10Preparing Your Partnership to 

Communicate During a TB Outbreak 

This	chapter	describes	each	of	the	phases	and	some	 

of	the	key	communication	planning	activities	a	 

partnership	must	perform	during	a	TB	outbreak.	 

Your	partnership	is	unique.	Therefore,	you	and	your	 

partners	must	decide	how	you	will	go	about	developing	 

a	partnership	communications	plan	that	prepares	you	 

for	outbreak	situations.	The	decision	will	encompass	who	within	the	partnership	will	 

lead	the	communication	planning	effort,	the	resources	you	have	available,	the	number	of	 

partners,	and	the	diversity	of	the	group.	The	steps	described	in	the	sections	that	follow	 

will	be	coordinated	or	performed	by	the	person	your	TB	partnership	decides	will	lead	 

the	communication	planning	effort.	 

Elements of Outbreak 

Communication Preparation 

•	 Pre-event phase 

•	 Event phase 

•	 Post-event phase 

Communication Planning for TB Outbreaks 

Emergency	risk	communication	is	the	attempt	by	scientists	or	public	health	professionals	 

to	provide	information	that	allows	an	individual,	stakeholders,	or	an	entire	community	 

to	make	the	best	possible	decisions	during	an	emergency	about	their	well	being.	Often,	 

this	communication	must	be	done	within	nearly	impossible	time	constraints	and	requires	 

public	acceptance	of	the	imperfect	nature	of	the	available	choices	for	action. 

In	terms	of	responding	to	a	public	health	emergency	such	as	a	TB	outbreak,	a	 

comprehensive	TB	outbreak	communication	effort	can	be	viewed	as	having	three	 

phases:	Pre-event	(before	the	event	occurs),	event	(while	the	event	is	occurring),	 

and	post-event	(after	the	event	has	concluded).	The	first	phase,	which	is	in	many	 

ways	the	most	important,	is	described	here	in	detail.	The	second	and	third	phases	 

and	their	activities	are	summarized.	Complete	information	about	all	of	the	phases	 

is	available	in	CDCynergy: Emergency Risk Communication (ERC) Training,	listed	 

under	Related	Resources	at	the	end	of	this	chapter. 

The Pre-Event Phase 

The	pre-event	phase	offers	your	partnership	the	opportunity	to	plan.	The	pre-event	 

phase	of	a	crisis	is,	in	many	ways,	the	most	important	phase.	Each	day	spent	preparing	 

is	a	priceless	investment	in	successful	communication	when	a	crisis	hits.	Those	who	 

have	survived	a	serious	TB	outbreak	know	that	sorting	out	major	issues	of	responsibility,	 

authority,	and	priority	is	tremendously	difficult	under	serious	pressure.	A	thorough,	 

flexible	plan,	developed	cooperatively	with	internal	and	external	partners,	and	fully	 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit  

Chapter 0: Preparing Your Partnership to Communicate During a TB Outbreak 
endorsed	by	your	TB	program’s	leadership,	will	lay	the	groundwork	for	effective	 

communication. 

All	of	the	planning	and	most	of	the	work	should	be	done	during	this	phase,	including	 

anticipating	potential	events	that	your	partnership	may	face.	Many	events	could	require	 

intense	public	information,	media,	and	partner	communication	responses.	Assemble	 

an	outbreak	communication	planning	team	within	your	partnership	to	brainstorm	 

credible	event	scenarios	that	your	partnership	may	have	to	address.	Any	event	that	your	 

partnership	has	to	address	will	require 

• Planning	for	message	content	development 

• Identification	of	the	target	audience 

• Spokesperson	preparation 

• Selection	of	effective	delivery	methods 

Reasonable	questions	can	be	anticipated	and	preliminary	answers	sought.	Initial	 

communication	can	be	drafted	with	placeholders	for	details	that	will	be	filled	in	later.	 

Communication	chains	can	be	laid	out.	Spokespersons	and	resource	mechanisms	can	 

be	identified.	Training	can	be	conducted	and	refinements	to	plans	and	messages	can	be	 

made.	Alliances	and	partnerships	can	be	fostered	to	ensure	experts	are	speaking	with	one	 

voice	(i.e.,	delivering	a	consistent	message). 

