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Influenza A(H1N1) outbreak: communication approaches and guidelines

© World Health Organization 2009. All rights reserved. This health information product is intended for a restricted audience only. It may not be reviewed, abstracted, quoted, reproduced, transmitted, distributed, translated or adapted, in part or in whole, in any form or by any means. The designations employed and the presentation of the material in this health information product do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this health information product is complete and correct and shall not be liable for any damages incurred as a result of its use.

Contents ABOUT THIS DOCUMENT: OVERVIEW AND CONTEXT ................................................................... 3 BACKGROUND .................................................................................................................................... 4 Essential information about influenza A(H1N1)................................................................................. 4 ABCs of influenza pandemics ........................................................................................................... 5 Effective outbreak communication .................................................................................................... 6 COMMUNICATION APPROACHES ..................................................................................................... 7 Principles .......................................................................................................................................... 7 Behavioural interventions for reducing transmission and impact: a framework for developing communication strategies ................................................................................................................. 9 Dealing with media: practical tips.....................................................................................................10 COMMUNICATIONS PLANNING ........................................................................................................12 Architecture .....................................................................................................................................12 Target audience identification ..........................................................................................................13 Communication channels ................................................................................................................14 Monitoring and evaluation................................................................................................................15 ANNEXES 1. WHO pandemic phase description...................................................................................................16 2. Prioritized behavioural goals in a country with cases of influenza A(H1N1) .....................................17 3. Messages for prevention of influenza A(H1N1)................................................................................19 4. Most frequently asked questions by journalists in an emergency.....................................................26 5. Checklist for strategic communications planning and implementation..............................................27 6. Sample monitoring and evaluation indicators...................................................................................28

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ABOUT THIS DOCUMENT: OVERVIEW AND CONTEXT
Whatever the situation of a country or region with regard to the influenza A(H1N1) outbreak, a communication strategy is essential. Communication plays two vital roles in a pandemic. 1. It is a tool to support the country reponse to the pandemic. It is only through effective communication that WHO can provide essential information to Member States, partners, and other audiences. 2. It is also a public health intervention. Information to the public about precautionary behaviours can help people limit the impact of the disease. Particularly in resource poor areas, communicating advice and guidance can be one of the most important public health tools in managing a risk. This document was prepared primarily to provide WHO Representatives and WHO communications staff with practical guidelines and tools for a country-specific communication response to the influenza A(H1N1) outbreak. It may also be shared with WHO partners and counterparts in ministries of health, UN agencies and other institutions as its content is useful for and adaptable to the needs of partners. It includes messages, target audiences, processes and notional information for the outbreak situation. Apart from the WHO draft communication strategy for influenza A(H1N1) that was developed by WHO headquarters and has been instrumental in formation of this document, the following WHO publications and presentations were reviewed and used in different parts of this document: • • • • • • • WHO communications: a global approach, 2006 WHO outbreak communication guidelines, 2005 Outbreak communication, Best practices for communicating with the public during an outbreak Report of the WHO Expert Consultation on Outbreak Communications held in Singapore, 21–23 September 2004 WHO communication training modules Effective media communication during public health emergencies: field guide Creating a communication strategy for avian/pandemic influenza, PAHO

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BACKGROUND

Essential information about influenza A(H1N1)
As of 6 June 2009 • This virus was originally referred to as “swine influenza” because the initial laboratory testing showed that many of the genes in this new virus were very similar to animal influenza viruses that normally occur in pigs in North America. However, it is now clear that the novel A(H1N1) virus has a unique combination of swine, avian and human genes that has never been seen before. • There is no evidence that the current influenza A (H1N1) outbreak started by transmission of the virus from pigs to humans. • The influenza A(H1N1) virus is a new virus that is spreading rapidly over the globe, carrying a high potential for pandemic due to the lack of immunity against it in the general population. The timing and severity of a potential pandemic cannot be predicted at this time. • New diseases are, by definition, poorly understood. As stated by Dr Margaret Chan, DirectorGeneral of WHO, “The only thing that can be said with certainty about influenza viruses is that they are entirely unpredictable. No one can say, right now, how the outbreak will evolve. From past experience we also know that influenza may cause mild disease in affluent countries, but more severe disease, with higher mortality, in developing countries.” • The virus is transmitted from human to human through infected respiratory droplets. When infected people cough or sneeze, infected droplets get on their hands, drop onto surfaces, or are dispersed into the air. Another person can breathe in contaminated air, or touch infected hands or surfaces, and be exposed. To prevent spread, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly. • Early signs of influenza A(H1N1) are flu-like, including fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting or diarrhoea. • In comparison with seasonal influenza, which causes more serious illness in the very young and the elderly, it appears that infuenza A(H1N1) virus tends to affect young, healthy adults. • The incubation period (time between infection and onset of symptoms) according to the latest information is around 3 days (it ranges from 1 to 7 days). • People appear to be contagious 1 day before the onset of their fever and other symptoms, and up to 7 days after the onset of symptoms. • At present there is no vaccine against influenza A(H1N1) but WHO collaborating centres are already working on development of a vaccine. Making a completely new influenza vaccine can take 5 to 6 months. • The best scientific evidence available today is incomplete but suggests that seasonal vaccines will confer little or no protection against influenza A(H1N1). • Tests on viruses obtained from patients in Mexico and the United States have indicated that current new H1N1 viruses are sensitive to oseltamivir and zanamivir. • As of May 2009, symptoms in most infected persons with influenza A(H1N1) virus have been mild and people have generally recovered without significant medical interventions. As the virus circulates within the population around the world, it might develop into a type to cause more serious disease. • The risk of severe illness requiring hospitalization does not seem higher for the current influenza A(H1N1) virus than in previous pandemics (about 1%–2%) in high resources settings. In low resource settings and among vulnerable groups with low access to health care and high prevalence of specific risk factors, the risks of severe illness may be up to 10%. Preliminary data from the current influenza A(H1N1) outbreak show a relatively low case-fatality ratio (probably less than 0.5%) in high resource settings that might reach up to 4% or more in low resource settings.

