BUILDING COMMUNICATION
CAPACITY TO COUNTER
INFECTIOUS DISEASE
THREATS

Proceedings of a Workshop

V. Ayano Ogawa, Ceci Mundaca-Shah, and Joe Alper, Rapporteurs

Forum on Microbial Threats

Board on Global Health

Health and Medicine Division

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This project was supported by Contract No. GHN-G-00-07-00001-00, Contract No. W81XWH-14P-0339, Contract No. 200-2011-38807 (Task Order No. 38), Contract No. HSHQDC-15-C-00043, Contract No. VA250-16-P-1998, Contract No. DJF-16-1200-P-0002127, Contract No. 1R13FD005335-01, Contract No. HHSN26300055, and Contract No. HT94104-12-1-0009, between the National Academy of Sciences and the U.S. Agency for International Development, the U.S. Army Medical Research and Materiel Command, the U.S. Centers for Disease Control and Prevention, the U.S. Department of Homeland Security, the U.S. Department of Veterans Affairs, the U.S. Federal Bureau of Investigation, the U.S. Food and Drug Administration, the National Institute of Allergy and Infectious Diseases/National Institutes of Health, and the Uniformed Services University of the Health Sciences, respectively, and by the American Society for Microbiology, the Infectious Diseases Society of America, Johnson & Johnson, Sanofi Pasteur, and the Skoll Global Threats Fund. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-45768-2
International Standard Book Number-10: 0-309-45768-8
Digital Object Identifier: https://doi.org/10.17226/24738

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Building Communication Capacity to Counter Infectious Disease Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24738.

PLANNING COMMITTEE FOR A WORKSHOP ON BUILDING COMMUNICATION CAPACITY TO COUNTER INFECTIOUS DISEASE THREATS¹

JEFFREY S. DUCHIN (Chair), Health Officer and Chief, Communicable Disease Epidemiology and Immunization Section for Public Health, Seattle and King County, Washington

BARUCH FISCHHOFF, Howard Heinz University Professor, Department of Engineering and Public Policy, Carnegie Mellon University

JENNIFER GARDY, Senior Scientist, British Columbia Centre for Disease Control; Assistant Professor, School of Population and Public Health, University of British Columbia

RIMA F. KHABBAZ, Deputy Director for Infectious Diseases, U.S. Centers for Disease Control and Prevention

RAFAEL OBREGON, Chief, Communication for Development, United Nations Children’s Fund

JENNIFER OLSEN, Manager, Pandemics, Skoll Global Threats Fund

J. DOUGLAS STOREY, Director of Communication Science and Research, Johns Hopkins Center for Communication Programs

JANET TOBIAS, Founder and Chief Executive Officer, Ikana Health and Media

Project Staff

CECI MUNDACA-SHAH, Director, Forum on Microbial Threats

V. AYANO OGAWA, Associate Program Officer

T. ANH TRAN, Senior Program Assistant

JULIE PAVLIN, Director, Board on Global Health

Consultant

JOE ALPER, Consulting Writer

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

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FORUM ON MICROBIAL THREATS¹

DAVID A. RELMAN (Chair), Thomas C. and Joan M. Merigan Professor, Departments of Medicine and of Microbiology and Immunology, Stanford University

JAMES M. HUGHES (Vice Chair), Professor of Medicine and Public Health, Emory University

LONNIE J. KING (Vice Chair), Professor and Dean Emeritus, College of Veterinary Medicine, The Ohio State University

KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security

ENRIQUETA C. BOND, Burroughs Wellcome Fund (Emeritus), QE Philanthropic Advisors

LUCIANA BORIO, Acting Chief Scientist for Science and Public Health, U.S. Food and Drug Administration

TIMOTHY BURGESS, Director, Infectious Disease Clinical Research Program, Uniformed Services University of Health Sciences

DENNIS CARROLL, Director, Pandemic Influenza and Other Emerging Threats Unit, U.S. Agency for International Development

ARTURO CASADEVALL, Professor and Chair, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health

