Outbreak Communications

1. Outbreak Communications

2. Learning Objectives At the end of the presentation, participants should be able to: • Explain the importance of outbreak communications • Describe best practices in outbreak communications • Develop clear and concise message • Identify basic structure in outbreak investigation report • Discuss benefits of integrating communication in overall outbreak management

3. Outbreaks: Unique public health events Urgent emergencies Unfolding/ Unpredictable Create anxiety Socially/ economically disruptive strong political dimensions Newsworthy! Behaviour plays role in transmission

4. Outbreak Communications - challenges • Public expects access to its government • Demand for information increases • Coordination is crucial • Workload increases

5. Outbreak CommunicationsBest Practices

6. Best Practice # 1 – Build Trust The overriding goal for outbreak communication is to communicate with the public in ways that build, maintain or restore TRUST • Public perceives communicator by: • Motives • Honesty • Competence Doctor are you sure this is an approved surgical technique? WHO Outbreak Communications Guidelines, 2005

7. Best Practice # 2 – Announce Early • The most critical of all outbreak communication messages • Must be early • Likely to be wrong When officials are concerned, the public should be warned.

8. Best Practice # 3 - Transparency • Transparency results in higher trust! • Two main issues • Defining limits e.g., patient confidentiality • Information delay (>>>)

9. Best Practices Most important in the Asian setting! Trust Announcing Early Transparency

10. Best Practice # 4 – The Public • It is nearly impossible to design successful messages that bridge the gap between the expert and the public without knowing what the public thinks.

11. Best Practice # 5 - Planning • Outbreak communication plan MUST be a part of outbreak management plan * WHO Outbreak Communications Guidelines, 2005

12. Message Development

13. Message Development When creating a message, consider Purpose of Message Channel/ Format Audience

14. Tips for clear, concise, interesting message • Use message map • 3 key messages with supporting materials • Each message can stand alone • Keep messages brief • 27 words (9 seconds) • Understandable to the audience • 4 grade levels below audience average • Avoid unnecessary “absolutes” • Leave room for unknown information • Avoid negative terms • Avoid “No”, “Do not”

15. Clear and easily understood Carcinogen Statistical significance Attributable risk Incidence rate Age-adjusted mortality rate Standard deviation Mutagen Prophylactic Relative risk Morbidity Odds ratio Mortality Dose-response Epidemiology Prevalence Toxicology Surveillance Reference dose Control group Confidence interval Variance Vector

16. Message Map General Public (could be any group, e.g., policymakers, media) (e.g., what should we know about cholera transmission?) This message should contain three sentences and three related concepts at most. It should require roughly 27 words. It should be stated as simply as possible. Most important message here. Least important message here. Second most important message here. Supporting information should add detail to overarching and key messages.

17. Message Map – an Example General Public What is pandemic influenza? Pandemic influenza is a new type of flu An influenza pandemic is likely to be more severe than yearly influenza The timing and nature of pandemics are unpredictable. It is caused by new viruses or by those that have not circulated among people for a long time. Illness and death rates are likely to be significantly higher than is normally seen during a seasonal influenza epidemic Influenza viruses change constantly, so it is impossible to predict their features and the impact on the population 11 Pandemic influenza will last longer than a regular influenza and will come in waves of activity separated by months. It spreads easily from person to person through coughing and sneezing and causes serious illness. We cannot predict how fast a new influenza virus will spread. Pandemic influenza viruses can spread worldwide within months, or weeks, and can cause illness and death in all age groups. A vaccine cannot be made until the virus has been identified. Most people will have little or no immunity to the new virus.

18. He who does not understand a look will not understand a long explanation either. (Arab proverb)

19. Basic message component Basic Message Component Basic Message Component • Express empathy • What you know • What you don’t know • Dealing with the problem • Commitment • Sources of information

20. Example: Create a Message • A virulent strain of Type A influenza has caused 1500 infections and 150 deaths in Southeast Asia • In the past 3 days, people have become ill in New York and Los Angeles • Today, 30 area residents were admitted to the hospital with high fever, difficulty breathing, and severe pneumonia; lab results will be available in 12-24 hours • No vaccines or drugs are known to be effective • Symptoms are treatable with supportive medical care • Public health is operating on the assumption that this is the same flu reported in Asia and the US • Public health is working closely with hospitals and medical staff to identify other cases

21. Example: Create a Message • Expression of empathy and caring “We’ve all been hearing news about the flu, and we’re concerned about what we might be facing in our communities.” • Confirming facts “Today, 30 people were admitted to hospitals with high fever, difficulty breathing, and severe pneumonia.”

