The World Health Organization’s Response to Zika via Facebook and Twitter in the Early Months of the Unfolding Crisis

Michelle Marasch Ouellette, PR Program Kirsten Isgro, Dept. of Communication Studies State University of New York College at Plattsburgh

The outbreak May 7, 2015 Nov. 11 2015 Dec.1 2015 Feb. 25 2016 WHO/PAHO alert on Zika & Micro- cephaly WHO/PAHO report: Possible Zika in Brazil Brazil declares increasing microcephaly a public health emergency Annenberg study: 1 in 5 Americans think Microcephaly related to vaccine or pesticide

The Facebook posts Nov. 11 2015 Dec.1 2015 Jan. 2016 Feb. 2016 WHO/PAHO alert on Zika & Micro- cephaly Brazil declares increasing microcephaly a public health emergency Colored stars are WHO Facebook posts: Jan. 23, Jan 28 and Jan. 30. Only posts on Zika by WHO in first two months of crisis. (Transparent stars are meant to show that WHO was not alone in posting late. These represent the CDC’s first posts on the matter: Jan. 20, Jan. 25 and Jan. 27. Note: On WHO’s Brazilian page (OPAS OMS Brasil), the Pan American Health Organization World Health Organization Brazil, also waited to post until Jan. 11, 2015. Used infographic. This post made no reference to microcephaly and was only mentioned after public comment on Zika. A second OPAS-OMS also used infographic and told how to prevent mosquito bites. The organization waited until Jan. 14 to mention microcefalia.

‘Effective Media Communication During Public Health Emergencies: A WHO Handbook’ Hyer and Covello, 2005. Available for free WHO Institutional Repository for Information Sharing. Mental Noise Theory: Mental noise from stress can reduce processing ability by 80 percent.

‘Effective Media Communication During Public Health Emergencies: A WHO Handbook’ Hyer and Covello, 2005. Timing. Simple Language. (Four Years Below Average.) Message Composition. (27/9/3) Compassionate Preamble. Graphs, Visuals, Analogies and Narratives. Primacy/Recency Effects.

WHO Facebooks posts from first two months

WHO Zika Facebook Post I Timing: Jan.23. (One month, 23 days after report was released.) Grade Level: Flesch-Kincaid 2.1. Message Composition: 16 words, 9 below 27. Four questions. Only questions. Compassion: ∅ Graphs, Visuals, Analogies and Narratives: ∅ Primacy/Recency: ∅ [

Where does Zika virus occur? Grade level: 12.1. Where does Zika virus occur? Zika virus occurs in tropical areas with large mosquito populations, and is known to circulate in Africa, the Americas, Southern Asia and Western Pacific. Zika virus was discovered in 1947, but for many years only sporadic human cases were detected in Africa and Southern Asia. In 2007, the first documented outbreak of Zika virus disease occurred in the Pacific. Since 2013, cases and outbreaks of the disease have been reported from the Western Pacific, the Americas and Africa. Given the expansion of environments where mosquitoes can live and breed, facilitated by urbanisation and globalisation, there is potential for major urban epidemics of Zika virus disease to occur globally. These are just thrown together. They still need some work.

Mentions “microcephaly” 549 words in. Defines Microcephaly 751 words in.

WHO Zika Facebook Post 2 Timing: Jan.28. In advance of Feb. 1 meeting. Simple Language: Flesch-Kincaid 18.1. First Paragraph Link: 23.2 Message Composition: 42 words, a link to a story and two messages -- that the director convening a meeting and that a committee will decide if the Zika outbreak rises to the level of an emergency of international concern. Compassion: ∅ Graphs, Visuals, Analogies and Narratives: Picture of the director- general. Primacy/Recency: No listing of details. [

WHO Zika Facebook Post 2, Link Grade Level: 24.7 WHO Director-General, Margaret Chan, will convene an International Health Regulations Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. The Committee will meet on Monday 1 February in Geneva to ascertain whether the outbreak constitutes a Public Health Emergency of International Concern.

WHO Zika Facebook Post 3 Compassion: Speaker’s tone is warm. Graphs, Visuals, Analogies and Narratives: Yes. Primacy/Recency: Questions move from basic to the most important point the public needs to know — how to protect itself. [ Timing: Jan.30. Two months after first post. Simple Language: Flesch-Kincaid 5.8. Transcript 11.4. Message Composition: 16 words. Four points. Only questions in post. Video asks and answers four questions.

Public response Basic understanding: Complete understanding: “if its not fatal then what’s the fuss about.” Complete understanding: “... Does that mean if my 6 yr old daughter was infected she would have to worry about possible birth defects in 15-20yrs?” Trust issues: “I don’t trust you at all. will you use this to force mass sterilization/cancer vaccines? ...” Conspiracy theories: “Sound like a ploy to vaccinate more people with their poison vaccines. ... Population control.”

The need to act quickly “... once people believe something, it is difficult to dissuade them. Public health officials must get out in front of the conspiracy theorists to educate and influence the population now.” “Zika vaccine misconceptions: A social media analysis” by Mark Dredze David A. Broniatowski Karen M. Hilyard

Takeaways Anger is the most viral emotion (Fan, et al., 2014; Berger and Milkman, 2012). Anger and fear are going to be chronic challenges: Social media needs to come early. Apply what you already know about communication: Post early and simply. Put important information first. (Don’t bury the lead.) Correct misinformation. (Do not feed the trolls. Correct them.) Show compassion. Aim for comprehension.