Welcome back. Let's talk about Communication During an Outbreak. Public health crises usually begin insidiously when sick individuals present to either their doctor's office or to emergency rooms. These individuals who are sick do not come in with a big sign on their chest saying what they have. Instead, they have vague signs and symptoms. Fevers, chills, cough, diarrhea, nausea, or vomiting. Usually the doctors will treat them for common ailments such as the flu or gastroenteritis. The outbreaks that are due to uncommon or novel microbes are by nature rare and unexpected. It should be anticipated therefore, that diseases from novel microbes are going to be rare and initially misdiagnosed. Novel microbes might present challenges for the medical community, particularly if they are zoonotic, meaning that if they are diseases of animals that infect humans, physicians aren't going to be familiar with them. Veterinarians, on the other hand, will be familiar with them, but they might not be consulted in the early periods of an outbreak. Here's an image of an emergency waiting room that's filling up with sick people. There are difficulties in crisis communication during an outbreak, particularly when people feel that their lives are threatened, they experience fear, anger, anxiety, and denial. These strong emotions then might impair their decision-making capabilities and leading to counter-productive actions. Crisis communications can be particularly difficult because of the inherent uncertainty of risk. Nobody can predict the future and the ability to communicate uncertainty is very difficult. In other words, probability and risk are difficult concepts to understand. Risk is the probability of injury, illness, or a damage, or other negative consequences caused by a threat that may be avoided through preemptive action. So risk means different things to different people. For example, the actual risk or probability of being shot by an automatic weapon such as this might be low. But nevertheless, the fear that it generates can be very high because of this weapon's potential catastrophic, fatal consequences. What is risk perception? Safe hazards are those that are familiar and voluntary and controlled by the individual, such as driving a car. Risky hazards, on the other hand, are unfamiliar and controlled by other people such as pilots flying these large jets that carry hundreds of passengers. So people might consider driving a car, smoking a cigarette, or owning a gun as safe because they are the ones in control while flying in an airplane might seem risky, even though the statistics suggest otherwise. To avoid panic, political and bureaucratic leaders must be able to effectively inform the public of the known risks. So risk communication is a scientific approach to effective communication during a crisis. It's goal, therefore, is to help keep fears in perspective and to allow people to make reasonable, rational decisions even under stress. Communication strategies must be effectively planned before they can be carried out. Successful messages are usually simple and repetitive. Crisis communications are not easy and problems frequently develop. Political leaders who either ignore or downplay a crisis or lessen the severity of it, providing false reassurances run the risk of giving misleading or inaccurate information. Journalists usually prefer, therefore, to get information from scientists, but they're even less able to communicate to the public than political leaders. Also scientists typically don't get training in communication and tend to rely on technical jargon when talking. Elected officials might be more effective at communicating but they run the risk of giving false reassurances or misleading information. Therefore, elected officials, scientists, bureaucratic leaders can lead to leadership confusion, misinformation, if they communicate risk poorly. Let's look at the 2001 anthrax crisis from another case study. This one involving Secretary of Health and Human Services Tommy Thompson. Tommy Thompson suggested to the press that the first anthrax victim was exposed to natural causes and was trying to downplay the severity of the crisis to calm fears. He was criticized for political grandstanding and for giving information that should have come from a medical professional. Dr. Larry Bush, a physician pictured here, was treating the initial anthrax victim. He was shocked when he heard Tommy Thompson suggest that the patient was exposed from natural causes. He was almost certain that the patient was exposed from a bioterrorist event. Dr. Jeffrey Koplan, pictured here, was the Director of the Centers for Disease Control at the time. He and his team were busy investigating the outbreak and did not prioritize public information. As a result, he and his staff were accused of being inaccessible and not providing enough information to the public. When the crisis ended, the CDC to its credit, developed a risk communication model called Crisis and Emergency Risk Communication, or CERC, that emphasized what's known and not known about the crisis and being able to communicate that to the public. The public is more likely to believe a message if it is given by somebody with credibility who they can trust. Communication during the 1947 New York City smallpox outbreak could be considered a gold standard. During that outbreak, Dr. Israel Weinstein, who was the Commissioner of Health of New York City, immediately announced the outbreak to the public. He notified