RISK COMMUNICATIONS

1. RISK COMMUNICATIONS

2. What is your understanding of risk communications?

4. “We have had great success in the last five years in controlling outbreaks. Only recently have we at WHO come to understand that communication is as critical to outbreak control as laboratory analyses or epidemiological investigation.” Dr. J-W Lee Director General, WHO

5. OBJECTIVE OF SESSION: • To allow you - as technical officers - to have a better appreciation of risk communications. • To demonstrate how the work of risk assessment and risk communications are inter-connected. • To illustrate - through real case studies - how risk assessments translate into risk communications and positive public health outcomes. • Put theory into practice during the scenario-based exercise.

6. WHAT IS RISK COMMUNICATIONS? • Risk Communications is the process of communicating risk to the people concern: public, internal audience and decision makers. • It often results from risk assessment of an event or situation. • It is an on-going process of exchange of information, and laying out of options for actions and responses >> Ever Changing

7. Health Emergency Communication Operation Communication Behaviour Change & Social Mobilization KEY COMPONENTS • Always remember the three key pillars of communication:

8. HEALTH EMERGENCY COMMUNICATIONS • Health emergency communications (outbreaks and other non-outbreaks emergencies) Rapid dissemination of information and health messages to target populations enabling them to reduce confusion/ anxiety and adopt protective measures >>PUBLIC, MEDIA

9. OPERATION COMMUNICATIONS • Operation communications: Timely exchange of information among health authorities, clinicians, laboratories, decision-makers, and other disciplines and other sectors to ensure coordinated response and for decision makers make informed choices on possible next steps and policy changes. >> INTERNAL COMMUNICATIONS

10. BEHAVIOUR CHANGE COMMUNICATIONS • Behaviour change communication: Development and implementation of programmes for positive behaviour changes. Two-way dialogue with community-level to work out with what is feasible (e.g hand washing campaign and access of clean water).

11. Risk Assessment & Risk Communications… Do they have anything to do with one another?

12. Risk Communications and Risk Assessment RISK ASSESSMENT EVENTS / FIELD

13. Risk Communications and Risk Assessment RISK ASSESSMENT INFO!! ? INFO!! ? ? EVENTS / FIELD TARGET AUDIENCES

14. Risk Communications and Risk Assessment RISK ASSESSMENT RISK COMMUNICATIONS EVENTS / FIELD TARGET AUDIENCES

15. RISK ASSESSMENT QUESTIONS • What is the threat? • What is the hazard? • What is the likelihood? • What are the consequences? • How vulnerable are the people? • What are the probably actions? • Feasibility / affordability / acceptability? • What follow up actions? • What else do we need to know? • What do we not know? RISK ASSESSMENT

16. RISK COMMUNICATIONS QUESTIONS • Who are our target audiences (internal and external) ? • What do we know and not know? • What do we want to tell them? • When do we want to tell them? • How much do we want to tell them? • What do we want them to do with the information they have? • What are the consequences? • What are the interim measures? RISK COMMUNICATIONS

17. TRANSLATING RISK ASSESSMENT INTO COMMUNICATIONS MESSAGES – EXAMPLE OF SARS ? ? ? RISK ASSESSMENT • Data are collected and sent to Labs but at this point, no causative agent was determined. • Transmissible only for close contacts and after patients become symptomatic • Some people can fall severely sick with respiratory failure • Caused by coronaviruses • Antibiotics are ineffective as this is a viral infection • Epi data suggested a human to human transmission. • Hospitals amongst other places have high rate of infection, hence deemed as high risk

18. RISK COMMUNICATIONS • At this point in time, we have not established the cause of the outbreak, but initial investigation suggested a viral infection. Investigations are on-going. • Public (esp those with travel history) should monitor if they fall sick and to seek IMMEDIATE medical help and stay at home. • There is no known cure for SARS. SARS patients receive supportive care and treatment for complications in hospitals. • Everyone has a part to play in this outbreak in monitoring their health. • Strict infection control procedures are in place around the patients. Only immediate family members of the patients are allowed to visit them. • The best way to protect against SARS is to practice good personal hygiene EXAMPLE OF SARS (CON’T) RISK ASSESSMENT • Data are collected and sent to Labs but at this point, no causative agent was determined. • Transmissible only for close contacts and after patients become symptomatic • Some people can fall severely sick with respiratory failure • Caused by coronaviruses • Antibiotics are ineffective as this is a viral infection • Epi data suggested a human to human transmission. • Hospitals amongst other places have high rate of infection, hence deemed as high risk

19. Best to learn through some real-life examples….

20. The mystery syringes & how quick risk assessment and a concrete crisis plan saved the company

21. THE STORY….. • In 1993 – first report of a syringe found in a can of soft drink P • 50 more reports surfaced, from 23 states • Again, news spread like fire • However, the scare was declared over in 8 days • An arrest was made • No product recall

22. WHAT DID THE COMPANY DO RIGHT…. • Quick risk assessment was done. • The cans in question were produced at different times, batches and plants with strict QC. • Hence assessed that tempering couldn’t have taken place at plants. • The company P urged stores not to remove product while investigation took place • Activated their multifunctional team to handle the crisis • Public and staff were kept informed • Released video-news on production process & also on a man arrested & surveillance video showing a person replicating the tampering incident.

