# Presentation: 720668

## Crisis & Emergency Risk CommunicationPandemic Influenza

## Communicating in a crisis is different 

- In a serious crisis, all affected people . . .
- Take in information differently
- Process information differently
- Act on information differently
- In a catastrophic event:  communication is different
- Be first, be right, be credible

## What the public seeks from your communication

**5 public concerns. . .**
- Gain wanted facts
- Empower decisionmaking
- Involved as a participant, not spectator
- Provide watchguard over resource allocation
- Recover or preserve well-being and normalcy

## Crisis and Emergency Risk Communication impacts  

**5 organizational concerns -- you need to. . .**
- Execute response and recovery efforts
- Decrease illness, injury, and deaths
- Avoid misallocation of limited resources
- Reduce rumors surrounding recovery
- Avoid wasting resources

## 5 communication failures that kill operational success

- Mixed messages from multiple experts
- Information released late
- Paternalistic attitudes
- Not countering rumors and myths in real-time
- Public power struggles and confusion

## 5 communication steps that boost operational success

- Execute a solid communication plan
- Be the first source for information
- Express empathy early
- Show competence and expertise
- Remain honest and open

## What Do People Feel Inside When a Disaster Looms or Occurs?

- Psychological barriers:
- Fear, anxiety, confusion, dread
- Hopelessness or helplessness
- Seldom panic
- Fight or flight

**Notes:**
Note to Instructor(s):

This is a short four slide section on the learning objectives and purpose of the course.

Run this slide and the next for 5 and 25 seconds respectively.

##  How Do We Communicate About Risk in an Emergency?

**All risks are not accepted equally**
- Voluntary vs. involuntary
- Controlled personally vs. controlled by others
- Familiar vs. exotic
- Natural vs. manmade
- Reversible vs. permanent
- Statistical vs. anecdotal
- Fairly vs. unfairly distributed
- Affecting adults vs. affecting children

## 5 Key Elements To Build Trust

- Expressed empathy
- Competence
- Honesty
- Commitment
- Accountability

## CREDIBILITY

**Accuracy of Information**
**__________**
**Speed of Release**

**Empathy**
**+**
**Openness**

**CREDIBILITY**

**+**

**TRUST**

## Initial Message

**Must **
- Be short
- Be relevant
- Give positive action steps
- Be repeated

## Initial Message

**Must *****Not***
- Use jargon
- Be judgmental
- Make promises that can’t be kept
- Include humor

## Media and Crisis Coverage

- Evidence strongly suggests that coverage is more factual when reporters have more information. They become more interpretative when they have less information.
- What should we conclude?

## Role of a Spokesperson in an Emergency

- Take your organization from an “it” to a “we”
- Build trust and credibility for the organization
- Remove the psychological barriers within the audience
- Gain support for the public health response
- Ultimately, reduce the incidence of illness, injury, and death by getting it right

## Emergency Risk Communication Principles

- Don’t overreassure
- Acknowledge that there is a process in place
- Express wishes
- Give people things to do
- Ask more of people

## What is different? 

## National Strategy

- Stop, slow, limit spread of pandemic to the U.S.
- Limit domestic spread of pandemic—mitigate disease, suffering, and death
- Sustain infrastructure/economy and functioning of society

## What is different? Biological

- Little or no immunity worldwide
- More people at higher risk
- Evolves in waves
- 2-3 waves, last 6-8 weeks, in 12-18 months

## What is different? Psychological/Spiritual

- Uncertainty
- Increases anxiety—people seek information
- Greatest uncertainty early in pandemic
- Community hardiness/personal resilience
- Number of deaths “out of time”

## What is different? Sociological

- Behaviors impact infection rates—less control
- Denial (it won’t happen to me)
- High-risk (Russian roulette coughing)
- Can’t be burdened (let someone else do it)
- Wants to but believes can not (I need to work)
- Inadequate vaccines/antivirals
- Primary communication steps
- Be 100% accountable

## Community Hardiness 

## Community hardiness: Defined

- Existing protective qualities and vulnerabilities that will determine the community’s ability to take deliberate, meaningful, and collective action against a public health threat
- Protective qualities: robustness, redundancy, resourcefulness, & rapidity
- Vulnerabilities: susceptibility related to sense of community, shelter, sustenance, security, and growth from adversity

## Community hardiness: Factors

- Socioeconomic status
- Community-based organizations
- Health care capacity
- Social stressors (racial, economic, political strife)
- Political and civic perspectives
- Community cohesion and group self-efficacy

## Personal resilience: Factors

- Mental toughness more important than physical strength
- A purpose for going on: “help my family”
- Self-efficacy: “I think I can”
- Prior experience
- Good coping strategies (repress negative and  take action)

## Stigmatization

## Stigmatization

- Can affect product, industry, animal, place, people
- Four characteristics to stigmatization
- Problem stigmatizer believes he can control
- Must be distinguishable
- Stigma associated with the party
- Reaction that distances

## Recent examples

- 1997 strawberries and hepatitis A in U.S.
- 1997 H5N1 outbreak in Hong Kong
- 1999 West Nile virus outbreak in New York
- 2003 SARS outbreak in China and Canada