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ABCs of influenza pandemics
A disease epidemic occurs when there are more cases of that disease than normal. A pandemic is a worldwide epidemic of a disease. An influenza pandemic may occur when a new influenza virus appears against which the human population has no immunity. With the increase in global transport, as well as urbanization and overcrowded conditions in some areas, epidemics due to a new influenza virus are likely to take hold around the world, and become a pandemic faster than before. WHO has defined the phases of a pandemic to provide a global framework to aid countries in pandemic preparedness and response planning. Pandemics can be either mild or severe in the illness and death they cause, and the severity of a pandemic can change over the course of that pandemic. Potential consequences In the past, influenza pandemics have resulted in increased death and disease and great social disruption. In the 20th century, the most severe influenza pandemic occurred in 1918–1919 and caused an estimated 40 to 50 million deaths worldwide. Current epidemiological models project that a pandemic could result in 2 to 7.4 million deaths globally. If an influenza pandemic were to occur today, we could expect the virus to spread rapidly due to the interconnected nature of the world and the high level of global travel. If the pandemic evolved to become severe and widespread over time, we could also expect: • vaccines, antiviral agents and antibiotics to treat secondary infections to be in high demand, and potentially in short supply; • medical facilities to be strained with demands to care for both influenza and non-influenza patients; • potentially significant shortages of personnel to provide essential community services. Effective pandemic preparedness around the world is essential to mitigate the effects of a pandemic, particularly if it becomes severe. WHO pandemic alert phase descriptions

Please see Annex 1

In the 2009 revision of the pandemic phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans. The grouping and description of pandemic phases have been revised to make them easier to understand, more precise, and based upon observable phenomena. Phases 1–3 correlate with preparedness, including capacity development and response planning activities, while Phases 4–6 clearly signal the need for response and mitigation efforts. Furthermore, periods after the first pandemic wave are elaborated to facilitate post pandemic recovery activities. WHO declares an influenza pandemic (Phase 6) when sustained human to human transmission of a novel virus occurs in two or more WHO regions.

IMPORTANT MESSAGES TO REMEMBER • The WHO pandemic alert system specifies the epidemiological criteria for each phase. When these criteria are met, as decided by a committee of experts, it is the responsibility of WHO to announce a new influenza pandemic alert phase immediately so as to alert Member States in order that they can prepare and respond appropriately. The pandemic alert phases indicate the extent of geographical spread of a disease, not the aggressiveness or severity of the disease. Geographical spread and severity should not be confused. Severity is determined according to specific epidemiological parameters and is based on a range of factors that include the virulence of the virus, the resistance of the host, the waves of a pandemic and the capabilities of health systems to respond. It is incorrect to state that the announcement of alert phase 5 or 6 means that countries will be paralysed and daily activities halted, especially if countries immediately activate their contingency plans. A pandemic may manifest itself in 2–3 waves (e.g. 2–3 months each year over 2–3 years). Not all parts of the world or of a single country are expected to be affected at the same time.
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Effective outbreak communication
Why there is a need for building trust, raising awareness and promoting behaviour change • Uncertainties are predominant in the influenza A(H1N1) outbreak and so far little is known regarding the virulence, transmissibility and pandemic potential of the virus. • The information gap puts health officials, at national and international levels, in the difficult position of needing to make far-reaching decisions urgently, yet without the kind of solid scientific back-up they normally like to have. In such an unstable information environment it is critical to make use of facts and solid data from trustworthy sources to inform educate, build trust and credibility through the establishment of a constructive communication strategy and plan of actions. • Sound and well documented communication approaches can assist to prevent or reduce public fears and rumours. Effective communication is a valuable tool to prompt appropriate public response such as good preventive practices contributing to the reduction of the disease spread. Good communication approaches are steps that health authorities can take in advance to better prepare communities and all segments of society. • An effective communication strategy should be an integral component of the influenza preparedness and response plan. It provides key directions on what to communicate, how to do it, by whom and to whom information is intended. • The risk communication strategy will look at what information is crucial, what are the messages to be delivered and what are the most appropriate vehicles and tools to use to do so. • By adopting a few key practices, people can protect themselves and reduce the chance of getting the virus. Everyone should follow preventive behaviours and learn how to protect themselves and their families from this new, emerging threat. It is important to be able to care for milder cases at home because if a community is hit by the disease, health care services could easily be overwhelmed and not be able to meet the demand from their population. Unique features of an outbreak • The impact may not be known for weeks or months, which leads to speculation and uncertainty • Decisions are often made when reliable information is limited: initial information will be incomplete and may be wrong • Outbreaks cause social and economic disruption, and therefore have strong political dimensions • Worry about public panic may lead to over-reassurance The main objectives of communication approaches and guidelines • Increase knowledge and change or sustain attitudes or behaviour of the intended audiences to ensure all segments of the population adopt preventive measures to reduce the human to human transmission of the influenza A(H1N1) virus. Protect the reputation of the Organization.

Whatever the situation of a country or region, a communication strategy is essential because communication plays two roles in a pandemic. • It is a tool to support the WHO's role in coordinating the global response to the pandemic. It is only through effective communication that WHO can provide essential information to Member States, partners, and other audiences. • It is also a public health intervention. Information to the public about precautionary behaviours can help people limit the impact of the disease. Particularly in resource poor areas, communicating advice and guidance can be one of the most important public health tools in managing a risk.

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COMMUNICATION APPROACHES Principles
Starting point • Outbreaks inflict harm • Outbreak communications cannot undo the harm…but they can help prevent further damage • Poor communications can do more damage…often a lot more Transparency • Trust is rooted in the perception of transparency • Information should be candid, easily understood, accurate and complete • This may require acknowledging uncertainty • Preparing senior decision-makers for candid communications is a key Influenza A(H1N1) is a new emerging disease about which little is known so far. Information is being collected by experts around the globe trying to understand its nature, its evolution and its impact on the community. The situation is evolving very quickly and the information released today may be amended the following days. When we don’t know something we should be frank with media and tell them that our information is subject to change and that there are still important gaps in information. Early disclosure • Get bad news out. Say what you know when you know it • Crisis situations are unlikely to “blow over” • Delay is a magnifier: the longer bad news is withheld, the worse the perception Speed counts • News travels fast…bad news travels faster • The first few hours are key to how the entire situation develops • How do you act quickly? By planning in advance Perception is reality • Public fears or concerns must be taken seriously • Acknowledge and address concerns • Deal with concerns factually but respectfully Plan ahead for your communication response • Establish an outbreak communications group in your office and determine responsibilities in advance • Anticipate, plan and rehearse different scenarios • Develop core message and Q&A documents in advance, then quickly update these as needed • Meet regularly to update scenarios, and each other • Know where to find everyone • Ensure that Ministry of Health understands, supports and participates in communication planning

