Interim Guidelines on Risk Communication for Dengue/Dengvaxia Immunization Concerns

March 1, 2018

DOH ADMINISTRATIVE ORDER NO. 2018-0008

 

I. BACKGROUND AND RATIONALE

The Dengue Vaccination Program utilizing the CYD-Tetravalent Dengue Vaccine (Dengvaxia) was implemented by the Department of Health (DOH) in March 2016, in regions where dengue was found to be highly endemic, namely: the National Capital Region (NCR), Region 3, Region 4A, and Region 7. At least 850,000 individuals were vaccinated through school- and community-based immunization programs. The programs were however suspended in December 2017, following the vaccine manufacturer's announcement of findings suggesting an increased risk of severe or hospitalized dengue among seronegative individuals.

The alleged adverse effects of Dengvaxia raised concerns from the public. And several conflicting messages aired by different groups in traditional and social media has affected the public's trust in the DOH immunization program. To address this concern, the DOH needs to employ risk communication measures that would allay the fears of the public while providing correct and evidence-based information.

Risk communication is defined as a conversation or a two-way engagement about an adverse event and the probability of that event affecting the health of individuals. It is used to help individuals adjust to the knowledge of an unexpected or undesirable outcome, inform them about courses of action to help themselves and the community, and to lead them to make the best choices given emergent and changing circumstances. Fear and anxiety among the public can be alleviated by providing well-timed, correct, and appropriate information. Thus, risk communication should be based on best available scientific information and is exercised with heightened consciousness of social responsibility. TIADCc

This set of interim guidelines outlines the strategies and tools that shall utilized to address public concerns about Dengvaxia immunization, and rebuild the public's trust in the immunization program of the DOH.

II. SCOPE

This Order shall apply to all DOH offices in the Central Office (CO), Regional Offices (ROs), all DOH-retained hospitals and attached agencies. It shall also apply to the local government units (LGUs), other government entities engaged in health care, and other health development partners.

It covers the delivery of key messages on immunization, dengue prevention, and actions undertaken by DOH.

III. OBJECTIVES

A. General Objective:

To institutionalize and streamline DOH's risk communication strategies to effectively address public concerns, misconceptions, and mistrust towards the DOH immunization program brought about by issues related to Dengvaxia.

B. Specific Objectives:

1. To streamline public engagement efforts of the DOH.

2. To properly disseminate information, education, and communication (IEC) materials.

3. To create a structured referral system and protocol for data release.

4. To provide a mechanism for monitoring and evaluation of health education strategies.

IV. GENERAL GUIDELINES

1. The DOH shall adopt an integrated risk communication strategy to effectively manage public concerns related to Dengvaxia vaccination.

2. The following principles shall be observed in the implementation of the risk communication plan:

a. Build Trust. Trust is based on public perception of the motives, integrity and competence of the messenger and the belief that they are acting to safeguard overall public health.

b. Lead. The DOH must lead in communicating clear, consistent, and positive messages. Credible and sincere leaders reinforce trust.

c. Acknowledge Fears. Public concerns shall be listened to and acknowledged as legitimate. Public perception must be respected as a force that can influence the outcome of a highly publicized vaccine-related incident.

d. Show Empathy and Care. The DOH must show empathy and concern while addressing public concerns and issues.

e. Respond. The DOH must respond timely and appropriately to alleviate the public's apprehensions and concerns.

f. Encourage Action. Encourage and involve the public to take action in resolving and alleviating the concerns and apprehensions.

g. Be transparent. The DOH must be transparent, open and accountable in addressing the public's concerns and apprehensions. Increased transparency helps build trust.

h. Be Timely. Timely approval and dissemination of all information shall be practiced.

V. SPECIFIC GUIDELINES

1. A speakers' bureau shall be organized at the CO, ROs, and all DOH-retained hospitals to provide orientations, presentations or lectures, as needed. The speakers should be oriented thoroughly, and the information drive must be closely monitored to ensure the appropriate use of recommended materials and to guarantee conformity with the standard message. SDAaTC

2. The Risk Communication Plan must utilize various platforms of communication.

3. Emphasis, focus and content of risk communication messages shall be adjusted to the local situation. Foreseen risks and susceptibilities of the local population to dengue infection or Dengvaxia vaccination concerns, and public reaction to these, shall be considered in the design of messages and communication strategies (See Annex A).

4. Monitoring and evaluation shall be conducted periodically to assess the effectiveness of risk communication interventions.