other bureaucratic leaders to get their cooperation. The New York City Department of Health had a sterling reputation and an excellent public relations team. Dr. Weinstein developed a two-part containment strategy. The first part was a mass vaccination campaign, and the second part was a campaign to identify the potentially exposed. He chose his words carefully to avoid panic and repeated his message, "Be safe. Be sure. Get vaccinated." It was simple and was repeated often. New York City Mayor William O'Dwyer followed model two by providing political support for Dr. Weinstein's decisions. Mayor O'Dwyer urged the public to get vaccinated while he himself received a vaccination from Dr. Weinstein. The media played an important role in Dr. Weinstein's communication efforts with the public. Squads of physicians were sent to vaccinate reporters, editors, and staff at the various New York City newspapers. Importantly, the health department had a very good working relationship with the media, which helped to keep frightening stories, gossips, and rumors to a minimum. The media played a key role in fostering the public sense of civic duty. The outcome of the smallpox outbreak was that in less than a month, more than 6 million people were vaccinated. Only 12 people developed smallpox and two people died from the disease. The smallpox vaccine was dangerous and there were some deadly consequences. For example, there were 46 cases of encephalitis, also known as brain inflammation. But if the smallpox vaccine had not been used, the consequences could have been far worse as exemplified by the Milwaukee Smallpox Outbreak of 1894. The 1894 Milwaukee Smallpox Outbreak response was a disaster. The press gave mixed partisan messages, poor people were forced into isolation hospitals, while rich people were able to stay in their homes. There was no public education campaign, and there were street riots. The end result of the Milwaukee smallpox outbreak was that over 900 people developed smallpox and 244 people died. But we have changing times now and our media has changed. As I mentioned in a previous slide, the US was an optimistic nation after World War II, and trust in government was at an all-time high. The country has changed since the smallpox outbreak of 1947. Events and developments such as the Vietnam war, the Iraq war, Hurricane Katrina, the rise of social media, have all worked to change the nation and public trust has been diminishing over time. The media is no longer confined to magazines, newspapers, or the radio. It now includes the Internet, social media, cable, and satellite television. The line between news and entertainment has been blurred. Information and news is now available 24 hours a day, seven days a week. Social media has had a profound influence on the dynamic of public communication; Facebook, Twitter, Instagram. Anyone can develop a following and disseminate information or inflammatory misinformation. In an effort to gain public attention, the CDC in 2011, came up with a brilliant media strategy by posting a zombie preparedness web page on its Center for Preparedness and Response website. Their reasoning is that if you're prepared for a zombie apocalypse, you're going to be prepared for any type of crisis. The website proved to be so popular that it crashed from thousands of visits. Vaccines are arguably our best strategy to prevent disease and contain outbreaks. The public, however, must trust the vaccines and the institutions promoting them. The current anti-vaccination movement can be traced back to 1998 when Dr. Andrew Wakefield published a paper in the Lancet using falsified data and implied a link between the measles, mumps and rubella vaccine and autism. The Lancet paper was subsequently declared fraudulent and was retracted but unfortunately, the damage to public trust had been done. Since that time, the reluctance of people to vaccinate or vaccinate their children has become epidemic. The World Health Organization has declared vaccine hesitancy, the refusal to vaccinate, despite the availability of a safe and effective vaccine as one of the top 10 threats to global health. Before the measles vaccine became available in 1963, the disease caused 48,000 hospitalizations, 400-500 deaths, and over 1,000 cases of encephalitis each year. In 2000, measles was eliminated from the United States because of the safe and effective vaccine. Unfortunately, now parental refusal to vaccinate their children has led to a resurgence in the disease in the US and around the world. The Ebola crisis also exemplifies a problem in lack of trust. The outbreak in North Kivu province has spiraled out of control despite the availability of diagnostics, experimental treatments, and a vaccine. The people there do not trust the authorities or the vaccine, and rumors and hatred spread easily. Unfortunately, political leaders are exploiting people's fears for their own political gain. So the questions for this section are: what is the concept of risk? How does the concept of risk differ between scientists and the general public? What is the difference between a safe hazard and a risky hazard? Have the media changes in the 21st century helped or hurt crisis communication? Why or why not? Why was the CDC's Zombie Preparedness website so popular? Why did the World Health Organization declare "vaccine hesitancy" to be a global public health threat? Finally, how should concerns about vaccines be addressed? With that, I'd like to thank you for your time and attention.
