Catching eyes to save lives: the giant mosquito disrupting dengue in Lao PDR

Across more than 100 countries, mosquito-borne dengue remains a serious – and potentially fatal – health risk. Globally, the number of cases reported to WHO has increased from 505 430 cases in 2000 to 14.6 million in 2024.  

With no specific treatment available for dengue, prevention (by destroying mosquito breeding sites and avoiding bites) and early detection and care for those suffering with dengue is essential to reducing cases, preventing severe illness and saving lives. 

The Lao People’s Democratic Republic has long faced recurring dengue outbreaks – especially during the tropical monsoon season from June to September, when environmental conditions like increased rainfall create favourable habitats for mosquito breeding. 

When a surge of dengue cases began in early 2024 – reaching levels comparable to the country’s last major outbreak in 2013, which saw 44 171 cases and 95 deaths recorded – Lao PDR health education officials faced a familiar problem: many people understood the routine household-chore style preventative actions required and the need to seek urgent healthcare if warning-sign symptoms began, but compliance and complacency varied.    

Something new, and attention grabbing, was required.  

“Be careful! Dengue is spreading!” The dengue awareness campaign used a human-sized mosquito, specifically designed to use humour to engage audiences. Photo credit: WHO 

A health risk requiring creativity  

“With technical and financial support from WHO, we developed a humour-driven risk communications approach, specifically designed to catch attention, ensure memorability and shareability, and drive action,” said Visith Khamlusa, Director of the Lao Ministry of Health’s Center for Health Statistics and Information (CHSI).  

“The strategy particularly targeted the 55% of the population (4.25 million) using Facebook, the country’s most popular digital platform, while also engaging traditional media and village outreach to reach other groups. We specifically targeted those who were indifferent to dengue or saw it as a routine health concern, emphasizing key messages such as mosquito control, symptom recognition and timely referral to hospitals for severe dengue cases.” 

Central to the campaign was a giant mosquito, played by a social media influencer, deliberately and humorously bothering people going about their daily activities. 

Highlighted in a recent Western Pacific Surveillance and Response journal article, striking but ridiculous visuals and day-to-day settings were designed to capture attention and engage social media audiences, drawing on tropes that had been well-received during previous campaigns in Lao PDR.  

Across a campaign of short videos and high-impact graphics, the giant mosquito invaded people’s homes, lives and daily routines – and was deterred through strong preventative action. Photo credit: WHO 

“Humour was chosen as the primary tool because, although it requires cultural context, it effectively draws attention and encourages active listening and information retention,” said former WHO Lao PDR Communications Team Leader Will Seal. 

“When people laugh, they become more receptive, enabling important health messages to be communicated in a positive, approachable and non-intimidating way. Additionally, leveraging humour through social media was identified as the most cost-effective approach in Lao PDR, offering wide reach at relatively low expense – in this case with extremely positive results.” 

What the numbers showed  

On social media, the campaign achieved extensive reach and engagement. Across 2024, content was viewed approximately 27 million times by almost 2.9 million unique users (reaching 68.2% of the country’s 4.25 million Facebook users), generating more than 86 342 comments, likes and shares.  

Video content was particularly successful, with more than 4.6 million views of at least 15 seconds. Of these, more than 800 000 exceeded one minute, suggesting genuine, sustained attention rather than passive scrolling.  

A comprehensive approach to data collection further underscored the campaign’s impact on public perception, with phone and digital surveys highlighting a number of shifts, including: 

• Post-campaign, respondents ranked dengue as the country's single most urgent health concern.
• The proportion of respondents describing themselves as "very concerned" about dengue rose from 21% before the campaign to 56% afterwards.
• On behavioural intention, 81% of respondents said they would seek hospital or health centre care immediately upon suspecting severe dengue symptoms. 
• Additionally, the humorous giant mosquito theme resonated strongly with audiences: 76% of respondents rated the campaign as appealing or very appealing; and 90% reported that it increased their likelihood of taking action to prevent dengue transmission.  

More importantly, epidemiological data showed a significantly flattened curve of dengue case numbers in 2024. 

Notably however, risk communications were one part of a multi-component dengue reduction campaign implemented by authorities that included high-level political engagement, vector control activities and enhanced case management. Attributing 2024’s change to any one or all parts of the dengue response is not possible with the data currently available. 

While the campaign showed strong results via phone and digital surveys, practical observation is essential to ensure actions are being taken and sustained – and represent a key area for expansion in the future. Photo credit: WHO 

Using behavioural insights  

With an approach rooted in behavioural science, campaign materials were pre-tested with at-risk communities to ensure cultural alignment and targeted messaging. Data available throughout the campaign was used to update and tweak materials, proving highly effective in maintaining audience interest. 

Community focus group discussions and household observational sessions were also conducted to identify behavioural enablers and barriers at the local level, with findings earmarked for future campaign design.  

Importantly, these tools form part of WHO’s Behavioural Research and Intelligence for Directed Guidance in Emergencies (BRIDGE) approach, which integrates behavioural and community insights to strengthen risk communication and community engagement strategies.  

With 2024 completed, data was used to refine the campaign in 2025 and beyond, with new videos and graphic styles utilised to avoid fatigue and catch scrolling eyes, while the giant mosquito character continued to appear across national events, campaigns and activities – including featuring in Lao PDR’s 50th anniversary national celebrations. 

Based on insights and learnings from 2024’s campaign, the giant mosquito character and a humour-led approach have been sustained across Lao PDR’s risk communications approach to dengue. Photo credit: WHO 

“For some, dengue has become routine or familiar, and people tend to discount threats that feel chronic rather than acute,” said Dr James Kelley, Team Lead for Malaria and Arboviruses, WHO Regional Office for the Western Pacific. 

“Introducing evidence-based, innovative and emotionally compelling approaches, including humour when appropriate, can make all the difference, cut through noise, and help save lives. Although risk communications is just one part of the health emergency response mix, as we have seen in Lao PDR, it shows how essential it can be, particularly in resource limited settings.” 

This work was made possible through support from the Korea Disease Control and Prevention Agency (KDCA), the Gates Foundation and Institute of Philanthropy (IoP).