CERC Transcript 05 24 2016

Zika CERC Discussion: First Local Transmission

Presenters: Barbara Reynolds, PhD

Date/Time: May 24, 2016 1:00 pm ET

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Operator:

Thank you all for standing by and welcome to today's conference call. At this time, all lines are on listen only for today's conference until the question-and-answer portion of our call at which time you will be prompted to press Star 1 on your touchtone phone. Please ensure that your line is unmuted and please record your name when prompted so that I may introduce you to ask your question.

Our conference is also being recorded and if you have any objections you may disconnect at this time. I will now the turn the conference over to our host, Ms. Barbara Reynolds. Ma'am you may proceed.

Barbara Reynolds:

Thank you (Jill). Good morning for those of you who are on the West Coast. This is our second of the weekly Zika Crisis and Emergency Risk Communication Discussions through the telephone. Today's topic is a really serious one. We're going to look at CERC principles -- Crisis and Emergency Risk Communication Principles -- in relationship to breaking new news when you're involved in an event and you end up pulling the first duty, so to speak, on a critical topic and in this case we're talking about Zika and one of those milestones that's lurking out there and we honestly don't - do not know how the roulette wheel is going to turn and who's number is going to come up.

But somewhere in the United States, some jurisdiction is going to be the first area where we document local transmission by mosquitoes to humans and there's a lot that could go into this discussion, but what I'd like to do is just present some CERC principles in relationship to that idea and then open it up for discussion and see what people are thinking and if we can come together and get some synthesis on where to go from here.

For those of you who may be in a place where you can follow this discussion online, we do have slides available and if you go to this CDC emergency.cdc CERC web site you should be able to get those slides and follow along, if you want. I sometimes sound like a broken record when I'm talking about CERC, but I want to explain that everything that we're talking about doing in relationship to CERC communication as we respond to a public health emergency it's because truly if we do things right, if we have the right message at the right time from the right person or organization we can save lives. And I'm going to talk a lot today about how important it is to be out there and be first.

But before I do that I think that when we're talking about new or novel situations. And it will certainly be new and novel for Americans in our communities in the continental United States - to face local transmission by mosquitoes of Zika. Now we do understand that Zika for most people isn't going to cause a serious illness, but we also understand that we're beginning to see the devastation that Zika can cause for woman who are pregnant in terms of birth outcomes so I thought I'd start just to as a reminder that when people are fearful -- and fear may generate some need to do something - people may be fearful at different levels.

Risk is a real - fear is a really personal component of our emotional makeup and so how people react to a novel situation, how fearful they are, (unintelligible) situations. So just understand that although you may be (unintelligible), there isn't a need for people to be fearful. That's not for us to do judge.

What we need to do is our best effort in helping people understand the situation. And I want you to pass onto your leadership that if they are talking to people or to, you know, pass under your science expert also, that if they're talking to people about Zika and Zika transmission in a local context, they'll tell them that they don't have anything to be afraid of.

That's not a healthy way to approach that conversation because then not only will I be fearful, but I'm going to be angry because you're treating me like a child - so be careful about that. Just let people be fearful, acknowledge the emotions that are occurring in people in this situation, and then try to give them context - give them some news or some pieces of information.

If you know there's nothing to be afraid of, that's great, so then tell people why there's nothing to be afraid, but don't tell them, "Don't be afraid" - so give them contextual information and then perhaps the emotional response will alter at some point. But just be prepared for different degrees of emotion.

And if you think it's your job as a communicator or as an expert or as a leader to make people to not be afraid, you're going to run into some trouble because truly it's not your job to make people not be afraid, your job is help people manage their emotions so they can take the steps that they need to protect themselves, their loved ones, their community, and in some cases, their nation.

So I threw this out here early in our discussion today because I just think it's really important that in a new situation people might be fearful. You may not be, but they may be. And we have to be tolerant of that emotional response along the way.

So I've kind of gotten a little off on another track completely and talk about crisis communication planning. And so next slide if you're watching the slides - I think that all of us could benefit by putting together at least an outline of a plan -- a communication plan -- for the possibility that we may be a jurisdiction that has the first transmission to humans of Zika via mosquitoes.

