2009 H1N1: Implications for Future Immunization Communication Glen Nowak, PhD Acting Director Division of News and Electronic Media Centers for Disease Control and Prevention

“The only thing predictable about a flu pandemic is how unpredictable it is.” USA Today editorial, Dec. 8, 2009

A Brief Look Back

Key Elements of 2009 H1N1 Influenza Communication Efforts Strong foundation in: Risk communication principles and practices Formative research Immunization communication best practices Comprehensive media relations and outreach Multiple communication channels Extensive collaboration and coordination with partners Guided/adjusted by surveys and other assessments

The Foundation – Some Core Components Tell people what you know when you know it – and you can: 1) put it into a context and 2) tell them what to do as a result of the information. Audience perspective first and foremost Acknowledge uncertainty – and what it means or could mean (e.g., “our interim recommendations may change quickly”) Foreshadow possibilities / share dilemmas Know the intent of your messages and communication strategies

April 23, 2009 “You can get swine flu without direct contact with swine, but it’s a bit unusual. We believe at this point that human-to-human spread is occurring. That’s unusual. We don’t yet know how widely it’s spreading and we certainly don’t know the extent of the problem. We are taking active steps to learn more... And as we learn more, we will work to keep you updated.” Dr. Anne Schuchat, CDC

Comprehensive Media Relations and Outreach Regular/frequent press briefings Initially daily Listen-only line for non-media Quick posting of transcripts Press access to CDC and other public health experts Media background briefings Group Individual CDC media relations website

Multiple Communication Channels News media HHS and CDC website (e.g., Flu.gov) Public service media time and space Purchased media time and space New and social media Podcasts Widgets (e.g., 11 flu-related) On-line video (e.g., 32 videos related to H1N1) CDC on Twitter (1.2 million followers) Content syndication

Content Syndication A streamlined (technical) process for disseminating CDC content on partner Web sites million views of H1N1 content via CDC RSS feeds 418,796 views of CDC H1N1 content via content syndication 42.8 million views of H1N1 content via CDC RSS feeds 418,796 views of CDC H1N1 content via content syndication

Extensive Collaboration and Coordination Other HHS components Other federal government agencies (e.g., Education, Homeland Security, Labor) State and local health department public affairs offices National Influenza Vaccine Summit WebMD (e.g., “Focus on Flu”), National Public Broadcasting, etc. Professional membership organizations Retailers and pharmacies Community-based and non-profit organizations

Guided/Adjusted by Data along the Way Focus group research Interviews with health care providers Harvard School of Public Health public opinion surveys BRFSS and NHFS State and local health dept. surveys Media summaries Website statistics Phone and inquiries

A Look Ahead

Implications for Future Immunization-related Communications

1. The Most Effective Immunization Communications will... Have a strong foundation in: Risk communication principles and practices Formative research Immunization communication best practices Be guided/adjusted by surveys and other assessments Utilize multiple communication channels Involve extensive collaboration and coordination with partners Potentially require a comprehensive media relations and outreach plan

2. Upcoming influenza and influenza vaccine- related communications should prepare for... Interest and questions about where things stand (e.g., is the pandemic over) and where things are– or may be going (including locally). Much media, public, parent interest in what this year’s H1N1 vaccination means for vaccination in the coming season (e.g., do I need to get another flu shot? Why do I need to do so?) Much media, public, parent interest in a) predictions related to the flu season (e.g., to gauge risk) and b) plans (e.g., what will be different?)

3. When it comes to the news media and all things influenza, it would be good to assume... Strong interest in the transition from this year’s flu season to next, especially forecasts (flu prevalence, flu severity, vaccine availability) and plans (including spending/budgets). Intensity and duration of interest that more closely resembles a usual flu season rather than that associated with a pandemic. Skepticism/questioning of forecasts and plans Interest in frequent/regular updates (e.g., websites)

4. When it comes to flu season communication plans... Undertake audience research to guide plans. Don’t assume “high risk” people self-identify. Universal immunization recommendation simplifies but also requires more communication and messages. Consider content syndication. Realistic expectations – e.g., matching vaccine supply with demand will always be challenging – including because demand for choice will likely always be higher than demand for vaccination

5. When it comes to other immunization recommendations H1N1 is a reminder that disease outbreaks can boost news media attention and public awareness of VPDs and vaccine recommendations but, 2009 H1N1 also illustrates the high bar that must be met to achieve broad, highly visible and sustained media interest and coverage H1N1 can provide a “teachable moment,” but a) impact may be fleeting and b) it won’t reduce need for all the other communication efforts.

6.When it comes to communications related to future pandemics... Practice – e.g., communication-related tabletops, exercises-- is critically important. Past year can and should shape those tabletops and exercises. Communication research and planning related to new flu vaccine technologies and formulations needs to be undertaken now/soon (i.e., before those vaccines will come into use).

What might the media say?

Five Things Media Might Say Much was done right and well in terms of providing the news media information and access (e.g., speed, access, quality and ability of spokespeople and experts). Terms, definitions and assumptions need to be clearer, more explicit – from words (e.g., “pandemic”) to the reason(s) for your recommendations (i.e., don’t assume we know). We want– and need– better estimates, forecasts, and predications, especially at state and local level.

Things Media Might Say continued... News media may provide good initial visibility of recommendations, immunization efforts, and the value of vaccination, but shouldn’t be expected to provide sustained visibility and publicity (i.e., the news media are not your partners). If you want news media interest/coverage, you need to have news (e.g., if you have a press briefing, we assume you have significant news).

Thanks!