Transcript Slide 1

Let’s Talk About the Pandemic:
Risk and Crisis Communications Basics
for the Post-SARS World
Roy Wadia
Director, Communications
BC Centre for Disease Control
BCFPA: 21 October 2009
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
China’s Reaction?
SILENCE
By the time China talked….
“I’m so worried, I’m taking sleeping pills….”
Chinese vice-premier Wu Yi : 9 April 2003
…it was too little, too late…
A disease in one country…
…can threaten the entire
world
A communications vacuum…
…creates panic…
…and distrust…
…and trust, once lost…
Beijing mayor Meng Xuenong lost his job over SARS
…is not easily regained
Beijing reassures WHO that it will tackle SARS…
But does the world believe China?
The toll of lies, half-truths and panic
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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
SARS: Truly a defining
moment…
SARS Memorial at the Great Wall of China
…but have we learnt its
lessons?
RISK AND CRISIS
COMMUNICATIONS
RISK COMMUNICATION
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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
RISK COMMUNICATION
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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 situation’s OUTRAGE
components: Control / Dread / Trust
Risk Communication Scenarios
 “High
 Need
Hazard, Low Outrage” :
to overcome audience’s apathy,
to communicate the high hazards or
risks involved
 Possible barriers: Audience
inattention, audience size, media
resistance, the need to “explain from
scratch”
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
H5N1 Avian Influenza
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Pandemic Preparedness
Communications:
A 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
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 say…
and 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 China’s provinces
and regions
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Risk Communication & Bird Flu:
“High Hazard, Low Outrage”
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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
2005: A new wave.. and fear
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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”
Death by Numbers
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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
Suddenly, bird flu is “sexy”
again…
“Pros” of Meta-Messaging:
Global Awareness
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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)
“Cons” of Meta-Messaging:
Pandemic “Fatigue”
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Greater global awareness – but no
pandemic yet… so what’s 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
Bird Flu Message Scorecard
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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
Balance between
“informed concern” and “panic”
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“We do not want to see complacency,
but we also do not want to see people
getting alarmed. You know what you
know. You don’t know what you don’t
know. This is what we need to
communicate – and it is a challenge.”
Margaret Chan, the current WHO DirectorGeneral, speaking to Newsweek in 2005,
when she led WHO’s fight against a
possible pandemic
Key Crisis Communications
Recommendations (P. Sandman)
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Don’t 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”
Key Crisis Communications
Recommendations (P. Sandman)
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Don’t “over-diagnose” or “over-plan”
for panic
Don’t aim for “zero-fear”
Don’t ridicule the public’s emotions
Legitimize people’s fears
Tolerate early over-reactions
Establish your own humanity
Tell people what to possibly expect
Key Crisis Communications
Recommendations (P. Sandman)
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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
Key Crisis Communications
Recommendations (P. Sandman)
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Be explicit about why your
explanations may run counter to
your audience’s prior base of
knowledge
Be explicit about changes in official
opinion, prediction, or policy
Don’t lie – or tell half-truths: Trust
once lost is hard to regain
Aim for total candour and
transparency
Be careful with risk comparisons
Risk & Crisis Communication
Questions:
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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?
Mexico 2009
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“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 swineorigin influenza virus H1N1 – potential
pandemic strain
Progression of H1N1:
Cases in the US (dates posted)
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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
http://flutracker.rhizalabs.com
Progression of H1N1: World
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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
http://flutracker.rhizalabs.com
Progression of H1N1: Canada
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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
H1N1 dominant flu strain:
Canada
H1N1 Key Questions
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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?
Key Pandemic Protection Issues
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Antivirals/medication
Vaccines (and vaccine safety)
Hospitals/life-saving equipment (enough?)
Business continuity
Family/home life continuity
PHAC Pandemic Vaccine
Priority Groups
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People with chronic medical conditions < 65
years;
Pregnant women
Children six mos. to < 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)
Mixed Messaging?
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Seasonal flu vaccine may increase your
risk of getting pH1N1?
Seasonal flu vaccine given to >65 yrs and
those with chronic conditions
pH1N1 vaccine won’t be given until
November – but could be ready in October
US using unadjuvanted vaccine but
Canada using adjuvanted – “it’s safe” but
not for pregnant women?
“Stop the Conflusion”:
Here are the H1N1 Facts
Andre’ Picard: Globe and Mail (October 9, 2009)
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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.
“Stop the Conflusion”:
Here are the H1N1 Facts
Andre’ Picard: Globe and Mail (October 9, 2009)
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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.
Maple Leaf and Listeria
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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
Crisis + Emergency Risk
Communications (CERC) Courses
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Public Safety Canada:
http://www.publicsafety.gc.ca
3M Emergency Management:
http://solutions.3m.com
US CDC CERC Course:
http://www.bt.cdc.gov/cerc/CERConline/
pandemic/index2.html
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