22. Example: Create a Message • What you don’t know about the situation “We suspect it is the same influenza that has recently appeared in southeast Asia and parts of the US, but we cannot conclusively identify this disease at this time.” • Process to deal with the problem “However, specimens have been sent to the state laboratory and we are awaiting the results. In the meantime, we have brought together the best medical and scientific expertise to care for the sick, learn the cause of their illness, and if it is a contagious disease, work to contain it.”

23. Example: Create a Message • Statement of commitment “This is a process that is going to take a little time. We will update the public on any information as it comes to light.” • Where people can get more information “We have established a public health hotline to answer people’s questions and have important information on our Web site. The number to call is 1-800-555-AFLU, or visit www.aflu.com.”

24. Outbreak Investigation Report • Complexity of the report depends on • the type of investigation, • the extent of the outbreak, and • the audience of the report

25. Outbreak Investigation Report: What and Why • What • Findings during different stages of outbreak investigation • Why • To document for action • Share new insights • Provide record of performance • To verify and substantiate recommendations In order to: • To enhance quality of investigations • prevent future outbreaks • assist in investigation and control of similar incidents • provide a document for potential legal issues

26. Some outbreak reports have become part of history…….

27. Outbreak Investigation Report:Who writes, when, who reads • Who writes • The outbreak investigation team • Other authors as assigned • When • When the investigation is ‘complete’ • When the investigation is ‘ongoing’ • Who reads • All agencies involved in outbreak investigation and response • Policy making bodies, professional colleagues • The public, the lawyers, the media

28. Outbreak Investigation Report: Basic Structure • Summary • Introduction and Background • Methods and Results • Discussion and Lessons Learned • Recommendations • Acknowledgements

29. Outbreak Investigation Report: Challenges • Writing reports • delay or not writing at all • Confidentiality • to patients, involved communities • Accountability • who owns the report/ data

30. Built on trust, effective outbreak communication will help speed up control WHO Outbreak Communication: Best Practices for Communicating with the Public during an outbreak, 2004

31. References Conducting an Outbreak Investigation. The North Carolina. Communicable Disease Control Manual, North Carolina Division of Public Health. Accessed at http://www.epi.state.nc.us/epi/gcdc/manual/outbreakinvest.pdf Crisis and Emergency Risk Communication. Atlanta, Center for Disease Control and Prevention, 2002. Effective Media Communication during Public Health Emergencies: A WHO field guide. Geneva, World Health Organization, 2005. (WHO/CDS/2005.31a). Message Mapping. PowerPoint presentation in: Risk and Emergency Communication for Avian Influenza and Pandemic Preparedness Workshop. Center for Disease Control and Prevention (CDC), Thailand, February 2006. Outbreak Communication Guidelines. Geneva, World Health Organization, 2005. Outbreak Communication handbook for Journalists, Geneva, World Health Organization, 2005. Outbreak Communications Guidelines (Draft). Geneva, World Health Organization, 2008 Risk Communication. PowerPoint presentation in: Risk Communication Workshop, MOPH, Thailand. Ray Kemp Consulting Ltd., November 2007. Risk and Crisis communication for Avian Influenza Rapid Response Team (AI RRT). PowerPoint presentation in: Training of Trainers for AI RRT, Thailand, July 2006. The Outbreak Investigation Report. PowerPoint presentation by Arnold Bosman and Meirion Evans. Epiet. Accessed at www.epiet.org/course/presentations2003.html Writing an Outbreak report. PowerPoint presentation in: I is for Investigation, Outbreak investigation from mystery to mastery. The North Carolina. Communicable Disease Control Manual, North Carolina Division of Public Health. Accessed at: http://www.wvidep.org/Portals/31/PDFs/TrainingResources/2007/Report_Writing.pdf