Robert Blendon, ScD Gillian SteelFisher, PhD, MSc Harvard Opinion Research Program Harvard School of Public Health Funded as part of a cooperative agreement between HSPH, the National Public Health Information Coalition, and the CDC Communicating with the Public in an Emergency: Lessons from Rapid Polling During H1N1

Emergency Polling Technology transfer from politics Support communications and material response in an emergency Telephone polls using randomized samples (landline/cell) Conducted at baseline, mid-crisis and aftermath 14 Polls during H1N1: 2

What Communications did the Public See and Hear? 3

4 Public’s Exposure to H1N1 Flu Communications % saying since April 2009, they have seen advertising that provides information about ways to keep them and their family safe from H1N1 Very often Somewhat often Not very often Not at all often Harvard Opinion Research Program, Harvard School of Public Health, March 17 – April 11, Yes, have

Public’s Assessment of State and Local PHD Communications Concerning the H1N1 Outbreak Excellent job 5 % saying state or local public health departments did an… Good job Fair job Poor job Harvard Opinion Research Program, Harvard School of Public Health, March 17 – April 11, 2010.

6 Public’s Exposure to H1N1 Flu Communications in Different Locations % saying, since the beginning of the H1N1 outbreak in April 2009, they have seen or heard advertising that provides information about ways to keep them and their family safe from H1N1… On the radio On billboards On websites In newspapers On television At airports At work At schools, colleges, or daycares Harvard Opinion Research Program, Harvard School of Public Health, March 17 – April 11, 2010.

7 **n = 296 Gone to website for information about staying healthy from H1N1 Got all information needed at website or had to go elsewhere** Easy or difficult to understand information from website** Public Efforts to Get Information on H1N1 From Their Local or State Public Health Department’s Website

What non-pharmaceutical flu-prevention behaviors did people adopt? Did communications play a role? 8

Adoption of Key Flu Prevention Behaviors Among the Public Washed hands more frequently Taken any steps to avoid being near someone who has flu-like symptoms 9 % saying, since the beginning of the H1N1 outbreak in April 2009, they have, at any point, done the following in response to H1N1 Used hand sanitizer more frequently Harvard Opinion Research Program, Harvard School of Public Health, March 17 – April 11, More frequently covered mouth and nose with tissue when coughing or sneezing More frequently coughed or sneezed into elbow or shoulder

10 Public’s Exposure to H1N1 Flu Messages % saying, since the beginning of the H1N1 outbreak in April 2009, they have seen advertising suggesting that they should… Wash their hands or use sanitizer frequently Clean or disinfect their surroundings Stay home from work, school, or other outside activities if sick with H1N1 Cover mouth and nose with tissue when coughing or sneezing Cough or sneeze into elbow or shoulder Harvard Opinion Research Program, Harvard School of Public Health, March 17 – April 11, 2010.

Flu Prevention Behaviors Among the Public: By Exposure to Specific Messages 11 % saying, since the beginning of the H1N1 outbreak in April 2009, they have, at any point, done the following in response to H1N1 Harvard Opinion Research Program, Harvard School of Public Health, March 17 – April 11, More frequently coughed or sneezed into elbow or shoulder More frequently cleaned or disinfected home or workspace More frequently covered mouth and nose with tissue when coughing/sneezing *Statistically significantly different from respondents who say they did not see an ad recommending that they do this Used hand sanitizer more frequently Wash hands more frequently * * * * *

What percentage of people got vaccinated? Did communications play a role? 12

H1N1 Vaccination Among the Public Got the H1N1 flu vaccine for self 13 % saying, since a vaccine to protect specifically against the new H1N1 flu first became available in October 2009 Harvard Opinion Research Program, Harvard School of Public Health, March 17 – April 11, Did NOT get H1N1 flu vaccine for self

14 Public’s Exposure to the Message: Take the H1N1 Vaccine % saying, since the beginning of the H1N1 outbreak in April 2009, they have seen advertising suggesting that they should get the H1N1 flu vaccine No Yes Harvard Opinion Research Program, Harvard School of Public Health, March 17 – April 11, 2010.

H1N1 Flu Vaccine Uptake Among Adults: By Exposure to Ad Saying Get the H1N1 Flu Vaccine 15 % saying, since the beginning of the H1N1 outbreak in April 2009, they have gotten the H1N1 flu vaccine Harvard Opinion Research Program, Harvard School of Public Health, March 17 – April 11, Saw the message *Statistically significantly different from respondents who say they did not see an ad recommending that they get the vaccine Did NOT see the message *

H1N1 Vaccination Among the Public: By Concern About Illness Among those who say they were very concerned they or family member would get sick 16 Harvard Opinion Research Program, Harvard School of Public Health, March 17 – April 11, Among those who say they were not concerned they or family member would get sick *Statistically significantly different from respondents who say they have been “somewhat concerned” and not concerned (including “not very” or “not at all” concerned) at the 95% confidence level Among those who say they were somewhat concerned they or family member would get sick **Statistically significantly different from respondents who say they have been not concerned (including “not very” or “not at all” concerned) at the 95% confidence level * ** % saying they have gotten H1N1 vaccine for themselves

Public Concern About Getting Sick with H1N1 Over Time 17 12/17: Sebelius Announcement - Vaccine Released More Generally % saying they are concerned that they or someone in their immediate family may get sick from H1N1 during the next 12 months… 40% 12/17/09 Harvard Opinion Research Program, Harvard School of Public Health, April 29, 2009, June 22-28, 2009, September 14-20, 2009, December 16-17, 2009 and January 20-24, NOTE: Timeline not to scale

H1N1 Vaccination Among the Public: By View of Safety of H1N1 Flu Vaccine Among those who say the H1N1 flu vaccine is very safe 18 % saying they have gotten H1N1 vaccine for themselves Harvard Opinion Research Program, Harvard School of Public Health, March 17 – April 11, Among those who say the H1N1 flu vaccine is NOT safe **Statistically significantly different from respondents who say that the H1N1 flu vaccine is “not very” or “not at all” safe generally for most people to take at the 95% confidence level Among those who say the H1N1 flu vaccine is somewhat safe *Statistically significantly different from respondents who say that the H1N1 flu vaccine is “somewhat safe” and “not very” or “not at all” safe generally for most people to take at the 95% confidence level ** *

Public Views of H1N1 Vaccine Safety Over Time 19 % saying they believe the vaccine is very safe… Harvard Opinion Research Program, Harvard School of Public Health September 14-20, 2009, January 20-24, 2010 and March 17-April 11, NOTE: Timeline not to scale

Lessons from Polling During H1N1 Exposure to public health messaging was widespread Traditional media plays a critical, primary role in getting the message out, while online and social media are an important support Many people followed key recommendations pertaining to NPI behaviors, and those who did were more likely to have seen relevant messages Although most people saw vaccine-specific messages, most people did not get vaccinated Vaccine messaging faced key challenges related to lack of concern about the seriousness of the illness and concern about the safety of the vaccine 20

Communicating with the Public in an Emergency: Lessons from Rapid Polling During H1N1