Brainstorming	about	events	your	partnership	may	have	to	address	will	help	you	as	you	 

complete	the	four	key	activities	of	the	pre-event	phase: 

• Conducting	an	outbreak	communication	needs	assessment 

• Developing	an	outbreak	communication	plan 

• Determining	the	resources	needed	to	carry	out	the	plan 

• Preparing	your	partnership	to	carry	out	the	plan 

Conducting a TB Outbreak Communication Needs Assessment — 

Things to Keep in Mind 

A	needs	assessment	is	a	checklist	of	the	important	steps	you	must	take	to	be	ready	 

should	an	outbreak	of	TB	occur.	Before	you	know	where	you	need	to	go	and	what	 

you	need	to	do,	you	must	first	know	where	you	stand	with	respect	to	your	TB	 

program’s	preparedness.	A	needs	assessment	will	help	you	identify	the	“missing	 

pieces”	and	avoid	under	or	over	utilization	of	resources. 

Tips and Strategies 

The	TB Outbreak Communication Needs Assessment Checklist	in	the	Toolkit	may	help	 

you	determine	your	partnership’s	readiness	to	communicate	during	a	TB	outbreak.	 

Once	you	have	completed	the	needs	assessment,	review	it	carefully	with	other	leaders	 

 Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter 0: Preparing Your Partnership to Communicate During a TB Outbreak 
in	your	partnership	to	identify	what	actions	you	need	to	take	to	be	fully	prepared.	As	 

you	review	the	checklist,	ask	yourself	who	might	be	a	resource	to	help	you	to	achieve	 

each	step.	This	checklist	can	form	the	basis	of	your	outbreak	communication	plan	 

(see	Developing an Outbreak Communication Plan	below)	by	serving	as	an	outline	 

of	what	you	need	to	accomplish.	When	you	are	finished	with	it,	ask	yourself,	“Is	 

there	anything	not	on	this	list	for	which	we	should	be	prepared?” 

Why It Is Important 

A	needs	assessment	can	be	a	powerful	tool	to	identify	where	you	are	not	prepared.	 

The	TB Outbreak Communication Needs Assessment Checklist addresses	the	essential	 

parts	of	any	outbreak	communication	plan: 

•	 Planning,	research,	 •	 Messenger	
 

training,	and	evaluation	 •	 Message	delivery	method
 

•	 Message	content	 •	 Personnel	 

•	 Target	audience	 •	 Other	resources 

Developing a TB Outbreak Communication Plan — 

Things to Keep in Mind 

A	TB	outbreak	communication	plan	documents	how	your	TB	program	will	respond	 

to	the	communication	needs	of	an	outbreak.	By	having	a	communication	plan,	 

you	are	creating	the	“go	to”	resource	for	must-have	information.	An	outbreak	 

communication	plan	should	include 

•	 A	signed	endorsement	from	your	leadership 

•	 Designated	partner	responsibilities	for	public	information 

•	 Agreements	on	information	release	authorities	(who	releases	what/when/how) 

•	 Procedures	for	information	verification	and	clearance/approval 

•	 Regional	and	local	media	contact	list	(including	after-hours	news	desks) 

•	 Procedures	to	secure	needed	resources	(e.g.,	space,	equipment,	and	people)	to	 

operate	the	public	information	operation 

•	 Procedures	to	coordinate	with	the	public	health	agency 

•	 Identified	communication	channels	to	the	public,	stakeholders,	partners	 

(e.g.,	e-mail	listservs,	broadcast	fax,	and	press	releases) 

•	 Designated	spokespersons	for	TB	outbreaks 

•	 Messages	that	have	been	developed	carefully	and	tested	by	potential	
 

audiences
 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit  

Chapter 0: Preparing Your Partnership to Communicate During a TB Outbreak 
•	 TB	control	program	outbreak	information	 

•	 Draft	fact	sheets,	questions	and	answers,	talking	points,	and	other	 

supplementary	materials,	which	have	been	tested	and	cleared,	for	all	credible	 

scenarios 

•	 Partner	recommendations	reached	by	consensus	 

•	 Evaluation	plan	to	measure	the	effectiveness	of	your	outbreak	
 

communication	plan
 

Tips and Strategies 

These	tips	will	help	you	put	your	plan	together: 

Integrate with TB 

program’s outbreak 

communication 

plan 

Collect, organize, 

and update 

important contact 

information 

Update the plan 

regularly 

An	outbreak	will	involve	a	number	of	agencies	 

and	departments,	and	a	good	plan	will	reflect	 

that	coordination.	 

Your	partnership’s	outbreak	communication	plan	 

should	be	integrated	into	the	overall	outbreak	 

response	plan	for	TB	control	programs	at	the	 

local,	state,	or	national	level.	An	important	 

benefit	to	this	integration	is	the	opportunity	to	 

mobilize	shared	resources,	such	as	a	citywide	 

telephone	number	to	respond	to	public	concerns.	 

