Right Steps & Poui Trees


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But Won’t They Panic If We Tell Them?- Communication re #ZikaVirus & other health emergencies

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:

cdc barbara reynolds

“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.CDC zika Reynolds slide for blog 1

 

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.” cdc zika Reynolds slide for blog 2Numbers 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.

cdc zika Reynolds slide for blog A4cdc zika Reynolds slide for blog 4

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.” 

cdc zika Reynolds slide for blog 5

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.

cdc zika Reynolds slide for blog 6

Dr Reynolds began with and ended with the following message:

cdc zika Reynolds slide for blog 7

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

cdc zap reynolds

Dr Reynolds’ presentation is available here.

cdc zap you tube reynolds Video recording of Dr Reynolds’ presentation available here. (Starts at 3:54)

cdc zap web page Link to CDC Zika Action Plan Summit page with presentations & other resources

 

 

 


#ZikaVirus Update: Jamaica, Caribbean & Beyond

The news regarding the Zika virus is being updated all the time. Underlying the updates is an acute awareness of how much is not yet known about the virus and its effects, how much there is still to learn. Almost on a daily basis, new information about the virus’ spread is reported. In this post, I’ll touch on a few of these updates.

Jamaica: 7 weeks after 1st confirmed case of Zika, 4 new cases confirmed

Up until Thursday, March 17, 2016, Jamaica had one confirmed case of Zika virus, a case which had been confirmed on January 29. The 4-year-old child had started to show symptoms on January 17. This was the first confirmed case and remained the only confirmed case for the following 7 weeks.

As I was driving to a Technical Update on Zika, Gillain-Barre & Microcephaly being held on the evening of March 17 at the Faculty of Medical Sciences at the University of the West Indies (UWI) Mona, this was the foremost question in my mind: Why hadn’t there been any further cases of Zika reported? I wondered what explanations the experts might have for this.

The Technical Update was a collaboration by UWI, the Ministry of Health and PAHO/WHO. A PAHO/WHO technical team was in Jamaica for consultations and the opportunity was seized to have an update which was open to the public.

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Dr Winston De La Haye, Chief Medical Officer, was chairing the proceedings and after the opening remarks, the first presentation began. Dr Stephane Hugonnet of WHO presented on Zika and arbovirus surveillance, microcephaly and other neurological disorders – recent evidence & implications for health systems. IMG_9648 (2)

At the end of his update regarding the global situation, Dr Hugonnet made some comments about the situation regarding the Zika virus in Jamaica. He said that for Jamaica, the epidemic curve of about 95 suspected cases showed a sharp increase, with a peak in week 5, which corresponded with the week in which there was the first confirmed case at the end of January.  This was then followed by a decrease in suspected cases.

IMG_9656 (2)

 

 

Dr Hugonnet said it was very surprising that there hadn’t been any other cases and it was hard to understand having only one case. He said that the surveillance system was working well, and there were suspected cases of dengue, chikungunya or fever and rash that were being picked up and sampled.

He said that it was a priority to assess whether or not the Zika virus was circulating in the country and that it was necessary to strengthen the investigation around the index case, including retesting to check if it was indeed positive. He also advised sampling of the negative tests to see if they were really negative.

Once it was established that the virus was circulating in Jamaica, there would be no need to keep testing all cases. It would then be necessary to monitor the trend of the epidemic and the geographical spread. It would also be necessary to monitor pregnant women and cases of Guillain-Barre Syndrome (GBS), and to establish baseline data for microcephaly and GBS.

At the end of Dr Hugonnet’s presentation, Dr De La Haye resumed the podium to continue his duties as Chairperson. In a rather dramatic turn of events, he told the gathering that on his way to the symposium, he had actually received information that 2 new cases of Zika had been confirmed. This meant that the country now had a total of 3 confirmed cases. He noted that the 2 cases had been confirmed by the recently upgraded Virology Lab at UWI, saying that it was an advantage to have a shorter turn around time for getting test results. (See JIS report regarding UWI Virology Lab upgrade)

MOH zika virus press conference 18-3-16

Ministry of Health press briefing on Zika virus, March 18, 2016 (Far left: Dr De La Haye. 2nd from left Minister Tufton.)

By the time the Ministry of Health held a press briefing the following afternoon (Friday, March 18), the number of confirmed cases had increased to 4. Remarks by Minister of Health Dr Christopher Tufton at Zika press briefing – 18-3-16 By the post-Cabinet press briefing on Tuesday, March 22, another case had been confirmed, bringing the total to 5. Four of the cases were in Portmore, St Catherine and one was in Lyssons, St Thomas. And it is expected that the number of cases will increase.

moh zika tufton more cases 18-3-16

Representatives of the Ministry of Health have been doing many media interviews, outlining the steps being taken by the Ministry regarding the increased number of cases and reiterating the ongoing public health messages about reducing the risks of being infected by the Zika virus.

Caribbean Public Health Agency Update on Zika in the Caribbean

On March 23, 2016, the Caribbean Public Health Agency (CARPHA) posted a short video in which Executive Director, Dr. C. James Hospedales provided an update on the Zika virus in the Caribbean region. (Click here for video.)carpha zika virus video update 23-3-16Some points made by Dr Hospedales:

  • 15 countries in the region have reported cases of Zika virus transmission in their countries/territories.
  • Microcephaly & Guillain-Barre are rare conditions and are not required to be reported in the Caribbean region, so there is little baseline data on these conditions.
  • CARPHA is now in the process of setting up collection of baseline data.
  • The Caribbean is vulnerable to Zika virus for a number of reasons: a susceptible population which has not met the virus before, wide spread Aedes aegypti mosquitoes & a lot of travel in and out of the region.
  • In another 2 months, many of the countries will see the start of the rainy season, which will increase possibilities for increased mosquito breeding.
  • The two most important messages for stopping the spread of Zika are stopping the mosquito breeding & stopping the mosquitoes biting.

CDC Issues Updated Zika Recommendations to do with Pregnancy and with Sexual Transmission

On March 25, 2016, the US Centres for Disease Control & Prevention (CDC), issued an update of its recommendations regarding aspects of Zika Virus. (Click here for full update.)

cdc update re zika 25-3-16

The updated recommendations, which are worth reading in full, are given under 3 headings:

Article 1: Updated interim guidance for pregnant and reproductive age women

Includes the following:

cdc zika 25-3-16 coloured page A

Article 2: Updated interim guidance for preventing sexual transmission of Zika

Includes the following:

cdc zika 25-3-16 coloured page B

Article 3: Increasing access to contraception in areas with active Zika transmission

Includes the following:

cdc zika 25-3-16 coloured page C

(It is significant to note that more than 50% of pregnancies in Jamaica are unintended, which impacts the public health education regarding Zika and pregnancy here also.)

As the spread and impact of the Zika virus continues in the region, we in Jamaica need to keep informed and act on the information to best protect ourselves from this new personal and public health challenge.