When Viet Nam reported its first case of Mpox in September 2022, the World Health Organization (WHO) Country Office in Viet Nam supported the Government’s response, including sharing information on this infectious disease and how people could protect themselves.
But as cases continued to rise, WHO reached for more data and evidence – and drew on existing partnerships – to design and deliver messages to people who were most at risk.
In July 2022, WHO first declared Mpox a public health emergency of international concern, after its rapid international spread.
In Viet Nam, WHO experts in HIV, health in emergencies, and communication collaborated to provide a range of support to the Government and people at risk of the disease. A key approach was Communication for Health (C4H), which harnesses insights from social, behavioural and communication sciences to increase knowledge, change attitudes and shift behaviours for improved health outcomes.
Initially, communication focused on using the Country Office’s Facebook page to inform the general community, and reduce fear and stigma.
Posts were about symptoms, transmission and how people could protect themselves and others from this previously unknown viral condition.
Mpox posts were among the page’s most popular content, generating thousands of likes, hundreds of comments, and more than 1700 shares.
However, after monitoring social media activity and speaking with key Government and community partners, WHO identified the need for more targeted public health communications, as WHO Representative in Viet Nam Dr Angela Pratt explained.
“Although the public were clearly hungry for more information, we started to notice that some of the comments on our Facebook posts and other online forums were sceptical or overly fearful. We worried our content was not necessarily reaching the right audiences.
“Good risk communication needs to strike the right balance. We need to raise people’s awareness – without creating unnecessary fear and anxiety, empower them to make good decisions, as well as ensure we reach those most vulnerable and at risk,” Dr Pratt said.
Against this backdrop, Mpox cases were rising, and Viet Nam experienced its first Mpox-related death in October 2023.
To develop a more targeted risk communications approach, WHO drew on the C4H approach of using data and evidence to design behaviour change communication.
First, WHO narrowed its target audience to the people who were at highest risk of contracting Mpox at that time – men who have sex with men (MSM) – especially those with new or multiple sexual partners. And, with about 80% of cases in southern Ho Chi Minh City, this location needed to be a focus.
But what information did MSM need? And how could WHO reach a group already fearful of stigma and discrimination?
To answer these questions, the C4H team analysed social media content – a process called social listening – to understand how people were talking online about Mpox. The team also drew on further insights shared by Government partners, including the former Vietnam Administration of HIV/AIDS Control (VAAC), which is now under the Vietnam Administration of Disease Prevention (VADP), and community-based organizations with expertise in sexual health.
“For years, WHO has developed relationships with Government agencies and with community-based organizations who are themselves made up of people from our target audiences. This trust has been crucial in linking WHO’s public health expertise with better sexual health on the ground over the years. For example, WHO has partnered with community-based organizations to pilot and promote HIV self-testing. Pre-existing relationships like this definitely paid off during Mpox,” Dr Pratt said.
WHO leveraged these existing partnerships to develop and roll out an Mpox survey to gather information from people who were at higher risk of contracting Mpox, and community-based organizations and health-care workers, who understood this group, and could also collect firsthand information. The survey provided baseline data on people’s knowledge, attitudes and behaviour too.
MSM said their main sources of information were social media such as Facebook and instant messaging platform Zalo, the internet and community-based organizations. But their most trusted sources of information were community-based organizations and health-care workers.
The survey also revealed that some misinformation remained. For example, some people wrongly believed that Mpox could be transmitted by mosquitos. In fact, the disease mainly spreads from person to person through close contact.
WHO discussed these research findings with Government partners and representatives of community-based organizations.
Using insights from the survey, WHO designed materials on two topics identified as priorities by community-based organizations: how people with Mpox could take care of themselves at home, and when to seek health care. Materials were co-branded with the Government.
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Language in these materials was clear, simple, descriptive and non-judgmental. Visuals were colourful drawings and a photo of a smiling young man.
Before using them, WHO conducted online focus group testing of each set of messages, design and imagery, scoring more than 90% approval for clarity and aesthetic appeal.
Then the materials were shared with partners, provincial Centres for Disease Control and community-based organizations to disseminate to health-care workers and MSM communities.
Consultation with community-based organizations and a follow-up survey with key audiences showed the positive impact of the materials. Using insights from this evaluation, WHO created a third round of materials.
For now, WHO in Viet Nam will continue to monitor Mpox through situation reports, social listening, media monitoring and information from Government and community partners, adjusting communications in response to people’s evolving information needs.
Dr Pratt said the effective, targeted communication was made possible by teamwork with Government partners and community-based organizations, and by drawing on the principles and approaches of Communication for Health, or C4H, which aims to use data and evidence to design targeted, people-centred communication interventions – all with the aim of empowering people to make choices that will help them protect and improve health and wellbeing.
“Unfortunately, Viet Nam – like other countries – will continue to face challenges and risks from infectious diseases like Mpox, COVID-19, rabies and avian influenza.
“One aspect of enhancing preparedness and response for outbreaks is strengthening our ability to reach the groups who are most affected by a disease, to give them the information they need to protect themselves and others.
“So, we are delighted that WHO, the Government and community-based organizations were able to work together on Mpox using the C4H approach. With the right resourcing, this approach will be crucial for minimizing the impact of infectious disease – but also for working towards a stronger, safer and healthier Viet Nam for everyone.”