How do you help the public understand what to do in a large-scale emergency requiring medical countermeasures (MCMs), a crisis situation that they have never contemplated? And how do you rapidly mobilize them to get government-provided medications? A portion of the public is wary of any guidance from health officials, and even those who trust the public health department may experience such high levels of emotion during a public health emergency that it may be difficult for them to process instructions. When we need people to take extraordinary protective actions, how do we garner their trust and spur them to action?
In most MCM emergencies, people must get medication quickly, but anxiety and fear will hinder people’s cognitive function. One way to break through the high levels of emotion is to help people mentally rehearse what we ask them to do. An MCM event will be utterly unfamiliar to most, so as a public information tactic, our MCM planning team chose to literally create the picture by illustrating an MCM response.
In the past, our health department used simple pictograms, but to prepare for an MCM event, we chose the comics medium. Comics allow us to combine images with dialogue and symbols to enhance clarity while keeping the amount of text low, making information and instruction more accessible to people with lower literacy and limited English.
In addition, the level of visual detail available in comics will better prepare the public for what to expect. For example, even without any text, the illustration of a point of dispensing (POD) location shows that they will be held in public spaces, like a school gym, and that there will be professional staff identifiable by their vests (Image 1). It also prepares people to wait in lines and conveys an organized, capable system in place. Illustration can also make instructions easy to understand, such as the comic panel on how to crush and mix medications for children (Image 2).
IMAGE 1—
This illustration was designed to help people visualize what to expect at a point of dispensing, including long lines, an organized system in place, and professional staff identified by their vests.
IMAGE 2—
Visual instruction on how to crush medication into child-sized portions, ready for mixing into applesauce or pudding.
The realistic illustration style also facilitates mental rehearsal by helping people see themselves in the situation. We ensured that the diversity within our communities was reflected in the illustrations. We also paid close attention to the emotional expressions of the people depicted so that they would credibly reflect the level of concern during an MCM emergency (Image 3) and also the POD staff as approachable and competent.
IMAGE 3—
The public will need to attend to frequent updates in an evolving public health emergency, so this illustration models the behavior of checking the news media and preparing to go to a medication center. We worked with the illustrator to convey a sense of urgency in the expression and movement of the woman preparing to get her medication.
To expedite the dissemination of public information in an MCM emergency, we predeveloped flyers using illustrations to instruct the public about (1) what to expect when they pick up medications, (2) where to pick them up, and (3) how to take them (Images 4 and 5). Electronic versions can be sent at a moment’s notice to vast networks of health care providers, emergency managers, news media, and community partners using blast e-mail and alerting systems. The square format of the comics makes them easy to share over social media, and sharing is aided by strategic boosting and coordination with the social media accounts of local news and response partners. In an emergency, we will also post the comics on our Web page and blog for easy online referral.
IMAGE 4—
To illustrate a point of dispensing held at a workplace, we chose an industrial location to avoid perceptions that private medication centers will only benefit people in the highest paid or white-collar jobs.
IMAGE 5—
This illustration cues people to fill out a voucher at home that lists the current medications of all their family members. This step will help efficiency at a point of dispensing (POD) and ensure that POD staff have the needed information. Providing the public with actions they can do in advance can help ease anxiety during a public health emergency.
Our jurisdiction has not yet experienced a large MCM event, but in the meantime, the comics have been useful in everyday public health promotion. For example, a single post to Facebook of a comic showing the vaccination of a pregnant woman reached nearly 5500 people and led to hundreds of clicks to our information about flu vaccine for pregnant women (Image 6). We had similar success in the 2017–2018 flu season when we posted a gallery of comics illustrating when to seek medical care; it reached more than 13 000 people, prompted more than 300 reactions, and led to thousands of post clicks. The accessibility of these comics has also been valuable in presentations given to potential private POD partners, helping explain components of MCMs.
IMAGE 6—
This panel shows doctors’ offices as a place where people can receive emergency medical countermeasures. We’ve also used this image for everyday public health promotion of immunizations.
Most importantly, these MCM comics are at the ready, should an emergency arise, to make critical information more accessible, help people visualize the protective actions they need to take, and instill confidence in the public health system.
ACKNOWLEDGMENTS
This project was supported by the Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response (award 118284).
David Lasky created the artwork.