## Why people stigmatize

- Shortcut when uncertainty and threat are both present to protect against physical and emotional harm
- Occurs in a social context
- Expect it early in a severe influenza pandemic unless dominant group first to become ill

## Steps before, during & after

- Avoid geographic links if not necessary (e.g., Spanish pandemic versus 1918 pandemic)
- Avoid visuals that link group to threat--watch out for subconscious links:  Avian Influenza H5N1
- Teach response professionals about stigma
- Share with media the concern
- Scan for stigma and confront quickly
- Watch out when creating historical products

## Understanding loss and bereavement

## Deaths in the U.S. vs Pandemic

- About 2.5 million annually
- Seasonal influenza 36,000 deaths/95% ->65 yrs
- In 12-18 months add 2 million
- Deaths “out of time” (healthy adults/children)

## Severe pandemic and loss

- Multiple deaths in families
- Truncated bereavement rituals
- Potential for kinship from shared misery
- Responders could feel guilt

## Cultural differences?

- Have you been to a funeral outside your own culture? What is the color of mourning?
- What matters matters a lot
- Acculturation attenuates differences—don’t stereotype
- Religious difference are cultural differences
- Bereavement ignored will cost in personal/community resilience

## Compassion in communication

- People will expect demographic details of first deaths (“How do I compare?”)
- Look of official reports must be respectful (web)
- Responders may be losing members too
- People mourn financial loss too

## Information Technology in Pandemic Influenza Communications

## The Internet as a Communication Channel during an Emergency

- 97% of all internet users and 64% of *non-users* expect to be able to find important information online
- The internet as an information source grew 8% in the two weeks after September 11th
- The 2001 anthrax attacks highlight the desire for any information, the prevalence of false information, and the willingness to “buy in” to panic-baiting

**Notes:**
97% of all internet users and 64% of non-users expect to be able to find important information online
More experienced users will undertake more extensive searches
The internet as an information source grew 8% in the two weeks after September 11th
People reported handling mail differently and more frequent hand-washing after receiving information from the internet
The 2001 anthrax attacks highlight the desire for any information, the prevalence of false information, and the willingness to “buy in” to panic-bating
Surges in sales of cipro and gas masks

## The Blogosphere as Community

- Number of internet users who *read* blogs jumped 11 to 39% from 2003 to 2005
- During a pandemic, blogs:
- Allow for news missing from mainstream media and discussions of sensitive information or issues
- May appeal to individuals and communities coping with crisis, illness or death

**Notes:**
Blogs – first received major attention after September 11th and the start of the Iraq War
Number of internet users who read blogs jumped 11 to 39% from 2003 to 2005
During a pandemic, blogs:
Allow for thorough and thoughtful analyses of news missing from mainstream media and discussions of sensitive information or issues without fear of reprisal
May appeal to individuals and communities coping with crisis, illness or death 

## Internet Rumor Monitoring

- Technorati (_[http://technorati.com/](http://technorati.com/)_) tracks ~50 million blogs
- Establish own organization blogs or address rumors on existing agency sites
- Monitor and edit wikis
- How to evaluate websites for individuals during their own internet searches

## Cedar Rapids, NE

**Cedar Rapids, NE**

## The Langan Boys-1918

- Thomas Langan, 25 years old
- William Langan, 22 years old
- Edward Langan, 20 years old
- David Langan, 16 years old
- Thomas and Carrie Langan were married in 1909 and had 5 children
- William, Edward, and David lived at home

## Thomas & 

**Thomas & **
**Carrie Langan**
**(seated)**
**On their 1909 **
**wedding day**

## H1N1 Comes to Cedar Rapids

- Dec. 1918 all four boys became ill with influenza
- Thomas fell ill and William dropped off a home remedy

## December 16: Edward (20) died

## December 19: William (22) died

## December 20: David (16) died

**Thomas, still ill,**
**attends the funerals **
**of William and David, **
**held the same day**

## Thomas & Carrie Langan 1941

**Notes:**
Note to Instructor(s):

This is a short four slide section on the learning objectives and purpose of the course.

Run this slide and the next for 5 and 25 seconds respectively.

## Thomas & Carrie, 1955

**Notes:**
Negative Actions
Misallocation of Treatment
Needless Destruction
Accusation of Preferential Treatment
Unreasonable Travel/Trade Restrictions
Fraud
Stealing/Looting (Group Behavior)
Rumor Spreading
Doomsaying
Bribery for Scarce Resources
Self Destructive Behavior 
MUPS

## 1918 Pandemic Deaths by Age

-  **Figure 2.** "U-" and "W-" shaped combined influenza and pneumonia mortality, by age at death, per 100,000 persons in each age group, United States, 1911–1918. Influenza- and pneumonia-specific death rates are plotted for the interpandemic years 1911–1917 (dashed line) and for the pandemic year 1918 (solid line)

**Jeffery K. Taubenberger* and David M. Morens†***Armed Forces Institute of Pathology, Rockville, Maryland, USA; and †National Institutes of Health, Bethesda, Maryland, USA