J. Risk Research: Communicating About Uncertainty & Evolving Science During The H1N1 Pandemic

Credit WHO

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Although the next global health crisis will bring with it a great many scientific, logistical, and political challenges, the toughest of them all may be in communicating honestly and effectively about the risks with an increasingly skeptical public.

A population who have not one - but hundreds - of sources of  information (or misinformation) to draw from.

The Internet, cable news (cue the dramatic bumper music!), and the tabloid press all thrive on viewers, `clicks', or web traffic, and the `sexier' the headline, the more dire or hyperbolic the story line, the more revenue they generate.

Officials, national, and international, often want to appear to have matters under control, and have been known to make well-meaning statements which don't always pan out.

Case in point: shortly after the 2009 H1N1 virus appeared - and was feared to be moderately severe -  the WHO projected nearly 2.5 billion doses of vaccine would be produced in 6 months time. 

While a safe and effective vaccine was produced in record time, production fell nearly 80% short of that goal.  Luckily the pandemic was relatively mild, and the demand for vaccines dropped rapidly.

Add in the growing distrust of science and scientists in general - on everything from climate change, to nuclear power, to vaccines and GMOs - and the effective delivery of credible information to the public during a pandemic becomes all the more difficult.

Regrettably, a lot of that can be mistrust attributed to self-inflicted wounds (see When Scientists Behave Badly).

Outbreaks also have a habit of upending our current scientific understanding of the risks, and can often require backtracking of advice and the reassessment of risks along the way. 

• After Ebola was imported to a Texas Hospital in 2014, the CDC had to scramble to amend their PPE recommendations following the infection of two nurses.  
• Until it was documented in 2015, nobody gave the idea of sexual transmission of the Zika virus a second thought.  Now, there are investigations into other vector-borne other viruses that may also be transmitted via semen.

Even under the best of circumstances, risk communications during a severe pandemic will be fraught with pitfalls, and all will not go as planned.  Preparing the public for such eventualities needs to be part of the message.

Looking back at how well Canadian officials did with their risk communications during the 2009 H1N1 pandemic, we have an article in the Journal of Risk Research that looks at what improvements are needed before the next global health crisis arrives.

It's a long article, and well worth reading in its entirety.

‘Damned if you do, and damned if you don’t’: communicating about uncertainty and evolving science during the H1N1 influenza pandemic

Abstract

During the 2003 SARS outbreak in Toronto, Canada, communication with the public was poorly executed by health authorities. Key problems included mixed and unclear messages, widespread public confusion, and attributions of incompetence toward health officials.

Subsequently, Canadian health officials developed pandemic plans that included specific sections dedicated to communication. Plans counseled a strategy of transparent risk messaging to give people the information they need and build public trust.

When the H1N1 influenza pandemic arrived in Canada in 2009, these plans were put to their first test in a major public health event. However, many of the same problems that existed during SARS arose again during pH1N1.

This study investigates the dissonances between the ideals and reality of communication during pH1N1 based on analyses of two data sources: (1) key informant interviews with senior health officials (n = 28) from federal and three provincial (Alberta, Manitoba, Ontario) health jurisdictions in Canada; and (2) focus groups (n = 15) with general population Canadians (n = 140) in Alberta, Manitoba, and Ontario.

Discussions with participants showed that even with a transparent communication approach, aspects of the pandemic, such as its ‘risk’ and the complexities of the immunization campaign, proved difficult to convey without causing public confusion. Members of the public often resorted to their own inventories of knowledge – usually those related to seasonal influenza – to interpret and make sense of pandemic messaging, but these did not guarantee accurate understandings.

The inherent uncertainty of a real-time pandemic was also a difficult concept to communicate to a public with little prior experience of such an event. While transparent communication was intended to build trust, resulting confusion fueled a loss of confidence in health officials.

A more ‘reasoned’ approach to transparency needs to inform future pandemic communication and further research is required to determine how to refine such an approach.

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