Outbreak Communication: How the Sources See the Story

Communicating the emerging details of an outbreak of pandemic flu to the public—and doing so in a timely manner while maintaining public trust—creates many challenges for those charged with the task. Speaking out of their experiences at two leading health organizations, the Centers for Disease Control and Prevention and the World Health Organization, respectively, communications specialists Glen Nowak and Dick Thompson share insights from their work.

On this page...
Glen Nowak, Chief of Media Relations, CDC:
  Communicating in a dynamic environment »
  Scientific standards versus news media reality »
  Education is not the sole purpose of news reporting »
  You can not just “FYI” the media »
  Why we need transparency in crisis communication »
  Experts and the public have different views »
Dick Thompson, WHO Pandemic and Outbreak Communication:
  From Time to WHO—just in time for SARS »
  If I were a reporter, what would I want from me? »
  The five principles of outbreak communication »
  Public terror during the 1918-19 pandemic »

Glen Nowak, Chief of Media Relations, Centers for Disease Control and Prevention:

Communicating in a dynamic environment

It’s not easy to base decisions, actions, communications or even recommendations on science since the science is often lacking and often changing. With influenza, it’s a rapid and dynamic environment in which we are working, and sometimes I think we don’t fully appreciate how dynamic it really is.

Challenge one: Scientific standards versus news media reality.

Scientists and physicians often think the news media and journalists should have the same standards as they do when it comes to what is allowed into stories—and that you, as journalists, should rely primarily on views that have been established or accepted by most scientists. There is also a belief that you should be providing all the nuances and caveats that would be found in a science journal article, and you should use as much space and time as it takes to get the information out there properly. As we all know, that isn’t a realistic expectation.

Challenge two: Education is not the sole purpose of news reporting.

It is often assumed that the news media should serve primarily as an educator of the public and of policymakers. That means you should be doing more to give us high visibility and provide frequent replays of the same messages. At the Centers for Disease Control and Prevention (CDC) I’m often told, “You know, we could use about three months of steady, ‘get-your-flu-shot’ stories.” And we have to say, “Well, perhaps at the beginning of the season we can hold a press conference and announce the kickoff of the season.” At the end of the day, the first three letters of news are n-e-w. At CDC, our consistent advice is that if our colleagues want to do those other things, they need to think about purchasing the time and space or using other venues.

Challenge three: You can not just “FYI” the media.

There is a strong belief among scientists and physicians and probably policymakers that we can at some level “FYI” the news media. People will come to me and say, “I’ve got a really important piece of information, and I think we should get it out there.” Then we will ask, “So what should people do with that information? How should they change their behavior? What’s our health recommendation as a result of the information?” and they will say, “I don’t know. But it’s really important to get this out there. We need to call a press conference.” The act of calling a press conference elevates the information. It may be the most efficient way for us to get this information out to multiple numbers of reporters—but that act becomes incongruous when the first thing out of your mouth is, “This really isn’t that important.” Journalists rightly question us and ask, “If it isn’t important, why did you call the press conference?”

Challenge four: Political leaders are rarely accustomed to the transparency needed in crisis communication.

A lot of appointments at Health and Human Services, and sometimes the CDC, are political ones. These people come in with a backload of experience in political communications and often what you’d do in political communications is the opposite of what you would do in health and risk communications. Good health and risk communications means sharing dilemmas, disclosing information, and being transparent. When people come in from political campaigns, this approach is the antithesis of what they’ve been doing. It is very scary for them when we say, “Let’s be transparent.” It’s the exact opposite of what they’ve been doing during the campaign.

Challenge five: Experts and the public have different views.

The public and our medical experts have different ways of viewing the world and that can be a communications challenge. When we spoke about the use of antivirals as a “treatment,” the public developed a mental model in which people who took antivirals stopped the progression of the disease and, therefore, were not going to develop really severe complications. The physicians’ mental model was different. They saw antivirals as an effective way to treat some of the symptoms, but they were not a cure. So there was a lot of confusion as the physicians were trying to say, “Look, it’s not a cure,” and people in the audience were saying, “But you said it’s a treatment. Treatments are cures.” Sometimes we don’t recognize these differences and, as a result, they can cause problems for us in communications.

Dick Thompson, private consultant and former team leader, WHO Pandemic and Outbreak Communication:

From Time to WHO—just in time for SARS

Shortly after I arrived at WHO after working for many years as a medical and health reporter at Time, SARS broke out. We were overwhelmed with calls. We had to speak constantly about something that was a new disease, and the virus was moving all around the world very quickly. It was up to us to decide how we were going to speak about this, so I looked around WHO to see what risk-communication resources were available there. There were none, which really surprised me.

If I were a reporter, what would I want from me?

We were pretty much left on our own, and what we did was to rely on our instincts as reporters. If I were a reporter covering this story, what would I want? And what I’d want first would be to hear from someone in my position at WHO. But while being accessible is really important, it’s hard to do when there are all sorts of calls coming in. As a reporter, I’d also want to have some kind of faith that what I was hearing was the truth. If I ever detected that someone was spinning or lying to me in any way or covering up or protecting an organization, I’d automatically devalue what I heard.

I applied these rules—from my instinctive behavior as a reporter—and somehow we stumbled through it and I think we did OK. There were a few missteps, but after that, we were asked to put it on more solid footing.

The five principles of outbreak communication

We built risk communications and called it “outbreak communication,” because we were focusing on a special type of public health event. There are a lot of special things about outbreaks, but most important is that they’re unfolding events. Nobody really knows where they’re going and, especially in the beginning, there’s high outrage and high concern in the absence of knowing what the hazard is.

We published a report called “Outbreak Communication.” It speaks to best practices for communicating with the public during an outbreak. Here are the principles we use:

Trust is the most important thing. Every communication we make is really part of our pandemic communication, because we’re either building trust or it’s costing us.
Be as transparent as possible.
Announce early, even when there’s incomplete information.
Listen to the public and then plan for the extreme demands of outbreak communication.
Never over-reassure or mislead. What helps shape our message is that we began talking about the “I don’t knows.”

Public terror during the 1918-19 pandemic

Once we finished our work with the outbreak guidelines, I finally was able to read “The Great Influenza” by John M. Barry. In the last two pages of the book, I was really hit hard by what he had to say, because he talked about the public terror that existed in 1918. He said it existed because public officials lied about what was going on, and it became apparent to people who were at risk that they were being lied to, and it was that broken trust that really led to what he calls the terror of 1918. He concluded his book with a plea that “Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, and to try to manipulate no one.” And I hope that’s what we’re doing with our guidelines.

Editor’s note: The content of this page was originally generated during discussions at the December 2006 Nieman Conference “The Next Big Health Crisis—And How to Cover It,” made possible with the generous support of the Dart Foundation. The transcripts have been edited to make the material accessible in this online guide.

1 Comment on Outbreak Communication: How the Sources See the Story
Pradip Dey says:
April 29, 2010 at 1:40am
Thanks to Glen Nowak and Dick Thompson for their nice presentation. I think response time is very important for pandemic reporting-it should be as quick as possible. Another important aspect is striking a balance between transparency and fallout.
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