New York City's Communication Trials by Fire, from West Nile to SARS

IN NEW YORK CITY, several public health events over the past five years—West Nile virus, the World Trade Center attacks and the air quality issues that ensued from these attacks, the anthrax attacks, the 2003 smallpox vaccination campaign, and the international SARS epidemic—have challenged and sharpened the communication skills of the people in the city health department who are charged with communicating with the public. Each situation made us profoundly aware of how integral good communication is to disease control work. When a public health threat descends on a city that hosts a dozen local television stations and several cable stations, three television networks, six daily newspapers and scores of community weeklies, and numerous radio stations, expect a big production and a great deal of fanfare for a new pathogen. Add to this mixture the fact that New York is an international city of 8 million people where more than 130 languages are spoken and that it has a powerful mayor’s office with more than 50 mayoral agencies (including our own); several layers of local government including a 51-member city council, a borough president in each of five boroughs, and 59 community boards; and hundreds of advocacy and special interest groups, and what results is complicated terrain that poses a potent challenge for effective communication in the best of times, much less during a crisis. It is not surprising that in New York City we regularly deal with public health issues and events that attract a constant stream of media, community, and political interest. We are, after all, hosts for a large proportion of the nation’s tuberculosis, AIDS, and other sexually transmitted disease cases, and we have our share of outbreaks and unusual illnesses—like the case of bubonic plague diagnosed in a traveler in early 2003. Our 20,000-plus restaurants are often the targets of investigative media reports, and, just recently, the ban on smoking in bars and all workplaces set off an international media storm. Clearly, we are no strangers to media attention and controversy. Although we were accustomed to a fast-paced media operation, the media storm that accompanied the introduction of West Nile virus in 1999 was, up until then, unprecedented for our department. In retrospect, the media frenzy, community controversy, and political interest surrounding West Nile virus primed us for larger communication challenges to come. In this article, I focus mainly on media communications and describe what we did well and what we did not do so well, recounting briefly some of the anecdotes and personal experiences that help illustrate this. It is my hope that these lessons, along with a growing literature on crisis and risk communication, will provide useful advice to health communications colleagues elsewhere. Among the most important lessons learned from some of our crises in New York City, ten things stand out. These are the areas that our agency strives to improve on in each time of crisis. Others here or elsewhere may come up with a different list that might be just as worthwhile. As the adage goes, the more we know, the more we know how much we don’t know and the more we realize how much we can improve. Some of the points that follow are drawn from risk and crisis communication theory translated into experience. These theories are well articulated by Peter Sandman, Vincent Covello, and others. My colleagues and I in New York City continue to learn as we tackle each challenge that comes along and prepare for the next one.