Homeland Security Watch

News and analysis of critical issues in homeland security

April 26, 2009

Swine flu risk communications, continued

Filed under: General Homeland Security,Preparedness and Response — by Philip J. Palin on April 26, 2009

FOURTH UPDATE (6:00 pm eastern):  The tone of US based media seems to be shifting to reflect today’s White House briefing, if the following represent a trend:

A new CNN story is headlined, Take standard flu season precautions to avoid infection.

Most suspected flu patients in Mexico now healthy is a Reuters headline filed late Sunday afternoon.
 
Swine Flu Outbreak Sparks Rapid Response is what Congressional Quarterly is reporting.

The risk communications challenge may now be greatest in terms of new media and social networks and how the Swine Flu threat is communicated outside the US.  For example, see a story from one London tabloid, the headline is “Swine Flu ‘could kill up to 120 million.”  In combination with the Internet’s own viral capabilities, a few stories like this one can have a significant echo.  MONDAY MORNING MENTION: Further to the global risk communications challenge, this morning’s Wall Street Journal leads with, “European stocks fall on fears over swine flu.”

THIRD UPDATE: (3:47 eastern): In a great example of risk communications good practice, the DHS press office just released a complete transcript of the mid-day Sunday White House press briefing.  This reinforces the briefing’s messages and helps ensure that the details of the briefing will be used in the Sunday night/Monday morning news cycle.   The transcript is available at http://www.dhs.gov/ynews/releases/pr_1240773850207.shtm  This will also give all of us in the blogosphere the opportunity to nit-pick individual answers, but the likely pay-off is well worth that hassle factor. (Also read transcript of 3:00 pm CDC teleconference.)

SECOND UPDATE (3:00 pm eastern): The White House briefing’s predictable headline was “US declares public health emergency.”  What could not be predicted 90 minutes ago is how the media would frame the story.  It is still too soon to reach that judgment, but following is an Associated Press summary (in its entirety):

AP Top News at 2:37 p.m. EDT

WASHINGTON (AP) — The U.S. declared a public health emergency Sunday to deal with the emerging new swine flu, much like the government does to prepare for approaching hurricanes. Officials reported 20 U.S. cases of swine flu in five states so far, with the latest in Ohio and New York. Unlike in Mexico where the same strain appears to be killing dozens of people, cases in the United State have been mild — and U.S. health authorities can’t yet explain why.

Fair enough and suggests the briefers — and on this headline, especially Secretary Napolitano — were effective in putting a “public health emergency” in its appropriate context.  Further, it demonstrates the AP reporter, at least, was listening for context.

UPDATE (12:25 pm eastern):  White House briefing on Swine Flu is scheduled for 12:30.  Can be seen streaming at: http://www.whitehouse.gov/live/ 

After-Briefing Comment(1:21 pm eastern):  The quartet of briefers came off as competent and credible.  They projected confidence.   They communicated, at least to me, that reasonable — even aggressive — measures are being taken to mitigate the currently modest threat from morphing into something more.  Yet they were also clear regarding the unpredictable nature of viral mutations.  Perhaps as important, they set-out a framework for regular updates and communication that should discourage undue speculation and rumor-mongering. The full impact of today’s intervention probably depends on:

1.  How well others follow-through with the  public communication process set-out, and

2.  The progress of the disease.

I thought it was an interesting decision to have this briefing at the White House and to have John Brennan as the first one up to brief.  There is not, however, enough information to make much meaning — yet — of these decisions.

It will be interesting to see what the public and media do with this briefing.  But, to me, it was a very effective example of a good risk communication intervention.   I certainly welcome your impressions and analysis via the comment function.

In terms of follow-through beyond the White House, at 3:00 pm (eastern) on Sunday there was a media teleconference with the CDC’s Dr. Anne Shuchat.  The transcript of the teleconference is available and packed with helpful information.

——————————————–

At 6:00 am (eastern) on Sunday the BBC has just posted a new headline story: Mexico flu sparks worldwide fear.

Global alarm at swine flu outbreak, graces the Boston Globe’s frontpage.

Swine flu spreads panic in Mexico City, is the headline on USAToday’s website.  (USAToday does not produce a print product on Sundays)

The Times Online, probably the most understated of the Murdoch media empire, offers, Fear of pandemic as killer flu strain spreads.”