WHO communications: musts • Support clear public health objectives • Be evidence-based and accurate • Identify problems and solutions • Focus on the actions WHO is taking to improve lives • Be consistent across the Organization • Be flexible to allow for changes in the global environment • Use a wide range of tools and outlets • Provide as many multilingual materials as possible
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Include and respond to monitoring and evaluation Take advantage of lessons learned

Be consistent internally and externally

In order to ensure consistency and avoid any confusion with regard to influenza A(H1N1), country offices should ensure that all communication materials, whether printed, video or audio, strictly adhere to the information released by WHO headquarters and regional offices. Where existing information is used, materials should use the same wording as the WHO documents on which they are based and which have already been cleared. • The internal audience is key. Make sure they know that the responsible officials are: – aware of the issue(s) – working to determine and communicate the facts – committed to rapid and candid disclosure Unauthorized staff should not communicate with any external audience Any information or enquiries should be shared with the communications team immediately

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Importance of the local context A good analysis of the national/local context is critical for the design of an adequate communication strategy. Several characteristics and indicators needs to be taken into account for the design of the communication interventions, the choice of channels and tools and the selection of the target audiences. Behavioural impact requires addressing important socio-cultural and economic factors, such as income level and gender, so that individuals are empowered to act on the information provided and marginalized and vulnerable groups have access to information and resources. Proper attention given to local characteristics will guide the communication specialist to tailor the communication strategy to the local features. Communication interventions will see their impact scaled up if the following factors are taken into account. • Demographic indicators (IDPs/refugees) • Literacy rate • Health systems, education system • Cultural and religious values, traditional beliefs • Population movements within and outside the country such as tourism • Numbers and location of airports, ports, railway stations, places of worship, etc • Immigration and health information sharing with the neighbouring countries • Traditional and modern media: reading, watching and listening habits of the population • NGO networks and community-based initiatives etc • Status of the national pandemic preparedness and response plan Coordination: A key to success Implementing a communication strategy to prevent human to human transmission of influenza A(H1N1) requires the combined efforts from contributing partners in order to ensure proper coordination and organization of communications for behaviour change activities at various stages (planning, implementation, logistics, monitoring and evaluation). The creation or reactivation of a communication joint steering committee appears to be the adequate response in order to foster an open partnership that will help harmonizing objectives, priorities, agendas, work plans and budget. In order to influence the adoption of positive behaviours, communications have to be cross-sectoral and closely linked to other programmes (agriculture, education, health, information, etc). Terms of reference should be developed indicating the key objective, specific objectives and outcomes of the working group. In this view, terms of reference of the task force will stress the roles and responsibilities of those involved and will clearly define the chain of command. The communication and coordination task force usually collects, analyses, develops and packages information based on inputs from other sources. It then distributes/disseminates information to a series of primary audiences either directly or via intermediaries.

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Behavioural interventions for reducing transmission and impact: a framework for developing communication strategies

The priority behavioural interventions (control and prevention measures) are global strategic recommendations that countries can adapt to reflect regional, national and local realities. The behavioural interventions support the public health goals of reducing transmission, morbidity and mortality related to influenza A(H1N1) through promoting actions for each of the following groups. 1. For those who are well, to avoid becoming infected 2. For those who are sick to avoid infecting others and recover from illness 3. For those who are caring for sick people to protect themselves and other family members from infection

Please see Annexes 2 and 3
Two important premises are:
• • information about the characteristics of the influenza A(H1N1) virus is limited and communication approaches and recommended behaviours will need to be adjusted as more evidence becomes available and over time behavioural impact requires addressing important socio-cultural and economic factors,such as income level and gender, so that individuals are empowered to act on the information provided and marginalized and vulnerable groups have access to information and resources.

Guiding principles in communicating about influenza A(H1N1)
• Share the rationale - explain to people why certain behaviours are important. Transparency in sharing information and its rationale helps build trust and is more likely to result in cooperation. • Encourage active engagement. Encourage people actively to seek information from credible sources, ensure that neighbours, communities and/or networks receive and understand accurate information, report possible influenza cases, and help communities in managing ill people. This approach views people as 'partners in prevention' and is critically different from perceiving people as simple recipients of information. It is likely to create ownership resulting in better adoption of recommended behaviours and thus more proactive communities. Such 'partners in prevention' are also more likely to find more creative ways of mobilizing community resources and will help build capacities which might be useful for future needs. • Aim to empower people with information. Be aware that individuals and communities will take their own decisions based on the balance of forces of their own circumstances. The communication approach should emphasize information sharing and community problem-solving as a way of supporting people to arrive at a set of do-able actions. How can we effectively prevent and protect against infection for ourselves, our families and our community?

• Adapt recommendations to the local context. Take into account people's capacity to act on advice
being given. Recommended behaviours need to be do-able and fit people’s lifestyle, or there will not be widespread adoption. Ensure that marginalized groups (such as slum dwellers, religious minorities, and those out of reach of mass media) are also engaged in prevention/protection, have access to information and the capacity to act upon it.

• Use existing resources and partnerships to develop effective communication strategies, messages
and materials quickly. Work through existing communication/ coordination bodies to harmonize messages, approaches and use of channels.