Keep	media	contacts	current	and	organized	 

in	order	to	readily	access	this	information	 

when	needed.	Media	contacts	can	change,	 

and	regularly	reviewing	and	updating	this	 

information	is	important	 

The	single	most	important	responsibility	that	 

can	be	assigned	to	someone	in	your	partnership	 

is	the	duty	to	keep	the	plan	“alive.”	 

Schedule	a	regular	review	of	the	plan;	do	not	 

wait	for	so	many	changes	to	occur	that	the	plan	 

is	useless	when	you	take	it	off	the	shelf.	 

8 Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter 0: Preparing Your Partnership to Communicate During a TB Outbreak 
Keep the plan 

focused and to the 

point 

Longer	is	not	better	for	your	plan.	Your	plan	 

does	not	have	to	spell	out	every	single	task	to	be	 

accomplished.	It	must	be	the	reference	that	will	 

keep	everyone	on	track	and	allow	the	tasks	to	be	 

completed	with	a	minimum	of	scrambling.	 

Get the plan 

endorsed 

Your	TB	partnership	should	know	that	you	have	 

thought	through	the	outbreak	communication	 

process,	that	you	have	coordinated	your	response	 

planning,	and	that	they	have	an	important	role	 

in	the	“ownership”	of	this	plan.	 

Obtain	a	signed	and	dated	endorsement	letter	 

from	the	directors	of	the	organizations	in	your	 

partnership.	Keep	the	endorsement	letters	to	a	 

couple	of	simple	paragraphs.	Have	the	letters	 

signed	and	dated	as	you	update	the	plan;	getting	 

that	endorsement	will	help	keep	everyone	 

accountable	for	updating	the	plan.	 

Use the plan to 

“get a seat at 

the table” for 

communications 

It	is	important	to	train	the	leaders	of	your	 

partnership.	Use	the	plan	to	help	your	partnership’s	 

leaders	understand	how	communication	planning	 

and	preparation—and	successful	communication— 

will	help	them	manage	an	outbreak	more	 

effectively.	Emphasize	that	TB	outbreaks	provide	an	 

excellent	opportunity	to	educate	the	public	about	 

TB.	Explaining	the	benefits	of	communicator	 

involvement	will	help	them	understand	a	 

communicator’s	role	and	gain	you	a	“seat	at	the	 

planning	table.” 

Why It Is Important 

The	plan	is	not	intended	to	be	a	step-by-step	guide;	it	is	the	foundation	of	your	 

work.	It	should	systematically	address	all	of	the	roles,	lines	of	responsibility,	and	 

resources	you	are	sure	to	need	as	you	provide	information	to	the	public	and	partners	 

during	a	TB	outbreak. 

An	effective,	well-thought-out	plan	will	save	you	precious	time	when	a	crisis	hits.	If	 

you	plan	well,	you	will	be	able	to	focus	on	the	quality,	accuracy,	and	speed	of	your	 

response	instead	of	who	is	going	to	do	what. 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit  

Chapter 0: Preparing Your Partnership to Communicate During a TB Outbreak 
Emergencies	are	chaotic	enough	without	the	disorganization	of	a	partnership	 

in	which	members	are	working	without	a	plan.	Lines	of	communication	and	 

relationships	with	your	response	partners	are	built	before	the	crisis,	not	during	 

the	crisis.	Too	often,	the	initial	confusion	and	mixed	messages	that	cripple	an	 

organization’s	or	partnership’s	credibility	with	the	public	come	from	a	lack	of	clear	 

definition	of	roles,	responsibilities,	and	lines	of	communication. 

Determine the Resources Needed to Carry Out the Plan — 

Things to Keep in Mind 

Think	through	the	resources	(e.g.,	space,	people,	contracts,	and	equipment	and	 

supplies)	you	will	need	and	ensure	that	they	are	available. 

Tips and Strategies 

Use	the	list	below	to	review	what	resources	your	partnership	needs,	then	make	a	plan	 

to	access	those	that	you	do	not	have. 

Space You	may	need	a	place	to	bring	media	onsite	to	one	 

of	your	TB	partnership	locations.	 

People Trained	and	qualified	people	are	needed	to	support	 

and	carry	out	the	functions	of	the	communication	 

team	and	to	conduct	the	outbreak	investigation.	It	 

is	especially	important	for	spokespersons	to	receive	 

media	training	prior	to	an	outbreak	situation.	 

Equipment and 

supplies 

Equipment	to	support	communication	to	media	 

and	partners	must	exist	before	the	crisis.	 

