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					                                 Lovran, Croatia 25-26 September 2008

                                 Workshop on food safety
                                  risk communication in
                                outbreak situations / crises


  Outbreak
  Communication
  From concept to application


                                          Cristiana Salvi
                                   Partnership & Communications
                                   WHO Regional Office for Europe
Outbreak communication
From concept to application
    Risk communication fills the gap between Risk assessment
    and Risk perception and is part of Risk management


        Risk assessment                     Risk perception




                              Risk communication



                              Risk management

Outbreak communication
From concept to application
                     Risk communication (RC):
                   from daily life to emergencies
    Risk communication                   Advocacy and IEC
                                         (Information, Education,
    in daily life                        Communication)

    Risk communication                   Advocacy and IEC
    in sporadic cases of                 / Outbreak
    (foodborne) diseases                 communication
    Risk communication                   Outbreak
    in emergencies                       communication
                       Outbreak communication is
                     a branch of risk communication.
Outbreak communication
From concept to application
            RC from daily life to emergencies:
           unlike management, same objectives
                                1.Evidence base communication
    Risk communication
                                2.Low risk perception
    in daily life               3.No community alert
                                4.No time pressure


                                 Behavioural change

    Risk communication          1.Communication in uncertainty
                                2.High risk perception
    in emergencies              3.Community alert / panic
                                4.Time pressure


                                  Behavioural change

Outbreak communication
From concept to application
               RC from daily life to emergencies:
                    similar principles apply

          Trust                           Transparency

                                   First Announcement

                              Listening
            Planning
Outbreak communication
From concept to application
   Background of outbreak communication (OC)

   •     Risk communication literature
   •     Threat of a avian influenza
         outbreak/influenza pandemic
   •     Expert consultation on
         Outbreak Communication,
         Singapore 2004
   •     Evidence-based
         communication guidance
         developed by WHO in 2004
   •     Field experience
   •     Ongoing: planning guide on OC

Outbreak communication
From concept to application
                        Outbreaks are unique

  • Public health emergency                Urgent health emergency is the
                                           "eye of the storm", and swirling
  • Unpredictable
                                           around political, economic and
  • Unfolding events                       cultural forces, which do the
  • Socially and economically disruptive   most damage.
  • Behaviour can play a key role          The primary goal of outbreak
  • Generate anxiety                       communication is to reduce the
                                           damage from these forces and
 Thus eminently newsworthy                 speed outbreak control.

                                            Now is the time to establish
                                            trusted communications as
                                           it is much harder to do when
                                                  the full storm hits.

Outbreak communication
From concept to application
         Trust
         « The overriding goal for outbreak
         communication is to communicate
         with the public in ways that build,
             maintain or restore trust »




Outbreak communication
From concept to application
                              What is trust?

                         The public perception of
                               Your motives
           Are the risk managers acting first and foremost to
           safeguard my health and the health of my family?

                               Your honesty
     Are the risk managers holding back information to reduce
          anxiety during the uncertainties of an outbreak?

                              Your competence
          Are the risk managers skilled enough to do the job?

Outbreak communication
From concept to application
          Counterintuitive principles of Trust
    Turkey. Express uncertainty: it is more credible than being
    overly reassuring. After confirmation of Avian Influenza (AI)
    outbreak from WHO, results from the national laboratory
    where communicated as final, not preliminary. Many proved
    false positive.

    Azerbaijan. Refrain from waiting for confirmed information to
    inform the public. Waiting for confirmation of results from WHO
    laboratory lead to a delayed first announcement.

    Romania. Balance the need to speak with one voice with early
    reporting. Animal health experts were not referring to AI as the
    cause of the outbreak, while human health officers were
    alerting the population for AI.

Outbreak communication
From concept to application
        Trust is the pillar of outbreak control

                 « …the less people trust those
                  who are supposed to protect
                them, the more afraid the public
                will be and less likely they will be
                  to conform their choices and
                      behavior with outbreak
                   management instructions ».

