# Presentation: 730219

## Smallpox Vaccine Program: Communications with the Public and Stakeholders

**Department of Health and Human Services**
**Centers for Disease Control and Prevention**
**December 2002**

## Smallpox Vaccine Program: Communications with the Public and Stakeholders

**Learning objectives:**
**Identify the types and location of communications and educational resources available on the CDC Web site**
**Identify the considerations for planning a smallpox communications program**
**Describe the factors that facilitate and hinder effective communications**

## 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.**
**Most people, including health care professionals, have relatively little knowledge about smallpox and smallpox vaccination. **

**Notes:**
Good communications planning begins with a brief situation analysis. In the case of smallpox, smallpox vaccination preparedness programs need to keep in mind they will affect a wide range of people, from response team members to emergency responders to the general public.  And we should also assume that most people, including healthcare professionals have relatively little knowledge about smallpox and small smallpox vaccination.  After all, smallpox and smallpox vaccination have not been things we’ve had to worry about for over 30 years. 

## CDC’s Smallpox Preparedness 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**

**Notes:**
At CDC when we developed our smallpox preparedness communication plans, we began by articulating what our goals were.  We have four primary goals.  The first goal with our smallpox preparedness communication plan is to increase awareness and understanding of smallpox preparedness activities, including the recommendations on who should be vaccinated. Our plans are also designed to help instill and educate the public -- or help instill and extend public confidence in national, state and local ability to respond to and effectively manage a smallpox release or outbreak. 

## CDC’s Smallpox Preparedness Communication Goals

**Provide accurate, consistent, timely, and comprehensive information and resources**
**Assist state, local, and health care professional communication efforts**

**Notes:**
Our third communication goal is to provide accurate, consistent, timely and comprehensive information and resources.  We have learned that there are many audiences and these audiences need to have a wide range of materials.  Our fourth goal is to assist state, local and health care professional communication efforts. 

## Developing Effective State Smallpox Preparedness Communication Plans

**Notes:**
In terms of developing effective state smallpox preparedness communication plans, there are a number of steps and a number of things that need to be kept in mind.  I want to walk through a few of them right now.

## I. What Should You Assume When Developing Smallpox Communications Plans?

**Notes:**
The first thing is, what should you assume when you're developing your smallpox communication plans? 

## Smallpox Communication Plans Should Assume. . .  

**1. Most people, including health care providers, need more information about the disease, vaccine, and vaccination.**

**Notes:**
At CDC we're making a number of assumptions that help us in our strategies and planning. The first assumption we’re making is that most people, including health care providers, need more information about smallpox disease, smallpox vaccine and smallpox vaccination.  Again, you need to keep in mind that for many people, these have not been topics that have been recently discussed. 

## Smallpox Communication Plans Should Assume. . .  

**2. Smallpox vaccinations will generate interest and requests for information from many people, including the public, the media, and families of those affected.**

**Notes:**
A second assumption that we're making here at CDC, and we recommend that others make, is that smallpox vaccinations will generate interests and requests for information from many people.  This includes the public, the media and the family of those affected.  There will be a lot of people interested in what smallpox is, a lot of people interested in the specifics of smallpox vaccination and we need to be prepared to answer and respond to requests from a lot of different sources. 

## Many systems will be needed to distribute messages, updates, and information (including partnerships and networks).

**Smallpox Communication Plans ****Should Assume. . .  **

**Notes:**
A third assumption we should make in developing communication plans is that we're going to need many systems to distribute our messages, to provide updates and to provide information to a wide range of people.  One of the things that will probably be invaluable in this effort is developing partnerships and networks that can help get messages, updates and materials to the intended target audiences. 

## 4.	The first serious adverse vaccine reaction, claimed or real, will generate much local and national media attention and public interest.

**Smallpox Communication Plans ****Should Assume. . .  **

**Notes:**
A fourth assumption that communication planners should make is that the first serious adverse reactions whether they are claimed or real, will generate much local and national media attention and public interest.  People are going to want to know the specifics about what happened, why the person may have had the adverse reaction and what is being done as a result of this report. 

