Keynote address delivered to the Sheela Basrur Symposium at the start of the Ontario Public Health Convention, 3 April 2013. See here for the storify http://storify.com/TOPHCtweets/the-sheela-basrur-symposium This presentation was a joint effort with Julie Leask and Claire Hooker. Other contributions are on the Acknowledgements slide.

1. SYDNEY MEDICAL SCHOOL
www.ncirs.usyd.edu.au
Effective communication strategies during
an infectious disease event
Sheela Basrur Symposium, Toronto, 3 April 2013
A/Prof Julie Leask
School of Public Health
Julie.Leask@sydney.edu.au
@JulieLeask
Dr Claire Hooker
Centre for Values, Ethics and the
Law in Medicine

2. Acknowledgements
› Sheela Basrur
› Claire Hooker, Centre for Values, Ethics
and the Law in Medicine, University of
Sydney
› Catherine King, May Chiew, Alexis Pilsbury
National Centre for Immunisation Research
& Surveillance
› Peter Massey, Hunter New England Local
Health District, NSW

3. H1N1
Source:
www.crikey.com.au

4. Outline
› Understanding public responses
› Key challenges
› Working with the media
› Changing media landscape
› Practical risk communication suggestions

5. Understanding public responses to risk
“If we want to be prepared for a major flu epidemic we must
understand not only the virus and how it spreads but also
cities and how they function, organizations and how they
operate, communities and how they relate, and individuals
and how they make choices.”
Kickbusch and Sakallarides 2006

6. THE RECIPIENT
› Availability heuristic
› Anticipatory regret
› Ambiguity aversion
Some particularly relevant
cognitive heuristics and biases

7. Perception of the hazard
FRIGHT FACTORS
› dreaded outcome
› affects ‘vulnerable’
› identifiable victims
› poorly understood by
science
› contradictory
statements from
sources
› involuntary

8. The goals in risk communication depend on the levels
of outrage and hazard
From: Peter Sandman

9. Competence, objectivity, fairness, consistency, empathy
(Renn and Levine in Communicating Risks to the Public 1991)

10. What is the strongest form of communication?

11. The challenges
“One serious effect resulting from the restrictions above mentioned was that
the general public was led to regard the disease as a very fearsome thing,
and the application of regulations dealing with contacts strengthened their
belief in the matter, with the result that so soon as the number of people fell
ill they were in very many instances left to do the best they could for
themselves because of the fear which the neighbours had of themselves
contracting the disease.
In some towns yellow flags and other symbols were displayed to warn the
public from entering the invaded premises, and this was cruelly insisted on in
some districts where, unfortunately, the local authorities had made no efforts
to provide proper help for the stricken inhabitants.”
Report on the Influenza Epidemic in New South Wales in 1919;172

12. Uncertainty
› The public and the mass media
have poor tolerance for uncertainty
› Uncertainty was communicated
reasonably well during the H1N1
pandemic

13. Defining the risks
› Illness and death
› Impacts of trade and travel
restrictions
› Psychosocial impact of restrictions
› Excessive healthcare usage
› Stockpiling medicines
› Reputation risks

14. Media Challenges
› Traditional mass media remains
prime
› Limitations
- Tendency to amplify high outrage
risks
- Tendency to reproduce error
- Lack of capacity to present
complexity
- Potential for stigmatisation

15. Working with journalists
› Study: how journalists
approached reporting avian
influenza stories in 2007

16. Working within constraints
Tyranny of deadlines
“On one axis you have maximum accuracy, integrity, detail - all of those
wonderful things. And then on the other one you've got time. Your job is
to do the best you can within that parameter.”
(Newspaper medical reporter)
Need for images
Human angle

17. Access to experts and transparency valued
Good ‘talent’
• Trusted
• Knowledgeable
• Communicate clearly and
compellingly
• Accessible
“Just make sure your talent is always available – because
nothing annoys media more than if they can't get someone,
that is when things go pear shaped, because no-one is
there to answer their questions”.
Newspaper reporter