Determine	what	you	may	need	to	augment	your	 

regular	day-to-day	office	equipment	and	what	you	 

may	need	if	a	crisis	persists.	(For	example,	in	the	 

midst	of	a	crisis,	you	may	not	be	able	to	wait	for	a	 

contractor	to	show	up	with	an	extra	fax	machine.)	 

As	you	think	through	the	equipment	and	supplies	 

needed,	consider	the	delivery	channels	you	plan	to	 

use	and	what	additional	equipment	or	supplies	are	 

needed	for	specific	channels.	For	example,	if	you	 

plan	to	use	mailings,	you	may	need	to	have	on	hand	 

specific	mailing	and	packaging	supplies. 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter 0: Preparing Your Partnership to Communicate During a TB Outbreak 

80 
Finally,	ask	yourself	what	is	not	on	this	list	that	you	should	acquire	in	order	to	 

communicate	effectively. 

Preparing the Partnership to Carry Out the Plan — 

Things to Keep in Mind 

Make	sure	your	leadership	has	had	input	into	the	plan	and	has	signed	off	on	it,	 

then	develop	and	implement	a	strategy	for	promoting	the	plan	and	keeping	it	alive.	 

Remember,	your	plan	is	not	a	document	that	goes	on	the	shelf.	It	must	be	kept	alive	 

and	updated.	It	must	be	promoted,	rehearsed,	and	revised	as	circumstances	change.	 

When	an	outbreak	occurs,	your	outbreak	communication	plan	should	be	the	“go	to”	 

document	to	help	you	and	those	who	depend	on	you	for	information. 

Tips and Strategies 

To	prepare	your	partners 

•	 Involve	top	leadership	and	management	of	related	official	 

functions	in	the	plan’s	development.	 

•	 Determine	who	needs	to	understand	the	plan,	and	develop	and	 

implement	a	communication/education	plan	to	reach	them.	Tell	 

your	leadership	the	benefits	of	involving	communicators	when	 

decisions	are	made	as	well	as	the	risks	of	not	doing	so.	 

•	 Have	your	TB	program’s	leaders	provide	written	endorsement	of	 

the	plan. 

•	 Set	up	a	formal	review	procedure	for	your	TB	program’s	top	 

leadership.	 

•	 Make	the	plan	and	the	endorsement	known,	internally	and	with	 

all	partners.	Ask	other	managers—especially	of	key	internal	and	 

external	partners—to	provide	written	endorsements.	 

•	 Train	your	spokespersons. 

•	 Conduct	rehearsals	as	needed.	 

Why It Is Important 

No	matter	how	comprehensive,	a	plan	that	is	not	reviewed	and	accepted	by	 

leadership	(and	understood	by	those	who	will	use	it)	will	be	useless	during	an	 

outbreak. 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 8 

Chapter 0: Preparing Your Partnership to Communicate During a TB Outbreak 
The Event Phase
 

When	an	outbreak	occurs,	the	outbreak	communication	activities	during	the	initial	 

hours—and	throughout	the	remaining	life	of	an	event—will	significantly	affect	its	 

outcome.	 

The	event	phase	of	an	outbreak	is	often	characterized	by	uncertainty,	rapid	rate	of	 

change,	and	intense	media	interest.	Usually,	disseminated	information	and	facts	are	 

incomplete.	It	is	important	to	recognize	that	information	coming	to	you	from	the	 

media	and	other	organizations	may	not	be	accurate.	That	is	why	simplicity,	credibility,	 

verifiability,	and	speed	count	with	communication	from	you	to	the	media.	 

The	event	phase	has	two	parts:	activities	that	are	critical	during	the	initial	hours	after	an	 

outbreak,	and	activities	that	must	be	conducted	during	the	remaining	life	of	the	event. 

During the Initial Hours After an Outbreak During the Remainder of the Outbreak 

•	 Verify the situation by determining the 

credibility of the information you are 

receiving. 

•	 Conduct notifications. 

•	 Assess the level of crisis. 

•	 Organize and delegate assignments. 

•	 Prepare information for release. 

•	 Release information to the public. 

•	 Monitor the event for new information. 

•	 Monitor the media coverage of the event. 

•	 Maintain your communications plan. 

•	 Keep media messages focused and to the 

point. 

•	 Adjust your procedures as necessary. 

The	procedures	you	will	follow	during	the	initial	hours	after	an	outbreak	should	be	 

detailed	in	the	outbreak	communication	plan	that	you	outlined	during	the	pre-event	 

phase.	Your	planning	efforts	from	the	pre-event	phase	will	be	evident	as	you	are	able	to	 

turn	what	was	a	potential	crisis	into	an	opportunity.	 