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Dealing with media: practical tips
Prepare now! • Develop in advance a process for rapid response to media questions • Whenever feasible, establish a hotline available for media enquires • Decide beforehand who will take media requests, how they will be reviewed, and who will decide how to address them • Establish a clear line of communications authority • Avoid conflicting messages or spokespersons • Identify a spokesperson or media focal point. Keep the person in charge visible. Make sure unauthorized staff do not communicate with any external audience • Make sure the official source is the best source Before accepting an interview, always ask yourself certain questions • Is the interview right for you? • Does the media outlet reach your audience(s)? • Are you the right spokesperson? • What is the reputation of this journalist or outlet? Things you should do before an interview • Know the journalist, outlet, and purpose of the interview • Know your audience • Know your messages • Plan an “exit” • Keep messages short and simple • Write them down • Practice them • Repeat them

Please see Annex 4 During the interview • Listen to the question • Emphasize your key message points • Establish your authority
Media interview Do’s and Dont’s Do’s • Tell the truth • Keep it simple • Be accurate • Be passionate • Respect time limits • Stick to your area of expertise and responsibility • No personal opinions Dont’s • Exaggerate or lie • Say anything you don’t believe • “Fake it” • Use insider language • Use foul language • Speculate about things you don’t know or can’t answer

Interview formats • Print – Face to face, or by phone; lasts forever, so choose your words carefully • Radio – Can be live or taped; in studios, on the phone, or elsewhere with a mobile microphone; warm up your voice; avoid pauses, “um” • If the interview is taped, you can ask for a chance to repeat your point more clearly Television • Confident speech and body language can be as important as your words • Be friendly; speak slowly, clearly and distinctly
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Good posture; cross your legs; hands away from face Use slight gestures to emphasize your points Reinforce messages with a brief pause When reporters ask questions make eye contact with them….when addressing the public make eye contact with the camera Avoid bright or heavily patterned clothes. Avoid dangling earrings

In all broadcasts: Assume the microphone is always on. There is no “off the record”. All the rehearsals may go live! Questions you don’t want to answer • Your task: communicate the key messages well • If they don’t ask the question, you still have to get the key message across • You are not obliged to answer every question Bridge to your key response • We’re as open and honest as we possibly can be • Likely the reporter knows the answer already • The balance: not saying what we cannot say; not jeopardizing our credibility by denying what is clearly true – E.g. "That is a national issue. What we are really talking about here is…" – "That's an important point. But what I think the main point is…" Building relationships with reporters If you are a regular and reliable source of trustworthy information, then reporters will be more likely to: • • • Consult WHO on a story Consider WHO’s perspective in a controversy Be receptive to WHO story ideas and recommendations

Making a news conference work • Schedule it right • Short and succinct: 4 speaker maximum; brief presentations • Consider visual elements • Leave plenty of time for Q&A

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COMMUNICATIONS PLANNING Architecture

Please see Annex 5

The communications architecture is basically a shifting series of meetings and discussions that result in materials produced. These meetings comprise people from many levels, departments and functional roles as well as regions. These discussions aim to update those involved on the current state of the virus, any new technical discoveries, news reported and questions expected. The discussions lead to the production of key messages and other materials. Many technical groups also produce materials to be distributed to specific target audiences. We will not discuss these in detail in this document, but they form a large portion of the communication that WHO has with the outside world. Ideally, the discussions result in agreement on the following outputs: 1) 2) 3) 4) 5) The key organizational messages of the day Identification if the newsworthy events or activities of the day Information to rebut rumours and misconceptions Talking points Web postings, including disease outbreak news, FAQs, and technical documents

The Communications Task Force collects, analyses, develops and packages information based on inputs from a number of sources. It then distributes/disseminates information to a series of eight primary external audiences, either directly, or via intermediaries.

Strategic Health Operation Centre

Senior Policy Group

Listening via media monitoring and rumour surveillance

Regions and countries

Communications Task Force

Social mobilization

Member States

General public

WHO staff

UN and sister agencies

Private sector

Scientific community and health care profesions

NGOs and civil society

Special groups

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Target audience identification
WHO messages on influenza A(H1N1) are meant to reach the following 8 key audiences. Some of the audiences will receive their messages from the same source, and some may need very specific messages just for them. The list is not exhaustive, but identifies the main audiences we often need to reach: 1) Member States (ministries of health and other governmental entities in tourism, transport and civil aviation, agriculture, interior and information sectors) and donors: Reached via direct communication from the Director-General, Regional Director or WHO Representative offices, IHR focal points, speeches, etc. 2) General public: Reached via WHO websites, media through news conferences, interviews, speeches and other channels 3) WHO staff: Reached via intranet and direct email 4) UN and sister organizations: Reached via IHR's network of communications contacts and those of other established networks 5) Private sector 6) Scientific community including healthcare professionals: Reached via WHO websites and functional networks 7) Nongovernmental organizations (NGOs), civil society and faith-based organizations 8) Special communities (high-risk and vulnerable groups) e.g. pregnant women, immunocompromised and patients with chronic diseases, poor/disadvantaged populations

Identify a person or a group to be responsible for each audience, and then assure that person or group's representative is part of the communications loop. This person (or group) should participate in conference calls with the Regional Office and headquarters, should be in constant contact with Ministry of Health communication authorities, should take care of media monitoring and rumour surveillance, and should address particular communications needs. New people do not necessarily have to be brought on board to do this; these tasks can simply be part of the responsibilities of some people already in the communications infrastructure.

Different products are developed to serve the various audiences • Technical documents: for Ministry of Health and other public health workers working on prevention, mitigation of and response to the event • Talking points: an internal document for WHO spokespersons to refer to • Press releases and Information bulletins: distributed and posted on the web, serving media and public • Frequently Asked Questions (FAQs): distributed and posted on the web, serving public • Situation reports: synopses of the day's situation, for distribution to UN partners • Briefing notes: for "surrogates", so that they can support WHO by independently conveying the same message • Community education and health education products • Prototype information,education and communications and advocacy materials, flexible and adaptable to country-specific needs

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Communication channels
In an outbreak situation, WHO should make best use of all the possible channels and tools in the interest of faster dissemination of health and policy messages to the target audiences. Not all methods are suitable for all segments of society. Some media tools may work in one country and not in another. WHO representatives and field communication officers should select the most appropriate channels for their local context. The following table shows a wide-ranging list of different dissemination channels and tools enclosed as a quick reference. • news releases • newsletters • news briefings and conferences (in person and by telephone) • interviews on television or radio news programmes • interviews on radio or television talk shows • call-in programmes (radio or television) • interviews in weekly or monthly journals and magazines • interviews in trade or professional publications • briefings for editorial boards of news organizations • faxes; direct mailings • paid advertisements 1 • Op-ed • text messages on mobile telephones • mobile and cell phone voice mail • pagers • web sites – including the agency’s public site as well as dedicated sites for specific users or events • email • social networking portals, e.g. facebook, Yahoo360 • blog2 3 • RSS • Podcast4 • Twitter5 • presentations for local community organizations, service clubs, religious organizations and voluntary organizations • participation in alreadyplanned community events • telephone hotlines and toll-free numbers • telephone hotlines and toll-free numbers • folk and traditional media (for example, storytelling) • short wave radio • information centres • public service announcements • flyers, brochures and circulars • billboards • displays and exhibits; • CDs • audio tapes

