# Presentation: 742255

## HHS Pandemic Influenza Risk Communication and Public Engagement 

- Sarah Landry
- National Vaccine Program Office
- Department of Health and Human Services
- November 30, 2005

## Why Communication and Outreach are Critical Components of Pandemic Influenza Preparedness

- Research continues to document the importance of risk communication and early public discussion for effective health/emergency preparedness activities
- 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

## Why Engage The Public?

- Tell me, I forget.
- Show me, I remember.
- Involve me, I understand.
- 					Chinese proverb

## Un-Ness of Pandemic Influenza

- Unknowns make communication challenging
- When ?
- Where ?
- How ?
- What ?
- Who ?
- Why ?

**Notes:**
Some of the other challenges – annual influenza and the misunderstanding or apathy that exists

## Risk Communications

- Inspire
- Inform
- Prepare

- Inflame
- Panic

## Pillar One: Preparedness and Communication 
Preparedness is the underpinning of the entire spectrum of activities, including surveillance, detection, containment and response efforts. We will support pandemic planning efforts, and clearly communicate expectations to individuals, communities and governments, whether overseas or in the United States, recognizing that all share the responsibility to limit the spread of infection in order to protect populations beyond their borders

- Preparedness is the underpinning of the entire spectrum of activities, including surveillance, detection, containment and response efforts. We will support pandemic planning efforts, and clearly communicate expectations to individuals, communities and governments, whether overseas or in the United States, recognizing that all share the responsibility to limit the spread of infection in order to protect populations beyond their borders

|      Encourages all Americans to be active partners in preparing their states, local communities, workplaces, and homes for pandemic influenza and will emphasize that a pandemic will require Americans to make difficult choices.  An informed and responsive public is essential to minimizing the health effects of a pandemic and the resulting consequences to society
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|     Outlines strategies and materials to support a pandemic response and to promote public trust and decrease fear and anxiety
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**Notes:**
Develop educational materials for healthcare and human services providers, the media, and the public on pandemic influenza preparedness and response, including facilities, vaccine, and antiviral drugs in short supply.

## Communications Priorities  

- Accurate, credible, and timely information, coordinated with partners
- 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 pandemic—prevention and control, and rationale for interventions

## HHS Pandemic Influenza Risk Communication and Outreach Strategy

- Planning and Assessment
- Formative Audience Research
- Message and Material Development
- Cross Government Coordination and Collaboration
- Training
- Media Outreach
- Community Continuity Planning
- Public Engagement
- International Support

## Planning and Assessment

- Inventory of current HHS communication activities
- Tracking of media activity
- 100 commonly raised issues/questions
- Polls of public and providers
- Development of a strategic communications plan
- Discussions/coordination with global partners

## Top Pandemic Flu Messages

***most reported***

**Bird flu could cause human pandemic**** **
**Foreign deaths from bird flu reported **** **
**Historical accounts of influenza epidemic/pandemic**** **
**Pandemic flu can kill thousands/ millions**** **
**Foreign official worried about bird flu**

**Notes:**
Getting the right messages out there

## National Survey of US Public

- To measure the public’s general awareness of pandemic influenza
- To measure the public’s level of concern and beliefs about pandemic influenza
- To assess amount of confidence in and attitudes toward public health measures that might be employed during a pandemic

## 	Conclusions

- Awareness of pandemic influenza is generally very low
- Respondents expressed some concern, although a large number (20%) were not concerned and feel pandemic influenza risk is being exaggerated.
- There is a lack of public awareness about vaccine and antiviral availability and lack of confidence that they will be distributed fairly.
- Most respondents feel that federal and local health officials are not prepared to respond to an influenza pandemic.
- Many predict they will not be willing to comply with public health measures.

**Notes:**
Gallup poll conducted on October 21-23 found that 24% say they are worried that they or someone in their family could contract avian flu, while 75% were not worried.  Adults 50 and over were twice as like as those 49 and younger to be concerned (18% versus 30%)
Gallup poll conducted on October 21-23 found that 24% say they are worried that they or someone in their family could contract avian flu, while 75% were not worried.  Adults 50 and over were twice as like as those 49 and younger to be concerned (18% versus 30%)

## Message Mapping

- Scientific process for ensuring that information is accurate, clear, concise, consistent, credible, and relevant
- Allows organizations to develop messages in advance for predictable events
- Based on extensive studies of post-CNN news environment

## News Study

- The average length of a sound bite in the print media was 27 words
- The average duration of a sound bite in the broadcast media was 9 seconds
- The average number of messages reported in both the print and broadcast media was 3

## Message Mapping

- Cross HHS teams (policy, communications, scientific) work on answers to 117 commonly asked questions.
- Goal is concise and accurate information that is consistent across HHS.
- Maps serve as foundation for other materials (talking points, materials, etc).
- 80 prepandemic messages have been developed
- 18 pandemic event messages developed

