Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
MAR 3 1 2010

ADMINISTRATIVE ORDER
No. 2018 - 0008

SUBJECT: INTERIM GUIDELINES ON RISK COMMUNICATION FOR

DENGUE/DENGVAXIA IMMUNLATION CONCERNS

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 communicationmeasures that would allay the fears of the public while
providing correct and evidence-basedinformation.

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.

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila 0 Trunk Line 651—7800 local 1113, 1108, 1135
Direct Line: 711-9502; 711—9503 Fax: 743—1829 0 URL: http://www.doh.g0v.ph;e—mail: [email protected]
/\/
 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

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.

Specific Objectives:
. To streamline public engagement efforts of the DOH.

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

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

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

IV. GENERAL GUIDELINES

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

. The following principles shall be observed in the implementation of the risk

communication plan:

few
 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.

SPECIFIC GUIDELINES
. 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.

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

. Emphasis, focus and content of risk communicationmessages 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).

. Monitoring and evaluation shall be conducted periodically to assess the effectiveness of

risk communication interventions.

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

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

fl
Wig
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/concernsrelated with dengue/Dengvaxia.

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.

The primary and alternate spokespersons may assign a Chairperson or C0-

Chairperson of the Dengue Task Force as their alternate in their absence when
necessary.

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

In the interim, all informationthat 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 informationthat is likely to be misunderstood shall
be handled with caution. Consultationwith Task Force Committeemembers 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;
0. Coordinate closely with the CO and ROs, all received updated data and various
queries;
(1. Contribute updated data to the informationbank maintained by HPCS.

Ai‘ ”l
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;
(1.Conduct risk communication training based on the approved module by Health
Human Resource Development Bureau (HHRDB);
6. 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;
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,
governmentorganizations (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 A0 58 s.
2001.
k. Shall adopt the attached Risk Communication Implementation Plan (Annex B).
The plan must utilize above-the-linemedia engagement (print, television, radio,
billboards and intemet) 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. Coordinatewith the HPCS in the development of risk communicationplans and
other related activities.

/§' fl
 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
(1. 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
0. 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.

/‘z§ Hi
 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 sponsorshipas reflected in A0 58 s. 2001.

Adopt the attached Risk Communication Platform Implementation Summary

(Annex B). The plan must utilize above-the-line media engagement (print,
television, radio, billboards and intemet) 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.
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 coordinationwith the R0.

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 A0 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 intemet) 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 intemet) 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.
(1. Collate and report common queries elicited from the Public Assistance Desk
‘

and Denghaxia 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.

/“2§“' fl”
 i. External Stakeholders Meeting:
a) Dialogue with parents/families of Dengvaxia Vaccinees
‘

b) PTA Meetings with School Doctors and DepEd Nurses

0) Forums with Chief of Hospitals and LGU partners
(1) 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.

ISCO . DUQUE III, MD, MSc

Secretary of Health
 ANNEXA
Scenario Based Audience Analysis

Audience Channels Messenger Concept Messages lMaterials,

etc.

Dengvaxia Face—to-face Health worker/clinic/ DOH cares for you; 0 We know that Messaging
vaccinees: HEPO we want to listen to people are
your concerns and concerned; W6
Parents guardians understand your
3 rebuild trust Training on
and children fears ,
act1ve
. listening, etc.
0 We W111 do
whatever we can to
Letter/call ::::::ry/DOH/Health Anyone who address your needs .
and concerns L ett er or scrlpt
received Dengvaxia
can get free health
check and health
care if needed

Facebook
. Secretary/DOH/Health
message/lee worker . .

