Pandemic Influenza Communication National Public Health Information Coalition

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Pandemic Influenza Communication National Public
Health Information Coalition
Dan Rutz drutz_at_cdc.gov October 18, 2005
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U.S. Pandemic Flu Planning
accomplishments / activities

• Unveiled draft national pandemic influenza
  preparedness plan in August 2004
• Objective to provide state and local health
  departments useful guidance on
  communications planning,
  preparedness and response activities.
• Collected input and feedback from external
  partners
• Refined HHS plan undergoing final review
• part of comprehensive Federal (inter-departmental)
  plan
• strategic plan is informing development of
  specific activities

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Influenza Preparedness Task Force
Secretary Leavitt initiative

• global surveillance network
• interoperable local, state, federal response
  plans
• geographically distributed anti-viral drug
  stockpile
• domestic capacity for pharmaceutical production
• vaccine stockpile against potentially pandemic
  strains
  
• enhance domestic capacity for pandemic vaccine
  production
• research into improved diagnostics / treatments

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HHS Interagency Public Affairs Committee
onInfluenza Preparedness and Response

mission

• Established in July 2005 as a subgroup of the HHS
  Secretary's Interagency Task Force on Influenza
  Preparedness.
• Primary focus is government-wide coordination of
  public affairs activities related to pandemic
  influenza.
• Chaired by HHS with invited representatives from
  all U.S. government departments and agencies.  In
  addition, membership is also extended to
  interested state and local partners, foreign
  governments, and other appropriate U.S. and
  international non-government organizations.

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HHS Interagency Public Affairs Committee
onInfluenza Preparedness and Response
core operating principles

• Pandemic influenza will be an international
  public health emergency.
• Participation of diverse sectors of government is
  important, as an influenza pandemic will have
  implications for all sectors of society.
• All public affairs related to public health and
  pandemic influenza will be coordinated through
  and led by HHS to ensure that information is both
  accurate and consistent across the U.S.
  Government.

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Pandemic Influenza Communication and Outreach
critical to preparedness

• Research documents the importance of risk
  communication and early public discussion for
  effective health / emergency preparedness and
  outcomes
• Need to begin laying the foundation of
  expectation with communities (business,
  education, labor)..
• Preparedness tool communication is a critical
  part of our preparedness efforts
• Will be one of the few, if not the only tool,
  available in the early days of a pandemic

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Communications Preparedness
getting it right
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HHS Plan Expectations
worst case scenario resource

• How, why, and what pandemic influenza could do
• Lists priority objectives and activities of
  federal and state governments during
  inter-pandemic and pandemic periods.
• Explanatory components e.g.,
  rationale/goals, outbreak risk communication
  principles, lessons
  learned, key messages
• Living Document additions /
  revisions to provide
  additional detailed guidance

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HHS Plan Elements defining
the audience, informing the message

• H5N1 When should clinician order a lab test?
  (clinical signs, history etc.)
• State / local responsibilities outlined
  (assure timely communication between healthcare
  and public health sectors)
• Pandemic vaccine strategy (targeting
  healthcare workers in advance of pandemic)
• Vaccine Development (antigen-sparing
  strategies cell- and recombinant-based products)
• Anti Viral Drug Prioritization
  (recommendations and rationale)
• Quarantine Social Distancing Snow Days
  (what, where, when)

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Communications Priorities relevant,
practical, accountable, consistent

• An accurate, credible, and timely national plan,
  coordinated with partners (state, local, private,
  
  international)
• Information clearinghouse for public, media,
  professional organizations, clinicians, health
  departments, and other health authorities
• Materials for stakeholders (e.g., guidance and
  recommendations, templates, prototypes)
• Transparency in providing information about the
  status of the pandemicprevention and control,
  and rationale for interventions

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Communication Collaboration
with, not just for partners

• Share problems and solutions with state and local
  partners similarly engaged in
  Pandemic Flu Preparedness
• National Public Health Information Coalition
  (NPHIC) calls and meetings
• Regional planning sessions (public forums)
• News media stories, articles, documentaries

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Common Ground
Peter Sandman

• There is no public in a crisis everyones a
  stakeholder...

