1. TM Centers for Disease Control and Prevention Planning Principles: OC 2 Marsha L. Vanderford PhD Director, Emergency Communication System Centers for Disease Control and Prevention mvanderford@cdc.gov

2. If I had all day to cut a large tree, I would spend most of the day sharpening my axe. Abraham Lincoln Source: The Chicago Historical Society The Importance of Planning

3. Case Study Anthrax Outbreak 2001 Caused by Bacillus anthracis Skin infection Inhalation infection Digestive infection Autumn 2001 U.S. experienced multiple cases of intentional Inhalational anthrax

4. Anthrax Cases 2001 5 letters 22 cases 5 deaths Florida Washington DC New York City

5. This is an official CDC HEALTH UPDATE Distributed via Health Alert Network Saturday, October 27, 2001, 21:30 EDT (9:30 PM EDT) CDCHAN-00048-2001-10-27-UPD-N CDC Statement Regarding Postal and Other Mailroom Facilities in the Metropolitan Washington DC Area Who should receive medications? When? Where? How much? How long? What medications?

6. Prophylactic Antibiotics Ciproflaxin – Congressional Staff – Media Celebrities – Brand name antibiotic Doxycyline – Postal Workers – Generic Drug

7. Discussion Questions What happened? What should have happened? What OC 1 Principle(s) were violated? Trust? Transparency? Early Announcement? Understanding Audience? Planning ahead?

8. OC 1 Best Practices Which Were Violated in Anthrax Case? Trust Between health authorities and the public – Compassion/empathy/concern – Expertise (includes consistency) – Honesty (Transparency) – Power – Identification

9. What can be done before an outbreak occurs to develop and maintain the public’s trust during an emergency?

10. CDC Communications Leadership Team Information Management Team (IMT) Web Team (WT) Communication Monitoring and Research Team (CMRT) EMERGENCY COMMUNICATION SYSTEM Department of Health and Human Services Assistant Secretary for Public Affairs Hotline Team (HT) Health Education Team (HET) Public Health Communications Team (PHCT) Media Team (MT) Clinicians Communications Team (CCT) Federal Governmental Communications Team (FGCT) Sept. 2003 Director’s Emergency Operations Center (DEOC) Emergency Communication Coordination Center (EC 3 )

11. OC 1 Best Practices Which Were Violated in Anthrax Case? Transparency – Easily understood – Includes communicating  What is known  What is not known  What is being done to answer questions – Disclosing bases of decision-making – Explaining limits of disclosure

12. What can be done before an emergency to increase your ability to communicate transparency?

13. OC 1 Best Practices Which Were Violated in Anthrax Case? Understanding the Public – Two-way communication – Find out public knowledge, opinions, beliefs – Respect public concerns (even when they conflict with experts’ assessments) – Increase public perceptions of control  Include personal protection actions

14. What can be done ahead of time to learn what the public knows and believes about potential outbreaks?

15. What can be done ahead of time to increase your ability to determine what the public is thinking about health threats and protection during an outbreak?

16. Case Study: Hurricane Katrina Hurricane Readiness & Recovery Drowning Prevention Carbon Monoxide Poisoning Prevention Food & Water Safety Electric Hazards Vector Borne Diseases Wound Care

17. Hurricane Katrina 80% of New Orleans evacuated 1200 deaths 1,700,000 homes without electricity

18. Coast Guard Request Request for workers safety guidance No electronic channels No overnight delivery No transportation into the site

19. Delayed Message Dissemination Delayed Communication Increased Health problems

20. Discussion Questions What happened? What should have happened? What OC 1 Principle(s) were violated? Trust? Transparency? Early Announcement? Understanding Audience? Planning ahead?

21. Announcing Early Reduces rumors and misinformation Delay causes distrust Delay causes over estimation of risk First messages provide the frame or context that subsequent messages must fit The earlier the risk is known the earlier prevention steps can mitigate harm Set expectations that information may change

22. What can be done ahead of an outbreak to increase your ability to announce information about health risks early?

23. A Template for Communicating Early

26. What can be done ahead of time to increase the speed of message dissemination?

27. Develop the Trust Triangle Communi- cation Scientist Policy Staff

28. Source Message Encoding/Language Channel(s) Audience Meaning

29. 3 Elements of Messages Content Element – Explicit information Relational Element – Caring – Respect – Power Contextual Elements – Beliefs and information held by the audience that will shape understanding of health messages

30. What can be done ahead of time to build trust and closer working relationships between scientists, policy staff, and communication staff (public affairs, health educators/communicators, social mobilization)?

31. What can be done ahead of time to get communication staff involved early in discussions with policy staff and scientists so communication mistakes are less likely?

32. Cross Cutting and Overarching Planning Principles Establish and strengthen relationships Develop and implement protocols Begin with the end in mind Plan for just-in-time public attention Plan for most-likely scenarios Use existing mechanisms and channels Others?

33. What Formats From Examples Work Best for Tools? Checklists Charts Flowcharts Templates Examples Others?