And, of course, we know as we're talking on a national call that there are some communities that may be more likely to have this occur than others, but it's not a bad idea to plan for the possibility. And I really remember when we were going through West Nile that we had West Nile occur in New York City and New York State and then it traveled across the country from the east to the west coast and each time that West Nile was noted in a state or a jurisdiction, the people in that state were as involved and interested and concerned as if they had never had been exposed to the idea of West Nile until that moment.

So the reason for that is because sometimes we just don't pay attention to risks that are bothering other people. It depends, but sometimes we don't. And so what shows up to us in our jurisdiction it becomes more imminent, more real to us then we're ready to pay attention and then we may be getting the information we need for the first time. We may not have bothered to do it before then.

So I would encourage people to do real on paper or at least on your screen planning for the first local transmission by mosquito of Zika and there are components to that plan. For the most part I want to just say think in terms of the different phases of the crisis - and so next slide I have the Crisis Communication Life Cycle.

Frankly, some of us are in the initial stage of this crisis and others are in the pre-crisis phase. We need to determine where we are and start to take the steps we need to. It's really imperative as much as possible to try to develop consensus recommendations as you go forward with your plan and to determine who's going to release what, when and how.

It's not a good idea to wait for the laboratory tests that confirm that you have mosquito transmission of Zika in humans before you start to determine who's going to announce it and how they're going to do it. I'm not going to tell you how to do that. What I'm going to tell you is start thinking about it and try to get agreements among the people who are responsible for that. And we can talk a little bit more about this when we open it up to discussion.

I would expect that in most instances that there would be some coordination and perhaps participation by CDC and maybe other departments as you go forward with that announcement. And as difficult as it was to manage the domestic Ebola response, the one thing I can say that we did well and I am completely indebted to Texas for doing this so well.

But within two hours of us having a concerned laboratory result of a locally diagnosed Ebola case in the United States, we were having a national press conference that involved the hospital, the local health department, the state health department and CDC and the reason that was seamless and went as well as it did was in part because we started planning long before the actual testing was being done - so we were prepared for that possibility.

And you may want to start thinking about this kind of planning immediately. So when we're talking about planning for a novel or unusual situation, sometimes we go kind of on one note. We think that we have to release information to the public. But I would like to encourage you on this next slide that talks about matching audiences with their concerns that as you go about planning you think through, "What will the audiences be and how might they might be different in terms of their needs for communication in this particular health situation?"

I would like to point out that you need to include in your planning how local politicians or elected officials will participate in this release of information because they have constituents who they want to have the opportunity to express concern too. You also may want to think about trade and industry issues. What does this mean for your community? And again, you know your community and your jurisdictions best, but it's worthwhile to ask those questions.

"What will be happening there? Will there be a concern about economic well-being?" And I've said before that when people are threatened, when their loved ones are threatened, when their pets are threatened, and when their economic security is threatened, that the way we take in process and act on information changes and so do understand who basically will be most affected by the information that you're about to share and react accordingly.

I often would say to someone, "Don't forget pregnant women," but in this case, pregnant woman are essential to any conversation that we're having about this. We need to make sure in our communication plan that we understand what the operational response will be so what's going to happen in terms of vector control in this jurisdiction and how will that effect people around them?

We talked last week about the aedes aegypti and the mosquito is one that doesn't travel very far away from where it first is - and I just still haven't learned this mosquitoes are born or not. And so there will be some consideration that will be a very small area in which this discussion about vector control could happen, so we'll have some challenges around why people - some people may be wanting that spread out further, some may want it to be as narrow as possible, some may want to determine who it was that had the case of Zika, and it won't necessarily happen just as somebody's home. It could happen in a workplace setting too and so think of those possibilities.

What if the first human transmission of Zika through mosquito in your area occurs where there's a hospital? Where there's a daycare center? Where there's an OB/GYN clinic? I mean, think it through and know your jurisdiction, walk through the neighborhoods in your mind or physically -- depending on where you are -- and ask, "What happens if the first case is here? What's around this? What will this do to this community and how might they react?"