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Avian Influenza
pre-pandemic coverage

• Familiarize public with
• Why experts are concerned
• What could happen
• How were preparing
• When might this occur
• Who is in charge
• Where is the threat
• Why should I care
• What can government do
• What must I do

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Risk Communication Critics
hype
USA Today 10/5/05 (Birmingham News)
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Sound the Alarm / Alarm the Sound ?
Ulterior Motive Public
health attention to the latest potential killer
instead of the known killers
is not only an "epidemic" of misinformation, it
is also a kind of job
justification that is politically expedient.

• Worry Agenda
• It is not simply a question of whether an
  infectious agent is going to greatly harm us.
  Many viruses and bacteria have the potential to
  harm, but it is up to public health agencies to
  distinguish between potential and actual. Disease
  information is contextual - it is never an
  all-or-nothing situation as portrayed in the news.

Speculation Science (what data?) No
self-respecting scientist would have it any other
way. Should the criteria be less stringent
when scientists inform the public about
these same health issues?
Marc Siegel, M.D. (internist, author) NY Post
Op-ED 2-17-04
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The Risk in Public Health Communication
you cant win

• Successful campaign Worst Case averted
• You over-reacted you overstated the risk.
• Failed campaign Worst case occurs
• You didnt do enough why didnt you warn us?
• Either way, credibility is in jeopardy

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Evaluating Risk

John Adams University College London Michael
Thompson of the University of Bergen
Risk management is a balancing act in which the
potential rewards of getting it right are weighed
against the potential costs of getting it wrong.
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Probability vs. Possibility
Lee Clarke Rutgers
University Sociologist

• Bad things happen
• Probabilist unlikely, so dont worry.
• worry doesnt pay
• Possibilist what happens if it does?
• focus on consequences, what if..

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Probability vs. Possibility
Lee Clarke Rutgers
University Sociologist

• Its irrational to worry about low probability
  events
• Probabilistic thinking is equated with reason
  itself.
• Ordinarily trumps worst case thinking,
  (though as individuals we buy insurance, etc.)
• Disasters, even worst cases are normal parts of
  life.
• Possibilistic thinking leads to preemptive
  resilience
• Probablism isnt the only way to be rational
• We need both kinds of thinking to plan for and
  cope with the inevitable.

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Pandemic Influenza Awareness
dividend of worry

• Health authorities know that too soft a warning
  wont be heard.(but).fear that too loud a
  warning could .. provoke fear .. economic damage
  .. panic ..
  (So)
• Authorities often miss the middle ground that
  can help build mutual trust involving the public
  early, arousing an appropriate level of public
  fear, and helping people to bear it.
• Peter Sandman and Jody
  Lanard Perspectives in Health, 2005

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Prevention and Treatment PrioritiesAmericans
discuss difficult choices on who to protect
first against pandemic influenza.
attention, trust, support

• All will be affected policy will not be set by
  Public Health alone.
• Engage citizens, local/state, federal officials,
  academics, non-governmental organizations, health
  care providers, and industry
• National Dialogue sessions with key stakeholder
  groups
• Citizen at Large sessions for unaffiliated
  private individuals

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Consumer Styles Survey
Kristine Sheedy, CDC

• Annual mail survey (April and May since 2002) by
  Porter Novelli, a public relations firm.
• Covers variety of U.S. consumer behaviors
  including media choices and general health
  attitudes.
• 2005 survey sent to a stratified random sample of
  20,000 potential respondents from a panel of
  600,000 households
• 63 response rate
• Data post-stratified and weighted to U.S. Census
  Current Population Survey on gender, age, income,
  race, and household size
• confidence interval approximately /- 1

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Awareness
Sheedy et al.

• Have you heard of pandemic influenza?
• 29 said yes, 71 said no
• 54 heard of avian influenza
• How often have you heard about pandemic
  influenza in the past month?
• 21 said a lot (at least 1-2 stories a week) or
  some (a few stories in the last 30 days)
• 79 not much (maybe a story or two in the last
  30 days) or nothing at all
• Following awareness questions, respondents were
• given a brief description of pandemic influenza.

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Concerns Beliefs
Sheedy et al.

