Let

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Lets Talk About the PandemicRisk and Crisis
Communications Basics for the Post-SARS World

• Roy Wadia
• Director, Communications
• BC Centre for Disease Control

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It all began on ProMED

• Have you heard about the EPIDEMIC in
  Guangzhou? An acquaintance of mine from a
  teachers chat room (who) lives there... reports
  that the HOSPITALS THERE HAVE BEEN CLOSED.
• and PEOPLE ARE DYING.
• Dr Stephen Cunnion, ProMED posting,
• 10 February 2003

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Chinas Reaction?
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SILENCE
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By the time China talked.

• Im so worried, Im taking sleeping pills.
  Chinese vice-premier Wu Yi 9 April 2003

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it was too little, too late
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A disease in one country
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can threaten the entire world
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A communications vacuum
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creates panic
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and distrust
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and trust, once lost

• Beijing mayor Meng Xuenong lost his job over SARS

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is not easily regained

• Beijing reassures WHO that it will tackle SARS
• But does the world believe China?

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The toll of lies, half-truths and panic

• Over 8000 CASES and 800 DEATHS globally from SARS
• BILLIONS UPON BILLIONS OF DOLLARS IN ECONOMIC
  LOSS in countries directly affected and around
  the world
• DISTRUST of governments and authorities even
  those that were trying to do the right thing

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SARS Truly a defining moment

• SARS Memorial at the Great Wall of China

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but have we learnt its lessons?
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RISK AND CRISISCOMMUNICATIONS
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RISK COMMUNICATION

• PARTNERSHIP AND DIALOGUE of Government/Industry
  with the PUBLIC
• Addresses a FUNDAMENTAL DILEMMA Risks that KILL
  people and risks that ALARM them are often
  completely different
• Peter Sandman www.psandman.com

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RISK COMMUNICATION

• The technical seriousness of a risk situation
  the HAZARD component can be virtually
  IRRELEVANT to public (and media) reaction
• Public (and media) reaction are instead a
  reflection of the risk situations OUTRAGE
  components Control / Dread / Trust

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Risk Communication Scenarios

• High Hazard, Low Outrage
• Need to overcome audiences apathy, to
  communicate the high hazards or risks involved
• Possible barriers Audience inattention, audience
  size, media resistance, the need to explain from
  scratch

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Risk Communication Scenarios

• Moderate Hazard, Moderate Outrage
• Stakeholders are usually an attentive audience,
  neither too apathetic nor too outraged to listen

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Risk Communication Scenarios

• Low Hazard, High Outrage
• Audience is outraged largely at YOU but the
  actual hazard is low
• You need to reduce audience outrage largely by
  listening, acknowledging, apologizing, sharing
  credit and sharing control (of the situation)

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Risk Communication Scenarios

• High Hazard, High Outrage
• Audience is huge and very upset (at you)
• Outrage is heightened by fear and misery
• Danger of denial -- or danger of terror and
  depression on the part of the audience
• You must help the audience bear its fear and
  misery, and ride the crisis successfully

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Pandemic Dress Rehearsal
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H5N1 Avian Influenza
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Pandemic Preparedness CommunicationsA Slow Start

• H5N1, Hong Kong, 1997 A short-lived alarm
• H5N1, Hong Kong (suspected via the Chinese
  mainland), 2003 Obscured by SARS
• H5N1, Viet Nam, late 2003 Initially concealed by
  the authorities, largely ignored by the rest of
  the world

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H5N1 in China?

• January 2004 Human cases confirmed and
  suspected -- surface in Viet Nam and Thailand
• But in China.
• We have NO bird flu on the mainland, and
  definitely not in southern China Guangdong
  government official to WHO, mid-January 2004

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Be careful of what you sayand when you say it

• 27 January 2004 H5N1 outbreaks in poultry
  reported in Guangxi (neighbouring Guangdong) in
  southern China
• End January March 2004 H5N1 outbreaks in
  poultry reported across half of mainland Chinas
  provinces and regions

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Risk Communication Bird FluHigh Hazard, Low
Outrage

• WHO sounds the alarm from the very outset (early
  2004) other agencies (FAO, OIE) join in
• Governments insist the situation is under
  control even as outbreaks and human cases
  mount
• Public reaction largely ignorance and apathy
• Human cases dwindle, so do outbreaks in poultry
  media interest declines