So just want you to think that not all audiences have the same concern. They may all be interested in their personal safety, but beyond that there may be other concerns that they have. What we know about a situation where people feel like they're responding or participating in an emergency is that any information is empowering and I caution you about that because I don't even say, they're correct information, just any information - so people will be in the information seeking mode when you get to the point to release that information.

And as much as we would like a very controlled way to release the information, you also need to consider the fact that it may leak before you're completely ready to go with this. And if I were doing my local communication plan for this, I would have a, "This is what we do when everything goes the way it supposed to. Oh, and this is what we do if it leaks," and so consider that possibility as you do this and, you know, it's best if it doesn't work that way, but consider the possibility.

We always talk about in Crisis and Emergency Risk Communication the idea of a substantive action step. That means be prepared in your early communication to give people things to do and recognizing that for some people they may not a have a direct action to this initial case, but you do have some action steps that you want routinely to be telling people to do around mosquito control - so certainly share that with them.

I want to stress that research tells us that we need to speak plainly. I have plain English on the slide, but it's plain whatever language people are receiving their information in. And just as a head's up, next week we're going to have a guest speaker from CDC who's known across the nation as one of our best experts on plain language and how to do plain language well. And she and another speaker will be talking about plain language in our health communications products, but also in our media products because the more plainly we describe what we're doing to the media, the easier it is for all of us - so they're going to touch on that.

Okay, as you're working through that initial plan for the first local human case from a mosquito of Zika, there are in any crisis response nine steps. I just wanted to have you think through in your plan what these steps are and who will be doing them.

Now not all nine steps are necessarily something that you would do just for the first local human cases of Zika from mosquitoes, but they are steps that you should consider and that means verify the situation. "How are you going to verify that this is real? Who's going to conduct notification?" That means, "Who's going to get to know this quickly as you start to organize your release of the information?"

Know if you need to activate your crisis plan, what that is, and then organize assignments, prepare materials to the extent that you might be able to prepare and clear some of those materials where you only have to fill in the blank -- that might be helpful -- but be careful because sometimes we forget that we have a template and it goes out looking like it's a template and that's not trust building for people along the way.

Then release the information, make sure you're getting feedback from your community, look for any rumors or misinformation, evaluate that, do more public education and keep on going. So these steps are important and help you put your plan together. That whole plan is meant to do one thing and that is to answer the questions that the public are going to be asking of you in this novel situation. So on the next slide we talk about generally what those kinds of questions will be.

If your materials answer these questions and do it in a way with plain language that people can understand, you're going to go a long way toward helping them trust you as you go forward dealing with this issue.

I wanted to sneak in just a minute to talk about vicarious rehearsal and the reason I say that is because we - none of us know who's going to end up on the roulette wheel with the - their number coming up, but all of us are going to be watching where and how this happens and how it unfolds and that includes especially interested members of the public and that you could almost do a rippling circle further out from wherever this first case occurred, people are going to be looking at what's going on and they may engage in vicarious rehearsal.

They're going to be wondering, "Well, gee, if this happened in my community, what would I be doing? Could I do it?" There's a lot of questions that may happen and it's also (unintelligible). It's also an opportunity for you to educate the public about (unintelligible) in this situation so take advantage -- I hate to say it that way. But if it's not you that comes up for the first one, use that opportunity to talk to your community and to the media in your community about what would happen in this situation and one of the struggles we're going to have with this is that not every jurisdiction or every community is going to respond exactly the same way in terms of vector control. So we need to be alert to that along the way and to allow for those differences and predict to media that there may be differences.

 

It's going to be a little bit more difficult, but it's important for us to do that. So there are six principles of Crisis of Emergency Risk Communication. We've already talked about some of them, but I want to stress the importance of being first.

Whenever possible, if we have information that we need to share in relationship to a health emergency or just a public health concern in our community, the faster that we get the information out or being first in getting that information out. Fast is good but first is not always fast; it's just first - is important. And I'm going to give you three reasons off the top of my head why I think it's important that we drive in our planning to be first in sharing that information.

The first one is because we know that the faster you release information when people are concerned about something, this is a marker for your preparedness so you actually gain confidence from your community they believe that you're better prepared to manage the event the more quickly you can talk to them in a informed way and answer the questions that you know are going to be coming from them in the situation. So it's really important because it increases your credibility in the situation as you go forward.

