Building communication capacity is a critical piece of preparing for, detecting, and responding to infectious disease threats. The International Health Regulations (IHR)2 establish risk communication—the real-time exchange of information, advice, and opinions between experts or officials and people who face a threat to their survival, health, and economic or social well-being—as a core capacity that World Health Organization (WHO) member states must fulfill to strengthen the fight against these threats. Despite global recognition of the importance of complying with IHR, 67 percent of signatory countries report themselves as not compliant (WHO, 2015). This lack of capacity has grave consequences, as shown during the West African Ebola epidemic that began in late 2013 and killed 11,325 people according to the U.S. Centers for Disease Control and Prevention3 (CDC). The lack of communication infrastructure and procedures delayed the transmission of key messages from public health and government officials to the public (Bedrosian et al., 2016). Furthermore, poor mechanisms were in place for the public to share questions, concerns,
1 The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
2 Available at www.who.int/topics/international_health_regulations/en (accessed February 13, 2017).
and fears with public health authorities (Wilkinson et al., 2017). By investing in communication capacity, public health and government officials and civil society organizations facing similar crises would be prepared to provide advice, information, and reassurance to the public as well as to rapidly develop messages and community engagement activities that are coordinated and take into account social and behavioral dynamics among all sectors.
Various organizations, including CDC (2011) and WHO (2008), have provided guidance on developing frameworks, standards, protocols, and conceptual approaches to communicating critical information during infectious disease outbreaks. Furthermore, governments and nongovernmental organizations have developed and implemented plans to address the gaps in communication capacity during these situations. Despite the progress, many governments have not streamlined, integrated, or translated these approaches into effective practice and self-reported to lack the full implementation of risk communication capacity as defined under the IHR (WHO, 2016b). Moreover, some of these efforts have not been replicated or tested in different outbreak scenarios and have not considered the entire political, social, and cultural environment in which communication occurs.
To learn about current national and international efforts to develop the capacity to communicate effectively during times of infectious disease outbreaks, and to explore gaps in the research agenda that may help address communication needs to advance the field, the Forum on Microbial Threats of the National Academies of Sciences, Engineering, and Medicine convened a 1.5 day workshop on December 13 and 14, 2016, in Washington, DC. This workshop brought together stakeholders at different levels of outbreak detection, preparedness, and response. They reviewed progress and needs in strengthening communication capacity for dealing with infectious disease threats for both outbreaks and routine challenges in the United States and abroad. An ad hoc committee with members Jeffrey S. Duchin (Chair), Baruch Fischhoff, Jennifer Gardy, Rima F. Khabbaz, Rafael Obregon, Jennifer Olsen, J. Douglas Storey, and Janet Tobias planned the workshop. The workshop featured invited presentations and discussions that aimed to meet the workshop’s objectives (see Box 1-1).4
In his welcome to the workshop attendees, David Relman, the Thomas C. and Joan M. Merigan Professor at Stanford University, noted that the forum members have been discussing the essential role communication plays in the prevention, detection, and response to microbial threats
and have sought to organize a workshop to discuss key problems and strategies around this important topic for several years. “We view these topics as fundamental to the business of translating theory and research and development into policy in the realm of emerging infectious disease,” said Relman. Jeffrey Duchin, health officer and chief of the Communicable Disease Epidemiology and Immunization Section for Public Health in Seattle and King County, Washington, added that the high-level goals of the workshop were to highlight the benefit and importance of cross-disciplinary contributions in this area and to examine opportunities and challenges for building improved communication capacity and capability.
In accordance with the policies of the National Academies of Sciences, Engineering, and Medicine, the workshop did not attempt to establish any
conclusions or recommendations about needs and future directions, focusing instead on information presented, questions raised, and improvements recommended by individual workshop participants. Chapter 2 outlines different perspectives on the challenges and opportunities of communicating infectious diseases threats. Chapter 3 lays out the scientific foundation for effective communication, drawing from the fields of social, behavioral, and decision sciences. Chapter 4 discusses effective communication in practice during an outbreak. It delves into approaches in packaging stories, managing misinformation and rumors, leveraging participatory surveillance and bidirectional communication platforms, and training journalists and other communicators on the ground. Chapter 5 presents the role of data and evidence in the field, using lessons from the recent Ebola and Zika outbreaks. Chapter 6 covers strengthening communication and community engagement efforts in disease outbreak response from a systems level. It describes the gaps of the international normative aspects of risk communication under IHR and the elements needed to implement communication capacity from a systems-strengthening perspective. Finally, Chapter 7 reports on crosscutting themes and possible strategies in building communication capacity to counter infectious disease threats.