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2005 A new wave.. and fear

• Human cases surface again and in new countries
  as H5N1 jumps to Europe/UK
• Indications H5N1 is being transmitted more easily
  from birds to humans, and within limited
  human-to-human scenarios
• The pandemic threat scenario takes on a new
  dimension A full-fledged numbers game

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Death by Numbers

• Hundreds of millions of birds slaughtered
• Hundreds of millions of dollars lost from
  backyard farmers to poultry conglomerates
• WHO messaging goes wild From tens of millions to
  over a billion people who could die in a
  possible pandemic
• Media messaging goes wild as well especially in
  the UK and US

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Suddenly, bird flu is sexy again
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Pros of Meta-MessagingGlobal Awareness

• Greater global awareness especially in
  countries not yet affected by H5N1
• Greater momentum and incentive to prepare the
  public and create pandemic preparedness plans
• Greater push to raise funds globally (e.g.
  Beijing Pledging Conference, January 2006)

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Cons of Meta-MessagingPandemic Fatigue

• Greater global awareness but no pandemic yet
  so whats the big deal?
• Momentum to prepare the public falters as the
  big event fails to materialize
• Push to raise funds globally begins to falter as
  well

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Bird Flu Message Scorecard

• Global awareness considerably higher now
• Governments have no excuse not to engage in
  pandemic preparedness planning and to ramp up
  overall emergency preparedness
• Developed nations have no excuse not to assist
  less-developed nations
• BUT messages must be consistently reiterated,
  acknowledging the uncertainty of the situation

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Balance between informed concern and panic

• We do not want to see complacency, but we also
  do not want to see people getting alarmed. You
  know what you know. You dont know what you
  dont know. This is what we need to communicate
  and it is a challenge.
• Margaret Chan, the current WHO Director-General,
  speaking to Newsweek in 2005, when she led WHOs
  fight against a possible pandemic

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Key Crisis Communications Recommendations (P.
Sandman)

• Dont over-reassure
• Put reassuring information in subordinate
  clauses with qualifiers
• Err on the alarming side
• Acknowledge uncertainty
• Share dilemmas
• Acknowledge diversity of opinion
• Be willing to speculate, but intelligently

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Key Crisis Communications Recommendations (P.
Sandman)

• Dont over-diagnose or over-plan for panic
• Dont aim for zero-fear
• Dont ridicule the publics emotions
• Legitimize peoples fears
• Tolerate early over-reactions
• Establish your own humanity
• Tell people what to possibly expect

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Key Crisis Communications Recommendations (P.
Sandman)

• Offer people things to do
• Let people choose their own actions, within
  reason
• Ask more of people
• Acknowledge mistakes, deficiencies and
  misbehaviour
• Apologize often for mistakes, deficiencies and
  misbehaviour

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Key Crisis Communications Recommendations (P.
Sandman)

• Be explicit about why your explanations may
  run counter to your audiences prior base of
  knowledge
• Be explicit about changes in official opinion,
  prediction, or policy
• Dont lie or tell half-truths Trust once
  lost is hard to regain
• Aim for total candour and transparency
• Be careful with risk comparisons

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Risk Crisis CommunicationQuestions

• Information Content
• What do we know about the crisis?
• What do we want people to know?
• How do we communicate it effectively?
• Logistics/Media
• How do we actually get our content into the hands
  (and hopefully the minds) of our audiences?

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Mexico 2009

• Severe Respiratory Illness surfaces in Mexico
  in March /April 2009
• Dozens of people die especially the young
  (teens to mid 40s)
• April A few paediatric cases are reported in
  California and Texas
• April Virus identified as novel swine-origin
  influenza virus H1N1 potential pandemic strain

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Progression of H1N1 Cases in the US (dates
posted)

• April 23 7 cases 2 states
• April 30 91 cases (1 death) 10 states
• May 29 8,975 cases (15 deaths) 49 states
• June 11 WHO declares full-fledged pandemic (Ph.
  6)
• June 26 27,717 (127 deaths) All
  states/territories
• July 24 43,771 cases (302 deaths)
• August US estimates it has well over 1 million
  cases

