Effective risk communications to counter emergence and resurgence of zoonotic diseases

Scaling Up One Health Approaches - A Case Study

The health security networks have played a critical role in strengthening risk communications for OH. This has been achieved through information sharing, communications support, and capacity building. With respect to capacity building on risk communications, training and programs have been instrumental in strengthening outbreak communications.

Why this case study?

Risk communication is a key component of emergency response that all countries should have to respond to health threats. It is one of the eight core capacities under the International Health Regulations (IHR) - a legal framework designed to help countries prevent and respond to public health risks.

Both RESPOND SEAOHUN and TEPHINET, have contributed to building this core capabilities to help one health stakeholders - organizations and health workers prevent and respond to public health risks effectively.

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Health issue

Zoonotic diseases, Health security

Setting

Greater Mekong Subregion

Background

The health security networks have played a critical role in strengthening risk communications for OH. This has been achieved through information sharing, communications support, and capacity building. With respect to capacity building on risk communications, training and programs have been instrumental in strengthening outbreak communications. With special reference to Greater Mekong Subregion (GMS), these trainings are of relevance given the vulnerability of the countries to be exposed to zoonotic problems[1]. The key risk communications training in focus for the purpose of this case study are from health networks - RESPOND SEAOHUN and Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET). Both these trainings bring rich thematic knowledge on zoonotic diseases and addressing communications challenges during an outbreak response[2].

Risk communication is a key component of emergency response that all countries should have to respond to health threats. It is one of the eight core capacities under the International Health Regulations (IHR) - a legal framework designed to help countries prevent and respond to public health risks. Both RESPOND SEAOHUN and TEPHINET, have contributed to building this core capabilities to help one health stakeholders - organizations and health workers prevent and respond to public health risks effectively. Both training modules have contributed towards OH promotion strategies during an outbreak response to build trust, reduce fear and understand the perceptions of risks.

However, key engagement challenges that persist in GMS are related to the culture of communications. Communications is situational, most of it happens when an emergency or disaster strikes. The preparedness aspect of communicating at all levels on OH related to emerging zoonotic diseases to prevent them from reaching the point of outbreak is an issue. Cultural norms also play a critical role in behavioral change communications. It is observed that staff shortage, financial and time constraints have also contributed to this situational nature of communications.

As these training programs guide organizations and health workers on best practices of communications when an outbreak happens - emergency response stage is recommending expanding the scope of trainings to include all stages of risk communications - preparedness, prevention/mitigation, reduction, control, response, and recovery.

This is to redirect the focus of OH risk communications strategies to be rooted in addressing the emergence and resurgence of zoonotic diseases. The content of the training must bring best practices of social marketing to sensitize before an outbreak happens and to control a spill over of zoonotic transmissions.

What took place?

Expansion of training to cover all stages will contribute towards addressing the issue of culture of situational communications. It is observed that often there is an overlap in between various stages, therefore effective risk communications require communications at all levels.

Expansion of the training content should address best practices on preparedness for OH stakeholders - organizations and health workers involved in responding to zoonotic problems. Content should aim at ensuring that OH stakeholders can anticipate and respond effectively to the impact of imminent, or current hazards, events, or conditions .

This expansion will grow the levels of engagement from organizations and health workers to OH communities . This will be done by including preparedness messages for health committees and other preferred communications channels for OH community. Preparedness communications will contribute towards building resilience at all levels - community, organizations and health workers involved in responding to emerging zoonotic diseases.

This expansion will include various mitigation methods for organizations and health workers to follow. These will include examples of zoonotic diseases and best practices on breaking the chain of transmission of these diseases. Overall, the focus of this expansion is to “act early” and create a culture of active and consistent communications.

Media plays a central role in sensitization of OH communities about emerging zoonotic diseases. Training will cover a section for journalists to inform early without creating a scare and panic. This will further create a culture of active communications.