The Post-Event Phase 

The	goal	of	the	post-event	phase	is	to	improve	your	TB	program’s	ability	and	capacity	 

to	deal	with	future	outbreaks.	You	can	achieve	this	goal	by	providing	for	the	well-being	 

and	recovery	of	those	conducting	the	outbreak	investigation,	using	the	opportunity	to	 

conduct	public	education,	monitoring	messages	and	events	(media,	public,	partners,	and	 

stakeholders),	and	establishing	a	new	state	of	readiness	in	response	to	outbreaks. 

The	post-event	phase	is	a	time	of	retrospection	and	critical	assessment	for	agencies	or	 

8 Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter 0: Preparing Your Partnership to Communicate During a TB Outbreak 
organizations	responding	to	an	outbreak.	During	this	stage,	it	is	important	that	your	 

partnership’s	leadership	take	the	initiative	in 

•	 Expressing	relief	and	thanks	to	all	involved	 

•	 Settling	internal	and	external	concerns	about	the	outbreak 

•	 Addressing	potential	aftershocks 

•	 Planning	for	future	outbreaks	 

•	 Helping	key	stakeholders	(e.g.,	employees	and	their	families,	public,	media)	move	 

from	the	crisis	situation	to	resolution	and	recovery	 

Research	has	shown	that	a	community	is	usually	most	responsive	to	risk	avoidance	 

and	health	education	immediately	after	a	disaster	has	occurred.	At	this	point,	the	risks	 

associated	with	a	crisis	are	recognized	as	real,	not	hypothetical. 

As	a	crisis	subsides	from	its	most	volatile	peak,	public	inquiries	and	calls	decrease.	 

Moreover,	although	the	questions	are	fewer	in	number,	they	are	typically	more	complex	 

and	difficult	to	answer.	The	public	wants	to	hear	about	lessons	learned	and	the	steps	that	 

will	be	taken	to	prevent	the	situation	from	recurring.	People	want	to	be	reassured	of	their	 

safety,	and	they	are	in	search	of	closure.	Even	your	own	TB	partnership	organizations	 

may	desire	to	move	quickly	back	to	its	routine,	day-to-day	operations.	However,	rushing	 

into	a	business-as-usual	mode	can	hinder	not	only	your	partnership’s	capacity	to	deal	 

with	future	outbreaks,	but	also	your	colleagues’	productivity	and	the	public’s	trust	in	the	 

members	of	your	partnership.	 

Communications	objectives	for	the	resolution	phase	include: 

•	 Improving	appropriate	public	response	in	future	outbreaks	through	education 

•	 Honestly	examining	problems	and	mishaps	and	then	reinforcing	what	worked	in	the	 

recovery	and	response	efforts 

•	 Persuading	the	public	to	support	public	policy	and	resource	allocation	to	the	 

problem	 

•	 Promoting	the	activities	and	capabilities	of	the	partnership 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 8 

Chapter 0: Preparing Your Partnership to Communicate During a TB Outbreak 
Related Resources 

Risk Communication Websites 

•	 Association of State and Territorial Health Officials (ASTHO) 

ASTHO’s	mission	is	to	formulate	and	influence	sound	national	public	 

health	policy	and	to	assist	state	health	departments	in	the	development	and	 

implementation	of	programs	and	policies	to	promote	health	and	prevent	disease,	 

including	risk	communication.	Visit	their	website	at	www.astho.org. 

ASTHO	also	offered	a	Web	broadcast	dealing	specifically	with	risk	 

communication	and	bioterrorism.	More	information	about	the	Web	broadcast	is	 

available	at	www.astho.org/docs/productions/0306riskcomm.html. 

•	 Center for Risk Communication 

This	website	features	information	dealing	with	the	development	and	use	of	 

advanced	communication	methods.	Visit	the	site	at		
 

www.centerforriskcommunication.com.
 

•	 Current Bibliographies in Medicine: Health Risk Communication
 

The	National	Library	of	Medicine’s	bibliography	listing	for	health	risk	
 

communication	is	available	online	at		
 

www.nlm.nih.gov/pubs/cbm/health_risk_communication.html.
 

Risk Communication Training 

•	 CDCynergy: Emergency Risk Communication (ERC) Training 

The	CDC	offers	ERC	training	appropriate	for	public	health	workers	and	 

communicators	both	inside	and	outside	the	government.	Information	about	 

CDCynergy	ERC	Training,	including	the	curricula	and	tools,	can	be	found	at	 

www.bt.cdc.gov/erc/erc.asp.	 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter 0: Preparing Your Partnership to Communicate During a TB Outbreak 

84