PETER DASZAK, President, EcoHealth Alliance

JEFFREY S. DUCHIN, Health Officer and Chief, Communicable Disease Epidemiology and Immunization Section for Public Health, Seattle and King County, Washington

EMILY ERBELDING, Deputy Director, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health

JENNIFER GARDY, Senior Scientist, BC Centre for Disease Control, Assistant Professor, University of British Columbia

JESSE L. GOODMAN, Professor of Medicine and Infectious Diseases, Director, Center on Medical Product Access, Safety, and Stewardship, Georgetown University

EDUARDO GOTUZZO, Director, Alexander von Humbolt Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia

STEPHEN A. JOHNSTON, Director, Center for Innovations in Medicine, The Biodesign Institute, Arizona State University

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

KENT E. KESTER, Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur

GERALD T. KEUSCH, Assistant Provost for Global Health, Boston University Medical Campus, Associate Dean for Global Health, Boston University School of Public Health

RIMA F. KHABBAZ, Deputy Director for Infectious Diseases, U.S. Centers for Disease Control and Prevention

STANLEY M. LEMON, Professor of Medicine and Microbiology and Immunology, University of North Carolina at Chapel Hill

JONNA MAZET, Professor of Epidemiology and Disease Ecology, Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis

JENNIFER OLSEN, Manager, Pandemics, Skoll Global Threats Fund

GEORGE POSTE, Chief Scientist, Complex Adaptive Systems Initiative, Arizona State University, SkySong

DAVID RIZZO, Chair, Department of Plant Pathology, University of California, Davis

GARY A. ROSELLE, Chief of Medical Service, Veterans Affairs Medical Center, Director, National Infectious Disease Services, Veterans Health Administration

JANET SHOEMAKER, Director, Office of Public Affairs, American Society for Microbiology

JAY P. SIEGEL, Chief Biotechnology Officer, Head of Scientific Strategy and Policy, Johnson & Johnson

PAIGE E. WATERMAN, Lieutenant Colonel, U.S. Army, Director, Translational Medicine Branch, Walter Reed Army Institute of Research

MARY E. WILSON, Clinical Professor of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco; Adjunct Professor of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University

EDWARD H. YOU, Supervisory Special Agent, Weapons of Mass Destruction Directorate, Federal Bureau of Investigation

National Academies of Sciences, Engineering, and Medicine Staff

CECI MUNDACA-SHAH, Director, Forum on Microbial Threats

V. AYANO OGAWA, Associate Program Officer

T. ANH TRAN, Senior Program Assistant

JULIE PAVLIN, Director, Board on Global Health

Reviewers

This Proceedings of a Workshop has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published Proceedings of a Workshop as sound as possible and to ensure that the Proceedings of a Workshop meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this Proceedings of a Workshop:

Baruch Fischhoff, Carnegie Mellon University

Peter Klein, University of British Columbia

Rafael Obregon, United Nations Children’s Fund

Barbara Reynolds, U.S. Centers for Disease Control and Prevention

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the Proceedings of a Workshop before its release. The review of this Proceedings of a Workshop was overseen by Georges Benjamin. He was responsible for making certain that an independent examination of this Proceedings of a Workshop was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this Proceedings of a Workshop rests entirely with the rapporteurs and the institution.

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Acknowledgments

The Forum on Microbial Threats staff and planning committee deeply appreciate the many valuable contributions from individuals who assisted us with this project. We offer our profound thanks to all the presenters and discussants at the workshop who gave so generously of their time and expertise. A full list of speakers and moderators and their biographical information may be found in Appendix C.

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Contents

ACRONYMS AND ABBREVIATIONS

1 INTRODUCTION

Meeting Objectives

Organization of the Proceedings of a Workshop

2 PERSPECTIVES ON BUILDING COMMUNICATION CAPACITY TO COUNTER INFECTIOUS DISEASE THREATS

Building Risk Communication Capacity: Can It Be Done?