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http//flutracker.rhizalabs.com
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Progression of H1N1 World

• October 11 WHO reports 4735 pandemic H1N1 deaths
  globally, real number higher
• pH1N1 dominant influenza strain
• Isolated antiviral resistance reported to pH1N1
• Limited human to animal transmission reported
  Pigs, poultry

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http//flutracker.rhizalabs.com
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Progression of H1N1 Canada

• April 26 6 cases 2 provinces / territories
• May 7 214 cases 9 provinces /territories
• June 12 3,515 cases (4 deaths) 10 p/t
• June 17 298 hospitalized c. (12 d.) 13 p/t
• August 29 1,454 hospitalized c. (72 d.) 13 p/t
• As of October 20 At least 81 deaths

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H1N1 dominant flu strain Canada
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H1N1 Key Questions

• How dangerous is it?
• How quickly is it spreading? (BC in 2nd wave)
• Who is at risk?
• Am I at risk?
• What is the Government/my employer/figure of
  authority doing to protect me?
• How can I protect my family and loved ones?
• How can I protect myself?

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Key Pandemic Protection Issues

• Antivirals/medication
• Vaccines (and vaccine safety)
• Hospitals/life-saving equipment (enough?)
• Business continuity
• Family/home life continuity

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PHAC Pandemic Vaccine Priority Groups

• People with chronic medical conditions lt 65
  years
• Pregnant women
• Children six mos. to lt five years
• People in remote and isolated settings or
  communities
• Health care workers
• Household contacts and caregivers of high-risk
  individuals and
• Populations otherwise identified as high risk
  (e.g. swine and poultry workers)

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Mixed Messaging?

• Seasonal flu vaccine may increase your risk of
  getting pH1N1?
• Seasonal flu vaccine given to gt65 yrs and those
  with chronic conditions
• pH1N1 vaccine wont be given until November but
  could be ready in October
• US using unadjuvanted vaccine but Canada using
  adjuvanted its safe but not for pregnant
  women?

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Stop the Conflusion Here are the H1N1 Facts

• Andre Picard Globe and Mail (October 9, 2009)
• H1N1 is a new virus so a lot of people will
  contract it. As many as one in three Canadians
  could fall sick with H1N1 if they are not
  vaccinated.
• so far, disease caused by H1N1 has been
  relatively mild. A small percentage but
  significant number of people will get very sick
  and some will die.
• Those at greatest risk of getting sick are
  pregnant women and people (especially children)
  with chronic medical conditions such as asthma.
• Healthy young adults seem to get a lot sicker
  from H1N1 than they do from seasonal flu.
• There's going to be a H1N1 vaccine available in a
  few weeks. It's a good idea to get it to avoid
  getting sick and infecting others.

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Stop the Conflusion Here are the H1N1 Facts

• Andre Picard Globe and Mail (October 9, 2009)
• It's also wise to get the seasonal flu vaccine.
  The normal flu sickens many and kills about
  5,000 people a year, most of them seniors.
• Handwashing is an effective way of reducing the
  spread of germs, including H1N1 virus. Staying
  home when you're sick is another way to avoid
  spreading illness.
• H1N1 is not the only disease out there. Even if
  you get the vaccine, you may get sick.
• Every effort is being made to ensure the H1N1
  vaccine is safe, but every drug has potential
  side effects. Experts believe that the benefits
  of the vaccine outweigh the risks.

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Maple Leaf and Listeria

• Classic crisis communications scenario
• Initial accusations of cover-up Government,
  Maple Leaf
• Maple Leaf apology / public outreach
• Public opinion Anger, outrage, fear, distrust,
  semi-forgiveness (of MP)
• Independent (?) investigation Revelations
• New round of acrimony, accusations

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Crisis Emergency Risk Communications (CERC)
Courses

• Public Safety Canada http//www.publicsafety.gc.c
  a
• 3M Emergency Management http//solutions.3m.com
• US CDC CERC Course
• http//www.bt.cdc.gov/cerc/CERConline/
• pandemic/index2.html

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Thank You

• BCCDC www.bccdc.ca
• PHAC www.publichealth.gc.ca
• WHO www.who.int
• US CDC www.cdc.gov
• Peter Sandman www.psandman.com