Risk Communication for Public Health Emergencies – contributing from the non-health sector
Written by FUSEGI Mitsuhide, the Chief of the Protocol Unit, Embassy of Japan in France
During my career as a diplomat, I have been involved in Public Health Emergencies (PHEs) on several occasions. The world is currently facing an unprecedented scale of health crisis by the COVID-19, which reminded me of the importance of risk communication when dealing with PHEs, such as an Ebola outbreak. My intention is to share the lessons learned through my experience, highlighting challenges and success while facing the infectious disease outbreaks on the front line. I wish the following will enhance collaboration between Public Health Experts and experts from other areas, including diplomats, at the time of PHEs.
From March 2015 to August 2017, I served as an assistant director at the ASEM division of the MOFA Japan (ASEM contact point). As a contribution to the ASEM process, the Government of Japan supports the ASEM Initiative for the Rapid Containment of Pandemic Influenza. The initiative consists of two pillars; the ASEM Stockpile of Antiviral Drugs and Personal Protective Equipment (PPE) and ASEF Public Health Network (ASEF PHN). For the former, the stockpiled items are stored in Singapore and distributed on-demand when there is a sign of a disease outbreak, potentially becoming a pandemic. The World Health Organisation (WHO) provides technical advice on deciding the use of the stockpile upon requests from one or more ASEM Partners. The latter, ASEF PHN, promotes the bi-regional exchange of public health priorities focusing on Emerging Infectious Diseases (EIDs), which includes Risk Communication for Public Health Emergencies.
On one occasion, the initiative received a request to release its stockpile for a potential outbreak. At that point, I was in a dilemma whether to issue a press release or not as it can be a “false alarm” if it was contained. I also learnt that we should always consider a recipient country that may be reluctant to disseminate such information – a country having a disease outbreak – to the public, both nationally and internationally. Fortunately, this case did not become an outbreak. A lesson learnt from this event is that Risk Communication is not just to provide information as such information impacts on society. The public might blame us for delaying information if we do not disseminate it on time. At the same time, if an incident does not become a pandemic, we can be blamed for causing unnecessary worry, almost like “the boy who cried wolf”. It is essential to consider such an aspect when informing to avoid unnecessary anxiety among all the stakeholders.
In the Democratic Republic of the Congo (DRC)
While I was posted at the Embassy of Japan in DRC from August 2017 to November 2019, there were two outbreaks of the Ebola virus disease. For DRC, it was their 9th and 10th time to have Ebola outbreaks.
The 9th Ebola outbreak
The 9th outbreak happened in Mbandaka city, the Equatorial state, located approximately 580 km to the north of Kinshasa city, the DRC capital. These two cities were not well-connected by road. There was a minimum risk that positive Ebola cases would travel via land from the epicentre to the capital city, where the population of approximately 14 million reside. However, the central government and international community were concerned with other modes of transport connecting the epicentre and other major cities. As there were flights and boat services available, the chances of positive cases travelling to the city by air or via the Congo river were relatively high. From the Equatorial state to Kinshasa, there were also numerous entry points leading to the capital that the central government was not even aware of. A 15 minutes boat ride could take us to another side, to Brazzaville, the Republic of the Congo’s capital. Therefore, this Ebola outbreak became a public health crisis attracting the international community’s attention beyond DRC.
Working as the Chief of the Economic Cooperation Unit at the Embassy, I received unofficial information verbally regarding the Ebola outbreak’s epicentre. The source of information appeared to be from someone related to the local government. Since the verbal information passed through several people, I decided to call WHO to check with the coordinator. The coordinator did not have the reliable latest update as they were facing a challenge providing a speedy update to the international community. Because of the nature of the communication under such an emergency, the reliability can be limited; for example, passing it orally via several people. There is often not enough time to verify the accuracy of the information. Hence, the judgment of individuals involved in an information exchange would significantly impact the contents itself.
Risk communication at the time of emergency puts a communicator under huge pressure as it requires accuracy and speed. I was in charge of disseminating the latest update promptly to the Japanese community in DRC as well as MOFA in Tokyo. As I was stressed out, I might have blocked a smooth communication due to my frustration, which I regret that I might have made a vicious circle. Diverse stakeholders, whose viewpoints are different, tried to access the latest information individually, which might have led to a miscommunication, including rumours, while people might twist facts unconsciously. Meanwhile, the situation evolved constantly, and informing the progress via the Embassy was useful to reassure own nationals living there.