                               WHO Outbreak Communication Guidelines

Outbreak communication
From concept to application
         Transparency
           « Maintaining the public's trust
          throughout an outbreak requires
             transparency. Transparency
            characterizes the relationship
          between the outbreak managers
                   and the public »

Outbreak communication
From concept to application
                       Transparency: benefits

                  People are entitled to information
                       that affects their lives
                              (Singapore consultation)

   • Controls rumours
   • Provides governments with greater credibility
   • Reduces the public's fear while increasing trust
   • Reduces political, social, economic impacts

       Evidence: the public is more likely to follow official
         recommendations when transparency is high

Outbreak communication
From concept to application
           Transparency: barriers and limits
    Barriers to Transparency:
    ● Competing interest (economic vs. public health)
    ● Spokespersons who are uncomfortable with delivering bad news
       (will either omit or over-reassure)
    ● Decision-makers who fear media misrepresent uncertainties
    ● Concern the public can't tolerate uncertainty or will panic
       (two ways trust)

     Limits to transparency:
     ● Unverified information, rumors
     ● Information that might result in stigmatization
     ● Information not useful to control the outbreak only generating alarm

 Tell what you won't be telling, and explain the reasons
Outbreak communication
From concept to application
                   Transparency: case study

     Madagascar, Rift Valley Fever (RVF)
     A very delayed
     announcement and unclear,
     not explicative messages to
     the populations, including to
     the health professionals,
     contributed to confusion and
     low resilience, thus to an
     uncontrolled outbreak for
     over 6 months.


Outbreak communication
From concept to application
         First announcement
            «The parameters of trust are
          established in the outbreak's first
            official announcement. This
           message's timing, candour and
         comprehensiveness may make it
         the most important of all outbreak
                  communications »
Outbreak communication
From concept to application
                          First announcement
    The most critical of all communication messages, when many
    catastrophes are launched
    ●    Must be early
    ●    Likely to be inaccurate
    Advantages:                        Disadvantages:
    ● Hard to hide outbreaks in a      ● May not have time to coordinate
      globalized world                   with partners
    ● Demonstrate leadership           ● Partners can disagree
    ● Fill information vacuum          ● Crying wolf
    ● Set up the tone of following
      communications                          Only 5% of all first
    ● Encourage protective behaviour         announcements are
    ● Stimulate surveillance                 from government!!!

Outbreak communication
From concept to application
          First announcement: case studies
       Madagascar: delayed first announcement
       A 4 months delayed first announcement of RVF outbreak
       caused very low coverage/information and inaccurate
       messages to the community.

      Turkey: non-coordinated first announcement
      Upon release of first results from the London laboratory, MoH
      announced the AI outbreak rapidly. WHO did not share the
      same information and was not able to validate it.

      Romania: inconsistent first announcement
      MoA referred to Newcastle disease in the poultry while MoH
      alerted people to protect their health from AI.

Outbreak communication
From concept to application
                              How early is early?

      The longer officials withhold worrisome information, the
      more frightening it will seem when revealed especially if
      by an external source.

      Difficult to define when “early” is. Information needs
      verification, but should not wait that a press release is
      cleared by a dozen of people in several agencies.

      Even if verified, the information is likely to be wrong. It
      is important to explain it can change as the scenario
      develops.


Outbreak communication
From concept to application
         Listening
            « Understanding the public is
         critical to effective communication.
             (…) it is nearly impossible to
          design successful messages that
         bridge the gap between the expert
           and the public without knowing
                what the public thinks »
Outbreak communication
From concept to application
                       Talking with the people
       The public is a major source of
   information as people’s judgments are
 influenced by many factors other than just
  data. Failing to consider them can lead to
       poor communication outcomes.

  ● Direct interaction with the public                 From Kananga to Mweka: visiting
                                                          villages. Ebola (DRC 2007)
            National/local surveys
            Meetings with citizens' representatives
            Meeting with medical doctors, religious
            leaders, heads of villages
            Door-to-door visits
            Dedicated telephone lines
  ● Use of communication surveillance tools
  ● Partnership with the media                        Kananga: discussing with journalists.
                                                               Ebola (DRC 2007)

Outbreak communication
From concept to application
                         Talking to the people

               Information                   Prevention
           Clear explanation of            Key measures to
            the outbreak and                 avoid risk of
          regular updates on its            exposure and
              development                   protect health


                                            Surveillance
                                          Description of clinical
                                           symptoms to report
                                          the suspect cases to
          From Kananga to Mweka: health   the health authorities
           promotion. Ebola (DRC 2007)