1

An op-ed, abbreviated from opposite the editorial page (though often believed to be abbreviated from opinion-editorial), is a newspaper article that expresses the opinions of a named writer who is usually unaffiliated with the newspaper's editorial board

A blog (a contraction of the term weblog) is a type of website, usually maintained by an individual with regular entries of commentary, descriptions of events, or other material such as graphics or video. Entries are commonly displayed in reversechronological order. Many blogs provide commentary or news on a particular subject; others function as more personal online diaries. The ability for readers to leave comments in an interactive format is an important part of many blogs. RSS ( most commonly translated as "Really Simple Syndication") is a format for delivering regularly changing web content. Many news-related sites, weblogs and other online publishers syndicate their content as an RSS Feed to whoever wants it. RSS solves a problem for people who regularly use the web. It allows you to easily stay informed by retrieving the latest content from the sites you are interested in. You save time by not needing to visit each site individually A podcast is a series of digital media files, audio, or video, that is made available for download via web syndication. The syndication aspect of the delivery is what differentiates podcasts from other files that are accessed by simply downloading or by streaming: it means that special client software applications known as podcatchers can automatically identify and retrieve new files when they are made available. Twitter is a free social networking and micro-blogging service that enables its users to send and read other users' updates known as tweets. Tweets are text-based posts of up to 140 characters in length which are displayed on the user's profile page and delivered to other users who have subscribed to them (known as followers). Since its creation in 2006, Twitter has gained extensive notability and popularity worldwide. It is sometimes described as the "SMS of the internet” 5
4

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3

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Monitoring and evaluation

Please see Annex 6

Monitoring and evaluation make it possible to judge the results of our work by answering the following questions. • Are we saying/doing the right things? • Are our messages (and actions) being received the way we want them to be received? • Are we doing them on a scale large enough to make a difference? • What do we need to change in order to improve our communications? Monitoring Monitoring is continuous and aims to provide management and other stakeholders of an ongoing programme with early evidence of progress (or lack of progress) in the achievement of behavioural results. To do so, monitoring mechanisms must be put in place to track implementation of planned activities and measure what is happening at a certain time. Monitoring is a warning system documenting process. It tells us how well the interventions worked and when strategies are not coming together. In other words, it lets us know whether we are effective in our communication activities so far. Monitoring helps to make adjustments and improve future activities, and help fulfil reporting requirements (see Annex 2 for example of monitoring indicators). Tools are essential for monitoring and documenting. Various tools can be developed such as forms, checklists, maps, observation etc. Evaluation Evaluation helps us to determine to what extent a communication initiative achieves its objectives in support of the programme. In this case, it will tell us if the communication strategy help reduce the transmission of the A(H1N1) and ultimately helps to limit the morbidity and mortality due to the virus. Evaluation is a periodic exercise that attempts to systematically and objectively assess progress towards the achievement of a programme’s objectives or goals. It tells us how well the interventions worked. An evaluation strategy must be built in the communication plan from the beginning. Reporting and documenting Reports are important to make the concerned parties aware of the outbreak communication’s impact, whether it is positive or not. Country offices are encouraged to share the positive impacts of their interventions widely with partners, allies, key stakeholders, the media, and funding agencies. Reports help disseminate the finding for funding purposes and for accountability. Success stories, photos and photo essays are valuable ways of documenting the implementation of activities and outcomes. Remember: pictures are worth 1000 words!

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ANNEX 1 WHO PANDEMIC PHASE DESCRIPTION
In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans. The grouping and description of pandemic phases have been revised to make them easier to understand, more precise, and based upon observable phenomena. Phases 1–3 correlate with preparedness, including capacity development and response planning activities, while Phases 4–6 clearly signal the need for response and mitigation efforts. Furthermore, periods after the first pandemic wave are elaborated to facilitate post pandemic recovery activities. In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans. In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat. In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic. Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion. Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way. During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave. Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature. In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required.

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ANNEX 2 PRIORITIZED BEHAVIOURAL GOALS IN A COUNTRY WITH CASES OF INFLUENZA A(H1N1)

PUBLIC HEALTH GOAL:
TO REDUCE TRANSMISSION

Keep your distance from someone who is coughing and sneezing.
RATIONALE: Flu is passed on through tiny droplets of water that come out during talking, spitting, coughing and sneezing. Infected droplets can travel to at least 1 metre from a person carrying the virus. Close, sustained contact with an infected person is more likely to transmit infection. Keeping a distance will help protect people from the infection; however, individuals and families should live life as normally as possible.
Behaviour examples:
• Stay at least 1 metre away from others who are coughing and sneezing. • Avoid touching, hand shaking, kissing • Reduce time spent in crowded places as much as possible.

Behavioural goals:
If well, to avoid becoming infected

Stay home if you feel ill.
RATIONALE: Early rest as soon as symptoms develop will usually improve the chances of sick people to recover faster. Limiting the movement of ill people will also slow down the spread of the virus. Most influenza patients will have the mild form of disease which can be taken care of at home. Making sure that sick people inform others will allow for the organization of help for activities which involve going outdoors, like shopping and paying the bills.
Behaviour examples:
• Work from home • Contact health care provider by phone for advice, if possible • Ask others for help with daily chores

If sick, to avoid infecting others

Cover your coughs and sneezes.
RATIONALE: People may be infected and may start spreading the virus before having signs and symptoms of the disease. Coughing and sneezing spreads the influenza virus at greater distances. Thus covering mouth and nose while coughing or sneezing would help reduce dispersing the virus and the risk of infecting other people.

