|A Media Handbook for HIV Vaccine Trials for Africa (UNAIDS, 2001, 45 p.)|
33 This section has benefited from Nusara Thaitawat's report for UNAIDS, 'Reaction to AIDS Vaccine Development in Thailand through the Media' (15 January 1999).
The communications challenge posed by the Thailand example is how to carry out a successful trial in an environment characterised by inadequate media reporting (and mis-reporting34), a general public that passively receives information about HIV/AIDS and public officials mishandling key communication issues. Thailand offers us a classic lesson in how not to prepare for a vaccine trial.
34 Chumpon Apisuk of Nam Chiwit, an advocacy group for PLAs in Thailand, believes that most Thai reporters do not have the appropriate education and background to report and educate the public effectively about HIV/AIDS vaccine development. (Interview with Nusara Thaitawat on 27 November 1 998).
Things appeared to have gone wrong right from the beginning. Advance news35-about the trials was filtered to the general public and transparency was sacrificed.
35 Reports say that the Thai Army had foreknowledge of the trial six months before the news broke to the general public.
Health officials clearly took advantage of the lack of interest of the public and the short attention span of the Thai media. In 1995, the Director of the Thai Red Cross Society's AIDS Programme, Dr Praphan Phanuphak, confessed that he had agreed to a trial of the GP-120 vaccine, not because he thought it was the ideal candidate, but only to gauge the public reaction to trials in Thailand. That confession came years later and provoked no reactions from the media and neither Dr Phanuphak nor his organization has suffered any tangible public rebuke. Indeed, he is already working on another trial based on a combination drug treatment.
This obvious abuse of public confidence is likely to undercut subsequent goodwill. The average Thai would quite correctly wonder: "If they lied about GP-120, are they also lying about, say, ALVAC?"
The general public first learned about the US Army's plan to conduct a large-scale vaccine trial from a report in The Economist based on an interview with an American. The Economist quotes the interview as saying: Thai Army recruits would make a good trial group. Following up on them, and army discipline being what it is, they are unlikely to object. Since Thai recruits get infected at a relatively high rate, a trial that gave a vaccine to one group and a placebo to another, and then gave all concerned the same sort of counselling, check-ups and treatment, should be able to produce answers fairly quickly'.36
36 A Thai translation of a story in The Economist of 21 September 1991. Cited in report by Nusara Thaitawat.
With such a background, it is no surprise that the Thai media, already marginally interested and ill-equipped in HIV/AIDS37, became hostile, coming out with scary headlines such as 'Thai Army recruits to be guinea pigs for the US Army' and asking 'Why not conduct the trials on US subjects in the US?'.
37 Nusara Thaitawat reports that the largest circulating daily, Thai Rath, (1 million copies) published less than 40 articles, analysis, commentaries and opinions in the past eight years; Matichon (circulation 300,000) published 60 items.
By 1993/94, following stories published by The Bangkok Post and The Nation based on interviews with HIV/AIDS victims, a new openness developed. HIV/AIDS got closer to the psyche of the average Thai and the media's interest increased.
The Thai media began to monitor development on HIV/AIDS in the western world and accused the local Ministry of Public Health of not taking seriously the problems of HIV/AIDS in Thailand, as well as intentional blocking of several vaccines available in foreign countries.
Although the Ministry of Health and the Reporters' Association of Thailand conducted seminars to educate journalists and editors on HIV/AIDS, sensational stories such as 'AIDS carried in flood water' still appeared in major newspapers.
The global economic crisis, which has hit Thailand, has adversely affected the media. Advertising revenue is on the decline; news publications are folding up and, by one estimate, 3600 media professionals have been put out of work,38 It is therefore to be expected that lesser attention would be paid to coverage of HIV/AIDS vaccine development and vaccine trials.
38 Figures from the Reporters' Association of Thailand. Cited in Nusara Thaitawat, ibid.
Alternative Communications Strategy
While it is difficult to plan a strategy without being familiar with the Thai terrain or having firsthand knowledge of many key social/cultural elements, more success could have been achieved by adopting the following measures:
· Identify the key partners/public and involve them in relevant pre-trial communications plans. Carefully explain the process of the vaccine development, the trial protocols, risks and potential benefits, stressing safety;
· Arrange a series of press conferences at which key political leaders and members of community-based organizations are conspicuously present. Have one or two representatives deliver a short address.
· Encourage (fund, if necessary) the CBOs to hold grass-roots meetings at which further possible questions should be answered by a member of the vaccine team. The team member should explain why the vaccine is safe and why the risk of intercurrent infections is minimal.
· Use television, radio, banners, fliers, etc. to reach the masses in the hinterland;
· Use video news releases (VNRs) and regular press releases about the vaccine to target key media executives;
· Hold routine media seminars/training for key journalists, editors, columnists, etc.;
· Assemble a ready rapid-response team to counter negative and erroneous reports with hard scientific (easily understandable) facts.
· Get ready to change/switch strategy midstream if circumstances change.