23. LESSONS LEARNED… • Importance of promptness and good risk assessment • Make use of different medium to get message across (conventional & video news) • Have in place a multifunctional team incl. personnel, scientist, regulatory, public communications etc. • After the crisis was over, Company P ran a series of ads to thank the public

24. Black Saturday & the failure of operation communications

25. THE STORY… • A series of bush fires started burning across Victoria State, Australia on 7 Feb 2009. • This resulted in Australia’s most devastated bushfire with 173 people dead and countless homeless and injured. • This was known as the Black Saturday. • An inquiry was carried out to examine what went wrong.

27. The Commission found that the response “faltered because of confusion about responsibilities& accountabilities and some important deficiencies of leadership.”

28. LESSONS LEARNED • While we cannot control the act of nature, we can prepare ourselves to react better • The failure was a result of breakdown of internal & operation communications & not due to insufficient equipments • Planning is needed, so is high level ownership • The importance of peace-time planning can never be underestimated

29. How quick risk assessment and decisive risk communications worked well together

30. THE STORY… • August 1999, hospitals in NYC began seeing unusual cases of a disease with neurological manifestations. • Risk assessments by epidemiologists determined that the disease was mosquito-borne • Officials were split: some wanted to wait for more data before making the information public, others argued that a long weekend ahead was coming, the weather was warm and people would be outdoor

31. THE STORY….. • Eventually, a public announcement was made. • People were told about the mosquitoes borne disease and were advised to take protective measures to protect against mosquito bites • The disease was subsequently diagnosed as the West Nile Fever • Thanks to the early announcements, people took protective measures

32. LESSON LEARNED… • Quick risk assessment coupled with a decision to make an early announcement worked tremendously well in this case • It is ok to go public with information even if the data are incomplete • Objective of the early announcement is so that people know what to do to protect themselves

33. ELEMENTS OF COMMUNICATIONS • Build trust and consensus • Be timely and transparent (First announcement) • Be the official & reliable source of information (official spokespersons – politicians / doctors / scientists) • Mentally prepare community what to expect (do not surprise them!) • Be prepared to address concerns / acknowledge unknowns • Make sure it is a two-way dialogue • Plan in advance (no short cut)

34. EFFECTIVE COMMUNICATIONS CAN… • Maintain and build public trust in health authorities • Help people overcome fear and anxiety • Keep internal partners and stakeholders informed & work more effectively • Help people make informed decisions on how to protect themselves • Reduce economic, social and political impact

35. CHALLENGES COMMUNICATORS FACE TODAY…. • Emergence of social media: how fast is fast enough? • Multiple sources of information: some credible, others not • Need to be flexible and versatile – no “one size fits all” or “plug and play” • Expectations of the public

36. RISK COMMUNICATIONS

37. The classic model example for Risk Communications

38. THE STORY…. • Fall of 1982, seven people in Chicago West Side died suddenly and mysteriously. • A quick risk assessment was done – particularly, investigators try to find the “common factor” amongst the unrelated victims • Within days, it was quickly determined that each of the people who died had taken a particular popular over the counter pain-killer. • Once this suspicion was established, the drug, T, was sent for investigation • To the horror of investigators, each capsule was found to contain 60mg of cyanide (more than 10,000 times needed to kill a person!!!)

39. THE STORY (CON’T) • As soon as a connection was made, the nation was quickly warned. Police drove around downtown Chicago announcing the warnings over loud speakers (Risk Comms: quick first announcement) • Officials from the manufacturers quickly launched an internal investigation and made clear that the tampering could not have taken place at the plant (Risk assessment: the poisoned drugs were from different shipment, manufacturing lots and plants) • Established that the bottles were tampered and placed back on shelves at five different stores

40. THE STORY (CON’T) • While the matter was still under investigation, the manufacturer systematically informed consumers via the media not to use drug T. They also did a total recall of the drug from shelves (Health emergency communications) • At the same time, they established links with the FDA, FBI, and Chicago Police to help in investigations (Operation communications)

41. THE STORY CON’T • Six weeks after the incident, the company revealed their PR plan for recovery • It became the first to introduced new triple-seal tamper-resistant packaging to rebuild confidence • Sales people met up with medical community to present their new packaging(Operation Communications) • Even though the suspect was never caught, the incident was praised as one of the best Risk Communications effort by a corporation.

42. LESSONS LEARNED • Importance of having a comprehensive crisis plan • To understand what and who matter most during such a crisis • Be sensitive to the affected • Be cooperative and transparent • Launched recovery plan asap

43. RISK ASSESSMENT and RISK COMMUNICATIONS are like a JIGSAW PUZZLE.. Do we wait for all information to come in before communicating?

44. OBJECTIVE OF SESSION: To allow you - as technical officers - to have a better appreciation of risk communications. To demonstrate how the work of risk assessment and risk communications are inter-connected. To illustrate - through real case studies - how risk assessments translate into risk communications and positive public health outcomes. Put theory into practice during the scenario-based exercise.

45. Scenario Based Group Exercise Risk Communication • Each group will be presented with a case study: • Changli Scenario • Renal Failure Cluster • Petrochemical Explosion • Questions for discussion are presented at the end of each case (remember, where appropriate you are not expected to come up with well-crafted messages; rather focus on the content) • Brief, concise, clear and always ask WHY? • Remember your target audience • You will have 50 minutes for your discussion • 5 minutes feedback for each group