
Focus: Communication is Key!
Striking the Balance Between Alert and Panic
Cooperation with the Mass Media
In countries with a high level of connectedness of the population, a central issue in vertical communication will be the control of the information accessible to populations. Dr KUO’s presentation, which focused on the relationship of the government with the mass media, is revealing in this regard. Policy makers and communicators in highly connected environments must make do with the instant availability of parallel communication channels and contradictory information which threaten to blur the government’s message, and impede behavioural change. Dr KUO showed a video taken from a Taiwanese show, featuring a young girl whose left arm and leg had – allegedly – been paralysed following vaccination. Such a video could potentially harm the government’s vaccination strategy, and the CDC, the agency in charge of the management of health outbreaks in Taiwan, was quick to prove the hypothesis wrong and issue a denial in the media. In order to prevent and absorb such competing claims, Dr KUO insisted on the need for policymakers to be proactive, and issue information as much as possible before the media, to be reactive, and most importantly to build trust amongst its population through early announcement, but also transparency and an ability to listen to the population.
As clearly illustrated by his finishing quote: “to declare war on the media, though tempting, is a game you will never win.”
Dr KUO’s presentation focused, quite significantly, on the importance of communication between decision makers and the media. The media is indeed one of the most institutionalised channels through which the information produced by decision makers will be passed on to the public. It is also the vector through which the state of mind of a given audience will be made visible, either indirectly, through reports and articles, or directly, through op-eds and tribunes.
A certain degree of management of the media space is therefore necessary if decision makers want to control the messages that they give out. Dr KUO advocated gaining a certain degree of control over the information produced, but also of controlling, as in “taking the temperature of”, the state of mind of the population. Thus a good timing, and transparency in the communication strategy were put forward as ways of dealing with the conflicting information that can emerge in the media – such as the story of the paralysed young girl that we mentioned earlier: produce information before the media does, be honest in communicating the amount of information that you know and that you don’t know. The perception of transparency will strengthen trust, thus making populations less vulnerable to competing claims. Dr KUO also insisted on the need for decision makers to demonstrate care. In his words, “people don’t care how much you know, they just want to know how much you care.” The projection of care is an important component of an effective communication strategy, to which we will come back to as we reflect on the final part of this session.
(Summarized by E. Broughton)
Managing Uncertainty in a Pandemic: the Singapore experience
Singapore’s communication strategy on the Pandemic A/H1N1 has been quite country and culture-specific. Singapore’s response system, the DORSCON (Disease Outbreak Response System), evaluated pandemic severity using a classification distinct from that of the WHO, integrating the parameters of transmissibility and virulence of a disease.
Singapore’s communication strategy was also remarkable for its directive style. In the words of Dr MENON, “soft warnings and reassurances do not work”, whilst “fear can be a constructive emotion.” Thus rather directive measures, in place of incentive ones, were communicated to the public – Home Quarantine Orders for travellers returning from Mexico and voluntary quarantine for those returning from other affected areas, travel restrictions through “strong” advise to postpone or avoid non-essential travel – travellers which had stayed at the Metropark Hotel Wanchai, in Honk-Kong, were requested to call the hotline of the Ministry of Health, deployment of thermal scanning in air, sea and land checkpoints.
Such measures, which were well accepted by the Singaporean population, could have been difficult to implement in a number of other countries. The position of the Singaporean government, which is endorsed by its population, is that “it is better to err on the side of over-reaction that under-reaction.”
Dr MENON’s presentation also illustrated the difficulties that may arise from the articulation of local and global governance levels. For instance, it would seem that Singapore, despite its independent system for evaluating the severity of the pandemic, dovetailed the progressive step-up of WHO phases, only to reverse this progression and retrograde shortly after, when it appeared that the disease was less serious than expected. This “evident confusion in the responses of Government Ministries and organisations having to amend processes mid-stream” was caused by the perceived “loophole in WHO’s pandemic alert system”, or more generally by the friction that can arise between global (WHO) and local standards.
