Smallpox Immunization Communications: Approaches and Activities

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Smallpox Immunization Communications Approaches
and Activities

• Glen Nowak, PhD
• Associate Director for Health Communication
• National Immunization Program

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Overview

• Smallpox Immunization and Risk Communication
• Managing emergency and large-scale health
  communications (such as smallpox immunization)
• CDC Smallpox Immunization Resources

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Smallpox Immunization A Brief Situation Analysis

• Smallpox vaccination preparedness programs will
  affect a wide range of people from response team
  members to emergency responders to the general
  public.
• The national smallpox vaccination policy will
  affect these various people in different ways
  and at different times.
• Policy decisions will affect communication
  effects and effectiveness.

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Immunization Policy Results in Four Groups of
People

• The Cant Get Vaccinated people with
  contraindications and others who we would refuse
  to vaccinate
• The Shouldnt Get Vaccinated those we advise
  against, but would do if they insist (e.g.,
  military personnel family members and perhaps
  many members of the public later this year)
• The Should Get Vaccinated those we advise to
  get vaccinated, but they dont have to (i.e.,
  were requesting that they do so)
• The Must Get Vaccinated some military
  personnel

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The Communications Environment, I

• There are three relevant risks that must be
  recognized (and communicated about)
• Risks associated with terrible vaccine adverse
  reactions
• The risk of a smallpox attack
• The risks associated with not being prepared for
  a smallpox attack

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The Communications Environment, II

• The smallpox vaccination program is grounded in
  much uncertainty
• Likelihood of an attack
• Frequency of adverse events
• The best ways to treat adverse events
• Liability (and injury compensation)
• Hospital and healthcare facility participation
• Public reaction and actions

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The Communications Environment, III

• The scope of the smallpox vaccination program
  was and still is a difficult decision. It
  could change if
• The threat of an attack goes up or down
• If the assessment of the frequency and severity
  of vaccine adverse effects goes up or down
• If the availability of licensed vaccine goes up
  or down

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The Communications Environment, IV

• A number of factors influence an individuals
  vaccination decision
• Primary motivators are relatively intangible
  and/or emotional (e.g., service to others,
  self fulfillment, role model, moral duty)
• Barriers are more tangible, and likely to be more
  significant in the decision making (e.g.,
  concerns over vaccine adverse events, inadequacy
  of injury compensation, and pre-vaccination
  screening)
• Impact on family and household members

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CDCs Smallpox Vaccine Policy Communication Goals

• Increase awareness and understanding of smallpox
  preparedness activities, including vaccine
  recommendations
• Help instill and extend public confidence in
  national, state, and local ability to respond to,
  and manage, a smallpox release or outbreak
• Provide accurate, consistent, timely, and
  comprehensive information and resources
• Assist state, local, and health care professional
  communication efforts.
• Foster informed smallpox vaccine decisions and
  decision making

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Some Important Smallpox Immunization
Communication Principles (Sandman 2003)

• Risk Hazard Outrage formula
• Do anticipatory guidance
• Tolerate the uncertainty and help others
  tolerate it too.
• Practice dilemma-sharing
• Recognize the risk communication seesaw
• 
  

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Risk Hazard Outrage

• Hazard actual likelihood and seriousness of a
  risk
• Outrage cultural perceptions regarding a risk
• There is a relatively low correlation between the
  two (i.e., between how many people are actually
  harmed by a risk and the number people who get
  upset or how badly upset they get)
• Outrage has a far greater impact on risk
  perception than does hazard (e.g., when people
  are upset, they will think the risk is great,
  even if it isnt).

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Factors that Influence Outrage include. . .

• Voluntariness (vs. mandatory)
• Familiarity (vs. unknown)
• Chronic (vs. catastrophic)
• Knowable (vs. unknowable)
• Fair (vs. unfair)
• Trustworthy sources (vs. untrustworthy)
• Responsive process (vs. unresponsive)
• Sandman (2002)

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Risk HazardOutrage applied to Smallpox Vaccine

• Smallpox vaccination outrage will almost
  certainly focus on side effects and terrible
  vaccine reactions
• Smallpox attack outrage may also focus on vaccine
  availability (or lack thereof)
• Communications need to recognize both If the
  threat of an attack werent so awful, we would
  never have recommended vaccination. If the side
  effects of the vaccine werent so awful, we would
  recommend even more people get vaccinated.

