High Impact, High Feasibility Interventions

Health policy coordination, especially during a disease outbreak, is a crucial measure to ensure that leptospirosis cases are addressed promptly. The government implements Code White Alerts during peak risk periods. This alert system is used by DOH to enhance the readiness of hospitals and health facilities while they remain on standby for potential case surges. The announcement of a Code White Alert is communicated through press releases and regional and local rollouts. DOH, through its Regional Epidemiology and Surveillance Units, actively tracks and reports cases, whereas local government units collaborate with DOH on real-time data reporting and flood-season mapping to guide targeted interventions. Those programs are crucial in reducing disease severity, preventing fatalities, and ensuring timely clinical care for diagnosed patients, helping them avoid further complications (10,11). The interventions have high feasibility and high impact in the Philippines.

High Feasibility, Low Impact Interventions

In the Philippines, the onset of typhoons and monsoon floods often triggers a surge in information, education, and communication (IEC) materials on leptospirosis from government agencies, local government units, universities, and nongovernment organizations; one such IEC material, posted on social media, informed the public about the transmission cycle of Leptospira and preventive and control measures (Appendix). That IEC material and other IEC materials, typically focus on ideal preventive actions such as avoiding wading in floodwater, wearing protective boots and gloves, washing with soap after exposure, and seeking early medical care if symptomatic. Although such advisories are medically sound, they often fail to account for the lived realities of urban flood-prone communities. In low-income settlements, many residents have no choice but to wade through floodwaters to evacuate, retrieve belongings, commute to work, or access basic needs. High flood levels make the use of boots impractical. Similarly, hygiene recommendations such as thorough washing with soap and clean water are challenging when water supplies are disrupted and soap is a low priority in emergencies. Messages about rodent control and drainage maintenance may also be irrelevant in the immediate aftermath of a disaster, when survival and shelter take precedence over environmental interventions. The mismatch between the prescriptive tone of IEC materials and vulnerable communities’ structural constraints may reduce the credibility and impact of public health messaging. To be effective, leptospirosis prevention campaigns must move beyond one-size-fits-all advice and integrate context-sensitive strategies, such as guidance for unavoidable exposure, accessible postexposure prophylaxis, and community-based flood safety measures, that reflect the realities on the ground.

For case management and clinical response, standardized Clinical Practice Guidelines developed by DOH with professional medical societies ensure uniform diagnosis and treatment protocols across health facilities (12). Benefit packages for leptospirosis, implemented by the Philippine Health Insurance Corporation (PhilHealth), help ease the financial burden on affected patients and support the cost of care by covering expenses related to hospital confinement, laboratory tests, and medications (13). The government also deploys medical missions and provides postflood doxycycline prophylaxis to high-risk persons in flood-affected areas. However, when those measures are activated, persons have already been exposed and infected, meaning the burden on the healthcare system and communities remains high.

Educational campaigns with structural constraints do not substantially help in reducing leptospirosis prevalence. On the other hand, case management and clinical response minimize fatalities and severe cases, but do not necessarily ease the burden on the healthcare system. Thus, both are feasible in the Philippines, but both have a low impact.

Low Feasibility, High Impact Interventions

Flooding, as a major risk factor of leptospirosis outbreaks, requires mitigation, including national flood-control projects. Flood control in the Philippines, particularly in urban communities like Metro Manila, faces chronic challenges from rapid, unplanned urbanization, inadequate infrastructure, and governance issues. Informal settlements along rivers and drainage systems obstruct waterways, whereas aging pumping stations and silted floodways like the Manggahan Floodway in Pasig City struggle to cope with intense rainfall and typhoon-induced surges.

Major projects intended to address these problems often have been marred by controversy. In a city in the Visayas region, for example, nearly 4 billion Philippine pesos’ worth of flood-control projects were reported in 2025 as incomplete, poorly built, or entirely missing. National audits have long indicated that many flood-control budgets are lost to graft, leading to stalled or substandard infrastructure (14,15). The head of government raised allegations of corruption and mismanagement from the executive and legislative branches, prompting nationwide investigations into several of those projects (16).