## II.  Recognize and Prepare for the Smallpox “Communication” Realities

**Notes:**
The second thing that communication planners need to keep in mind is that they need to recognize and prepare for what we're calling smallpox communication realities. 

## Smallpox Communication Realities

**You need to anticipate the questions and concerns that different audiences will have regarding your smallpox preparedness efforts.**
**The more messages, materials, and resources that are prepared and ready--  before vaccinations begin or before a confirmed case of smallpox-- the better.**

**Notes:**
There are a number of things that we need to keep in mind about smallpox communications, but the ones I want to list here are probably the most important.  First, it is very helpful if you anticipate the questions and concerns that different audiences will have regarding your smallpox preparedness efforts.  One of the things we recommend doing is taking and listing your specific target audiences and then trying to write down for each of the audiences the kinds of questions, the kinds of interests and kinds of concerns that those audiences may have and then trying to formulate answers to those questions right now.  The second thing that people need to be prepared to do is that it's helpful to have more messages, more materials, more resources prepared in advance and ready before a smallpox vaccination begins or before there is a confirmed case of outbreak.  The more messages, materials and resources that you have prepared in advance, the better you will be able to manage the communications needs.

## 3.	Different groups or audiences will have:
Different information questions, needs and interests
Different ways of being reached (e.g., sources, media interests, etc.)
Different education, cultural, and occupational backgrounds

**Different information questions, needs and interests**
**Different ways of being reached (e.g., sources, media interests, etc.)**
**Different education, cultural, and occupational backgrounds**

**Smallpox Communication Realities**

**Notes:**
It's also important to recognize that different groups and audiences will have different information questions, different information needs and different interests.  And that one brochure, one pamphlet, one fact sheet is not likely to serve all those different audiences.  Rather, you need to keep in mind that different groups will have different ways of being reached, they will have different sources that they rely on for information, they will use different media to learn about these recommendations and finally, they will have different educational, cultural and occupational backgrounds.  These backgrounds will affect the kinds of things they're interested in and will also affect the kinds of things we need to provide in order to reach their needs. 

## III.  State (and local) smallpox preparedness communication plans need to address five key elements. . .

**Notes:**
State and local smallpox preparedness communication plans need to address five key elements.  I'm going to walk through them now. 

## Key State Communication Plan Elements

**Identify the primary populations or audiences for your messages and efforts, including:**
**People for whom vaccination is now recommended**
**People for whom vaccination is now recommended, but who are contraindicated or not interested**
**People for whom the vaccination recommendation will or may be extended**
**The general public (including the media)**

**Notes:**
The first element that your plan needs to address is the target populations or audiences.  You need to start by identifying the primary populations or audiences that you need to reach with your messages and your efforts.  There are at least four audiences that we think are important.  The first audience is, the people for whom smallpox vaccination is now recommended.  This group of people is going to have a number of questions and a number of needs relative to communications and education.  A second group is people for whom smallpox vaccination is now recommended but who are contraindicated or are not interested in receiving smallpox vaccine.  These people are going to want reassurances that they, too, are protected without being vaccinated.  A fourth group -- or a third group is people for whom vaccination -- the vaccination recommendation may be extended to.  There are obviously some people who will be among the first to receive smallpox vaccination and others for whom smallpox vaccination is recommended, but they will not be part of the immediate vaccination efforts.  These people will have questions as to when will they be able to receive smallpox vaccine and why will they have to wait for a few weeks before they can get it?  A fourth group that you need to be prepared for is the general public.  And this includes the media.  You need to be thinking about the kinds of messages that you want to disseminate and provide to members of the general public about your program and about these recommendations. 