Overall, expansion of training content must include new zoonotic diseases and not limit itself to Zika as a case study example. Previous training module by TEPHINET used Zika as an example, extended modules must include emerging food borne diseases. Risk assessment and engagement with climate change actors must be done to inform selection on emerging zoonotic diseases in GMS region to maximize impact of expanded trainings. Relapse and resurgence of zoonotic diseases is commonplace in GMS region. Both TEPHINET and RESPOND SEAOHUN, provide critical information on management of diseases, however recovery stage must be covered in module expansions.

Recovery stage must carry the same message to “act early”, best practice examples must be included to encourage practices to prevent relapse and resurgence of zoonotic diseases. For example, COVID - 19 pandemics which is a zoonotic disease had relapse after recovery. Recovery food has been recommended by medical practitioners to prevent resurgence of pandemics.

How active social marketing can change behaviors on food habits?
Many initiatives address spill over risk among people at high risk because of occupation or avocation (e.g., working in wet animal markets, recreational hunters), cultural norms, 19 or who are subsistence wild animal consumers. In the Brazilian Amazon, a before-after control-intervention design assessed social marketing (an information campaign and community engagement) with and without an economic incentive (discount coupons for chicken) on wild meat consumption. Coupons increased chicken consumption but did not reduce wild meat consumption. Social marketing without the price incentive reduced wild meat consumption by ∼62%.

Similar social marketing best practices should be included for risk communications to raise awareness on prevention of emergence and resurgence of zoonotic diseases. For the ultimate objective to create a culture of consistent and proactive communications on emerging zoonotic problems and prevent an outbreak in the GMS region and afar.

Interlinkages between existing infectious diseases and emerging risks of zoonotic diseases cannot be ignored. Therefore, its essential that expanded training modules address drivers of spill overs to avoid new emerging risks of zoonotic problems. Therefore, effective risk communication methods proposed in the training curriculum must ensure “control” stage receives attention in the module. Reporting techniques must be included - to strengthen self-reporting capacity of health committees and OH communities to make them drivers of change and active participants in controlling spillover of zoonotic diseases.

Since the purpose of the expanded training module is to inculcate active communication habits, there will be inclusion of case examples related to traditional methods of communications on preparedness existing in the GMS. This would make it more appealing for GMS stakeholders as it will be related to their culture of communications. Similar work has been done in other contexts like the pacific – where learning of traditional knowledge has ignited interest of stakeholders to work towards preparedness communications.

How can traditional knowledge build preparedness communications capacity?
In Vanuatu, disasters like cyclones lead to zoonotic problems especially food borne diseases due to contamination of food. Villagers in Tanna have actively used traditional language to predict a cyclone so they can preserve their food and prevent food borne disease related zoonotic problem. Generations of Indigenous islanders have learned to look for signs of oncoming cyclones. These include trees bearing unusually large amounts of fruit, and a sea-dwelling bird that appears on land only when a cyclone threatens. These signs are used as preparedness information to store food and avoid food borne zoonotic diseases .

What have we learnt?

Overlaps often happen between various stages of risk communications. Therefore, its pivotal that trainings build linkages between all stages with example of emerging zoonotic diseases in the GMS region. Since culture plays a significant role in changing behaviors - preparedness risk communication methods must address connection to all stages in the trainings with sensitization message at each stage to build the consistency of communications.  How various levels engage with each other - the media, OH committees - communities, health workers and organizations will be clarified. Lastly, the health networks will play central role in sharing of training practices to expand knowledge on all stages of risk communications for a better prepared OH community.

References

  1. Zoonoses are diseases that are transmitted between animals and humans.
  2. RESPOND SEAOHUN, One Health Training - Risk Communications
  3. Humanitarian Response, https://www.humanitarianresponse.info/en/coordination/preparedness/what-preparedness, accessed on June 7, 2022.
  4. One health (OH) communities are communities receiving OH services or under risk of (OH) related issues.
  5. Sama, Divya, Back to the future in cyclone stuck Vanuatu -  “we can learn from traditional knowledge”, accessed on June 7, 2022.
  6. Harvard Global Health Institute, Report of the Scientific Task Force on Preventing the Pandemics, pg 18.
  7. TEPHINET