Crisis & Emergency Risk Communication Barbara Reynolds, Ph.D.

1. Crisis & Emergency Risk CommunicationBarbara Reynolds, Ph.D.

2. Hong Kong H5N1 Outbreak, 1997

3. CDC Epidemiologic Investigation

4. Surveillance & Control

5. 1918 Pandemic Deaths by Age Figure 2. "U-" and "W-" shaped combined influenza and pneumonia mortality, by age at death, per 100,000 persons in each age group, United States, 1911–1918. Influenza- and pneumonia-specific death rates are plotted for the interpandemic years 1911–1917 (dashed line) and for the pandemic year 1918 (solid line) Jeffery K. Taubenberger* and David M. Morens†*Armed Forces Institute of Pathology, Rockville, Maryland, USA; and †National Institutes of Health, Bethesda, Maryland, USA

6. Communicating in a crisis is different • In a serious crisis, all affected people . . . • Take in information differently • Process information differently • Act on information differently • In a catastrophic event: communication is different • Be first, be right, be credible

7. What the public seeks from your communication 5 public concerns. . . • Gain wanted facts • Empower decisionmaking • Involved as a participant, not spectator • Provide watchguard over resource allocation • Recover or preserve well-being and normalcy

8. Initial Maintenance Resolution Evaluation Precrisis • Prepare • Foster alliances • Develop consensus recommendations • Test message • Evaluate plans • Express empathy • Provide simple risk explanations • Establish credibility • Recommend actions • Commit to stakeholders • Further explain risk by population groups • Provide more background • Gain support for response • Empower risk/benefit decisionmaking • Capture feedback for analysis • Educate a primed public for future crises • Examine problems • Gain support for policy and resources • Promote your organization’s role • Capture lessons learned • Develop an event SWOT • Improve plan • Return to precrisis planning Crisis Communication Lifecycle

9. 5 communication failures that kill operational success • Mixed messages from multiple experts • Information released late • Paternalistic attitudes • Not countering rumors and myths in real-time • Public power struggles and confusion

10. Six Principles of CERC • Be First: If the information is yours to provide by organizational authority—do so as soon as possible. If you can’t—then explain how you are working to get it. • Be Right: Give facts in increments. Tell people what you know when you know it, tell them what you don’t know, and tell them if you will know relevant information later. • Be Credible: Tell the truth. Do not withhold to avoid embarrassment or the possible “panic” that seldom happens. Uncertainty is worse than not knowing—rumors are more damaging than hard truths.

11. Six Principles of CERC • Express Empathy: Acknowledge in words what people are feeling—it builds trust. • Promote Action:Give people things to do. It calms anxiety and helps restore order. • Show Respect: Listen. Treat people the way you want to be treated—the way you want your loved ones treated—always—even when hard decisions must be communicated.

12. Decisionmaking in a Crisis Is Different • People simplify • Cling to current beliefs • We remember what we see or previously experience (first messages carry more weight) • People limit intake of new information (3-7 bits)

13.  How Do We Communicate About Risk in an Emergency? All risks are not accepted equally • Voluntary vs. involuntary • Controlled personally vs. controlled by others • Familiar vs. exotic • Natural vs. manmade • Reversible vs. permanent • Statistical vs. anecdotal • Fairly vs. unfairly distributed • Affecting adults vs. affecting children

14. Successful Communication = Accuracy of Information __________ Speed of Release CREDIBILITY + Empathy + Openness TRUST

15. Sources of Social Pressure • What will I gain? • What will it cost me? • What do those important to me want me to do? • Can I actually carry it out?

16. Trust and Mistrust • Stakeholders judge the response to an issue or crisis based on trust • Trust is the natural consequence of promises fulfilled • Mistrust is an outgrowth of the perception that promises were broken and values violated • CDC fulfills trust by combining our best science with strong ethics and values

17. Consequences of mistrust • Health recommendations ignored and disease and death go up • Demands for misallocation of resources • Public health policies circumvented • Opportunists prey on others in the “trust gap” • Fiscal and medical resources are wasted We can’t accomplish our mission

18. Causes of conflict: perception by either party of • Superiority • Injustice • Distrust • Vulnerability • Helplessness

19.  Stages of Values Disputes • Feels threatened (you survive or I do) • Situation becomes distorted (they are evil) • Rigid explanations for own behavior (we’re protecting people from quacks) • Conflict becomes self-identity

20. Dealing With Angry People Anger arises when people. . . • Have been hurt • Feel threatened by risks out of their control • Are not respected • Have their fundamental beliefs challenged Sometimes, anger arises when . . . • Media arrive • Damages may be in play

21. Deescalating conflict with “them” • Seek input early • Seek common principles • Approach the process fairly • Acknowledge emotions, appeal to reason

22. H1N1 outbreak April 2009 • CDC had been on the hunt for a pandemic influenza virus for nearly half a century • Between 1997 and 2009, pandemic planning included communication planning • With H1N1, CDC used social media widely for major outbreak

23. Crisis Communicator Richard Besser led the United States’ top public-health agency as swine flu broke out on its doorstep. And his communication shaped the early days of a pandemic

24. CERC Communication Principles • In his office at ABC News in New York, Besser talks about the principles he looked to when talking about the H1N1 pandemic. He refers to a CDC pamphlet on crisis and emergency risk communication with the subtitle: 'Be First, Be Right, Be Credible'. • 13 January 2010 | Nature 463, 150-152 (2010) | doi:10.1038/463150a

25. Social Media: Crisis Role

26. Social media in a crisis: the good • Need to be where people are • Leverage unique characteristics of emerging channels • Tailored health messages • Facilitates interactive communication and community • Empowers people in making health decisions