5. Queries from all social media platforms shall be answered in real-time.

6. Messages shall be periodically developed and updated based on the public's feedback and from monitoring and evaluation findings.

VI. ROLES AND RESPONSIBILITIES

A. DOH EXECUTIVE COMMITTEE MEMBERS & SPOKESPERSONS

1. The Secretary of Health shall be the primary spokesperson tasked to respond to issues/concerns related with dengue/Dengvaxia.

2. In the absence of the Secretary of Health, the Co-Chairperson of the Dengue Task Force Steering Committee and the Chairperson of the Technical Committee are the designated alternate spokespersons.

3. The primary and alternate spokespersons may assign a Chairperson or Co-Chairperson of the Dengue Task Force as their alternate in their absence when necessary.

4. At the ROs, the Regional Director shall be the primary spokesperson and the Assistant Regional Director shall be the alternate spokesperson.

5. In the interim, all information that will be released to the public (orally or in writing) shall be reviewed and cleared by the Dengue Vaccine Task Force, and/or appropriate DOH offices. New information that is likely to be misunderstood shall be handled with caution. Consultation with Task Force Committee members and/or experts shall be made to ensure that information is communicated in the best way possible.

a. The Media Relations Unit (MRU) shall prepare all press releases. The press release shall be cleared by the offices concerned (e.g., Disease Prevention and Control Bureau (DPCB), Epidemiology Bureau (EB), among others) and approved by the Office of the Secretary (OSEC) before they are released to the media.

b. All concerns from the sub-national levels (province, city, municipality and barangay) shall be managed at the regional office under the leadership of the Regional Director.

B. CENTRAL OFFICE UNITS

1. Dengue Vaccine Task Force shall:

a. Provide technical clearance on all data and materials to be released to the public through its respective committees;

b. Coordinate closely with Health Promotion and Communication Service (HPCS) in planning and conducting risk communication activities;

c. Coordinate closely with the CO and ROs, all received updated data and various queries;

d. Contribute updated data to the information bank maintained by HPCS.

2. Health Promotion and Communication Service shall:

a. Conduct planning and promotion activities for dengue/Dengvaxia risk communication;

b. Lead in the development and production of risk communication materials in consultation with the Dengue Vaccine Task Force, and/or other concerned DOH offices and partners/stakeholders;

c. Plan and produce advocacy and information materials, subject to technical clearance from the Dengue Vaccine Task Force, and/or other concerned DOH offices. The Secretary of Health shall approve the IEC materials before mass production;

d. Conduct risk communication training based on the approved module by Health Human Resource Development Bureau (HHRDB);

e. Monitor and evaluate the implementation of activities in the risk communication implementation plan;

f. Translate plans, validated and approved reports, statistical updates and technical materials into various visual and audio-visual forms; acEHCD

g. Disseminate appropriate and adequate IEC materials and communication plans/reports to CO, ROs and target audiences (i.e., public, media, and other stakeholders);

h. Maximize the use of all social media platforms to reach the public by posting dengue/Dengvaxia-related IEC materials and providing responses to their queries and concerns;

i. Be authorized to respond directly to social media comments based on current messaging and standard answers of Frequently Asked Questions (FAQs).

j. Shall mobilize partners in the private sectors such as, business organizations, government organizations (GO), non-government organizations (NGOs), faith-based organizations (FBOs), and development partners for information dissemination, IEC reproduction and media space or airtime following the guidelines of HPCS for partnership or sponsorship as reflected in AO 58 s. 2001.

k. Shall adopt the attached Risk Communication Implementation Plan (Annex B). The plan must utilize above-the-line media engagement (print, television, radio, billboards and internet) and below-the-line engagement (public engagements, forums, meetings).

3. Media Relations Unit shall prepare and issue press releases, conduct press conferences, and arrange media interviews in relation to dengue/Dengvaxia concerns.

4. Epidemiology Bureau shall:

a. Provide relevant, timely, validated and approved epidemiological data for the use of risk communication planners;

b. Conduct risk assessment in coordination with the DPCB, HPCS, and their regional counterparts; and

c. Coordinate with the HPCS in the development of risk communication plans and other related activities.

5. Health Emergency Management Bureau shall:

a. Provide relevant and validated data/information from EB for the consumption of the general public;

b. Compile feedback from the Public Assistance Desk and respective Dengvaxia hotlines;

c. Communicate feedback to HPCS and DPCB; and

d. Coordinate with HPCS in the development of risk communication plans and related activities such as capacity building.

