Investigating inclusive risk communication in the context of influenza outbreaks Insights from South Korea and Vietnam By: Stina Nygren & Moa Zeidlitz Supervisor: Clas Lindberg Södertörn University | School of Natural Sciences, Technology and Environmental Studies Bachelor’s thesis 15 credits Development & International Cooperation | Spring semester 2020 Abstract 2 Abstract Outbreaks of novel influenza viruses are continually occurring on many places on our planet, with the ultimate and most extreme consequence being a full-scale pandemic. Modern communication technology is widely used for risk communication regarding recommended change in behavior patterns and other precautions in order to mitigate the transmission. However, the assumption and bias that modern communication technology constitutes the norm causes vulnerable groups to be at possible risk of systematic exclusion to correct and updated information. Through conducting a literature- and case analysis, the aim of this study is to identify insufficient or inadequate risk communication efforts in South Korea and Vietnam during influenza outbreaks, especially with concern of vulnerable groups. Further, to analyze how national influenza preparedness plans observe or ignore these insufficiencies. Results show that vulnerable groups are explicitly recognized in the preparedness plan of Vietnam. However, the South Korean preparedness plan show a more homogenous approach. Both South Korea and Vietnam showed a broad variety of channels used in their risk communication strategies which could be positive in terms of a broad outreach to a heterogenous population, including vulnerable groups. Four key factors that moderate the outcomes of risk communication were identified: Channels, Messages, Transparency and Trust. Keywords Information and communication technology, Epidemic, Pandemic, Communication inequalities, Public health emergency preparedness, Digital divide, Risk communication, Preparedness strategies, Communication strategies Table of Contents 3 Table of Contents Abstract................................................................................................................................. 2 Keywords .............................................................................................................................. 2 Abbreviations ........................................................................................................................ 5 Introduction ........................................................................................................................... 6 Problem statement, purpose & research questions ............................................................... 7 Problem statement ............................................................................................................ 7 Purpose & Research questions ......................................................................................... 7 The Context .......................................................................................................................... 8 The role of communication and equality ............................................................................ 8 Epidemics & pandemics .................................................................................................... 9 “The Avian Influenza” A/H5N1 outbreaks 2003 .............................................................. 9 “The Swine flu” A/H1N1 pandemic 2009 ...................................................................... 10 “Middle East Respiratory Syndrome” MERS outbreak 2013 - 2015 .............................. 10 “COVID-19” SARS-CoV-2 pandemic 2019 - ongoing ................................................... 11 Study objects ................................................................................................................... 12 South Korea ................................................................................................................. 12 Vietnam ....................................................................................................................... 13 Theoretical framework ......................................................................................................... 15 Government trust theory .................................................................................................. 15 What causes the public not to trust its government? .................................................... 15 Compliance connected to trust ..................................................................................... 16 Crisis & risk communication theory .................................................................................. 17 The foundation of risk communication .......................................................................... 17 Vulnerable groups & communication inequalities ......................................................... 18 Structural Influence Model (SIM) of Public Health Emergency Preparedness Communication ............................................................................................................ 19 The Digital Divide ......................................................................................................... 20 Summary of the theoretical framework ............................................................................ 22 Method ................................................................................................................................ 23 Limitations ....................................................................................................................... 24 Empirical data ..................................................................................................................... 25 South Korea .................................................................................................................... 25 Selected influenza outbreaks in South Korea ............................................................... 25 ICT access in South Korea .......................................................................................... 26 Key findings South Korea - Pandemic Influenza Preparedness and Response Plan 2006 .................................................................................................................................... 27 Table of Contents 4 Key findings South Korea - A(H1N1)pdm09 and MERS ............................................... 28 Key findings South Korea - Covid-19 ........................................................................... 29 Vietnam ........................................................................................................................... 29 Selected influenza outbreaks in Vietnam ..................................................................... 29 ICT access in Vietnam ................................................................................................. 31 Key findings Vietnam - The Vietnam Integrated National Operational Program on Avian Influenza, Pandemic Preparedness and Emerging Infectious Diseases (AIPED) 2011- 2015 ............................................................................................................................. 32 Key findings Vietnam - H5N1 & A(H1N1)pdm09 .......................................................... 33 Key findings Vietnam - Covid-19 .................................................................................. 34 Analysis & interpretation ..................................................................................................... 35 ICT Access of the South Korean people .......................................................................... 35 ICT Access of the Vietnamese people ............................................................................. 36 Risk communication strategy and outcomes .................................................................... 37 Messages .................................................................................................................... 37 Channels...................................................................................................................... 38 Trust and Transparency ............................................................................................... 40 Compliance .................................................................................................................. 43 Risk communication key factors of success or failure ...................................................... 44 Conclusion .......................................................................................................................... 45 Discussion .......................................................................................................................... 46 Suggestions for further research ...................................................................................... 47 References ......................................................................................................................... 49 Appendix 1 .......................................................................................................................... 59 Appendix 2 .......................................................................................................................... 62 Appendix 3 .......................................................................................................................... 66 Appendix