27. Social media . . . Good & bad • Provided rich choices to support CDC’s desire to communicate with, not to, the public in a more personal and targeted way. (good . . . ) • What was essentially unknown was whether the use of social media during the H1N1 outbreak would work to increase or decrease the public’s trust in CDC’s recommendations and response. (bad . . . )

28. www.cdc.gov/socialmedia

29. CDC H1N1 Social Media • Buttons & Badges • CDC-INFO • eCards • Image Sharing • Micro-blogs (Twitter) • Mobile • Online Videos • Podcasts • RSS Feeds • Social Networking Sites • Text Messaging Pilot • Widgets

30. Buttons and Badges • Add a button to your Web site. Let your Web site visitors know how to stop the spread of novel H1N1 flu and where to get more information about novel H1N1 flu. • Choose a novel H1N1 flu Button in English • Choose a novel H1N1 flu Button en Español

31. E-Cards H1N1 • Keep your friends, family and coworkers informed. Send them tips for staying healthy and avoiding the flu by washing their hands. Visit the CDC Health-e-Cards site today to send a loved one an eCard.

32. H1N1 Image sharing • View and share novel H1N1 flu images from the CDC Flickr site

33. CDC Mobile Web site • Your Mobile Source for Credible Health Information • CDC's health information is now available on your mobile device. Visit m.cdc.gov on your mobile phone or PDA for information on seasonal flu, H1N1 flu, public health emergencies, and more.

34. Public Inquiry • CDC National Contact Center • Representatives are available 24/7 to answer your questions in English and Spanish. For up-to-date information about novel H1N1 flu and hundreds of other health and safety topics: • Call: 1-800-CDC-INFO (1-800-232-4636), TTY: (888) 232-6348, English/Spanish, 24 Hours/Every Day • Email:cdcinfo@cdc.gov • Postal Mail:Centers for Disease Control and Prevention1600 Clifton Rd,Atlanta, GA 30333U.S.A.

35. Trust is needed first before someone will: Feel able to rely upon a person (organization), Take reasoned risks, and Willingly cooperate and achieve a goal. Social media and trust building

36. Social media and trust . . . Our intuition • Public suspicions of scientific experts and government are increasing • Nonetheless, trust and credibility are essential elements of persuasive communication. • In fact, the more people know about efforts to openly share accurate information, the more they trust the government or industry as the source.

37. Before we got started . . . • CDC made the conscious decision to maintain its scientific integrity in its messaging through these new media (e.g., it used simple but still formal language not jargon) • and also to respect the norms of the social networks it joined.

38. Facebook entries: shot or no shot? • Male: Never had any flu vaccination for 10 years and never had any problem...UNTIL last month I give it a try..BIG mistake, first time feeling sick like a dog...tsk tsk...talking about conspiracy theory by Ex-Governor J Ventura was talking about... • Female 1: baaaa baaaaa Amazing how many of you are clueless. I would swear that you are being paid to post your nonsense here. By whom? I can think of a few possibilities.hmmmm Oh and my uncle just got his h1n1 shot and got sick with the flu within 1 weeks time. Go ahead baaaaaaaaaaa get that shot. • Female 2: what flu did he get sick with? was it confirmed h1n1? If he got sick within a week his inoculation was too late, it takes 2 weeks before the antibodies make you immune to the virus. Makes me sick how many people think the flu vaccines are killing so many people and causing autism. Now there is the conspiracy. Go take a microbiology class, and an anatomy and physiology class. Stop reading junk science articles.

39. CDC Tweets targeted & quick • RT @FluGov: Be Advised of New Spam Myth in Circulation. CDC has NOT implemented a vaccination program requiring registration. • RT @CDCFlu H1N1 Flu Vaccine -- Why the Delay? Watch a new CDC video to find out how flu vaccines are made: http://is.gd/4OVFq • RT @CDCFlu Anyone with asthma is at higher risk for flu-related complications. Learn more: http://is.gd/3jwfB

40. Benchmarking:Top Federal Twitter Profiles

41. CDC Audiences Use Social Media • Those who use social media on CDC.gov: • Have higher satisfaction ratings (84 out of 100) than those who do not use CDC social media tools (79 out of 100) • Are more likely to return and recommend the site to others than those who do not use CDC social media tools • Rate CDC as more trustworthy that those who do not use CDC’s social media tools

42. The good: Trust, transparency & participation in government • Pilot to measure TTP in government • CDC scored higher than other Fed agencies/benchmark • Largest difference for collaboration online

43. The ugly • Crass, anonymous discussions (stigmatization, xenophobia, conspiracies . . . )

44. Swine Flu #1 Google in News Category, 2009 • Google News - Fastest Rising • swine flu • susan boyle • jon and kate • adam lambert • rihanna (chris brown) • new moon • inauguration • michael jackson • nadya suleman • missing link found

45. CDC Earthquakes Web site Page Views for January 1st through 24th

46. Search terms focus on earthquake preparedness and response. Large spikes in traffic over norm. Professional guidance getting heavy traffic (wound management, crush injury, etc.). Many Spanish speakers visiting site. Haiti Earthquake Web

47. CDC Earthquake PSAs and Podcasts provide messages about what you can do to protect yourself and your family before, during, and after. To subscribe to this and other CDC podcasts, visit the CDC Podcast Subscriptions page. Earthquake PSAs and Podcasts

48. Conclusions • “trust is the natural consequence of promises fulfilled.” Social media helped CDC to fulfill a promise to provide fast, accurate, and credible information to the public that recognized their emotional stake in the event and respected their need for autonomy and individuality.

49. Face the Media

50. Working with the Media • What is news? • Messenger • Message • Method of delivery