6. Disease Prevention and Control Bureau shall:

a. Provide technical assistance in the development of risk communication plans, key messages, and IEC materials;

b. Compile feedback from the Public Assistance Desk and respective Dengvaxia hotlines; and

c. Communicate feedback to HPCS and HEMB.

7. Family Health Office shall:

a. Compile feedback from the Public Assistance Desk and respective Dengvaxia hotlines; and

b. Communicate feedback to HPCS and DPCB.

8. Food and Drug Administration shall provide relevant and validated information on Dengvaxia for the formulation of risk communication messages.

C. REGIONAL OFFICES

The ROs shall:

1. Take responsibility in implementing the plans and directives of HPCS at the regional level.

2. Assist in the development and implementation of risk communication plan in coordination with local health authorities in the regional level.

3. Coordinate with HPCS and regional HEPOs in implementing, monitoring and evaluating the regional risk communication plan.

4. Designate an alternate spokesperson/s in the absence of the Regional Director as deemed necessary.

5. Translate and reproduce available media and IEC materials and develop media and IEC materials in the local vernacular. Materials produced by the LGUs and local partners must be cleared by the respective ROs for consistency.

6. Avail of relevant website and Facebook page postings in the DOH website after clearance of these materials from HPCS.

7. Mobilize partners in the private sectors such as, business organizations, GOs, NGOs, FBOs, and development partners for information dissemination, IEC reproduction and media space or airtime following the guidelines of HPCS for partnership or sponsorship as reflected in AO 58 s. 2001. HSAcaE

8. Adopt the attached Risk Communication Platform Implementation Summary (Annex B). The plan must utilize above-the-line media engagement (print, television, radio, billboards and internet) and below-the-line engagement (public engagements, forums, meetings).

D. DOH-RETAINED HOSPITALS

The DOH-retained hospitals shall:

1. Orient all hospital staff on the risk communication plan relevant to their situation.

2. Coordinate with ROs for necessary directives and plans in the region.

3. Utilize IEC materials produced by HPCS and ROs and develop media and IEC materials as deemed necessary. Materials produced by the LGUs and local partners must be cleared by the respective ROs for consistency.

4. Conduct interpersonal communication strategies as deemed necessary.

E. LOCAL GOVERNMENT UNITS

The LGUs shall:

1. Lead the provincial risk communication planning under the leadership of the Provincial Health Office (PHO) in coordination with the RO.

2. Lead the city/municipal risk communication planning under the leadership of the City Health Office (CHO)/Rural Health Unit (RHU) in coordination with the PHO.

3. Translate and reproduce available media and IEC materials in the local vernacular with the approval of the RO as deemed appropriate.

4. Mobilize partners in the private sectors such as, business organizations, GOs, NGOs, FBOs, and development partners for information dissemination, IEC reproduction and media space or airtime following the guidelines of HPCS for partnership or sponsorship as reflected in AO 58 s. 2001.

5. Adopt the attached Risk Communication Platform Implementation Summary (Annex B). The plan must utilize above-the-line media engagement (print, television, radio, billboards and internet) and below-the-line engagement (public engagements, forums, meetings).

6. Avail of relevant website and Facebook page postings in the DOH website after clearance of these materials from HPCS.

F. HEALTH EDUCATION PROMOTION OFFICERS

The HEPOs at HPCS, ROs and PHOs, and health workers designated as health promotion officers in RHUs/CHOs shall conduct the following strategies/activities as deemed necessary:

1. Plan for the optimal use of different mass media and social media communication resources: print, television, radio, short messaging system, facebook, website and other available social media.

2. Adopt the attached Risk Communication Implementation Plan (Annex B). The plan must utilize above-the-line media engagement (print, television, radio, billboards and internet) and below-the-line engagement (public engagements, forums, meetings). The plan shall indicate the distribution platform (traditional and social media), target audience, strategic areas for posting and frequency of circulation.

