.In North East Nigeria, anti-immunization rumors and sentiments have negatively impacted the country’s polio eradication efforts. Since 2014, the CORE Group Partners Project (CGPP) has leveraged local-level strategies to help change prevailing attitudes and behaviors by improving immunization acceptability in some of the most difficult settlements in Nigeria’s states at highest risk for polio. The CGPP’s communication model in Nigeria, in part, emphasizes the need to counter suspicion and address myths and misunderstandings by convening community dialogs and compound meetings, both of which serve as safe spaces for open discussion primarily aimed at addressing non-compliance. In the communities in Kaduna, Katsina, Kano, Borno, and Yobe states located in the CGPP implementation areas, there has been a consistent reduction in the number of missed children and consistent improvement in polio immunization uptake, providing evidence of the effectiveness of the CGPP communication model. The last case of wild poliovirus in Nigeria was detected in August 2016. Since Nigeria has gone more than 3 years without a case of wild poliovirus, the CGPP communication model promises to remain highly relevant in sustaining the community’s awareness about immunizations that will be required to keep the population coverage of polio immunization high and, by extension, the herd immunity required to maintain zero transmission of poliovirus in Nigeria. This article describes the various strategies used to address noncompliance and provides examples of community engagement in Yobe state, which is one of the project’s largest implementation areas.

The Northern states were the epicenter of the wild poliovirus outbreak in Nigeria in 2016. To raise immunization coverage, particularly of polio, the Polio Eradication Initiative (PEI) in Nigeria introduced the use of nongovernmental organizations and volunteer community mobilizers (VCMs) through the CORE Group Polio Project (CGPP). The CGPP has been contributing to Nigeria's polio eradication efforts since 2013. This article explores the contributions of the 2,130 VCMs deployed in 31 participating local government areas in the five implementing CGPP states from 2014 to 2017 to increase awareness, understanding, and acceptance of polio immunization. Data for the study were collected from primary and secondary sources using five collection methods: a survey of VCM supervisors, focus group discussions with VCMs and their supervisors, key in-depth interviews with community stakeholders, case studies of specific best practices of VCMs, and a review of documents and records. A review of the data shows that the VCMs received comprehensive training on the importance of the PEI, routine immunization, Acute Flaccid Paralysis (AFP) surveillance, social mobilization and community engagement, use of behavior change communication tools, and interpersonal communication skills. According to the data collected, the VCMs used the following innovative strategies to ensure high vaccination coverage: house-to-house mobilization, community dialogues, compound meetings, community health camps, and tracking of non-compliant families, missed children, and dropouts. The involvement of VCMs in Nigeria's PEI efforts has been a pivotal contribution to reductions in the number of households rejecting polio immunization, the proportion of families with missed children, the proportion of families that were non-compliant, and the number of polio cases.

Since 1999, the CORE Group Polio Project (CGPP) has developed, refined, and deployed effective strategies to mobilize communities to improve vaccine uptake for polio (and other vaccine-preventable diseases such as measles) and conduct surveillance for infectious disease threats in high-risk, border, and hard-to-reach locations. CORE Group Polio Project teams have been called upon to address the COVID-19 pandemic, and, like with polio, the pandemic response is impacted by stigma in all areas of response, from health education, testing, contact tracing, and even treatment for infected individuals. The CGPP has reached back into its polio experience and is redeploying successful community engagement activities to address stigma as part of the COVID-19 response. Across country programs, community health volunteers communicate risk and behavior change at the household level by integrating health education and promotion activities with a focus on practical measures of COVID-19 prevention. Moreover, leveraging established and trusted partnerships with community networks and community leaders are providing lessons that can be adopted by the global community. The CGPP offers three overarching recommendations to curb stigma: 1) facilitating inclusive community engagement, 2) leveraging existing community networks and 3) cocreating with community leaders.

The last case of wild poliovirus in Ethiopia was reported in 2014. Until the disease is eradicated globally, the risk of reimportation remains high. In 1999, the CORE Group Polio Project (CGPP) began its community-centered polio eradication efforts in Ethiopia, using community volunteers (CVs) to ensure that no child has missed polio vaccine. This article documents the efforts of CVs and highlights innovative strategies, successes, and contributions. Qualitative data were collected from the CGPP implementation areas in 85 border woredas (districts) of Benishangul-Gumuz; Gambella; Oromia; Southern Nations, Nationalities, and Peoples' Region; and Somali. A total of 151 in-depth interviews were conducted with CVs, parents, CGPP partners, and project stakeholders. Results of the study showed that CVs secured the buy-in of community members through open and fair eligibility and selection processes, thereby ensuring representation of community needs and perspectives. Community-driven participation consisted of identifying and choosing credible, trusted individuals who were willing to actively engage as caretakers of the community. Community volunteers then received specialized training and supportive supervision to build and expand their command of child health and vaccination information and interpersonal skills, fortifying the legitimacy of health messages and supporting the community's sense of collective efficacy. The robust network of CVs built by the CGPP continues to effectively reach the most remote, rugged, and underserved areas of Ethiopia. Stakeholders credit the CGPP with playing a significant role in keeping Ethiopia polio-free and increasing the population coverage of polio and routine immunizations.

Despite numerous setbacks, the Global Polio Eradication Initiative has implemented various community strategies with potential application for other global health issues. This article reviews strategies implemented by the CORE Group Polio Project (CGPP), including pursuit of the missed child, microplanning, independent campaign monitoring, using community health workers and community mobilizers to build community engagement, community-based surveillance, development of the capacity to respond to other health needs, targeting geographic areas at high risk, the secretariat model for non-governmental organization collaboration, and registration of vital events. These strategies have the potential for contributing to the reduction of child and maternal mortality in hard-to-reach, underserved populations around the world. Community-based surveillance as developed by the CGPP also has potential for improving global health security, now a global health priority.