Role of Communication in Avian/Pandemic Influenza Programme

In this 5-page background paper written for the United Nations Children's Fund (UNICEF) in preparation for the Technical Meeting on Highly Pathogenic Avian Influenza (AI) and Human H5N1 Infection in Rome, Italy, the strategic role of communication on the avian flu or bird flu virus is presented with an emphasis on behaviour change communication and social mobilisation, including community dialogue, as strategies to overcome cultural and socioeconomic issues as impediments to change. According to the document, the efforts by UNICEF to mobilise against AI have been catalysed by two grants from Japan and one from Canada, as well as funding for individual countries by several bi-lateral donors.


According to the document, "[a] key lesson learned is that all stakeholders ...need to ...identify those priority behaviours that are absolutely critical for prevention and control of avian influenza. At the same time, these behaviours must be feasible and appropriate for change through communication strategies, and need to be informed by ongoing dialogue with communities." In addition to identifying critical prevention behaviours, the authors report successful inter-sectoral partnerships in affected countries, including creating national inter-agency communication taskforces and advocating with ministries to develop and implement communication plans, resulting in a high awareness of AI. Despite high awareness, however, there is low risk perception and continuing unsafe behaviour practices among individuals and communities, and evidence that "behaviour change is difficult to achieve in resource-poor settings due to socio-economic hardships and competing priorities."

The document points out that the ongoing confusion between avian influenza and a pandemic is a challenge. AI control requires particular attention to animal health, while the response needed for pandemic influenza (PI) is very different, though there are some overlaps (e.g., handwashing hygiene). However, "[t]he connection between avian and pandemic flu is that the H5N1 virus that is currently causing highly pathogenic avian influenza (HPAI) in birds (and the rare human infection) could change and become a human virus causing a pandemic." Recommended here is that technical experts need to work with communicators on determining behaviour changes that will minimise the threat of avian and pandemic influenza by building upon local practices and integrating new behaviours with culturally relevant practices to find feasible solutions.

For the AI strategy to be effective, people’s actions, especially habitual behaviours, should reduce the risk that animals become infected, and that humans become infected as a result of handling animals. The authors state that these will only occur if they are understood to be worth the effort, i.e., are locally feasible and produce results. "Policies and systems such as incentives for reporting, compensation for culling poultry, functioning surveillance systems and availability of veterinary services are vital..."



Two strategic AI communication response listed here are:

1. "outbreak/risk communication that focuses on how authorities responsible for animal
   and human health assist in mobilising the media and other channels to provide
   communities with timely and accurate information; and
2. behaviour change
   communication that focuses on how individuals, communities, and institutions can
   reduce risks through changed or modified behaviour."

Four responses were chosen to define key behaviours for AI control: Report, Cook, Separate, Wash. Since these were determined in March of 2006, governments have begun to develop strategies to reinforce them. In December of 2006, four suggested behaviours, "Flu-WISE," for pandemic flu preparedness were developed along with 4 suggested behaviours, "Flu-CARE," developed for pandemic recovery. These are now a focus of communication strategising to produce behavioural outcomes if a pandemic should occur.


Some achievements in AI prevention and control recognised in this document include:

• Inter-sectoral partnerships including national communication task forces, often even where no AI outbreaks have occurred;
• Progress in awareness of AI and risk reduction, especially in Southeast Asia;
• Documentation of communication effectiveness shown by a census of individuals who know the key preventative behaviours and those adopting prevention practices (shown on a bar graph);
• Knowledge, attitude, and practice (KAP) surveys of 20 countries - showing high awareness, but continuing risky behaviours, due to low risk perception;
• Data showing that communication results of desired behaviours to control avian influenza are dependent on factors such as compensation policies, surveillance
  systems, and veterinary and animal health infrastructure; and
• An inter-agency communication planning toolkit for AI and PI being finalised to help governments address preparation of national communication response plans.

Challenges include communication focused on control of animal to animal transmission through bio-security practices that are realistic and feasible within the specific socio-economic and cultural context. Reaching the hard-to-reach with credible information and practices on a regular basis is a challenge where, for example, separating birds from humans is not feasible. Complacency where the virus has not yet appeared is a challenge which can be met with meaningful messages to vulnerable groups like poultry farmers and food handlers and transporters, generated through training of media and communicators.


In conclusion, as stated in this document, progress has been made in awareness raising, though behaviour changes are taking longer to implement. Capacity building for planning and implementing crisis response strategies, including understanding the need for dialogue with communities, rather than marketing messages, is a lesson learned. More research using community feedback to inform prevention strategies is needed, along with evidence-based planning. The economic impact of an AI outbreak needs to be addressed through advocacy with governments. A balance needs to be found at a local level between putting the onus of behaviour change on the individual and promoting collective action for AI control. Sound technical guidance is the underpinning of communication on bird management recommendations to stop disease transmissions at the source. Interagency communication and leadership responses need to continue to develop through discussions and agreements on risk management and social mobilisation.