Opportunity to raise Script/talking

p01nts
concerns and ask
questions

Health workers Training/internal DOH/Regional Build trust among 0 We care about Training
guidance Ofiices/LGU health workers; people’s health. materials
Health workers and
K
At//
 .
mafififibmtom w:E_0§&:0m w:fl~0§::0m

Wfifiwfiwmmoz wfiw0mm0§ wfiw0mm02 wfiw0mm0§

wfififih 0:00.500:

3:5: 3:6: 3E0:

00
0:0 0:0 m0 0:0 8 00
d—HMQOQ
0000: 0000: 0000:
00 :00 WEBER :00 :00

0:03 0:00:
055:: 30070
20 0:0: 0B
:0 03 03
0:00:03
03H 50% 50% 50%
wofifimm
00 9:00:00
0:0Et0m0m

000
00 0:60:00
00 mEDOfiOO

mo
:00 :05 0.00m 00 :05 0:00
53
:0 850:3 m0E000>
00:56”: 550003 55:06,»
wfiviok O>OHQEH @0300:

0 :29: 0 0 0
002000 008000 008000
0:00: £000:

2: 3 3
0:0 0:0: 0:0 flan
W0 >9 0:0 0:: >9

03

8 mU—HHOHNQ
EOQ
mafia,
0550:
0:09:50
0:0
EOQ

0:0
0 E00
0.0300:

E
300.:
80%05
0:03
:0 8 8
00500
00:0
8
0000:3888
@6300 £05
$0000 00:00:60
000.: 030:0:
0m900 50% Son—0

5:0: 0:03
Em
:000::0m£
UOEOOQOO

0
:0fi0w8 05:0:00 0w0mm0E m0fioo0>

0
0w0w:0 3:00.:
00:5 mom 2:5 0:80
«ms: M000
0:0 0:0 03 0:0 0:0
0:00
00 >9

:0
8:00 8:00 8:00
“:8“

:
0
00:05:00:

9:30: 0
M
: 0:0 0:0 0:0
.

0
B
a:
0mm0n<EOQ

0mx0>m:0m
3000:00m b000000m 3000:00m
0EO0Qm £0650 03050 £0630
wfififi:
00
m

.00080002
008:0”3003 350002
000

-0H-000m\wfifi0:k
E00:
m
00
$30002
008:0”: #0::0m
:Borw 8509 000
000,:

0:0
0:0EE0>0w

0:0 200050

000:0m\000:w:00

0:0:000H
3:08:300 0:0M0EB0A
E
200:8
EDD :200 #003
 «:58

wqgéafim €233:an
Etoflbfi2

L
wfiwmmmvz wfiwgmog

3E8 EEO 3:59 32%

mo
8 mo
8 8
$8:
8
mucus muons
S8 :3 :8
#38:
:23: 3:8:

En:
:28:
95
59»
8 25 H59»
Bonn 5:3:
o?
So»
Sons
.523:

0.5
ow 8m
ow ow
3.50:8 mEoonoo 25280

can WERE 93 Senna

EB 352880 wagoafiw
53 28 EB 88
SEE? 553:3 558:3
$8??? mafia? 965:: $823 whisk,» $0.63
who—moon
3335 923%
ECO EDD

% 85 was
an 03 can 0.3 03 was 03

03
EDD m0
88
@0389
was
3
8
33.5
E 0858 a Ba
:8» Scan
“25 0336“
is
ES,» notmgomfi

a
8388’
333.:
:28: 33m 23m EOQ
M93 83
03 ma

mEoEo 308

5:8 550
ES PE“
owns
can can
$3050

mOmE :38
Hoaofibfiobom

msoaommoxomm

bfioaoom bmwoaoom Meg—comm

.588 “DOM SEE

can
wmoa
quuooz

comm
«€05

8 mzmohuotoq

“memOEm
woouohomnoo

mBoHEBE

$8.8m
Eoom
cash

can
83:9
336a
E0608

$393305
3:068on
358qu

.580
33on £82
 ANNEX B
REGIONAL/LOCAL DENGUE RISK COMMUNICATION PLATFORM IMPLEMENTATION SUMMARY
LOCATION OF
TARGET AUDIENCE TIMELINE
Platforms DISSEMINATION
(Who will see it?) (When will it be posted?)
(Where will it be posted?)
A. Multimedia and Social Media
1. Poster
Social Media Card
Brochure
Flyer
Letter to Parents
Print Ad
EWPWSF‘P'PP’P

Radio Ad
TVAd
Text Blast

. External Relations
Forum
Dialogue
5‘5”?J
Interview/Briefing
Press Conference and Press
Release

§\