3. Monitor the dissemination of IEC materials.

4. Ensure prominence and visibility of developed risk communication tools/materials by utilizing the following audience engagement tactics:

a. Ensure frequent and strategic mass media engagement to effectively inform the public.

b. Strategically use social media as a real-time and direct means of communication to both external and internal stakeholders.

c. Maintain a Public Assistance Desk and Dengvaxia hotlines, in coordination with the FHO, to address concerns relating to dengue/Dengvaxia especially questions on financial assistance.

d. Collate and report common queries elicited from the Public Assistance Desk and Dengvaxia hotlines.

e. Create weekly content addressing queries posted online, including those coursed through the Public Assistance Desk and Dengvaxia hotlines.

f. Answer at least 50% of incoming social media queries on a daily basis.

g. Initiate a quarterly internal and external stakeholders meeting that aims to maintain a sound relationship with various audience groups affected by the Dengvaxia vaccination. HESIcT

i. External Stakeholders Meeting:

a) Dialogue with parents/families of Dengvaxia Vaccinees

b) PTA Meetings with School Doctors and DepEd Nurses

c) Forums with Chief of Hospitals and LGU partners

d) Training of Barangay Health Workers

ii. Internal Stakeholders Meeting:

a) Training and briefing of DOH employees.

h. Create a timeline of field visits to strategically plan frequency and monitor implementation of DOH efforts to directly address queries of internal and external stakeholders.

VII. FUNDING

The funding necessary to implement the provisions of this Order shall be chargeable against the funds of HPCS and regional offices, whichever is applicable. Also, the Office of the Secretary shall augment the funds as deemed necessary.

VIII. EFFECTIVITY

This Order shall take effect immediately.

(SGD.) FRANCISCO T. DUQUE III, MD, MScSecretary of Health

ANNEX A

Scenario Based Audience Analysis

Audience	Channels	Messenger	Concept	Messages	Materials, etc.
Dengvaxia vaccinees: Parents, guardians and children	Face-to-face       Letter/call         Facebook message/Live	Health worker/clinic/HEPO     Secretary/DOH/Health worker         Secretary/DOH/Health worker	DOH cares for you; we want to listen to your concerns and rebuild trust Anyone who received Dengvaxia can get free health check and health care if needed Opportunity to raise concerns and ask questions	• We know that people are concerned; we understand your fears • We will do whatever we can to address your needs and concerns	Messaging Training on active listening, etc.   Letter or script         Script/talking points
Health workers	Training/	DOH/Regional Offices/LGU Specific training on Dengvaxia response	Build trust among health workers; build capacity to engage with concerned parents and communities	• We care about people's health. Health workers and the DOH are working hard to improve the health of all Filipinos	Training materials   Messaging
Teachers and schools	Training/face-to-face	DOH/DepEd joint training Health workers	DOH cares; DOH and DepEd working together to rebuild trust	• We will do whatever we can to address your needs and concerns • Vaccines work and are safe	Training materials Messaging
DOH Officials	Town Hall/Formal Meetings	Secretary and senior officials	We must all continue to support the EPI program and reinforce the message that vaccines work	• Health workers and the Department of Health are working hard to improve the health of all Filipinos	Script/talking points Messaging
Other government departments	Town Hall/Formal Meetings	Secretary and senior officials	Build trust in DOH as a reliable and truthful source of information	• We will do whatever we can to address your needs and concerns • We care about people's health	Script/talking points Messaging
Lawmakers and staff in Congress/Senate	Face to Face Formal Meetings	Secretary and senior officials	We want to earn back your trust; we care about people's health	• We will do whatever we can to address your needs and concerns • DOH and health workers are working hard to improve health of all Filipinos	Script/talking points
Other medical and professional groups	Face to Face Letters/calls Formal Meetings	Secretary and other senior officials Secretary/senior officials	We want to earn back your trust; we care about people's health	• We will do whatever we can to address your needs and concerns • DOH and health workers are committed to improving health of all Filipinos	Script/talking points Draft letter/script
Media, including broadcasters	Briefings, press conferences and interviews	Secretary and other spokespersons	Build trust in DOH as a reliable and truthful source of information	• We will do whatever we can to address your needs and concerns • We care about people's health	Script/talking points Messaging
Concerned public	Social media	RCC, HPCS and social media team thru Facebook page	Build trust in vaccines and in DOH	• We will do whatever we can to address your needs and concerns • We care about people's health.	Messaging Social media kit

ANNEX B

Regional/Local Dengue Risk Communication Platform Implementation Summary

 

Platforms	TARGET AUDIENCE (Who will see it?)	LOCATION OF DISSEMINATION (Where will it be posted?)	TIMELINE (When will it be posted?)
A. Multimedia and Social Media
1. Poster
2. Social Media Card
3. Brochure
4. Flyer
5. Letter to Parents
6. Print Ad
7. Radio Ad
8. TV Ad
9. Text Blast
B. External Relations
1. Forum
2. Dialogue
3. Interview/Briefing
4. Press Conference and Press Release