Another reason is because we know that when people are seeking new information about especially a new risk that first messages carry the most weight. So, why does that matter? Well, because sometimes people may seek information may be exposed to incorrect information and then you have the job of not only communicating the right information, but you're going to have to overcome the information that they've already received that they believe is accurate for one reason or another. So be really conscious of the fact that we need to get information out quickly because otherwise it just makes everyone's job harder and, of course, reduces credibility also.

And then the third reason and I think, perhaps, the most important reason to get out there as quickly as possible and be first with information that's important to the community about their well-being is because if you don't, you leave a vacuum and the moment that vacuum exists, there's a possibility that somebody may fill that vacuum -- an opportunist -- who may not have the public's best interest at heart so it's worthwhile to do some planning and to share this as a rationale for going the extra mile to get this information out as quickly as possible once it's verified.

And when we do that in our Six Principles of Crisis in Emergency Risk Communication do remember to promote an action, give people things to do. It helps calm anxiety in a situation. Okay, what I'd like to do now is to go ahead and open it up to discussion. (Jill). Do you want to see if somebody has a point they'd like to make or a clarification or a question?

Operator:

Certainly. At this time if you would like to make a comment or ask question, please press Star 1 on your touchtone phone. Please be sure to unmute your line and please record your name and affiliation to have your line open. Once again if you would like to ask a question or make a comment, please press Star 1 at this time. Please standby for questions.

Barbara Reynolds:

So while we're waiting for people to decide that they're willing to make a comment or ask question I do want to go on with some of the slides and talk about trust and mistrust and you'll probably hear me talk about this a lot because I truly do believe that crisis and emergency risk communication more than anything is an effort to try to be trustworthy and to be an expert at the same time which adds to our credibility and trust is promises fulfilled, mistrust is the outgrowth of the perception, the promises were broken, or that values were violated and so understand that as you're preparing your community for the possibility of a first local transmission of Zika to humans by mosquito, what are you implying in the way that you're talking?

Sometimes we have a tendency absent the threat itself to talk in lofty terms about where we're going to end up in the situation. So (Jill), do we have any questions or comments lined up?

Operator:

We have one from Eric Benson with the Lubbock State Supported Living Center. Sir, your line is open.

Eric Benson:

Can you recommend a scenario or technique for an organization or groups of organizations to rehearse practicing these principles?

Barbara Reynolds:

That's interesting since the conversation today is about these principles and relationship to Zika. I think that the scenario that you might want to use to exercise this is you have to have some basic understanding of the biology of, "What happens? What is this disease?" and then think it through within your local situation and ask, "What would we need to do? What would people who we are serving in the community would expect from us?" and I would do it that way.

I wouldn't make it overly detailed to get a scenario going. I have been in many exercise situations where we might start with just a two or three sentence possible situation and from that the conversation flows and I would expect that somebody in the group would keep close some of these principles that we're talking about today and say, "Okay, so one of the principles that makes for good communication in a crisis is to be empathetic.

What does that mean to express empathy? What does that mean? How are we going to do that?" or, "One of the principles is to promote action, so what kind of action would we suggest people should do in our situation?" and it could be very revealing if you just do it as simply as that. I think it's a great question and let me know if you do it, and how it turns out.

Eric Benson:

Thank you very much.

Barbara Reynolds:

Sure. (Jill), do we have any other comments or questions?

Operator:

We have another one from David Reddick with the Bio-Defense network. Sir, your line is open.

David Reddick:

Hi there. Thank you very much for doing these series of webinars. My question is about in advance of the first mosquito transmitted Zika case in the United States. Would it be smart for local public health departments especially those in areas that are more likely to have this mosquito and have the - and perhaps be the first - would be smart for them to start doing some things talking to the media, talking to the public about, "Here's what we're going to do when we do get that first case and here's what you'll know and here's how you'll know it and here's the steps that we're going to be taking beyond notification but also taking to be controlling of the mosquito?"