Behaviour examples:
• Use a single-use tissue if possible • Dispose of it as soon as it is used • Wash hands immediately • Cough or sneeze into your sleeve, your jacket, etc. to prevent droplets travelling in the air

Wash hands with soap and water.
RATIONALE: Hand hygiene is a good measure to protect people from respiratory infections. Droplets from an infected person will land on hands or surfaces when they cough or sneeze. If a healthy person touches soiled hands or surfaces, and bring their hands to own mouth, or nose they can become infected.
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Behaviour examples:
• Wash hands frequently • If possible, wash hands after coughing or sneezing • Wash hands after taking off any type of face cover • Keep hands away from face

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PRIORITISED BEHAVIOURAL GOALS FOR HOME CARE OF INFLUENZA A(H1N1) ILLNESS

PUBLIC HEALTH GOALS:
1. Reduce transmission 2. Reduce mortality

Give the sick person a separate space at home.
RATIONALE: Keeping the sick person away from others helps reduce transmission of the disease from them to the healthy members of the family. It may also help protect the sick person from other disease causing agents from other people.

Behaviour examples: • Keep the sick at least 1 metre away from others • Keep this space well aerated by making use of natural breezes from doors and windows

Behavioural goals:
Protect carers and other family members from infection Aid recovery from illness

Assign a single caregiver to the sick person.
RATIONALE: Assigning one household member to consistently provide care for the sick person minimizes the number of people in close contact with respiratory droplets. If possible, the caregiver should be someone who has had a recent illness and recovered. Pregnant women should avoid being carers if possible.

Behaviour examples: • Assign mother as care-giver if breastfed infant is sick • Care givers should take special care to wash hands before and after care-taking and cover mouth and nose during contact with the sick person

Give plenty of fluids to the sick person.
RATIONALE: Fever, fast breathing and increased discharges from the nose and mouth will increase water loss from the body. Loss of appetite, vomiting or diarrhoea could further increase water loss. Excessive water loss may result in serious complications.

Behaviour examples: • Let the sick person drink as much as they can. • Use 'sweet-waters', fruit juice, soup or ORS • Continue to breast-feed healthy or sick infants unless the clinical condition of the sick mother does not permit

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ANNEX 3 MESSAGES FOR PREVENTION OF INFLUENZA A(H1N1) General information
The main route of transmission of the new influenza A(H1N1) virus seems to be similar to seasonal influenza, via droplets that are expelled by speaking, sneezing or coughing. You can prevent getting infected by avoiding close contact with people who show influenza-like symptoms (trying to maintain a distance of about 1 metre if possible. Places requiring special precaution Any crowded public place including • airports and ports, railway stations • schools • places of worship • marketplaces, including shopping malls, supermarkets • places of leisure, including sport clubs, theatres, movie theatres • camps for internally displaced populations Key preventive steps and actions • Regular washing of hands with soap and water (or with an alcohol-based handrub, if available) is strongly recommended • Keep a distance of at least two metres (six feet) from the infected person to avoid coming into contact with the influenza droplets • If contact with a sick person or with potentially infected surfaces or objects occurs, those involved must not touch their eyes, nose or mouth with unwashed hands • Close contact with a sick person should be avoided; people are advised to refrain from handshaking, kissing or hugging during an outbreak • Those taking care of a sick person should use a face mask in accordance with guidelines provided by national health authorities • People should be physically active, drink plenty of fluids, eat well, reduce stress and have enough sleep to boost their immunity

Information, education and communication
This section aims at providing selected target audiences with potential messages/tools and channels of communication. It should be adapted to the country context and the level of pandemic phase. It is important to note that the self-protection measures may be the only measures available, at least initially until a vaccine is available. Target audience: Policy-makers

Objectives − Informing the policy-makers/political leadership that with effective promotive and preventive measures, the onset of the disease can be delayed and the severity of the disease minimized, with improved outcome Possible messages 1. The threat of H1N1 is real 2. The virus is a very contagious virus and it is expected to continue to spread to new countries and continue to spread within countries already affected 3. The virus is tricky. It does not announce its presence or arrival in a new country 4. It is observed because of a sudden explosion of patients seeking medical care or requiring hospitalization. 5. You should adjust your responses in line with the changing pattern of disease and prepare your health care service to respond to the health needs 6. There is still limited knowledge about the virus and it is important to watch the behaviour of H1N1 very carefully as it encounters other influenza viruses circulating 7. There is no evidence that the virus transmission will decrease with summer, and preventive measures should still be in place.
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8. 9.

10. 11. 12. 13.

We are in Phase 5 (see Annex 1) and Phases 5 and 6 do not differ in terms of actions you should take You should not expect at present, a sudden and dramatic jump in severe illnesses and deaths BUT you should prepare to see more than the present small number of severe cases, especially where populations are most vulnerable In case where the H1N1 virus is widespread and circulating within the general community, you must expect to see more cases of severe and fatal infections However, there isn’t sufficient stock of vaccine and prevention is key to contain and prevent the spread of the disease The available medicines may not work in most cases or the ample availability of medicines cannot be ensured in every area of a country when there is a pandemic The chances of every individual getting the vaccine in each country are also very slim

Citizens can still be protected - Establish a national level preparedness and response mechanism - Engage actively important stakeholders in decision making - Institute mechanisms for providing supportive environment - Ensure that the health system (at all levels) has pre-positioned itself for both preventive and curative interventions - Develop community capacities by enhancing their coping skills - Establish a robust information mechanism - Identify vulnerable populations Mechanisms of action − Priority setting − Preventive versus curative interventions − Pooling of human and financial resources − Risk factor surveillance mechanisms − Identification of high risk/vulnerable groups and settings − Strong intersectoral coordination and collaboration: − National level multisectoral committee (existing emergency preparedness and response mechanisms can play this role) − Without creating a scare, institute preventive measures in places frequented by people − Reach out to local donors for financial resources − Involve media as an active partners for identification of risks to health − NGOs can build community skills on how to cope with the disease − Information flow, synthesis and dissemination − Establish national level initiative where all information is channeled before being shared with the public − Careful synthesis of information and meticulous dissemination will minimize scare to a great extent − Share information only from trustworthy sources − Providing a supportive environment − Access of people to meaningful information − Means available to the people to carry out actions − Promotive and preventive aspects of health systems: − Health care-providers are well-informed about the way the virus is behaving, the availability and effectiveness of medicines, the virulence of the virus at different stages − Compulsory health education sessions for all patients presenting at health centres/hospitals with flu symptoms Regular follow-up of flu patients through community outreach Target audience: Local and national health authorities