## Focus Group Testing

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

## Findings, Recommendations, Comments

- Pandemic Flu as “Flu” vs. “emerging virus”
- Flu vs bird flu vs pandemic flu vs avian flu
- Importance of Google for information gathering
- Desire for more information
- Balance of immediacy vs. preparedness
- Misunderstanding about vaccines and therapeutics – how used
- Concern about fairness in access and use of resources
- “priority groups” – strong negative connotation

**Notes:**
Flu vs emerging virus
Importance of web for information
CDC trusted source
HCW can’t focus on this now --- not immediate issue
Discussion raises some level of alarm ....need to be prepared to tell people what they can do

## Message / Materials Development

- Factsheets on avian influenza, pandemics, and H5N1 available
- FAQs
- Citizen’s guide
- toolkits for communities, businesses, schools – *“What ____ should do to prepare...”*
- Outreach to partners

**    **

## Message Themes

- Scientists say an influenza pandemic is likely
- Impossible to predict when; prudent to plan
- HHS, WHO, and other partners are engaged
- U.S. plan requires citizen participation
- We care.
- We’re in this together.
- Government can’t do it all
- Difficult options require broad discussion
- Now is the time to identify and “work out” issues

***Interpandemic period***

## Slide 21

**Notes:**
CNN selection as site to highlight...

## Trainings and Tabletops

- Operations plan under development by DHS, USDA, and HHS
- Tabletop trainings – Federal government exercise, tools for states and local governments
- Federal Secretary of Public Affairs level exercise planned for Dec 2005.

## Media Outreach

- Media Guide
- Media Roundtables in three cities
- Resources on pandemicflu.gov

## International 

- International Pandemic Influenza  Risk Communications Workshop – December 8-10 in Geneva
- Staff support
- Survey of member state activities
- Development of an international risk communications framework
- Secure website for resource sharing
- Global Communications and Instructional Systems – International sites that foster collaboration with NGOs to enhance communication and public health education efforts.
- Bangkok – November 14 -  Message testing and meeting
- GHSAG – Mexico City Meeting on Pandemic Influenza
- Coordination with Canada and UK

**Notes:**
Importance of developing sustained channels of communications...identifiying existing channels in countires

## Definition of Public Participation

**   ***Public participation is engaging openly and respectfully in “give and take” discussions with citizens and/or stakeholders*

## The NVAC Working Group on Enhancing Public Participation in Vaccine Policy Deliberations

-    Charge: To consider options for enhancing public participation in vaccine policy deliberations and to evaluate the proposal from the Wingspread Public Engagement Planning Group for a demonstration project - the Vaccine Policy Analysis Collaborative (VPACE)

**Notes:**
No constituent group
Out of sight – Out of Mind
Treatment society– quick fix vs Prevention
Autonomy
No constituent group
Out of sight – Out of Mind
Treatment society– quick fix vs Prevention
Autonomy

## NVAC Working Group on Public Engagement

**There is a need for enhanced efforts to engage the broad public in vaccine policy discussions.**
**NVAC has an important role to play in supporting public engagement.**
**The general public must be adequately represented.** The forum for this dialogue should represent all vaccine partners and more must be done to engage the broad American public, not just advocacy groups.
**In order to ensure that public engagement activities are based on an understanding of the scientific strong scientific foundation, training of public representatives may need to be provided.**
**A one size fits all approach will not fit provide enough flexibility to address all vaccine topics.**

## Why Is this Important for Pandemic Influenza?

- Pandemic Influenza will likely affect every American
- Critical decisions will need to be made regarding the use of limited resources
- Builds trust in the government, which will be essentially during a crisis
- Provides better, sounder information on public’s response for which planners can base decisions
- don’t need to base decision on assumptions

**Notes:**
Roz Lasker’s Redefining Readiness in which she examined criticial assumptions on which plans are based

## Pandemic Flu Vaccination Priorities Public Engagement Pilot Project

**Lounsbery Foundation**
**CDC National Immunization Program**
**Institute of Medicine**
**National Vaccine Program Office**
**Study Circles Resource Center**

## 
Ed Marcuse
Seattle Children’s Hospital
Roger H. Bernier
NIP
Louis Z. Cooper
Past President, American Academy of Pediatrics 
Geoffrey Evans
HRSA

Mark Feinberg
Merck Vaccine Division

Kathleen Stratton 
Institute of Medicine

Mary Davis Hamlin 
Center for Science and Public Policy, The Keystone Center

- Ed Marcuse
- Seattle Children’s Hospital
- Roger H. Bernier
- NIP
- Louis Z. Cooper
- Past President, American Academy of Pediatrics
- Geoffrey Evans
- HRSA
- Mark Feinberg
- Merck Vaccine Division
- Kathleen Stratton
- Institute of Medicine
- Mary Davis Hamlin
- Center for Science and Public Policy, The Keystone Center

