradication Initiative(GPEI) was already facing significant challenges to polio eradication due to outbreaks ofcirculating vaccine-derived poliovirus type 2 (cVDPV2) in multiple countries and endemic
wild poliovirus type 1 transmission (WPV1)(Chad et al, 2020). Actually, the overwhelming
threats to the global health security generated by COVID-19, redirected the programme’s
significant human resources and other assets to tackle the pandemic and suspended house-tohouse supplementary immunization activities (SIAs) (Burkholder et al, 2021). Theinterruption of these eradication-focused activities coupled with disruptions to delivery ofessential immunization services allowed poliovirus transmission in established outbreaks topersist and created the potential for spread to new areas (Burkholder et al, 2021).
PARENTS APPROACH TO POLIO VACCINECOVID-19 outbreak really had a serious impact on parents approach to polio vaccine.
Decisions whether to consume health services or not are usually taken by the head of thefamily. In homes where the head of the household were women, it was easy for them toaccept the vaccine against polio meanwhile in houses with male head of house acceptance totake the vaccine depended on them. Most women who refused to take the vaccine said theirhusbands told them not to accept it. To make the long story short, they said they will take thevaccine at the hospital or health Centre during their normal routine. These women did notknow that the polio vaccine that was administered during the campaign was to prevent thetype polio virus.
In most cases where the parents showed any signs of refusal, the vaccination team had toconvince them before they could allow their children receive the oral vaccine against polio,
vitamin A and Mebendazol. They did this by telling them that it was not the vaccine against
COVID-19. They thought the government was using the polio campaign as a pretext tovaccinate children against COVID-19. Some parents became hesitant thinking that theywanted to use the campaign in order to inject their children with COVID-19.
Speaking with some workers in one of the health centers in Yaounde, they exposed that mostparents who refused to take the polio vaccine during the door to door campaign did not also
accept that the vaccine should be administered to their children when they were brought forroutine checkup. In other cases we found out that, some parents avoided the vaccination bysaying their children were suffering from fever, since the vaccine was not to be administeredon sick children. Since the target was to vaccinate as many children as possible so as to limit
the spread, parents were informed about it through the school authorities. Some schools
refused their pupil from taking the vaccine saying the vaccination team should meet thechildren at their various homes.
Normally during vaccination campaigns, schools usually send notes to inform parents about it.
Some schools did not send any notification letters to parents and stop the vaccination teamfrom getting into their premises. Also, parents who did not want their children to be
vaccinated in school, informed the school authorities especially in schools that accepted thevaccination team to vaccinate children in school. Parents’ attitude change toward polio
vaccine has been greatly influenced by the COVID-19 vaccine. Since many people have been
hesitant to take the COVID-19 vaccine, they though that it was a strategy to vaccinate
children under the alleged reason of polio, since the COVID-19 vaccines were available ingreat quantity.
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Asian Journal of Social Sciences & Humanities Vol. 12, Jan-Dec 2023__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________“I saw a woman who has never given any vaccine to her children and was noteven ready to give. She said her religious belief does not permit her to
Vaccinate her children, so even the polio vaccine was not given to her children’(Female, 3pm, hospital staff, 2022, Yaounde)
From the above quotes, we realize that people have different approach toward health services
depending on their belief systems. Holding to her religious beliefs, enables her to look forsolution to her health problem within that sphere.
The last phase of the campaigned was from the 2-4 of December 2022. Though it was limited
only to deworming the children with Albendazol/Mebendazole tablets and the administrationof vitamin A supplements, parents were still not comfortable with that. This was affected by
the nationwide COVID-19 vaccination campaign which took off on the 18-27 of November
2022. They thought that it was a strategy from the state to provide their children with
COVID-19 related drugs. Though there was no polio vaccine involved, parents still showed
luck worm attitude toward this campaign.
STRATEGIESCHILDREN

PUT

FORTH

BY

HEALTH

WORKERSTOVACCINATE

During the door to door campaign, parents who became hesitant to the vaccine wheretargeted at the hospital. They administered the vaccine to these children like the normal
routine vaccine. Some parents claimed that the vaccination team did not visit their homes.
This could be true because during field work, we realized that no signs were put in somehomes to indicate that they had children eligible for vaccination, meanwhile those homes had
children. Also, maybe those in charge of identifying the children did not meet anyone athome when they were identifying other homes and the homes were not taken in to account.
During the vaccination campaign, we noticed that some homes were indicated not to havechildren but when we knocked and asked whether there were children in, they accepted andalso accept that they should be vaccinated. Encouraging parents and telling them theimportance of the vaccine to their children was one of the ways we used to enable parents
accept the vaccine. Another important strategy to enable massive vaccination uptake was totarget pupils of school going age in their various schools. In collaboration with the Ministryof Basic Education, health personels were dispatched to different schools to administer the
drugs. Coping strategies are very important especially in situations where one cannot
consume health services except with the authorization of a second or third party. Like thecase of children whose parents must accept that their children should take the vaccine.
CONCLUSION
Cameroon’s objective to free children from polio outbreak has not been attained with therecent outbreak in 2021, coupled with the Covid-19 outburst and the institution of the
COVID-19 vaccine. Though some parents use to be hesitant in accepting the polio vaccine
for their children, the situation has become worst since after the outbreak of the COVID-19
and the arrival of the vaccine to curb its spread in Cameroon. The authenticity of the vaccine
has been much doubted by many people to the extent that it has affected the routine
poliomyelitis vaccination campaign which is carried out nationwide. Even though mostparents have not put in much efforts to see to it that the wild polio type two be eradicated by
vaccinating their children, the State has not relented its determinations to eradicate this virus
and to keep children safe from its effects. From an ethno medical approach, systems of
medical care are affected by how people perceive health and well-being and what they
practice to stay healthy. However, deviant behavour will set in when people are made to thinkthat their beliefs and practices relating to health are influenced by other health system.
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