The importance of local/national specificities in elaborating an adequate communication strategy does not preclude however the existence of a global framework actively shaping it. Dr MENON underlined that the specific content of Singapore’s management of the Pandemic A/H1N1 outbreak took place under the umbrella of the WHO. Information between both levels circulated, and was either adapted at the local/national level from the global one, or compatible with it. Specific communication styles did not send contradictory signals.
(Summarized by E. Broughton)Download here Dr. Menon’s PPT
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Communication is key! Best practises from the management of global health outbreaks.
A summary of proceedings after the colloquium which was held on November 28, 2009 in Taipei
On the positive side, the crisis demonstrated achievements, such as a high level of transparency and efficient communication strategies by the WHO, the (US) CDC, and other actors. If a close and thorough study of the experience of the new influenza remains to be written, the A/H1N1 outbreak has raised issues and lessons that are common to any global public health crisis communication strategy.
The first lesson, which now seems to have been widely acknowledged but may not yet be fully implemented, is that communication not only matters, but is key to the successful management of any crisis.
This being acknowledged, the second lesson is that communication should be first and foremost about “horizontal communication”, i.e. about the getting together of decision-makers from different sectors and organisations to exchange information and analyses through transparent processes and to coordinate their responses to maximise impact. Within one given country, how do different ministries and agencies coordinate to respond to a public health crisis? At the global level, how does the WHO play its coordinating, and information-pooling role, how does it rationalise the global response? What options exist to improve such communication processes?
The third lesson underlines the importance of “vertical communication”, between decision-makers and the public, and “transversal communication”, amongst members of the public. Often, fear of panic and the desire to “reassure” dominate the strategies to manage public health crises. This can lead to discourses fostering anxiety or on the contrary disinterest, rather than the development of a social space nurturing behavioural change and preparation. What options can we think of to circumvent such a paradox? Could and should public health communicators rely more on bottom-up strategies (empowerment of the public) or “transversal communication”?
Finally, the rise of new media (one needs only to think of twitter) has already revolutionised public health communication. What are the innovative trends and options currently being developed to improve global public health communication? What can we learn from such experiences?
Read the complete report (pdf)
The Challenges of Facing the H1N1 in the Taipei Region
The SARS epidemic of 2003 highlighted the communication difficulties between local government and central government. The command structure was changed in the aftermath of SARS. Under the revised system, the central government operated the command center and local governments executed these commands. This ensured that messages delivered during H1N1 were more consistent.
The government had two phases of dealing with H1N1:
1.Stage of containment – June 2009. Many foreign tourists so hotels used as checkpoints; and
2.Stage of mitigation – September 2009. Coincided with the Deaf Olympics in Taipei. This was at the height of the pandemic. Letters sent to guests.
The 2009 H1N1 campaign was successful because it was simplicity (message was easy to understand), credibility and delivered in a unified voice.
Roles and Limits of Communication
From the Global response to Avian Influenza through Pandemic A/H1N1, towards "One Health"
[inset side="left" title="Alain Vandersmissen"] has been the Coordinator of the External Response of the European Commission to the Avian Influenza Crisis since January 2006. In this capacity, he has strongly contributed to the orientations and achievements of the global AI response. He is one of the promoters of the evolution of the AI response towards a “One Health” approach addressing all major risks at the interface between animals, humans and ecosystems. [/inset]
The Global Fight Against Avian Influenza
The term “Avian Influenza” (AI) refers both to: 1/ the existing and related avian influenza epizooty and epidemic, and 2/ the possibility of an influenza pandemic, that would result from a mutation of the H5N1 virus.
The issue of AI therefore implies two necessities: 1/ the need to control the existing avian influenza virus and 2/ the need to prepare for the next pandemic.
The reaction to the AI issue has thus articulated itself, over the years, in two movements: 1/ a strong solidarity drive, from the better prepared, to the less prepared and 2/ a “national preparedness drive”, as the majority of countries strove to strengthen their own capacity to respond to an AI outbreak/pandemic. The tension between those two dimensions of the management of AI contributed to the build-up of a strong mobilisation, from very different communities (animal health, human health, environmental health, security, media, private sector, etc.). This process of mobilisation resulted in the emergence of what appears to be, with the benefit of hindsight, a real “global fight against avian influenza”, which reaps significant results, as this report highlights. Such a dynamic may not last forever, however, as a lurking fatigue with the issue seems to be spreading amongst actors, and threatening past and current efforts. The new “One World One Health” agenda could, in this regard, prove to be a necessary option to remobilise actors, and consolidate the outcomes of the fight against AI.