## Develop your primary communication messages:
Overall
For each identified population or audience

**Overall**
**For each identified population or audience**

**Key State Communication Plan Elements**

**Notes:**
The second important thing to do in terms of developing a communications plan is to articulate or develop your primary communications messages.  And you need to do this on two levels.  First, what are your overall communications messages?  What do you want to say to everybody?  After you've articulated or identified those messages, the next thing you need to do is identify the primary messages for each of your identified populations or audiences.  At CDC we have a number of primary messages regarding smallpox vaccination.  I want to touch upon five of them. 

## CDC’s Primary Messages

**“****The probability of an intentional release of the smallpox virus is low, but since the consequences of an outbreak would be great, we must be prepared.”**

**Notes:**
One of our first messages is in regards to the likelihood of a smallpox release or outbreak.  And at CDC what our primary message is there, is that the probability of an intentional release of smallpox virus is low but since the consequences would be great, we must be prepared. 

## “Our recommendations strengthen national and state preparedness by making licensed vaccine available to those people who would be called upon to respond to a smallpox release or outbreak.”

**CDC’s Primary Messages**

**Notes:**
Our second primary message speaks to the need for these recommendations and the purpose of these recommendations. These recommendations strengthen national and state preparedness by making licensed vaccine available to those people who would be called upon to respond to a smallpox release or outbreak.

## “Smallpox vaccination before a confirmed smallpox case or outbreak provides response teams and other first responders personal protection from smallpox disease.”

**CDC’s Primary Messages**

**Notes:**
Our third primary message speaks to why it's important that these people receive smallpox vaccination. And the message there is that smallpox vaccination before a confirmed smallpox case or outbreak provides response team members and other first responders personal protection from smallpox disease. 

## “It thus enables them to rapidly take the actions necessary to protect the public, which includes identifying people who need to be vaccinated to control the outbreak as well as establishing public vaccination clinics.”

**CDC’s Primary Messages**

**Notes:**
Thanks to this personal protection from smallpox disease it enables them to rapidly take the actions necessary to protect the public, which includes identifying people who need to be vaccinated to control the outbreak as well as establishing public vaccination clinics.  In other words, by vaccinating the people who would first be called upon to respond to a smallpox outbreak, we are strengthening our ability to quickly and effectively respond and in doing so, we are protecting the public.

## “By protecting those people who would be initially called upon to respond:
We further strengthen our ability to protect the public;
We increase the capacity and capabilities of the public health system and the nation’s hospitals to respond to, and control, a smallpox outbreak.”

**We further strengthen our ability to protect the public;**
**We increase the capacity and capabilities of the public health system and the nation’s hospitals to respond to, and control, a smallpox outbreak.”**

**CDC’s Primary Messages**

**Notes:**
In terms of summarizing the CDC's primary messages, what you see here are -- the bottom line -- by protecting those people who would initially be called upon to respond, we, one, further strengthen our ability to protect the public and, two, we increase the capacity and capabilities of the public health system and the nation's hospitals to respond to and control a smallpox outbreak. 

## Get prepared to communicate about vaccine reactions, risks, and adverse events NOW.

Establish your systems and methods for getting messages, information, and materials to your identified populations and audiences.

**Establish your systems and methods for getting messages, information, and materials to your identified populations and audiences.**

**Key State Communication Plan Elements**

**Notes:**
The third part of effective communications plans is to get prepared now to communicate about vaccine reactions, vaccine risks and adverse events.  We have learned there's much interest among people when it comes to immunization about the kinds of reactions that are typical, the risks associated with immunization and vaccine adverse events, including how to recognize them, how to respond to them, and who to call if a person thinks that they may be experiencing an adverse event.  You need to have all that information ready to go right now in order to effectively communicate to people when they want that information.  Related, you need to establish your systems and methods for getting messages, information, and materials to your intended populations today.

## Establish protocols for meeting the frequent, perhaps daily, information requests from the media and public (e.g., updates, status reports, number of people vaccinated, etc.)

