Outbreaks: When and How to Inform the Public

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1 Outbreaks: When and How to Inform the Public Johan Giesecke, MD Chief Scientist, ECDC Stockholm

2 My background Clinical infectious diseases MOH, Stockholm County, State Epidemiologist for Sweden (Break to lead the small IHR development team at WHO HQ) Head of Unit for Scientific Advice, ECDC, since summer 2005

3 When and how inform public? More and more a non-issue: signal detection largely rests on public media (GPHIN, MedISys), and listservers (ProMED) are open to anyone public usually informed at same time as (or before) the public health community

4 Source of threats - ECDC 274 threats picked up by ECDC from June 2005: - Open info on web or media >35% - EU-wide surveillance networks 20% - WHO OVL list 9% - EU Early Warning and Response system 27% but also in these cases, media often catch on before report, or just after, leaving no time to prepare communication

5 Thus The first information step that the outbreak has occurred is usually passed already Instead concentrate on Verifying threat Starting rapid risk assessment

6 The information paradox Public/Media reaction Weak Strong Real threat Low High x x x x

7 Most common problem Public/Media reaction Weak Strong Real threat Low High x x x x

8 A good piece of news An event that is: unusual unexpected human angle (affects people)

9 An outbreak An event that is: unusual unexpected human angle (affects people, could affect me) outbreaks will always be news

10 My old teacher:

11 My old teacher: Newspaper billboards will save their biggest font for:

12 My old teacher: Newspaper billboards will save their biggest font for: When war is declared

13 My old teacher: Newspaper billboards will save their biggest font for: When war is declared When the king dies

14 My old teacher: Newspaper billboards will save their biggest font for: When war is declared When the king dies When there is an epidemic

15 Consequence We must always be prepared to communicate even if we perceive the incident as trivial Prepare statement ASAP Prepare 10 statements for each actually used Include Q&A section but it takes experience to foresee which questions will be relevant

16 Rarer situation Public/Media reaction Weak Strong Real threat Low Medium /High x x x x

17 When to inform? We know something that the public does not Basic rule: Always go public as soon as possible Don t underestimate people s intelligence (Cf. the old custom within clinical medicine of sparing the patient from bad news...)

18 Informing early Better to publish what we know and be fully open about our uncertainties Describe on-going verification process Describe work on risk assessment An educational aspect here: in time the public will learn and start trusting

19 Always inform? Imperative: when people could take personal action to protect themselves (boil drinking water, avoid certain food items) Problem with brand names risk of litigation If little risk, and non-treatable disease? exposure to BSE? contact tracing for retrovirus?

20 Summary 1 Inform early Don t hide information Be open about uncertainties, and describe how they are being addressed

21 How to inform? Most important: co-ordinate messages Nothing creates more public anxiety than different assessments from different authorities Rapid sharing of statements and preliminary risk assessments (should not vary much, if built on facts)

22 Order Good practice: first inform those who are responsible for action (often not the surveillance institutes) They are the ones who will take the flak need to prepare Also important for the low risk/high attention situation

23 Media Good idea to have a cadre of well-informed journalists to contact However in my experience they seldom work late Friday s or weekends be prepared to talk to novices Good idea to have lay text fact sheets about all diseases on web site

24 Practical tips Arrange press conference with regular updates Be prepared to have a 24/7 web update function Install hot-line facilities (and practice them) If national outbreak inform health care system (ready-made lists)

25 Summary 2 Co-ordinate messages Use media pro-actively Prepare web and hotline 24/7 function

26 Thank you!

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