Putting Planning Into Practice: The Communications Response to H1N1

This 7-page report summarises the key points to emerge from the conference Putting Planning into Practice: The Communication Response to H1N1 (Washington, DC, United States (US), July 22 2009). The meeting, which was organised by the Pan American Health Organization (PAHO) and the US Department of Health and Human Services (HHS), drew communicators from international and national public health organisations, along with risk communications experts, to share information about their respective H1N1 communications efforts and experiences to date, to assess lessons learned, and to identify common challenges all countries will face as the 2009 H1N1 pandemic continues to unfold.

The main communication challenges discussed during the meeting included:

• "Pandemic preparedness planning worked, but the plans didn't, at least not fully [see Theme 1, below, for details].
• The first countries had to deal with media pressures while handling stigmatization, economic losses and rapidly changing guidance.
• International coordination and networking among communicators played an important role in sharing information and unifying messages.
• As risk perception about severity decreased in the Northern Hemisphere, public perception in the South exceeded the risk assessments.
• Comparisons of H1N1 to other outbreaks or diseases diminished the perception of potential risks.
• Despite the projections, there were not many unfounded, sustained rumors in the media.
• Politics affected the outbreak communication responses in countries where elections were scheduled or in progress.
• Efforts to change the outbreak name from Swine Flu to H1N1 largely failed.
• The pandemic vaccine, which was not yet ready for the Southern Hemisphere's first wave, poses enormous communication challenges about perceived safety, especially among young adults, pregnant women and other at-risk groups."

Eight presentations from the meeting are briefly summarised, with the following themes and highlights gleaned from the discussion:

"Theme 1: Planning helped a lot, less so the plan itself...Many presenters and participants indicated that their response to the H1N1 outbreak to date would not have been as effective as it was had they not engaged in serious pandemic planning activities and exercises over the past few years....The limited usefulness of the plans themselves was seen to be, in part, due to the very rapid spread of the H1N1 virus itself, and in part because the 2009 H1N1 outbreak did not match several key assumptions that underpinned most national and international pandemic response plans....most were developed to respond to the potential emergence from Asia of the much less infectious, but much more severe H5N1 avian flu virus...

Theme 2: We're all in it together....Most presenters and participants made it clear that...in a global pandemic we all occupy a shared information marketplace. For example, when WHO [the World Health Organization] or PAHO provide briefings to news media, country-level news media routinely monitor these events remotely in real-time, and can actively participate through the Internet and global telephone link-ups. Following these briefings, national authorities are quickly solicited for follow-up interviews by national media....To the degree possible, successful communications about the 2009 H1N1 pandemic will require that everyone know...what everyone else is doing, and plans to do. Particular encouragement was given to WHO and PAHO to ensure that country-level communicators have access to new statements and guidance at least at the same time as this information is released to the media.

Theme 3: One size does not fit all...while participants agreed that we are operating in a global communications environment...H1N1 flu outbreak communications challenges in the northern and southern hemispheres were noted to be very different in nature....[P]resenters and participants also noted the importance of communicators being attuned to social, cultural and other factors among and within countries that can and will create profound differences in how pandemic risks are perceived, and in the appropriate communications messages and tools needed to effectively reach audiences and promote appropriate behavior....There was general agreement that the most effective antidote to the 'one size doesn't fit all' dilemma is to test and research all pandemic communications with all audiences, to listen actively and constantly to our social and community partners, and to be very committed to taking a 'whole-of-society' approach to communications planning and delivery...

Theme 4: Communicating amidst great uncertainty....In particular, discussion at the conference about how to promote vaccines and immunization programs to stop the spread of disease underscored the crucial role that uncertainty plays in developing effective communications on the H1N1 flu outbreak....While the participants at the conference struggled to understand the impact of uncertainty on their ability to communicate effectively, there were several points of agreement.

• There is no choice but to communicate as best possible in the circumstances...
• All pandemic communications needs to be based on science, on what we actually know and do not know...
• All guidance communicated about the pandemic and the public health interventions needed to manage it must be openly and routinely flagged as being tentative in nature and subject to revision should new evidence become available. If better evidence does emerge, guidance must change, and the changes must be openly communicated in a transparent and timely manner.
  

...[T]here was a strong consensus that effective communications in an environment of great uncertainty can only be built on a foundation of trust between health authorities and the people they serve. Building and maintaining trust, in turn, requires transparency about what is known and not known, two-way communications, and broad social engagement in the planning and delivery of pandemic communications.

Theme 5: Now comes the hard part...much bigger challenges loom as the pandemic proceeds. Some of the major challenges noted, and remedies to address them, were as follows:

• Health authorities and pandemic response planners must continue to ensure that the voices and expertise of communicators are included at all decision-making levels in the planning and delivery of interventions needed to manage the outbreak...
• Given the possibility that the outbreak may come in two or more waves over the next 12-18 months, communicators at all levels - international, regional, national, sub-national - must look ahead realistically to ensure that their pandemic communications capacity can be sustained for the long-term...
• Communicators must continue to promote hygiene and personal protection measures that individuals and families can adopt to limit their exposure to the H1N1 virus. As well, communicators need to develop, even on a contingency basis, plans, messages and programs to support all the other public health interventions that may be needed, such as home care, immunization programs, self-isolation, social distancing, and community-level action such as school and business closures. Communications will be needed to facilitate compliance with any required interventions while minimizing personal and community disruption, social dislocation, and potentially significant economic costs that may be associated with these pandemic response measures.
• Communicators need to be prepared to do their best to shape public perceptions of the risks associated with the H1N1 virus in a manner that avoids creating complacency and overconfidence about what must and can be done to manage the outbreak, while avoiding the creating individual and community-level paralysis owing to fear and panic about the challenges posed by the pandemic..."