Guiding Principles for Pandemic H1N1 Influenza Communication: CDC's Response to Date and Preparing for What May Be Ahead

This 21-slide PowerPoint presentation emerges from the conference Putting Planning into Practice: The Communication Response to H1N1 (Washington, DC, United States (US), July 22 2009). It outlines key elements from the Center for Disease Control and Prevention (CDC)'s communication response to date.

In responding to the emergence of a novel influenza virus (H1N1), the CDC was challenged with several communication objectives, including: acknowledging uncertainties and challenges; recognising direct fear and concern (vs. attempt to minimise); providing timely, accurate, and helpful guidance (e.g., information that helps people protect themselves and their families); and utilising multiple communication channels (e.g., media, health care providers, health departments, social media) to increase reach and visibility of messages and recommendations.

In its response, the CDC has been guided by several principles, including: acknowledge the situation early; maintain transparency; identify uncertainties and the unpredictable nature of influenza (recognise that the amount of uncertainty is more than everyone would like, trust the public to tolerate incomplete and potentially upsetting information, and recognise that news media will have many opportunities to highlight/find uncertainty, conflicting views and opinions, incomplete science, or data); and offer anticipatory guidance.

The CDC's strategies and actions have included:

• Providing frequent updates - initially: daily press briefings, interviews, distribution of key points, updates to case count on the Worldwide Web; then: numerous meetings and conference calls with public and private sector partners; currently: weekly press briefings and continued extensive collaboration with public and private sector partners.
• Inviting news media to the CDC - providing inside access.
• Working to accept almost all media invitations.
• Engaging many experts to assist in media interviews/engagements.
• Actively assessing the communication environment (e.g., partner calls, media monitoring, looking at public opinion polls, calls to the CDC hotline).
• Updating the CDC website and other CDC resources continually.
• Using numerous channels for distributing CDC's resources and messages.

Challenges to the goal of protecting as many people as possible from influenza, particularly those at highest risk for serious implications and do so with as little social, economic, other disruption as possible, include:

• The situation will continue to evolve - including in unexpected ways.
• Views on the path and speed to take will likely vary - including publicly so.
• There are varied assessments and views related to threat, risk, vaccine, and mitigation measures - as well as uncertainties and incomplete data regarding the severity, transmission, and prevalence of novel H1N1 as well as seasonal influenza.
• US public concern is difficult to gauge - e.g., there is a relatively weak belief in value of influenza vaccine (as evidenced by seasonal flu vaccine use); there is likely a widespread perception that novel H1N1 disease is "mild" for most people; there is recognition or awareness of mixed messages; and there is concern that an H1N1 vaccine will have been made too fast and will be "too new" to be safe and/or effective.

Factors that impact demand for the H1N1 influenza vaccine include: perceptions/indications regarding when influenza viruses are expected to begin circulating; actual circulation of influenza viruses; severity and visibility of initial cases; the population groups most affected and/or most severely affected; and beliefs re: personal susceptibility to severe disease; ease of access to vaccination; past experience with vaccine and influenza; risk perception/assessment; and/or benefit perception/assessments (including whether antivirals would be a safer or more effective option).

Amongst the key considerations for pandemic influenza vaccine communication:

• In practice, it will be difficult to differentiate between seasonal and pandemic H1N1 illness - messages should prepare people for this and focus on general guidance that is applicable to all flu; messages comparing pandemic H1N1 with seasonal flu should not inadvertently foster or support public perceptions that seasonal influenza is a mild disease.
• Many "high-risk" people do not self-identify as such.
• The following can be expected to generate vaccine safety questions/issues/concerns: vaccination recommendations that involve children and pregnant women, variation in vaccination practices between locations/providers, and variation in vaccines and immunisation recommendations/approaches.
• Consumer demand for "choice" will likely exceed consumer demand for H1N1 vaccine.

Amongst the strategies identified for preparing in the face of uncertainty is the promotion of seasonal flu vaccine as a core which can be expanded and adapted. The author also suggests planning for a few key scenarios and being prepared to adapt communication approaches, messages, and materials. It is crucial to identify and train spokespeople to "communicate, communicate, communicate". Also mentioned in the presentation is the power of health care providers, the public health community, and state/local political leaders who are willing to support public health; "actions will be as or more important than statements" and getting vaccinated (vs. encouraging vaccination) will be important.