- Sarah Landry
- NVPO
- Alan Hinman
- NVAC
- Matt Leighninger
- Democracy Workshop
- Senior Associate, Study Circles Resource Center
- Barabra Loe Fisher
- Co-Founder/President, National Vaccine Information Center
- Debbie McCune Davis
- Wisconsin Women’s Network
- Mona Steele
- The Arizona Partnership for Immunization

## Americans Discuss Difficult Choices on Who To Protect First Against Pandemic Influenza

**Engage citizens, local/state and Federal officials, academics, non-governmental organizations, **
**health care providers, and industry**
*“**National Dialogue*” Sessions
- with Key Stakeholder Groups
*“**Citizen at Large”* Sessions
- individual citizens not representing any organized interests

**Notes:**
National meetings:  
July 13-14, September 7-8 
	Institute of Medicine 

Citizen at Large Sessions 
Aug 27, Atlanta, Georgia
Sept: Mass., Nebraska, Oregon
National meetings:  
July 13-14, September 7-8 
	Institute of Medicine 

Citizen at Large Sessions 
Aug 27, Atlanta, Georgia
Sept: Mass., Nebraska, Oregon

## Stakeholder Organizations

- American Association of Retired Persons (AARP)
- American Academy of Pediatrics
- Service Employees International Union
- National Medical Association
- Trust for America’s Health
- Wisconsin Women’s Network
- America’s Health Insurance Plans
- American Medical Association
- Vaccine Education Center
- National Business Group on Health
- National Hispanic Medical Association
- Merck and Co, Inc
- Sanofi Pasteur
- State Health Officials
- National Network for Immunization Information
- National Vaccine Information Center
- National Asian Women’s Health Organization
- International Institute for Indigenous Resources

## Key Assumptions

**Severity**: Moderately severe pandemic in the US with half a million deaths and two million hospitalizations
**Death & Hosp rates:** Death and hospitalization rates will be highest in infants under 1 and persons 65 and older, but could vary from these past patterns.

## Key Assumptions

**Who Guides Choices:** Guidance about who first to vaccinate comes from the federal government
**Supply Control:** Government buys all the vaccine and distributes it

## Key Assumptions

**Supply Availability:** Only 3M persons per month vaccinated---Very limited supplies of vaccine become available in the early days of the

## Potential Goals – 1st Stakeholder Meeting

- Give everyone an equal chance to be protected (e.g. lottery or first come, first served
- Protect persons with the most life ahead of them
- Seek to protect those of any age or health condition most or more likely to die from a new influenza strain

## Potential Goals

- Assure public safety
- Maintain emergency and/or life saving services (e.g. health care workers)
- Protect society’s key government leaders and decision makers
- Protect those providing the most critical services which keep society running (e.g. utility workers)

## Potential Goals

- Provide some vaccine to other countries even if it is at the expense of vaccinating some persons in the US
- Protect those who provide homeland security and those who defend us against threats abroad
- Assure vaccine production

## Atlanta Citizens Group

- Limit the larger effects on society
- Save those who are most at risk
- Put children and young people first
- Use a lottery system
- Use the principle of first come, first served

## Hierarchy of Goals

- Assure functioning of society
- Reduce individual deaths and hospitalizations due to influenza

**Notes:**
Recognition that the federal government will provide guidelines; 
Specific definitions will occur at the local level (state and local health departments, specific facilities)

## 1. Assure functioning of society

- Assure production, distribution, administration of vaccines (includes manufacturing, workers associated with vaccine clinics, etc.)
- Maintain emergency response and life saving services (e.g. healthcare workers)
- Assure provision of other critical services

## Critical Services

- Public safety and maintaining law and order
- Protecting society’s key government leaders and decision makers
- Homeland security
- Utilities
- Food distribution
- Communications

## 2. Reduce Individual Deaths and Hospitalizations

- Protect those most or more likely to die from a new influenza strain, as defined by the ACIP/NVAC recommendations, unless the emerging epidemiology of pandemic influenza defines new risk groups
- Health persons 2-64 years not in other groups above

## ACIP/NVAC 

- To limit morbidity and mortality of influenza and its complications during a pandemic
- To decrease social disruption and economic loss

## Conclusions from Pilot Project

- Public wants to be involved and is interested
- Consistency in results despite diversity in citizens, stakeholders, geography
- Importance of assuring the functioning of society
- Importance placed on fairness and responsible use
- Need for local specificity

**Notes:**
If assuring the functioning of society can be accomplished without vaccinating everyone in the first priority group and without depleting the available supply, remaining vaccine should be used for the second priority group in sequential order

## Conclusions 

- Pilot project provides “proof of principle” that a diverse group of stakeholders and citizens can interact in give and take discussions and reach a productive outcome
- It is possible to get a higher level of public involvement in vaccine policy discussions.