# 4235
“This next week, or beginning this weekend, we're going to kick off the national influenza vaccination week. This is a concerted effort that the CDC, health and human services and all of our partners to encourage vaccination.
It includes a focus on people at high risk for complications, adults with emphysema, pregnant women, seniors, children, really encouraging vaccination for anyone who hasn't yet been vaccinated and wants to be.” – Dr. Anne Schuchat, CDC News conference Jan 8th, 2010
Yesterday, the CDC basically stated that it was time for seniors to get in line for the novel H1N1 vaccine. Until now, with vaccine in short supply, the focus has been on vaccinating children, teenagers, and adults under the age of 64.
While this change was anticipated, many seniors – after hearing for months that they are at low risk of catching the virus – may not be very quick to embrace the vaccine. And that is something that Dr. Peter Sandman worries will backfire on public health officials.
Dr. Peter Sandman is an expert on effective crisis communications, and he along with his wife and colleague Dr. Jody Lanard produce a wealth of invaluable risk management advice on their website:
I’ve highlighted their work on numerous occasions, including:
Peter Sandman: Swine Flu For Grownups
Experts: `Mild’ Is A Misleading Term For This Pandemic
Peter Sandman On Pandemic Risk Communication
Yesterday Newsweek ran a story entitled Why Seniors Really Should Fear Swine Flu which was based largely on an analysis created by Dr. Sandman back in December, looking at the relative risks that various age groups face with the H1N1 swine flu.
Dr. Sandman used data from CDC Estimates of 2009 H1N1 Influenza Cases, Hospitalizations and Deaths in the United States, April – November 14, 2009 which is pretty much summarized in the chart below.
First we’ll look at the opening paragraphs of the Newsweek article, then we’ll go to the original analysis by Dr. Sandman, and end with a few brief comments of my own.
Why Seniors Really Should Fear Swine Flu
The CDC's vaccination advice for the over-65 set has been misleading.
Jan 8, 2010
In the federal government's explanations of swine flu, through its Web site and public-service announcements, one message has come through loud and clear: seniors can rest easy. Children face a much greater risk from this disease, and they are dying from it in numbers never seen with regular, seasonal flu. Maybe seniors even have some special immunity to H1N1.
There's only one problem: according to a new analysis, the CDC's own numbers show clearly and unequivocally that H1N1 is more than twice as deadly to seniors as to children. As a result, "many older adults undoubtedly underestimate their own risk and the importance of getting vaccinated," says Peter Sandman, a longtime scholar of risk communication. "Older adults have been told they don't have to worry, and that's not true. If the virus comes back, people will die."
Sandman's analysis of the latest estimates of cases, hospitalizations, and deaths by the U.S. Centers for Disease Control and Prevention is here, but let me summarize the basics. Children 0 to 17 are likeliest to catch swine flu. But adults (18 to 64) and seniors (65 and older) are much more likely to die of the disease. Kids are least likely to die if they catch swine flu.
The analysis from the Sandman website follows. You’ll want to follow the links to read this in its entirety.
What the CDC Is Saying about Swine Flu Severity
- How deadly is the pandemic so far?
- What age groups is it hitting hardest?
- What age groups does the government say it is hitting hardest?
by Peter M. Sandman
This update draws some inescapable tentative conclusions from the most recent (December 10) tentative estimates of U.S. pandemic flu cases, hospitalizations, and deaths provided by the U.S. Centers for Disease Control and Prevention (CDC).
The update also contrasts the CDC’s estimates with CDC communication about them, and with the Department of Health and Human Services’ new H1N1 vaccination campaign, “Together we can all fight the flu,” launched on December 7.
I don’t have any opinion on whether the estimates the CDC reported on December 10 are reliable, valid, and useful. But I am certain that the arithmetic I have performed on those estimates to show what they mean is solid. And I am certain that what the CDC’s estimates mean diverges significantly from what the U.S. government is telling people about the pandemic.
It is important to note that Dr. Sandman is not criticizing the CDC’s decision to target children, teenagers, and younger adults for vaccination. That is, as he points out, not his field of expertise.
He cautions, however, that the messaging from the CDC needs to accurately convey the facts, and not just support their policy decisions. Something he feels hasn’t always happened with their vaccine messaging.
Otherwise, he warns, they risk losing credibility.
Last summer, when the Advisory Committee On Immunization Practices decided to target children, teenagers and young adults (see The ACIP Committee Recommendations) for vaccination, the data was showing mostly children and teenagers being hit by this virus.
The downsizing of the estimated volume of vaccine to be available by mid-October, from 120 million doses to about 45 million (a target that was not met), further complicated matters.
Between the early demographic data, and the scarcity of vaccine supplies, one can understand the focus by the CDC on vaccinating pregnant women, children and teenagers.
Since kids are walking Petri dishes, targeting them first appeared to provide the most bang for the buck.
Although it was only 3 weeks ago that I was able to get the H1N1 vaccine (I’m 55 and not in a risk group), we now find ourselves awash in vaccine. To the point where there is talk of giving away millions of doses lest they go unused.
Admittedly, all of this has been a precarious balancing act for the CDC, with shifting demographics and vaccine supplies. Trying to convey a simple `sound byte’ message about vaccination, without it becoming too convoluted, has been a challenge.
And perhaps, that’s the problem. Trying to deal in `sound bytes’.
Designing an information campaign that relies on 10 second, or even 30 second PSAs, is the equivalent of my giving up this blog and only posting 140 character `microblogs’ on Twitter.
It makes it difficult to `flesh out’ a message.
I’m not an expert on crisis communications, but following the ACIP recommendations, a better message early on might have been:
“Pandemic flu is a risk to everyone, although some in our older population may be lucky enough to have developed limited immunity to this virus.
Eventually we hope to see everyone vaccinated against H1N1, as vaccination is our best protection against influenza.
Right now, however, vaccine supplies are limited. More is on the way.
But for now we need to target those who are the biggest spreaders of the flu – children and young adults – and those we currently believe to be at highest risk – pregnant women and those with chronic health problems.
We ask for your patience. When more vaccine becomes available, we will expand coverage to all ages.”
Too complicated? I don’t think so.
But it requires more than 10 seconds.
And it requires trusting the public to understand that there are physical limits as to what the government can do. Something that many in government are loath to admit.
As we face an increasingly complicated world, with threats that are not always well defined and solutions that are not always clear cut, we should be moving towards better risk communication . . .not shorter risk communication.
And for that, I can think of no better resource than the Sandman website. Something that should be required reading for anyone charged with communicating with the public.