In a different aspect, Laguna Lakeshore Expressway–Dike, another flood-control project, has faced opposition from some environmentalists and fisherfolk because of concerns about displacement, ecologic damage, and inequitable benefits (17). Similarly, the proposed Pasig River Expressway drew criticism for threatening heritage areas, worsening urban heat, and potentially increasing flood risk by reducing river buffer zones (18). Even long-standing flood-control structures like the Manggahan Floodway have had unintended consequences, such as aggravating flooding in downstream communities around Laguna de Bay because of siltation and pollution (19). Such controversies hamper engineering capacity, transparent governance, inclusive urban planning, and sustained maintenance, making the affected areas vulnerable to recurring, often catastrophic floods.

Although the flood-control projects in the Philippines are not yet adequately managed, other interventions also must be considered. Rat-catching campaigns in the Philippines have long been promoted to reduce leptospirosis and other rodentborne zoonotic diseases, particularly in flood-prone urban and agricultural areas where human–rat contact is frequent (20,21). However, their long-term effectiveness is challenged by the biology of rats, which have exceptionally high reproductive potential. Many common rat species, such as Rattus norvegicus and Rattus rattus, reach sexual maturity in as little as 3 months, and female rats can conceive again within weeks after giving birth. Because each litter may produce 6–12 offspring and multiple litters can occur annually, rat populations can rebound quickly even after intensive control efforts (22,23). This rapid turnover means that without sustained, integrated control, combining environmental sanitation, secure food storage, habitat destruction, and public health education, rat-catching alone offers only temporary relief. The importance of sustained, integrated control cannot be overstated, given that it is the key to long-term prevention and control of leptospirosis transmission, particularly after flooding events when contaminated water is widespread.

Environmental hygiene, an approach that can be integrated with rat-catching, also faces substantial challenges in urban communities, especially in low-income areas of the Philippines. Many urban low-income families live in informal settlements where water access is limited to shared or purchased sources, often of questionable quality (24). Housing frequently does not meet the family’s needs, being makeshift, overcrowded, and vulnerable to flooding, creating ideal habitats for rats and other disease vectors (25). Waste-management systems are inconsistent or absent, accumulating garbage in streets and waterways, attracting rodents, and exacerbating flooding. Toilet facilities, if present, often are shared by multiple households and may lack proper sewage connections, resulting in environmental contamination that increases the risk for leptospirosis and other zoonotic diseases (26). Those constraints mean that, even when communities engage in rat-catching activities, unhygienic environmental conditions continually undermine disease-control efforts, making sustainable prevention difficult without broader improvements in urban infrastructure and social services.

Flood control, rodent control, and environmental hygiene and sanitation are key interventions for mitigating leptospirosis cases and preventing outbreaks. Their collective impact is considerable because they directly disrupt the transmission cycle of Leptospira bacteria. However, because of poverty, corruption, and a lack of political will, the feasibility of these essential interventions remains low in the country.

Low Feasibility, Low Impact Interventions

Some interventions are challenging to implement and yield minimal benefits when executed. For example, developing targeted educational materials for leptospirosis prevention can be challenging because of the diverse and complex social structures across Philippine communities. Cultural variations, language barriers, and differing levels of health literacy make designing messages that resonate effectively with all audiences difficult. In addition, when targeted educational materials are used in isolation, they cannot produce a high impact on reducing leptospirosis transmission. This limitation also applies to rodent control, which will remain ineffective without the integration of improved environmental hygiene and sanitation.

The limited effectiveness of isolated, reactive interventions highlights the importance of prioritizing preventive, integrated strategies over responses. Preventive measures, such as effective flood control, rodent population management, improved urban sanitation, access to protective equipment, and health education before flood events, address the root causes of leptospirosis transmission. Unlike responsive measures, which are reactive and resource-intensive, preventive strategies can reduce exposure risk, lower the incidence of infection, and minimize the need for costly hospitalization and emergency care. In the long term, prioritizing prevention saves lives, alleviates pressure on the healthcare system, conserves public funds, and fosters healthier, more resilient communities.