HHS Pandemic Influenza Risk Communication and Public Engagement

1
HHS Pandemic Influenza Risk Communication and
Public Engagement

• Sarah Landry
• National Vaccine Program Office
• Department of Health and Human Services
• November 30, 2005

2
Why Communication and Outreach are Critical
Components of Pandemic Influenza Preparedness

• Research continues to document the importance of
  risk communication and early public discussion
  for effective health/emergency preparedness
  activities
• Need to begin laying the foundation of
  expectation with communities (business,
  education, labor)..
• Preparedness tool communication is a critical
  part of our preparedness efforts
• Will be one of the few, if not the only tool,
  available in the early days of a pandemic

3
Why Engage The Public?

• Tell me, I forget.
• Show me, I remember.
• Involve me, I understand.
• Chinese proverb

4
Un-Ness of Pandemic Influenza

• Unknowns make communication challenging
• When ?
• Where ?
• How ?
• What ?
• Who ?
• Why ?

5
Risk Communications
Inflame Panic
Inspire Inform Prepare
6

• Pillar One Preparedness and Communication
• Preparedness is the underpinning of the entire
  spectrum of activities, including surveillance,
  detection, containment and response efforts. We
  will support pandemic planning efforts, and
  clearly communicate expectations to individuals,
  communities and governments, whether overseas or
  in the United States, recognizing that all share
  the responsibility to limit the spread of
  infection in order to protect populations beyond
  their borders

7
(No Transcript)
8
Communications Priorities

• Accurate, credible, and timely information,
  coordinated with partners
• Information clearinghouse for public, media,
  professional organizations, clinicians, health
  departments, and other health authorities
• Materials for stakeholders (e.g., guidance and
  recommendations, templates, prototypes)
• Transparency in providing information about the
  status of the pandemicprevention and control,
  and rationale for interventions

9
HHS Pandemic Influenza Risk Communication and
Outreach Strategy

• Planning and Assessment
• Formative Audience Research
• Message and Material Development
• Cross Government Coordination and Collaboration
• Training
• Media Outreach
• Community Continuity Planning
• Public Engagement
• International Support

10
Planning and Assessment

• Inventory of current HHS communication activities
• Tracking of media activity
• 100 commonly raised issues/questions
• Polls of public and providers
• Development of a strategic communications plan
• Discussions/coordination with global partners

11
Top Pandemic Flu Messages
most reported

• Bird flu could cause human pandemic
• Foreign deaths from bird flu reported
• Historical accounts of influenza
  epidemic/pandemic
• Pandemic flu can kill thousands/ millions
• Foreign official worried about bird flu

12
National Survey of US Public

• To measure the publics general awareness of
  pandemic influenza
• To measure the publics level of concern and
  beliefs about pandemic influenza
• To assess amount of confidence in and attitudes
  toward public health measures that might be
  employed during a pandemic

13
Conclusions

• Awareness of pandemic influenza is generally very
  low
• Respondents expressed some concern, although a
  large number (20) were not concerned and feel
  pandemic influenza risk is being exaggerated.
• There is a lack of public awareness about vaccine
  and antiviral availability and lack of confidence
  that they will be distributed fairly.
• Most respondents feel that federal and local
  health officials are not prepared to respond to
  an influenza pandemic.
• Many predict they will not be willing to comply
  with public health measures.

14
Message Mapping

• Scientific process for ensuring that information
  is accurate, clear, concise, consistent,
  credible, and relevant
• Allows organizations to develop messages in
  advance for predictable events
• Based on extensive studies of post-CNN news
  environment

15
News Study

• The average length of a sound bite in the print
  media was 27 words
• The average duration of a sound bite in the
  broadcast media was 9 seconds
• The average number of messages reported in both
  the print and broadcast media was 3

16
Message Mapping

• Cross HHS teams (policy, communications,
  scientific) work on answers to 117 commonly asked
  questions.
• Goal is concise and accurate information that is
  consistent across HHS.
• Maps serve as foundation for other materials
  (talking points, materials, etc).
• 80 prepandemic messages have been developed
• 18 pandemic event messages developed