Barbara Reynolds:

So I think that's an ideal situation to be thinking in those terms and I can tell you that based on a discussion I had with the Texas Health Department's PIO that they have done exactly that sort of thing and I shared with it with the National Governor's Association when I talked to them a couple of weeks ago because I thought it was so fantastic that they weren't sitting around just waiting for things to unfold and then start to talk to the public or the media.

They actually talked about what they know, what they don't know, what they're going to try to do with the resources that they have, and invited the media into that discussion. Because you - again when we're talking about trust or mistrust - there might be a lot of information swirling around.

And there may be some assumptions in the part of the public or the media about what will happen and they may have overinflated in their mind how prepared we are, what we can or can't do, what's it going to look like.

And there also might be some scares or trepidation about issues related to mosquito control how pesticides might be used in the environment - that sort of thing.

And I'd rather start having that discussion absent the risk so that you can feel your way through it and it isn't being discussed for the first time when emotions are kind of high or people are fearful, but I do want you to know don't get your feelings hurt if you start to try to have that conversation and people aren't plugging in right away.

There's certainly a part of the population that's not going to pay attention to this risk until it's imminent, until it's personal to them so to the extent that you can get people interested and involved in it in advance, it's the ideal situation, but you probably won't have 100% participation or interest in it. It depends on how you approach it, but I would certainly bring all of my partners in to have a conversation and I would include the media in that along the way.

David Reddick:

Thank you.

Barbara Reynolds:

Sure. Any other comments or questions (Jill)?

Operator:

We have no other comments at this time. Let me just remind parties to press Star 1 and record your name and affiliation to ask a question or make a comment.

Barbara Reynolds:

Okay. Well while we're waiting to see if someone else comes up with a question, I want to talk about what it means to act trustworthily. One of the things that we talked about is sharing information early so the question from David is really right on the mark by sharing information early. You can be first in the moment, but you can also be first or early by engaging your community early on around a potential risk like Zika.

And again, I'm going back to what I witnessed in the early 2000's when West Nile marched across the United States is that I sat here thinking, "Wow, by the time it gets to the West Coast no one's going to get excited about West Nile because we've all seen it go from state to state to state." They anticipated it could happen but there was still a sense of real concern in people even when it made its way to California. So share information early and even if they're not paying attention to it, there might be something in the back of their mind that says, "Oh, yes, they've been talking to us about this. Well, I guess they're prepared," and then they'll start to pay attention at that point. So do we have any questions or comments (Jill)?

Operator:

No Ms. Reynolds, we have no other questions or comments at this time.

Barbara Reynolds:

All right. Well, I promised that on each of these calls that I'm going to try - I shouldn't overpromise though, right? I'm breaking some of my own rules. I am going to try at some point in these conversations to just give you a little piece of information that you might have missed along the way that will help manage some of the rumors or misinformation that could happen out there and as I was reading some of the Zika materials here at CDC, it struck me, as the piece of information that I'm going to share with you today, it struck me as something that, "I would like to have that in the back of my head just in case it comes up in a conversation either professionally or even when I'm just talking to friends and family," and that is you can say with certainty that, "Flies do not spread Zika," okay?

So we're going to be talking a lot about vector control, we're going to talk a lot about mosquito control, but you can reassure people that flies do not spread Zika. I'll leave it to you to learn the science behind that as to why flies are not the ones that are spreading Zika. That is spread by mosquitos. It actually has something to do with the way they eat and there's a difference between mosquitoes and flies on that.

I also want to share with you some of the risk communication resources. It's on the web site online and to invite you to go to it to learn more about Zika and also about Crisis in Emergency Risk Communication resources and remind you for those that have the possibility of traveling that we're holding a three-day training here at CDC in Atlanta August 10 through August 12 on emergency risk communication and we are taking a global point of view as part of that training and if you're interested in this or if you have additional questions along the way that perhaps you just didn't feel comfortable talking about this on this call, you can send an email to us here at CDC at cercrequest@cdc.gov. That's cerccrequest@cdc.gov.

And with that, we'll wrap it up for this week and look forward to hearing about plain language and working with the media in your health communication products as a plain language concept and we'll talk to you next week. Take care.

Operator:

That does conclude today's conference call. We thank you all for participating. You may now disconnect and have a great rest of your day.

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