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Do Anticipatory Guidance

• Tell people in advance what to expect including
  how they are likely to react (i.e., give people a
  chance to rehearse).
• Anticipatory guidance must extend to
  unanticipated events as well i.e., warn people
  to expect the unexpected

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Anticipatory Guidance and Smallpox Immunization

• The prospect of vaccine adverse events
• The prospect of serious or even fatal outcomes
  from vaccinia virus shedding
• How bad the ordinary reactions can be
• The inevitability of novel adverse events (and
  causality may be difficult or impossible to
  establish)
• The risks of facing a smallpox attack without
  having a trained cadre of vaccinated responders

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Tolerate Uncertainty

• Acknowledge the smallpox vaccination program is
  grounded in uncertainty.
• We must allow room for the possibility that we
  will sometimes be wrong.
• Its not being wrong that kills you its being
  wrong after sounding sure.

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Practice Dilemma-sharing

• Dilemma sharing is explicitly claiming that a
  decision is difficult, and the right answer isnt
  obvious.
• It is acknowledging uncertainty about decisions
  you face- and asking for help.
• It builds credibility because it is usually the
  truth, and thus has the ring of truth.

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Risk Communication Seesaw

• When people (e.g., the public) see merit on both
  sides of an issue, they will emphasize whichever
  side the communicator fails to emphasize
  (Sandman). For example,
• If you dont want people to be excessively
  fearful, dont be excessively reassuring.
• If you take a particular risk very seriously,
  people will usually be less, rather than more,
  concerned.
• If you want to calm fears, then share and express
  fears.

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Key Communication Elements

• Continue to utilize the smallpox risk
  communication principles to address the concerns
  of each audience
• Develop, distribute, and expand smallpox
  immunization resources (e.g., depth, breadth,
  scope, type, languages)
• Continue to utilize partnerships to identify
  needs, refine materials, and reach members of
  affected populations

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CDC Smallpox Immunization Communication
Management and Resources
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Emergency Communications
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CDC Emergency Communications Structure
CDC Communications Leadership Team
Content Team
Web Team
Communi-cation Monitoring and Research Team
Hotline Team
Commu-nity Health Education Team
Public Health Communi-cations Team
Media Team
Clinicians Communi-cations Team
Federal Govern-mental Communi-cations Team
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Currently Available Web Resources

• Main Website www.cdc.gov/smallpox
• Smallpox Basics Index in Spanish
  http//www.bt.cdc.gov/agent/smallpox/basics/espano
  l/index.asp
• Smallpox Resource Kit for Health Professionals
  http//www.bt.cdc.gov/agent/smallpox/reference/res
  ource-kit.asp

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Available CDC Materials for the Public

• Fact Sheets, including
• Smallpox Overview
• Vaccine Overview
• Who Should NOT Receive the Smallpox Vaccine?
• Reactions after Smallpox Vaccination
• Information on Live Virus Vaccines and Vaccinia
• Frequently Asked Questions Answers

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Available CDC Materials for Clinicians and Health
Care Providers Include. . .

• In-Depth Resources
• Smallpox Response Plan Guidelines, including
  the Smallpox Vaccination Clinic Guide
• Medical Management of Smallpox (Vaccinia) Vaccine
  Adverse Reactions
• Smallpox What Every Clinician Should Know Online
  Training (and CD-Rom)
• Images (including smallpox disease and reactions
  to smallpox vaccination)

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CDC Clinician Resources continued. . .

• Fact Sheets, including
• Adverse Reactions Following Smallpox Vaccination
• Smallpox Vaccine Information Statement
• Training tools and materials
• Webcasts
• Slide presentations (on the CDC website)
• Smallpox vaccination and adverse events training
  module
• Telephone information service (i.e., hotline)

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Ongoing and Upcoming Activities

• Weekly teleconferences with state public health
  information officers
• Public service announcement and additional
  materials on policy and its purpose
• Mailing to clinicians
• Media teleconferences and updates, including
  vaccine safety system, vaccination levels,
  vaccine adverse events, new or updated
  recommendations, etc.

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Questions?