17
Focus Group Testing

• 39 interviews with health care providers
• 97 members of general public in 24 groups
• 4 cities during August 2005
• New York City, NY
• Wichita, KS
• Portland, OR
• San Francisco, CA

18
Findings, Recommendations, Comments

• Pandemic Flu as Flu vs. emerging virus
• Flu vs bird flu vs pandemic flu vs avian flu
• Importance of Google for information gathering
• Desire for more information
• Balance of immediacy vs. preparedness
• Misunderstanding about vaccines and therapeutics
  how used
• Concern about fairness in access and use of
  resources
• priority groups strong negative connotation

19
Message / Materials Development

• Factsheets on avian influenza, pandemics, and
  H5N1 available
• FAQs
• Citizens guide
• toolkits for communities, businesses, schools
  What ____ should do to prepare
• Outreach to partners

20
Message Themes
Interpandemic period

• Scientists say an influenza pandemic is likely
• Impossible to predict when prudent to plan
• HHS, WHO, and other partners are engaged
• U.S. plan requires citizen participation
• We care.
• Were in this together.
• Government cant do it all
• Difficult options require broad discussion
• Now is the time to identify and work out issues

21
(No Transcript)
22
Trainings and Tabletops

• Operations plan under development by DHS, USDA,
  and HHS
• Tabletop trainings Federal government exercise,
  tools for states and local governments
• Federal Secretary of Public Affairs level
  exercise planned for Dec 2005.

23
Media Outreach

• Media Guide
• Media Roundtables in three cities
• Resources on pandemicflu.gov

24
(No Transcript)
25
International

• International Pandemic Influenza Risk
  Communications Workshop December 8-10 in Geneva
• Staff support
• Survey of member state activities
• Development of an international risk
  communications framework
• Secure website for resource sharing
• Global Communications and Instructional Systems
  International sites that foster collaboration
  with NGOs to enhance communication and public
  health education efforts.
• Bangkok November 14 - Message testing and
  meeting
• GHSAG Mexico City Meeting on Pandemic Influenza
• Coordination with Canada and UK

26
Definition of Public Participation

• Public participation is engaging openly and
  respectfully in give and take discussions with
  citizens and/or stakeholders

27
The NVAC Working Group on Enhancing Public
Participation in Vaccine Policy Deliberations

• Charge To consider options for enhancing
  public participation in vaccine policy
  deliberations and to evaluate the proposal from
  the Wingspread Public Engagement Planning Group
  for a demonstration project - the Vaccine Policy
  Analysis Collaborative (VPACE)

28
NVAC Working Group on Public Engagement

• There is a need for enhanced efforts to engage
  the broad public in vaccine policy discussions.
• NVAC has an important role to play in supporting
  public engagement.
• The general public must be adequately
  represented. The forum for this dialogue should
  represent all vaccine partners and more must be
  done to engage the broad American public, not
  just advocacy groups.
• In order to ensure that public engagement
  activities are based on an understanding of the
  scientific strong scientific foundation, training
  of public representatives may need to be
  provided.
• A one size fits all approach will not fit provide
  enough flexibility to address all vaccine topics.

29
Why Is this Important for Pandemic Influenza?

• Pandemic Influenza will likely affect every
  American
• Critical decisions will need to be made regarding
  the use of limited resources
• Builds trust in the government, which will be
  essentially during a crisis
• Provides better, sounder information on publics
  response for which planners can base decisions
• dont need to base decision on assumptions

30
Pandemic Flu Vaccination Priorities Public
Engagement Pilot Project

• Lounsbery Foundation
• CDC National Immunization Program
• Institute of Medicine
• National Vaccine Program Office
• Study Circles Resource Center

31

• Ed Marcuse
• Seattle Childrens Hospital
• Roger H. Bernier
• NIP
• Louis Z. Cooper
• Past President, American Academy of Pediatrics
• Geoffrey Evans
• HRSA
• Mark Feinberg
• Merck Vaccine Division
• Kathleen Stratton
• Institute of Medicine
• Mary Davis Hamlin
• Center for Science and Public Policy, The
  Keystone Center

