risk communication during an infectious disease event - pandemics and public health

SYDNEY MEDICAL SCHOOL

www.ncirs.usyd.edu.au

Effective communication strategies during an infectious disease event

Sheela Basrur Symposium, Toronto, 3 April 2013

A/Prof Julie Leask School of Public Health

Julie.Leask@sydney.edu.au @JulieLeask

Dr Claire Hooker

Centre for Values, Ethics and the Law in Medicine

Acknowledgements

›  Sheela Basrur

› Claire Hooker, Centre for Values, Ethics and the Law in Medicine, University of Sydney

› Catherine King, May Chiew, Alexis Pilsbury National Centre for Immunisation Research & Surveillance

›  Peter Massey, Hunter New England Local Health District, NSW

H1N1

Source: www.crikey.com.au

Outline

› Understanding public responses

›  Key challenges

› Working with the media

› Changing media landscape

›  Practical risk communication suggestions

Understanding public responses to risk

“If we want to be prepared for a major flu epidemic we must understand not only the virus and how it spreads but also cities and how they function, organizations and how they

operate, communities and how they relate, and individuals and how they make choices.”

Kickbusch and Sakallarides 2006

THE RECIPIENT

›  Availability heuristic

›  Anticipatory regret

›  Ambiguity aversion

Some particularly relevant cognitive heuristics and biases

Perception of the hazard

FRIGHT FACTORS ›  dreaded outcome ›  affects ‘vulnerable’ ›  identifiable victims ›  poorly understood by

science ›  contradictory

statements from sources

›  involuntary

The goals in risk communication depend on the levels of outrage and hazard

From: Peter Sandman

Competence, objectivity, fairness, consistency, empathy

(Renn and Levine in Communicating Risks to the Public 1991)

What is the strongest form of communication?

The challenges

“One serious effect resulting from the restrictions above mentioned was that the general public was led to regard the disease as a very fearsome thing, and the application of regulations dealing with contacts strengthened their belief in the matter, with the result that so soon as the number of people fell ill they were in very many instances left to do the best they could for themselves because of the fear which the neighbours had of themselves contracting the disease. In some towns yellow flags and other symbols were displayed to warn the public from entering the invaded premises, and this was cruelly insisted on in some districts where, unfortunately, the local authorities had made no efforts to provide proper help for the stricken inhabitants.”

Report on the Influenza Epidemic in New South Wales in 1919;172

Uncertainty

› The public and the mass media have poor tolerance for uncertainty

› Uncertainty was communicated reasonably well during the H1N1 pandemic

Defining the risks

›  Illness and death ›  Impacts of trade and travel restrictions

› Psychosocial impact of restrictions › Excessive healthcare usage › Stockpiling medicines › Reputation risks

Media Challenges

›  Traditional mass media remains prime

›  Limitations -  Tendency to amplify high outrage

risks

-  Tendency to reproduce error

-  Lack of capacity to present complexity

-  Potential for stigmatisation

Working with journalists

› Study: how journalists approached reporting avian influenza stories in 2007

Working within constraints

Tyranny of deadlines “On one axis you have maximum accuracy, integrity, detail - all of those

wonderful things. And then on the other one you've got time. Your job is to do the best you can within that parameter.”

(Newspaper medical reporter)

Need for images Human angle

Access to experts and transparency valued

Good ‘talent’ •  Trusted •  Knowledgeable •  Communicate clearly and

compellingly •  Accessible

“Just make sure your talent is always available – because nothing annoys media more than if they can't get someone, that is when things go pear shaped, because no-one is there to answer their questions”.

Newspaper reporter

Journalists balance ethical tensions

“We don't want to panic people, but at the same time we do want them to watch our news. There will be headlines, promos saying 'tonight Pandemic kills x many people' – but we just have to make sure we give an accurate report of what happens. But we always try to give advice. We want to reassure people what to do to protect themselves.”

(TV news producer)

Specialist Medical Reporters

› Better knowledge › Access to a wider range of sources › Gatekeepers and advocates › Cooperative but critical

“The media is not the public relations wing of the health department. We are not there simply to report what they want to tell the public - though we will usually do that also. But our role is to ask challenging, independent questions.”

(Newspaper medical reporter)

A changing media landscape

Slide courtesy of Carolyn Der Vartanian

Slide courtesy of Carolyn Der Vartanian

Social Media: A group of Internet-based applications that … allow the exchange of user-generated content. (Kaplan 2010)

The pitfalls….

… and the opportunities

Information: "Train services are resuming in parts of Brisbane. Stop walking on the tracks #TheBigWet #qldfloods" "No homes can be reconnected to electricity until they have been certified as safe by an electrician #qldfloods #TheBigWet“

Mythbusting Wivenhoe Dam is NOT about to collapse! #thebigwet #qldfloods"

There is currently NO fuel shortage in Brisbane. #qldfloods #thebigwet

The lighter side We're building an Ark Help! I've lost my Goldfish

Source: http://www.brightlabs.com.au

Signorini A, Segre AM, Polgreen PM (2011) The Use of Twitter to Track Levels of Disease Activity and Public Concern in the U.S. during the Influenza A H1N1 Pandemic. PLoS ONE 6(5): e19467. doi:10.1371/journal.pone.0019467 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0019467

Estimate disease activity in real time

Consider this How could you and your organization use social media?

Effective communication during an infectious disease event

Being Prepared

› WHO do you need to communicate with?

› HOW are you going to communicate with them?

› WHAT do they need to know?

Source: http://www.sti.risk-technologies.com/AnnouncementPreview.aspx?eid=4845

Pre-event •  Prepare

Event

•  Media is ally •  Be available •  Work with specialist reporters •  Appeal to ethical commitments to reduce stigmatization •  Focus on action •  Use social media

Post-event

•  Media’s reflective and critical phase •  Acknowledge shortcomings •  Address non-medical costs •  Evaluate

Preserve trust Working with the media

General advice

› Use trusted spokespersons › Be honest, frank and transparent › Err on the side of disclosure

Preserve trust

Not  usually  a  helpful  

concept  

“Officials routinely expect the public to panic if told alarming things, and misdiagnose orderly efforts to prepare as panic.”

Peter Sandman Nature;2009

‘Panic’ is not usually a helpful concept in outbreaks

Talking about probability

›  Define the risks ›  Qualitative & quantitative estimates

›  Framing -  Loss frame “If you don’t wear PPE…. -  Gain frame “If you wear PPE….”

From http://www.chiin.ca/decisionaid.html

Communication tips

› Acknowledge uncertainty › Be dedicated to good technical

information › Explain rationale › Acknowledge emotional aspects › Communicate with all

stakeholders -  Preparing channels before the

event -  Have mechanisms for listening

› Prioritise special risk groups

Good communication requires supportive leadership

Prioritise special risk groups

› listen then share with communities the information needed

› localise, personalise and humourise › avoid paternalism, tokenism and ‘Aboriginalising’

An example… The pandemic project with Aboriginal and Torres Strait Islander communities

From: Massey PM et al Health Policy 2011;103:184-90 Australian Aboriginal and Torres Strait Islander communities and the development of pandemic influenza containment strategies: community voices and community control.

Social investment

Ministry of Health Report, October 1920

Retrospective assessment of what was needed in 1918-19

Conclusions

› Social and infrastructure investment › Action is a form of communication › Work with the traditional media › Evaluate efforts › Social media brings some risks but many opportunities

“The smart city builds these long before a crisis” Kickbusch and Sakallarides. Flu City—Smart City: applying health promotion

principles to a pandemic threat. Health Promotion International 2006

THANK YOU