18. Journalists balance ethical tensions
“We don't want to panic people, but at the same time we do
want them to watch our news. There will be headlines,
promos saying 'tonight Pandemic kills x many people' – but
we just have to make sure we give an accurate report of what
happens. But we always try to give advice. We want to
reassure people what to do to protect themselves.”
(TV news producer)

19. Specialist Medical Reporters
› Better knowledge
› Access to a wider range of sources
› Gatekeepers and advocates
› Cooperative but critical
“The media is not the public relations wing of the health
department. We are not there simply to report what they
want to tell the public - though we will usually do that also.
But our role is to ask challenging, independent
questions.”
(Newspaper medical reporter)

20. A changing media landscape

21. Slide courtesy of Carolyn Der Vartanian

22. Slide courtesy of Carolyn Der Vartanian
Social Media: A group of Internet-based
applications that … allow the exchange of
user-generated content. (Kaplan 2010)

23. The pitfalls….

24. … and the opportunities
Information:
"Train services are resuming in parts of Brisbane. Stop
walking on the tracks #TheBigWet #qldfloods"
"No homes can be reconnected to electricity until they have
been certified as safe by an electrician #qldfloods
#TheBigWet“
Mythbusting
Wivenhoe Dam is NOT about to collapse! #thebigwet
#qldfloods"
There is currently NO fuel shortage in Brisbane. #qldfloods
#thebigwet
The lighter side
We're building an Ark
Help! I've lost my Goldfish
Source: http://www.brightlabs.com.au

25. Signorini A, Segre AM, Polgreen PM (2011) The Use of Twitter to Track Levels of Disease Activity and
Public Concern in the U.S. during the Influenza A H1N1 Pandemic. PLoS ONE 6(5): e19467. doi:
10.1371/journal.pone.0019467 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0019467
Estimate disease activity in real time

26. Consider this
How could you and your organization use social media?

27. Effective communication during
an infectious disease event

28. Being Prepared
› WHO do you need to communicate with?
› HOW are you going to communicate with them?
› WHAT do they need to know?
Source:
http://www.sti.risk-technologies.com/
AnnouncementPreview.aspx?eid=4845

29. Pre-event
• Prepare
Event
• Media is ally
• Be available
• Work with specialist reporters
• Appeal to ethical commitments to reduce stigmatization
• Focus on action
• Use social media
Post-event
• Media’s reflective and critical phase
• Acknowledge shortcomings
• Address non-medical costs
• Evaluate
Preserve trustWorking with the media

30. General advice
› Use trusted spokespersons
› Be honest, frank and transparent
› Err on the side of disclosure
Preserve trust

32. Not
usually
a
helpful
concept
“Officials routinely expect the public to panic if told
alarming things, and misdiagnose orderly efforts to
prepare as panic.”
Peter Sandman Nature;2009
‘Panic’ is not usually a helpful concept in outbreaks

33. Talking about probability
› Define the risks
› Qualitative & quantitative estimates
› Framing
- Loss frame “If you don’t wear PPE….
- Gain frame “If you wear PPE….”
From http://www.chiin.ca/decisionaid.html

34. Communication tips
› Acknowledge uncertainty
› Be dedicated to good technical
information
› Explain rationale
› Acknowledge emotional aspects
› Communicate with all
stakeholders
- Preparing channels before the
event
- Have mechanisms for listening
› Prioritise special risk groups
Good communication requires supportive leadership

35. Prioritise special risk groups
› listen then share with communities the
information needed
› localise, personalise and humourise
› avoid paternalism, tokenism and
‘Aboriginalising’
An example… The pandemic project with Aboriginal and Torres
Strait Islander communities
From: Massey PM et al Health Policy 2011;103:184-90 Australian Aboriginal
and Torres Strait Islander communities and the development of pandemic
influenza containment strategies: community voices and community control.

36. Social investment
Ministry of Health Report, October 1920
Retrospective assessment of what
was needed in 1918-19

37. Conclusions
› Social and infrastructure investment
› Action is a form of communication
› Work with the traditional media
› Evaluate efforts
› Social media brings some risks but many opportunities
“The smart city builds these long before a crisis”
Kickbusch and Sakallarides. Flu City—Smart City: applying health promotion
principles to a pandemic threat. Health Promotion International 2006

38. THANK YOU