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Objectives Inform governments of speedy measures to protect citizens Possible messages 1. The threat of H1N1 is real 2. The virus is a very contagious virus and it is expected to continue to spread to new countries and continue to spread within countries already affected 3. It is observed because of a sudden explosion of patients seeking medical care or requiring hospitalization 4. There is no evidence that the virus will decrease with summer and preventive measures should still be in place 5. We are in phase 5 (please see Annex 1) and Phases 5 and 6 do not defer in terms of actions you should take 6. You should not expect at present a sudden and dramatic jump in severe illnesses and deaths BUT you should prepare to see more than the current small number of severe cases, especially where populations are most vulnerable 7. The chances of obtaining a vaccine for every individual in your country are also very slim 8. You can protect citizens • Institute mechanisms for providing supportive environment • Ensure that the health system (at all levels) has pre-positioned itself for both preventive and curative interventions • Develop community capacities by enhancing their coping skills • Identify vulnerable populations • Ensure public places with restroom areas are kept clean and disinfected • Managers of crowded areas, e.g. train/bus stations, airports and leisure places are aware of the virus and potential sources Mechanisms of action • Flyers • Posters • Television/radio health programmes Possible channels − News on television or radio − Community centre − Ministries of health − Spokespersons − Call centres Target audience: Health staff in health care services

Objectives − Educate health staff on protective behaviours and quick action to respond to patient needs − Limit spread of the virus − Contain potential panic Possible messages 1. The threat of H1N1 is real and you should be prepared to see more cases of influenza patients in your services 2. The virus is very contagious and it is expected to continue to spread, especially in vulnerable population groups 3. The virus attacks young healthy adults 4. Not all influenza-like symptoms are influenza A/H1N1 and patients visiting the health care services may be patients with seasonal influenza 5. You should adjust your responses in line with the changing pattern of disease and prepare your health care service to respond to the health needs 6. There is no evidence that the virus will decrease with summer and preventive measures should still be in place

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7. We are in Phase 5 (please see Annex 1) and Phases 5 and 6 do not differ in terms of actions you should take 8. You should not expect at present, a sudden and dramatic jump in severe illnesses and deaths BUT you should prepare to see more than the present small number of severe cases, especially where populations are most vulnerable. 9. In case where the H1N1 virus is widespread and circulating within the general community, you must expect to see more cases of severe and fatal infections. 10. There is insufficient stock of vaccine and preliminary action should be on prevention through awareness raising 11. You can protect health care providers and limit spread of the virus and assist a sick person − brief health care service staff on the virus and other influenza viruses − provide mask for health care providers − develop hospital guidelines to inform health care providers on ways to deal with H1N1 patient e.g. o Staff to use a mask when caring for a patient with flu like symptoms o One caregiver to assist a patient with flu like symptom o Ensure strict personal hygiene o Take the sick person in a single room to avoid spreading of the virus until the type of influenza virus is known Mechanisms of action − Workshops − Briefings − IEC materials Possible channels − Ministries of health − Spokesperson − Call centres Target audience: Management staff at airport, train stations, bus stations

Objectives • Educate staff on protective behaviours and quick action to respond to public needs • Limit spread of the virus • Contain potential panic Possible messages 1. 2. 3. 4. 5. 6. The threat of H1N1 is real The virus is very contagious and it is expected to continue to spread to new countries Crowded places are considered a key risk factor for spreading the virus The staff should be briefed about the virus and its symptoms Not all flu like symptoms are influenza AH1N1 We are in Phase 5 (add description of Phase) and Phases 5 and 6 do not differ in terms of actions you should take 7. You can protect your staff and commuters o Briefing employees particularly those dealing with commuters and cleaning staff on the virus o on influenza AH1N1 and its symptoms o Allow employees with flu symptoms to take a sick leave o Ensure facilities are kept clean o Ensure that restrooms have soaps and disinfectants o Ensure rooms and halls are well ventilated. o Post reminders in restrooms of basic hygiene measures

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Mechanisms of action • Flyers • Posters • Television/radio health programmes • Briefings to employee Possible channels • Ministry of Health, Ministry of Transportation • Mass media

Target audience:

General public

Objectives − Educate on basic measures to protect themselves − Educate the general public on measures to assist a sick person − Limit spread of the virus Possible messages 1. The threat of H1N1 is real 2. The virus is very contagious and there is still limited knowledge on its evolution 3. Crowded places are considered a key risk factor for spreading the virus 4. Being close to a person with flu like symptoms is a risk factor 5. The virus attacks young adults and children 6. Not all flu like symptoms are influenza AH1N1 7. We are in Phase 5 (please see Annex 1) and Phases 5 and 6 do not differ in terms of preventive measures you should take 8. You can protect yourself − Practise basic hygiene, including washing your hands frequently with soap and water − Avoid using public restrooms 9. You can protect your relatives − Refer to the nearest health centre − Disinfect places where the sick person has been sleeping, coughing etc − Limit contact of other members of the family − Wear a mask − Observe strict personal hygiene Mechanisms of action − Flyers − Posters − Television/radio health programmes Possible channels − Schools − Primary health care − News on television/radio − Community centre Target audience: Schools

Objectives − Educate the school staff and students and their community on speedy measures to protect themselves − Educate health staff on protective behaviours and quick action to respond to patient needs − Limit spread of the virus − Contain potential panic

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Possible messages 1. The threat of H1N1 is real 2. The virus is a very contagious virus and there is still limited knowledge on its evolution 3. Crowded places are considered a key risk factor for spreading the virus. 4. Being close to a person with flu like symptoms is a risk factor 5. The virus attacks young adults and children 6. Not all flu like symptoms are influenza AH1N1 7. We are in Phase 5 (please see Annex 1) and Phases 5 and 6 do not differ in terms of preventive measures you should take 8. You can protect your staff and students − Advise students with flu symptoms to take sick leave − Inform the health staff in school about the disease − Refer a flu like student to school nurse/doctor for quick diagnosis − Ensure strict personal hygiene at schools − Review personal hygiene behaviours of staff and children − Ensure that restrooms have soap and disinfectants − Inform pupils about potential risk factors and preventive measures, e.g. avoiding crowded places, keeping your distance from someone who is coughing or sneezing, covering your nose and mouth when you sneeze − Ensure that the classroom has sufficient ventilation Mechanisms of action • Flyers • Posters • Television/radio health programmes • Briefing to health staff and teachers • Workshops for school principals and school doctor • Send out a letter accompanied with a brochure with the students to bring home to their families • School visits and presentation of audio-visuals + tips from nutrition specialist followed by a Q&A session • Post child-appropriate posters in classrooms and the school cafeteria Possible channels Ministry of Health and Ministry of Education Target audience: Nongovernmental organizations, community members, marketplaces

