Power, Fairness and Trust: Understanding and Engaging with Vaccine Trial Participants and Communities in the Setting Up the EBOVAC-Salone Vaccine Trial in Sierra Leone

Zeinabou Sakou, a nurse and the head of the health centre in Ouana, prepares a dose of intravenous polio vaccine before administering it to a child at the Centre for Integrated Health, Ouna, Dosso District, Niger, Wednesday, 13 April, 2016. Niger is no longer poliovirus-infected, according to the Global Polio Eradication Initiative, but remains at high risk of outbreaks. Detection of wild poliovirus type 1 (WPV1) in 2016 in north-eastern Nigeria means the entire region is currently at risk. Niger, along with other countries of the Lake Chad sub-region, declared the outbreak to be a regional public health emergency and is implementing a regional outbreak response, coordinated with neighbouring countries. Polio is spread through person-to-person contact. When a child is infected with wild poliovirus, the virus enters the body through the mouth and multiplies in the intestine. It is then shed into the environment through the faeces where it can spread rapidly through a community, especially in situations of poor hygiene and sanitation. If a sufficient number of children are fully immunized against polio, the virus is unable to find susceptible children to infect, and dies out. In Niger, the majority of the population lives far from health facilities. In order to provide health services to people living in the most remote areas, health outreach programs are organized. Health workers travel to designated villages to perform vaccinations and prenatal checkups. Villages situated within a 17-kilometre radius are informed of these events in order for mothers and children to travel to the site on the scheduled day. This strategy has increased the vaccination coverage in many areas.