• Sarah Landry
• NVPO
• Alan Hinman
• NVAC
• Matt Leighninger
• Democracy Workshop
• Senior Associate, Study Circles Resource Center
• Barabra Loe Fisher
• Co-Founder/President, National Vaccine
  Information Center
• Debbie McCune Davis
• Wisconsin Womens Network
• Mona Steele
• The Arizona Partnership for Immunization

32
Americans Discuss Difficult Choices on Who To
Protect First Against Pandemic Influenza

• Engage citizens, local/state and Federal
  officials, academics, non-governmental
  organizations,
• health care providers, and industry
• National Dialogue Sessions
• with Key Stakeholder Groups
• Citizen at Large Sessions
• individual citizens not representing any
  organized interests

33
Stakeholder Organizations

• American Association of Retired Persons (AARP)
• American Academy of Pediatrics
• Service Employees International Union
• National Medical Association
• Trust for Americas Health
• Wisconsin Womens Network
• Americas Health Insurance Plans
• American Medical Association
• Vaccine Education Center
• National Business Group on Health
• National Hispanic Medical Association
• Merck and Co, Inc
• Sanofi Pasteur
• State Health Officials
• National Network for Immunization Information
• National Vaccine Information Center
• National Asian Womens Health Organization
• International Institute for Indigenous Resources

34
Key Assumptions

• Severity Moderately severe pandemic in the US
  with half a million deaths and two million
  hospitalizations
• Death Hosp rates Death and hospitalization
  rates will be highest in infants under 1 and
  persons 65 and older, but could vary from these
  past patterns.

35
Key Assumptions

• Who Guides Choices Guidance about who first to
  vaccinate comes from the federal government
• Supply Control Government buys all the vaccine
  and distributes it

36
Key Assumptions

• Supply Availability Only 3M persons per month
  vaccinated---Very limited supplies of vaccine
  become available in the early days of the

37
Potential Goals 1st Stakeholder Meeting

• Give everyone an equal chance to be protected
  (e.g. lottery or first come, first served
• Protect persons with the most life ahead of them
• Seek to protect those of any age or health
  condition most or more likely to die from a new
  influenza strain

38
Potential Goals

• Assure public safety
• Maintain emergency and/or life saving services
  (e.g. health care workers)
• Protect societys key government leaders and
  decision makers
• Protect those providing the most critical
  services which keep society running (e.g. utility
  workers)

39
Potential Goals

• Provide some vaccine to other countries even if
  it is at the expense of vaccinating some persons
  in the US
• Protect those who provide homeland security and
  those who defend us against threats abroad
• Assure vaccine production

40
Atlanta Citizens Group

• Limit the larger effects on society
• Save those who are most at risk
• Put children and young people first
• Use a lottery system
• Use the principle of first come, first served

41
Hierarchy of Goals

• Assure functioning of society
• Reduce individual deaths and hospitalizations due
  to influenza

42
1. Assure functioning of society

• Assure production, distribution, administration
  of vaccines (includes manufacturing, workers
  associated with vaccine clinics, etc.)
• Maintain emergency response and life saving
  services (e.g. healthcare workers)
• Assure provision of other critical services

43
Critical Services

• Public safety and maintaining law and order
• Protecting societys key government leaders and
  decision makers
• Homeland security
• Utilities
• Food distribution
• Communications

44
2. Reduce Individual Deaths and Hospitalizations

• Protect those most or more likely to die from a
  new influenza strain, as defined by the ACIP/NVAC
  recommendations, unless the emerging epidemiology
  of pandemic influenza defines new risk groups
• Health persons 2-64 years not in other groups
  above

45
ACIP/NVAC

• To limit morbidity and mortality of influenza and
  its complications during a pandemic
• To decrease social disruption and economic loss

46
Conclusions from Pilot Project

• Public wants to be involved and is interested
• Consistency in results despite diversity in
  citizens, stakeholders, geography
• Importance of assuring the functioning of society
• Importance placed on fairness and responsible use
• Need for local specificity

47
Conclusions

• Pilot project provides proof of principle that
  a diverse group of stakeholders and citizens can
  interact in give and take discussions and reach a
  productive outcome
• It is possible to get a higher level of public
  involvement in vaccine policy discussions.

48
(No Transcript)