Outbreak communication
From concept to application
                         Listening: case study

    Romania, Avian Influenza (AI)
  • Conflicting messages                • Sense of resignation
    from human and animal
                                        • Lack of understanding
    health authorities
                                          of the health risks
  • Lack of information on
                                        • Fear and desperation
    the outbreak
                                          (loss of property)
  • Imposition, not
                                        • Loss of trust
    explanation, of
    measures (i.e. culling)             • Weak resilience
  • Lack of understanding of
    the people’s perception

Outbreak communication
From concept to application
               Media are a great opportunity
                              Are in contact with    Convey most of the
     Support trust for         the population to     useful messages to
      the outbreak                 pick up the      the people for health
       managers.                risk perception.         protection.




Outbreak communication
From concept to application
        People get most of the useful messages
                    from the media

● Media can cover most of
  the country;
● Media convey simple
  messages that people can
  understand;
● People trust information    Antananarivo: press
  reported in the media.         coverage RVF
                               (Madagascar 2008)


   Media’s voice is the
   most listened by the
      population!                                   Kananga: radio spot by journalists.
                                                           Ebola (DRC 2007)

Outbreak communication
From concept to application
           The FOS messages: RC and OC

   General messages for risk
   communication on FOS in
   daily life are the basis for
   messaging during
   outbreaks.

   To be effective,
   messages need to be
   tailored to the specific
   outbreak.


Outbreak communication
From concept to application
         Planning
          « Risk communication should be
           incorporated into preparedness
         planning for major events and in all
         aspects of an outbreak response »




Outbreak communication
From concept to application
          In the heat of an outbreak effective OC
                  can directly affect events
    If crisis are difficult to predict, an outbreak communication
          strategy can and should be planned beforehand.
        Then it should be adapted to the current emergency.

    1. Feed trust
    2. Communicate early and transparently
    3. Establish yourself as a reliable, timely and transparent source of
       information for media
    4. Dialogue with the community and keep it informed on potential
       risks and how people should protect themselves
    5. Set up collaborations with other sectors / organizations as part of
       an effective risk management

Outbreak communication
From concept to application
 Trust needs consistency and coordination

                                People should
             Trust depends      receive the same
             on consistency     key messages or
                                will lack guidance




            Speaking with one      Consistency
            voice contributes      needs
            to trust               coordination


Outbreak communication
From concept to application
                 Consistency & Coordination
  It is important to coordinate among
 the various risk managers to provide
          consistent messages

           ALL partners in a crisis
           are part of the internal
          communication process.

                                      ●   other health / FOS agencies
                                      ●   other sectors
  Identify your partners
                                      ●   WHO / FAO / UNICEF …
          and…                        ●   NGOs
                                      ●   (…)
Outbreak communication
From concept to application
          …set up a communication system
  ● have ready the outbreak communication plan with
    roles and activate it shortly after crisis notification
  ● identify the leading spokespeople across the various
    partners (political and technical)
  ● agree on ownership of information release (who
    releases what/when/how)
  ● develop procedures for coordination with partners
  ● coordinate the release of information before going
    public
  ● coordinate speaking with one voice

Outbreak communication
From concept to application
     Establishment of a national committee

   The establishment of a national
   committee centralizes operations
   and consolidates action.
   Nevertheless it risks paralyzing
   rapid initiative and identification
   of responsibilities.                                   Turkey: AI 2006




            One sector should            All sectors should be
       coordinate the outbreak           empowered in the same
     response and involve the            way including for
                 other sectors.          communication purposes.

Outbreak communication
From concept to application
                       Challenges to planning

  • While an OC strategy should be in place now,
    countries fail to feel its need before an outbreak starts;

  • Financial and human resources are a critical aspect of
    OC planning as OC is not considered central to
    response yet;

  • In some cases the involvement of other sectors and
    the lead taken by the Prime Minister’s cabinet could
    change the planned procedures.


Outbreak communication
From concept to application
         Thank you
         3 QUESTIONS FOR YOU
         1. Is this experience applicable to you?
         2. What is especially valuable?
         3. What is of concern?


Outbreak communication
From concept to application

				
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