Potential Challenges for Achieving Successful Communications for Infectious Disease Threats

Perspectives of the American Society for Microbiology

3 LAYING THE FOUNDATION FOR EFFECTIVE COMMUNICATION

The Building Blocks of Successful Communication Capacity

Learning from the Decision Sciences to Design Targeted Messages

Evidence-Based Methods and Evaluation Strategies

Goals for Risk Communication

Translating Risk Perception into Behavior Change

Sources of Information: Lessons from Communication in Liberia

Advocacy and Communication of Health Risks: Examples from Tobacco Control

Discussion

4 ACHIEVING EFFECTIVE COMMUNICATION

Packaging a Story: Traditional Versus Digital Media

Responding to Misinformation and Rumors

Participatory Surveillance and Social Listening

Bidirectional Communication Platforms

Training the Trainers

Discussion

5 INTEGRATING DATA AND EVIDENCE INTO COMMUNICATION STRATEGIES IN THE FIELD

Using Data to Refine Communication Strategies

A Bottom-Up Approach to a Successful Response

The Front Lines: Where Data Meet Reality

Discussion

6 A SYSTEMS PERSPECTIVE ON STRENGTHENING RISK COMMUNICATION AND COMMUNITY ENGAGEMENT IN DISEASE OUTBREAK RESPONSE

Risk Communication as a Core Capacity Under the International Health Regulations

Strengthening Risk Communication: Coordination and Leadership

Discussion

7 WORKSHOP HIGHLIGHTS AND REFLECTIONS

REFERENCES

APPENDIXES

A STATEMENT OF TASK

B WORKSHOP AGENDA

C BIOGRAPHICAL SKETCHES OF WORKSHOP SPEAKERS AND MODERATORS

Boxes, Figures, and Tables

BOXES

1-1 Workshop Objectives

6-1 Communication Strategies Often Needed in Countering Infectious Diseases

6-2 Post-Ebola Lessons Learned Identified in 2015 World Health Organization Stakeholders’ Meeting

7-1 Lessons Learned from the Workshop

FIGURES

2-1 As the delay between outbreak and risk communication widens, the opportunity to control the outbreak diminishes

3-1 Connecting professionals with the public in creating a risk communication plan

3-2 Different devices for communicating numbers visually

3-3 How risk can be translated into behavior change

3-4 Changes in the distribution of people in four risk perception attitude framework groups

3-5 Effect of budget cuts to the Florida TRUTH campaign on campaign-targeted beliefs

3-6 Effect of budget cuts to the Florida TRUTH campaign on intentions to avoid trying cigarettes

3-7 Relationship between levels of education and recall of Wisconsin smoking cessation ads

4-1 Global spread of vaccine sentiments following Japan’s suspension of its human papillomavirus recommendations

4-2 Percentage of people who disagreed with the statement, “Overall, I think vaccines are safe ”

4-3 Proportion of vaccine-related reports in the media categorized as positive or neutral

4-4 Tweets about Zika vaccine tracked those with pseudo-scientific claims

4-5 Fear of stigmatization over time after a nationwide anti-stigma campaign in Sierra Leone

4-6 Improvement in following quarantine restrictions over time in Sierra Leone

4-7 The public’s sense of progress as an indicator of controlling the Ebola outbreak

5-1 Progression of the Ebola outbreak in Liberia

6-1 The World Health Organization’s integrated systems model for assessing emergency risk communication capacity in joint external evaluations

7-1 Responses to the question, “In one word, what do you think the biggest challenge is with building communication capacity to counter infectious disease threats?”

TABLES

3-1 Sources of Risk Communication on the Ebola Outbreak in Liberia During the 2014 West African Ebola Crisis

3-2 Assignment of Blame for the Ebola Crisis According to Different Media Sources

3-3 Multiple Sources Receiving Credit for Resolving the Ebola Crisis According to Different Media Sources

3-4 Rumors About Ebola Circulating in Liberia

4-1 The Vaccine Confidence Project’s Rumor Diagnostic Tool

Acronyms and Abbreviations