In a vulnerable country like African nations, it is often challenging to access an epicentre physically or obtain accurate information due to a lack of infrastructures. Therefore, it is preferable to establish a network of counterparts in other organisations, such as WHO and the central government, under the respective country’s lead. It will help to clarify the source of information as much as possible and prevent confusion.
It would also be essential to note that the rural communities in DRC refused foreigners’ involvement, making it extremely difficult to provide necessary medical aids. To overcome this challenge, the international medical teams approached the central government and the community leaders who assisted in bridging them with the local population for necessary health care. It highlights the importance of community engagement in communicating risks during PHEs, as they might have different perspectives.
The 10th Ebola outbreak
The 10thEbola outbreak in the East part of DRC occurred soon after the declaration announced the end of the 9th outbreak on 24 July 2018. It expanded to neighbouring countries, namely Uganda and Rwanda. The collaboration between the international teams and the local governments involved was deemed successful in conducting risk communication, disseminating clear, reliable, and up-to-date information through the media. Hence, people could keep up with what was happening in the concerned regions. Moreover, as part of the international partners, Dr Tedros ADHANOM, Director-General of the WHO, frequently visited the affected areas and provided briefings to diplomatic corps with intensive Q&A sessions in the capital helped transparent risk communication. Simultaneously, the meetings between various stakeholders, including WHO, IOM, UNICEF and other government representatives, were held in Kinshasa regularly to exchange information. For ASEM Partners, there were regular direct flights between Kinshasa and European capitals, such as Paris and Brussels, the Ebola outbreak in the African continent should not be treated as “fire on the other side of the river” problem in an interdependent world with increased connectivity.
There is often an information gap between the frontline and the headquarter in any organisations. For instance, the headquarter handles policy and gives direction to the local Embassy, while the Embassy is the one facing the emergency locally. When I was working in DRC, I heard Tokyo’s news reports about the Ebola outbreak which did not always include sufficient details or background information to understand the local context. Consequently, my family and friends were worried about me living in DRC. A similar situation can be found between the headquarters and the Embassy; they had a different impression due to the distinct level of information and local knowledge. One way to prevent such differences is to send an external public health expert to assess the local situation to provide the third person’s point of view.
I am currently posted in France, where the number of COVID-19 cases has remained high. In Paris, the Embassy of Japan has been providing the update on the COVID-19 situation via the email list of the Japanese community in France, translating official announcements issued in French into Japanese. It is found to be useful, especially for those working during the day who are unable to watch TV, as they can receive up-to-date information handily on their smartphone.
It is crucial for the governmental authorities abroad, such as embassies, to have established good relationships with their citizens residing in their respective countries. It will help to communicate effectively when an emergency occurs. If the citizens do not have full confidence in information dissemination of the Embassy, communication in case of disaster or pandemic will become problematic. For example, protecting our citizens overseas to keep them safe is one of the most critical missions for the embassies, and if we are not trusted, their safety can be compromised. Therefore, being in close contact with the nationals overseas in peacetime, such as using a mailing list, can be a beneficial method – it helps the Embassy be functional in case of emergency.
Suggestions: role of MFA in times of Public Health Emergencies (PHEs)
The Ministry of Foreign Affairs has a leading role in converging local information to the headquarters and sharing it with relevant health agencies via its embassies and experts from international organisations. We should always be aware of such a role and be an active player for PHEs that supports the health sector. In this regards, Mr KISHIDA Fumio, ex-foreign minister of Japan, emphasised the crucial role of the ASEM Initiative for the Rapid Containment of Pandemic Influenza in his contribution to ASEF’s publication “20 years of Asia-Europe Relations in 2016”1. He mentioned the spread of infectious disease as the risk related to increased connectivity and called for the necessity of pandemic preparedness and response. While all forms of connectivity increase, the Ministry of Foreign Affairs’ role and involvement also increase in PHEs.
The world is facing challenges due to the ongoing COVID-19 pandemic. It is not the sole responsibility of the health sector, but it also requires a collaborative effort involving different sectors. As part of ASEM initiative, I hope that the ASEF PHN will keep playing a vital role in connecting Asia and Europe. It provides a unique platform, which encourages public health dialogue involving relevant stakeholders beyond the health sector to address issues like Risk Communication for PHEs.
*All views expressed in this article are the author’s own and do not represent any entity’s opinions.
For more information about ASEF’s work in Public Health, kindly visit https://asef.org/themes/public-health/