Before highlighting some key lessons from the fight against AI, one should draw some key features of the architecture of the global governance of avian influenza.
Which Global Governance of AI?
- Governing AI at the global level has been a fluid process, as it took some time to structure the large range of actors that had mobilised. Today still, as the agenda One World One Health is gains momentum, the exact role played by the different institutions involved in this process
might start to shift again.
- States are the key actors, as they raise political momentum at the global level, and as no possible response/control/preparedness is possible without them.
- Intergovernmental Organisations are very important supporting actors in the fight against AI; it is important in this regard to understand their role and limits. If IOs are faced with some problems
i.e. bureaucratic problems, traditional aid issues), they also proved to be extremely innovative.
- The regional level can have a facilitating effect on the global fight against AI. However, strong discrepancies exist between the regional organisations.
- A strong mobilisation was possible thanks to yearly conferences at the high political level; high political support from the national level: continuity of leadership; simulations; a cautious use of the “security” agenda.
- Coordination, which is always a problem at the global level, appeared to be less of a problem her thanks to global, regional, national and institutional coordinators, who had both a high visibility and sufficient time, and used frequent meetings of all stakeholders to insure coordination worked. UNSIC was useful but not very present on the ground; the question of its persistence in 2009 is still open.
- The Global Governance of AI confirms that strengthening existing organisations and coordination mechanisms can prove more efficient than creating new institutions.
LESSONS from a Global Fight:
- One needs a blend of horizontal and vertical approaches to global health issues to ensure that both animal and human health systems and the specific realities of a given diseases are taken cared of.
- Communication is a key factor.
- Surveillance systems are now better, but they can still be improved, and this needs to be done.
- A rapid emergency response requires long term investment. Even fire brigades have structural costs.
- Decision-making in grey environments implying investing time and money in research, but one should accept the fact that there will never be enough knowledge, and that grey decisions will thus have to be taken.
- Global norms are essentials, but they need to be adapted to local settings. Furthermore, a robust system to check on implementation of global norms needs to be established.
- Controlling epizootic will always imply a risk for livelihoods and an increase in poverty levels. Sustainable financial solutions have to be found. Eradication will always be extremely difficult with complex ecologies and should therefore take place as soon as possible, before the virus spreads.
- The best options to respond to human cases is to strengthen [one] health systems. This implies an increase in the surveillance and response capacity, the distribution of pharmaceutical options, and the surge capacities. Non pharmaceutical options are important, but they cannot replace the medical response.
- Pandemic preparedness is a complex and constant effort. It requires both: 1/specific health efforts and multisectoral efforts to detect and solve gaps and vulnerabilities (importance of simulations); 2/ the recognition that there is no “zero risk”. Indeed, the real issue may be the resilience of the system and its capacity to survive to such a traumatic experience.
- Global Health and the virus-sharing issue would strongly benefit from a reformed WHO sharing system, and more widely a solution has to be found to improve access (included delivery) to drugs and vaccines against emerging diseases of global impact.
The future of AI
Prevention and preparedness efforts are difficult to evaluate. However in terms of surveillance and control, the effects of the fight are positive, and the world seem better prepared now than five years
ago to face an AI pandemic. Will this situation last? AI will remain a problem for some countries where the virus has become endemic and where, as soon as efforts diminish or falter, AI will re-emerge. People are still dying from H5N1. The pandemic risk will last. The fight is not over.
In July 2008, several persons interviewed in Washington D. C. were positive that if Senator Obama were to be elected, more funding would be dedicated for the management of global health issues and health systems. However, the advent of the financial crisis may make health issues appear like less of a priority for many decision-makers.
A new momentum has to be raised, for global health, for “One World One Health”, and for AI.
Read here the complete report
The Formula of Risk Communication
Communication and its Contradictions
Inform and Communicate Through Community Mobilization
Download here the complete presentation in PDF
Communication in a Time of Crisis
Rumour and prevention
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