**Key State Communication Plan Elements**

**Notes:**
Finally, can you also expect there's going to be a lot of interest and demand from the media, the public and policymakers for information and it's important that you establish the protocols for meeting those demands. You should assume there will be frequent, perhaps daily information requests from the media and the public.  They will want updates, status reports.  They'll be interested in the number of people who are eligible to be vaccinated, the number of people you have vaccinated, the number of people who have suffered reactions to the vaccine.  You need to have systems in place to get that kind of information on a regular and frequent basis and also have systems in place so that the media and members of the public know where to get that information.

## IV.  Use the CDC’s Smallpox-related Resources and Materials-- and tailor them as appropriate and needed.

**Notes:**
One of the things we strongly encourage states and others to do in terms of the communications efforts is to use the CDC's smallpox-related resources and materials and to tailor them as appropriate and necessary. 

## Currently Available Web Resources

- Main Website:  www.cdc.gov/smallpox
- Smallpox Basics Index in Spanish: www.bt.cdc.gov/agent/smallpox/basics/ espanol/index.asp
- Smallpox Resource Kit for Health Professionals**:  **www.bt.cdc.gov/agent/smallpox/ reference/resource-kit.asp

**Notes:**
At CDC we have been working to develop a wide range of materials and our portfolio materials can be found on our main CDC website.  We have a specific address for smallpox resources, www.cdc.gov/smallpox.  On the CDC website, you will also find a large number of materials available in Spanish.  We have also developed a smallpox resource kit for health professionals.  This resource kit contains a wide range of materials, including educational materials for perspective patients about smallpox and smallpox immunization. 

## 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**

**Notes:**
In terms of materials that are available for the public, the CDC is working to develop a portfolio of fact sheets.  We currently have fact sheets on smallpox disease, on smallpox vaccine, on who should not receive the smallpox vaccine, on reactions after smallpox vaccination.  We have information on live virus vaccines and vaccinia.  We have a list of frequently asked questions and answers.  These materials are available in not only English, but also are available in Spanish. 

## Available CDC Materials for Clinicians and Health Care Providers

**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)**

**Notes:**
The CDC website also houses a wide range of materials for clinicians and healthcare providers.  It ranges from in depth resources to, again, one page or two-page fact sheets. In terms of in-depth resources, people can find the Smallpox Response Plan Guidelines, which includes the Smallpox Vaccination Clinic Guide on the CDC website. We also have information on medical management of smallpox and vaccinia vaccine adverse events and we have a CD-ROM that is available, included on the website on What Every Clinician Should Know about smallpox and smallpox immunization. You can also find an image library.  There are images on the CDC website that show what smallpox looks like as a disease, as well as reactions to smallpox vaccination, including vaccine adverse reactions. 

## 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)

***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)**

**Available CDC Materials for Clinicians and Health Care Providers**

**Notes:**
We have fact sheets on adverse reactions following smallpox, we have fact sheets on smallpox vaccine. We also have the vaccine information statement for smallpox available on the CDC website. We also have training tools and materials.  This includes webcasts, slide presentations, smallpox vaccination and adverse events training modules and finally, we have telephone information services for both the public and health care professionals. 

## Concluding Advice

**Remember, communication needs will be ongoing (e.g., before, during and after smallpox vaccinations begin).**
**Be prepared to respond to daily information requests from the media, public, and people for whom smallpox vaccination is now recommended.**
**Get prepared for immediately and effectively responding to vaccine safety questions and issues.**

**Notes:**
In terms of concluding advice, there are three points I would like to leave you with -- first, remember that communication needs will be ongoing.  There will be things that people will be interested in before smallpox vaccinations begin, during the program and after smallpox vaccinations begin.  Communication needs are something that are going to have to be responded to regularly.  Second, be prepared to respond to daily information requests.  These requests are likely come from the media, the public and from people for whom smallpox vaccination is now recommended.  And finally, get prepared for immediately and effectively responding to vaccine safety questions and issues. The more prepared you are today, the better you will be should the need arise. 

## For More Information

**CDC Smallpox website**
**	****www.cdc.gov/smallpox**
**	**
**National Immunization Program website**
** ****	****	****www.cdc.gov/nip**