Objectives Raise awareness about the diseases Mobilize the community to create a protective environment Possible messages 1. The threat of H1N1 is real 2. The virus is very contagious and there is still limited knowledge about its evolution 3. Crowded places are considered a key risk factor for spreading the virus. 4. Vulnerable people are most at risk of contracting the virus 5. The virus attacks young adults and children 6. Not all flu like symptoms are influenza AH1N1 7. We are in Phase 5 (add description of phase) and Phases 5 and 6 do not differ in terms of preventive measures you should take 8. You can protect your community o Inform public about the influenza and preventive measures o Mobilize the community to maintain public places with restroom areas are kept clean o Train/bus stations, airports and leisure places are briefed with information on influenza and protective measures Mechanisms of action Flyers Posters Television/radio health programmes
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Briefings to NGO members Possible channels Primary health care, community centres Ministry of Health Ministry of Interior WHO Representative’s Office Website Podcast

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ANNEX 4 MOST FREQUENTLY ASKED QUESTIONS BY JOURNALISTS IN AN EMERGENCY
1. What is your name and title? 2. How do you spell and pronounce your name? 3. What are your job responsibilities? 4. Can you tell us what happened? Were you there? How do you know what you are telling us? 5. When did it happen? 6. Where did it happen? 7. Who was harmed? 8. How many people were harmed? 9. Are those that were harmed getting help? 10. How are those who were harmed getting help? 11. Is the situation under control? 12. How certain are you that the situation is under control? 13. Is there any immediate danger? 14. What is being done in response to what happened? 15. Who is in charge? 16. What can we expect next? 17. What are you advising people to do? What can people do to protect themselves and their families now and in the future – from harm? 18. How long will it be before the situation returns to normal? 19. What help has been requested or offered from others? 20. What responses have you received? 21. Can you be specific about the types of harm that occurred? 22. What are the names, ages and hometowns of those that were harmed? 23. Can we talk to them? 24. How much damage occurred? 25. What other damage may have occurred? 26. How certain are you about the damage? 27. How much damage do you expect? 28. What are you doing now? 29. Who else is involved in the response? 30. Why did this happen? 31. What was the cause? 32. Did you have any forewarning that this might happen? 33. Why wasn’t this prevented from happening? Could this have been avoided? 34. How could this have been avoided? 35. What else can go wrong? 36. If you are not sure of the cause, what is your best guess? 37. Who caused this to happen? 38. Who is to blame? 39. Do you think those involved handled the situation well enough? What more could or should those who handled the situation have done? 40. When did your response to this begin? 41. When were you notified that something had happened? 42. Did you and other organizations disclose information promptly? Have you and other organizations been transparent? 43. Who is conducting the investigation? Will the outcome be reported to the public? 44. What are you going to do after the investigation? 45. What have you found out so far? 46. Why was more not done to prevent this from happening? 47. What is your personal opinion? 48. What are you telling your own family? 49. Are all those involved in agreement? 50. Are people over-reacting? 51. Which laws are applicable? 52. Has anyone broken the law?

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ANNEX 5 CHECKLIST FOR STRATEGIC COMMUNICATIONS PLANNING AND IMPLEMENTATION
• • • • • Is there technical consensus by agencies on the control measures and is there harmonization of these interventions and messages to at-risk populations and other stakeholders? Is there a coordinating mechanism among authorities and institutions involved in providing communications interventions? Is there agreement on the priority behavioural interventions, audiences and channels for the different stages of a pandemic Are existing networks and partnerships being used effectively, e.g. for communications strategy development, message development, material production and dissemination? Are communications products (materials such as leaflets, posters, etc) being developed to contribute to an overall strategic communications plan with clear public health objectives, i.e. to minimize disease transmission, mortality and morbidity? Is this linked to clear communications objectives? Has a quick assessment of knowledge, awareness and perceptions among at-risk and other populations been carried out? Are there any gaps? Are participatory methods being used to learn from community groups including the vulnerable and marginalized, on how to adapt priority behaviours to local contexts, i.e. are the proposed control measures specific, realistic and culturally appropriate? Are there existing cultural and societal values and practices that could be used to promote the uptake of control measures? Have these been incorporated into the messaging and design? Are communications strategies and messages consistent with social and cultural values of target populations such as at-risk populations and other stakeholders? Do communications materials and messages clearly promote the proposed control measures, i.e. inform target audiences on what to do, how, why, and when? Have these been quickly pre-tested with the target audiences? Have non-communications barriers to proposed control measures been identified and therefore control measures adjusted accordingly e.g. access to water and soap if promoting hand hygiene? Have credible, empathetic and trustworthy sources of information been identified for multiple audiences, activities and channels? Is there a system for getting feedback on the reach, and effect of communications interventions, e.g. are people doing things differently as a result of the communications interventions? Are there rumours, misunderstandings circulating that need to be corrected?

• •

• •

• • •

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ANNEX 6 SAMPLE MONITORING AND EVALUATION INDICATORS Sample monitoring indicators
Media broadcast • Has the radio public servce announcement been aired? The number of stations that aired the spot? The number of time per station and per day the spot was aired? Have the listeners heard the spot? • Types of messages broadcast? Quality of messages? Number of messages per day? At what time of the day? Workshop for journalists on influenza A(H1N1) • Did the training take place? • How many participants? Was the training appropriate to target? • Pre and post tests (outcome indicators) • Supporting materials distributed to participants or not?

Sample evaluation indicators
Baseline data: 62% of parents feel that covering the nose with a tissue when coughing is a useful measure to prevent human to human transmission of influenza A(H1N1) virus. Objective of the campaign: 80% of parents feel that covering the nose with a tissue when coughing is a useful measure to prevent human to human transmission of influenza A(H1N1) virus Impact after intervention: 75% of parents feel that covering the nose with a tissue when coughing is a useful measure to prevent human to human transmission of influenza A(H1N1) virus

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