I found myself nodding in agreement frequently as I watched a presentation given by Dr Barbara Reynolds at the US Centers for Disease Control & Prevention’s (CDC) Zika Action Plan Summit which was held in Atlanta, GA on April 1. The title of Dr Reynolds’ talk was “Crisis and Emergency Risk Communication: What the public needs when risks are uncertain”. (Scroll down for link to presentations.)
As I watched the live stream of the presentation, I kept thinking back to a number of public health situations in the past couple of years when the Jamaican public would have benefited from better communication by Government agencies:
- the chikungunya/ChikV epidemic in 2014
- the Riverton dump fire in 2015
- the problems in health facilities & deaths of premature babies in 2015.
And although the current situations with Zika virus and H1N1 influenza virus are being handled significantly better, there are still some ways in which communication can be improved.
Dr Barbara Reynolds’ Presentation
Dr Reynolds defined crisis and risk communication as “the kind of communication that leaders will do, along with their experts, to help people and communities make the best possible decisions when the information is imperfect and we’re under impossible time constraints.” Early in her presentation, she made a very important statement:
“And it may be actually surprising to learn that people can accept bad news more easily than they can accept uncertainty.”
I didn’t actually find this surprising, as from experience I know it is true. With bad news, you know more clearly where you stand and what actions you need to take; with uncertainty, you don’t know where you stand and decisions about what actions to take are that much more difficult. Dr Reynolds emphasized that during such times the public need to have the facts and need to be empowered by having not just the how of what to do, but also the why.
In discussing common communication failures, she noted that “a poor operational response cannot be saved by good communication….[and] a good operational response can be spoiled by poor communication.” Numbers 2 and 3 on this list – late release of information & paternalistic attitudes – certainly were among the problems with the communication responses we experienced during the three health crises I mentioned earlier.
Dr Reynolds said she had seen over the years that:
“people often talk about changing messages based on the fear that people will panic. Panic behaviour is actually very rare, but if it does happen the research tells us it happens when there’s no credible authority and all options seem equal. So what we should be working towards is being as credible as possible at every stage along this response.”
She discussed six principles of Crisis and Risk Communication, which were a useful framework for developing messages.
The issue of credibility and trust was raised repeatedly, and the need for these qualities in leaders and spokespersons communicating with the public. Dr Reynolds stated that:
“Condescension is the number one failure in good communication in a response.”
She shared a number of communication lessons particularly relevant to the developing situation with Zika, where there is a lot still not known about the virus and knowledge is being added to almost on a daily basis.
Dr Reynolds began with and ended with the following message:
Jamaica’s Communication Responses
I believe lives were lost because of both the poor operational response and communication response to the ChikV epidemic. Despite prior warning years before, the Jamaican Government failed to prepare adequately for the possibility of an epidemic. And the poor communication response failed to inform the public adequately about the risks. The initial messages downplayed the risks, which was particularly dangerous for those with pre-existing medical conditions and vulnerable groups such as the elderly. There was also a failure initially to inform the public about the possible medium and long term effects ChikV could have on a percentage of people.
That experience has had an impact on the response to Zika virus to date, not solely because of the toll it took on the lives and health of Jamaicans, but also because of the political fallout. As continues to be shown , the full impact of Zika is not yet known to the scientists and medical practitioners, the public health authorities and political leaders or the public. In this situation, with more possible impacts being discovered and discussed on an ongoing basis, it is essential that the public is kept informed and updated.
Public health spokespersons have been far more visible and accessible, both regarding Zika and the H1N1 flu virus since the start of 2016. It is good to see and hear from the Ministry of Health’s current Chief Medical Officer Dr Winston De La Haye and other Ministry spokespersons on radio and TV and in the print media. Both the current Minister of Health Christopher Tufton and his predecessor Horace Dalley learned lessons from the experience of Dr Fenton Ferguson, whose handling of the ChikV crisis was devastating. I know that Jamaica has experts with the skills and experience to handle communication during public health emergencies, and we must benefit fully from this expertise.
One way in which we need to improve is in making information accessible in more permanent and official ways. For example, although Dr De La Haye and other Ministry of Health representatives give updates about numbers of confirmed cases, number of samples tested, etc, this data is not routinely made available on the Ministry’s website. So if you miss the update in the media, there isn’t a clear place to go to to retrieve it. It is also important that the public aren’t left to guess when the next update will be. More information is also needed regarding Jamaica’s state of readiness to deal with a possible increase in cases of microcephaly, Guillain-Barre Syndrome and other neurological disorders being associated with Zika virus outbreaks.
Zika virus is being increasingly regarded as a puzzling and complex virus, with possible severe effects, despite its relatively mild symptoms. Effective communication with the public is essential, though challenging.
Links to CDC Presentations
Video recording of Dr Reynolds’ presentation available here. (Starts at 3:54)