• How concerned are you that an influenza pandemic
  will occur in the U.S. in the next 3 years?
• (1-10 scale, 1 being not at all and 10 being
  very concerned)
• 31 expressed concern (selected 8, 9 or 10)
• 20 expressed little or no concern (selected 1,
  2, or 3)

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Concerns Beliefs
Sheedy et al.

• Health authorities are exaggerating the risk of
  a pandemic.
• 22 agreed or strongly agreed
• 54 disagreed or strongly disagreed
• 24 said dont know
• An influenza pandemic is too far into the future
  to worry me now
• 20 agreed or strongly agreed
• 66 disagreed or strongly disagreed
• 14 said dont know

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Concerns Beliefs
Sheedy et al.

• A vaccine will be developed fast enough to
  control or stop a pandemic from severely
  affecting the U.S.
• 32 agreed or strongly agreed
• 42 disagreed or strongly disagreed
• 27 said dont know

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Concerns Beliefs
Sheedy et al.

• During an influenza pandemic there will be
  enough medicine to help all people who get
  sick.
• 17 agreed or strongly agreed
• 63 disagreed or strongly disagreed
• 21 said dont know
• During an influenza pandemic, vaccines and drugs
  will be distributed fairly.
• 54 disagreed or strongly disagreed
• 28 agreed or strongly agreed
• 18 said dont know

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Perceived Preparedness
Sheedy et al.

• If an influenza pandemic happened in the next
  year,
• a), b), c), would be prepared to quickly
  and effectively respond
• Local health officials
• 27 agreed or strongly agreed
• Federal health officials
• 29 agreed or strongly agreed
• Health care providers
• 34 agreed or strongly agreed

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Acceptance of Response Measures
Sheedy et al.

• How willing do you think you would be to
• Care for yourself or sick family members at home
• 85 willing or very willing
• Limit contact you and your family have with
  others for one month or longer
• 62 willing or very willing
• Keep your children home from school for one month
  or more
• 62 willing or very willing

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Testing Pandemic Influenza Messages
Oak Ridge Institute for Science and Education
(ORISE)

• Message testing among samples of key
  stakeholders
• How well messaging addressed concerns
  questions
• What people know, feel, believe about pandemic
  flu

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Data Collection ORISE

• 39 interviews with health care providers
• 97 members of general public in 24 groups
• August 2005
• New York City, NY
• Wichita, KS
• Portland, OR
• San Francisco, CA

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Health Care Providers too Busy to Worry
little sense of urgency

• Recommendations
• Be ready for just in time delivery
• E-mail update databases, be ready for blasts
• Make arrangements with proprietary sites
• Provide to electronic databases
• Web and PDA delivery

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What is Pandemic Influenza? awareness
varied, generally low

• Recommendations
• Develop familiarity through communication
• Provide opportunity now to think and feel through
  the issues
• Focus on preparedness, personal actions.

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People find Pandemic Influenza Scary
relieved by knowing what to do

• Recommendations
• Incorporate personal, protective actions
• Develop home care course

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What about reserving drugs, vaccine?
Priority Groups strongly negative
(when explained, concept endorsed)

• Recommendations
• Avoid the term
• List groups and why they are included
• Be prepared to address vaccination of family
  members

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Good Luck / Misfortune
human nature
Whats

• Power Ball Win 1 /
  120,500,000
• Death by Auto 1 / 216 (30
  year odds)

most
exciting?
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Message / Materials Development
practical
products

• fact sheet Information about Influenza Pandemics
  (posted)
• fact sheet Key Facts about Avian Influenza
  (Bird Flu) and
  Avian Influenza A (H5N1) Virus (posted)
• Spanish language translations in process.
• internal media talking points about avian
  influenza
• additional fact sheets, pandemic influenza
  glossary, QAs, training and education resources
  planned and in development
• public version of the National Pandemic Plan
• toolkits for communities, businesses, schools
  What X should do to prepare

• www.pandemicflu.gov

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Risk Communication Critics
burn out
USA Today 10/12/05 (Las Vegas Sun)
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Pandemic Influenza Communication


thank you
Dan Rutz drutz_at_cdc.gov