dealing with a potential crisis. CDC has outlined four communication principles: (1) consistency and consensus; (2) acknowledgement of and tolerance for uncertainty; (3) communication research; and (4) importance of addressing diversity of communication needs. In addition to these principles, and as previously noted, the committee finds a need to differentiate between political and public health communications and to position CDC firmly in the realm of evidence-based public health communications. Finally, but perhaps most important, there is the principle of informed consent, mentioned above. All communication materials and strategies targeting potential vaccinees and the general public should emphasize the voluntary nature of the vaccination program.

The second through fourth communication principles are addressed to some extent throughout the report. In regard to the first communication principle of consensus and consistency, the committee was unclear about how communication between CDC communicators and their state and local health communicators will occur. What strategies will be employed to ensure standard language is used and that local, state, and national decisions and plans are well aligned?

The committee has concluded that CDC’s communication strategy seems well developed in two broad areas: passive information (e.g., training materials, fact sheets) about the disease, the vaccine, and the vaccination campaign, available on the website; and crisis material, prepared to respond to a news event/vaccine crisis or smallpox release. Although the first phase of the vaccination program involves only health care workers, it is never too soon to begin educating the general public; therefore, the committee recommends that more attention be given to developing a variety of materials and channels to inform and educate the public about the immunization program before vaccinations begin.

Furthermore, communication planning and tools should differentiate between pre- and post-event information needs. Current training needs and news events are different from potential crisis response, and planning must take place to address each area individually.

A wide range of channels should be used to communicate to and with various audiences, from the media to the general public, from health care workers to policy makers. As the time to make the vaccine available to the general public nears, CDC may wish to consider a mass mailing to every U.S. household, in the style of former Surgeon General Koop’s mailing on HIV/AIDS.

Some of the communications questions submitted by CDC to the committee were not answered, as they require empirical and formative communications research (e.g., message development, literacy-level testing). Other than recommending a candid, transparent communications approach that is sensitive to and appropriate for the range of literacy levels and cultural



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