State of the Globe: Ensuring Effective Communication in Public Health Emergencies

The world will never forget the epidemic of severe acute respiratory syndrome (SARS) more than a decade ago that gripped the Mainland China and Hongkong from November 1, 2002, to July 31, 2003, killing 648 of the 7082 probable cases of SARS. Five years ago and exactly 10 years after the SARS epidemic, the emergence of the novel influenza A (H7N9) virus caught the attention of the entire world. If, on the one hand, these epidemics raised questions on the fragmented and ineffective public health system in China, on the other hand, eyebrows were raised on Chinese Government's efforts to curb the flow of information.[1]

One of the vital components to take a beating in case of public health emergencies is “Communication.” Public health emergencies invariably involve some forms of communication failure. This failure in communication not only contributes to the disruption of other essential services but also gives rise to false and unwarranted alarm sending panic button rolling.

A constant need to improve communications related to public health emergencies is being felt more than ever before. It is being understood now that effective communication is an important component of emergency response initiatives. In fact, realizing this with regard to disasters, the UN Sendai Framework for Disaster Risk Reduction called upon national governments to continue to develop “people-centered” disaster risk and emergency management mechanisms.[2] The framework assumes significance in case of emergencies with cascading effects. Public health emergencies have an adverse cascading effect on not just our health systems but also the general public as well. Therefore, effective communication is the key.

A public health emergency generates a widespread public concern and therefore media attention. It becomes incumbent on the Government to keep the public informed about the emergency as well as the emergency response mounted to tackle it. Information on the emergency and its effect can be communicated through some simple means such as through the schools or community meetings or via the mass media such as radio, newspapers, and television. In wake of wide reach of social media, this can also be used for effective information dissemination.[3] However, the most important aspect of this information dissemination is that the information should be simple and clear.[3] This will not only help allay fears but will also convey important public health message regarding preventive, promotive, and curative aspect of public health emergency under question.

The media print, electronic or social, has to be involved as a major stakeholder in keeping the population informed. The health department needs to come out with regular press releases and conferences to help the media play their role and help avoid “media hounding.” A designated spokesperson must be appointed to receive clear instructions from the Government and update information to the media. The most important aspect of these media briefings is not to rely on media for the interpretation of emergency and the response but provide experts' opinion for media to publish or release.

Probably, the most important and at the core of public health interventions to tackle public health emergencies is “risk communication.” Neglecting risk communication serves a deleterious blow to the preventive and curative management in a public health emergency. As risk communication relies largely on real-time exchange of information, advice, and opinions between experts, officials, and people who face a threat to their well-being, to enable informed decision-making and to adopt protective behaviors, effective risk communication goes a long way in managing public health emergencies.

Effective risk communication involves multiple stakeholders. Any interruption in this communication chain and flow of information between functionally interdependent stakeholders is a trigger for our failure to manage emergencies. Therefore, coordination and information sharing between key stakeholders will avoid and reduce the potential vulnerability in the emergency affected sociotechnical systems.

Health systems across the world are based around organizational setups functioning in a top-down manner. Public health system is no exception to this. Using this top-down approach in public health emergency may not work. The command and control approach to public health emergency has given way to a more flexible multi-stakeholders approach. This multi-stakeholders' approach places a greater faith on the members of the general public to effectively manage and exchange information. However, this “shared responsibility” does not mean that all members of the public are involved in the information flow, but it means to identify roles played by the members of the public in dissemination of information. These multiple stakeholders help effectively quell rumors, misinformation, and disinformation.[4] In addition, the presence of these multiple stakeholders helps public health researchers and policymakers with an independent pool of information for future use and reference. Critical collation of this information serves a long way in the effective management of public health emergencies. The article by Qiu W et al., will probably lead the way in identifying the communication problems for emergency management in infections disease epidemic.[5]