On Saturday afternoon the CDC released a new Health Advisory. Combined with other communications pieces, the health advisory might have been a  helpful risk communication tool.  But it is clearly oriented to the health care community, not to the media or general public.  Just as the CDC is working to anticipate the needs of public health officials and clinicians, there is a need to anticipate the needs of the media and the public.  Contrast the CDC’s Health Advisory to the NYC Health Department’s Saturday announcement (see last post from Saturday below).  The NYC statement is sensitive to context and public implications in a way the CDC statement is not.

(Editorial note: On Saturday I was regularly checking the CDC website and clearing my cache.  While it could certainly be the result of user error, I was not seeing the 3:00 pm time-stamped statement as late as 5:45 pm.) 

 The White House blog, a  usually lively and user-friendly place, merely  points to the largely dormant CDC website for Swine Flu information.  In his media briefings White House spokesperson, Robert Gibbs, has emphasized that the Homeland Security Council, under the leadership of John Brennan, is monitoring the situation in the United States and Mexico. UPDATE: Appearing this morning on Meet the Press, Reuters quotes Mr. Gibb’s as saying, “It is important for the public to understand that we are taking proper precautions to address anything that happens, it’s not a time to panic.”

Sunday morning on CNN, Sanjay Gupta, a physician once considered a possible Surgeon-General, interviewed a CDC senior official.  (As of 8:30 am eastern I cannot yet find a weblink, but expect it will soon be added to the CNN House Call website.)

Late on Saturday (very late Geneva-time) the WHO released a statement that includes, “After reviewing available data on the current situation, Committee members identified a number of gaps in knowledge about the clinical features, epidemiology, and virology of reported cases and the appropriate responses. The Committee advised that answers to several specific questions were needed to facilitate its work. The Committee nevertheless agreed that the current situation constitutes a public health emergency of international concern.” 

Fear of the unknown is a predictable human response.  We can sympathize, even admire, the WHO committee’s acknowledgement of the null hypothesis.  I would suggest the world’s physician needs to better acknowledge the role of an effective bedside manner.

Media are telling us about new diagnoses in New Zealand.   Otherwise, there is not much new information, which is one of the reasons the media is shifting its attention from cause (biology) to effect (psychology).  This will, in any case,  be the tendency of journalist generalists (and even more the tendency of bloggers and such) unless the risk communications operation is consistently providing new — or even re-packaged — facts. 

An early morning report from Bloomberg, Swine Flu Emergency Caused by New Variant of Old Bug, is one of the more informative and least bombastic of the media reports.  But even here it is hard to read without a slight increase in one’s blood pressure.

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5 Comments »

Comment by William R. Cumming

April 26, 2009 @ 9:59 am

Great follow up and thanks. Again EPI–Emergency Public Information could be critical in response to this growing story. A real test of White House now underway given the centralization of public information since 24/7 and 365 news cycle on TV began in 1982. A revolutionary development really and not fully analyzed for its impact on domestic crisis management!
Somewhat interesting is that if this turns out to be a real Pandemic event started in the Western Hemisphere while the “watchers” all looking at Asia.

Comment by William R. Cumming

April 26, 2009 @ 12:57 pm

Would like to have been fly-on-the-wall for run-up to Brennan’s briefing and who was there to help prep? Is there an MD on either HSC or NSC staff? A virologist or epidemiologist? Any kind of scientist?

Comment by William R. Cumming

April 26, 2009 @ 3:08 pm

Nice coverup by the White House. In June 2002 President signed into law Public Law 107-188 that gave directly to the Secretary HHS or her delegate (CDC?) authority to declare a Public Health Emergency. Since no Secretary HHS and no permanent head of CDC most of press conference featured Secretary DHS who has NO repeat NO authority to declare a Public Health Emergency. See some of these federal jobs are important. Surprise surpise. I should have mentioned Anthony Fauci’s full name in previous comment as expert at NIH but not sure he is still there. The vaccine stockpile (mainly Tamiflu in this instance) was in part to be biefed up under new legal authority granted in BIOSHIELD program, once housed in DHS and then returned by statute to HHS. It is called the National Strategic Stockpile not to be confused with the National Defense Stockpile under the Defense Strategic Stockpile Act of 1950, as amended. Not quite 100% sure of the information above but 90% confident.

Comment by William R. Cumming

April 26, 2009 @ 4:32 pm

Okay nit picks are eye of the beholder. Just heard NPR story on Health Emergency Declaration including the Secretary DHS giving her take on the declaration. First, extraordinary that DHS is the lead according to NPR. Second, The Secretary DHS stated on the record that this declaration was “Nothing Special” just like the declaration of an emergency for flood or hurricane. And that the feds were leaning forward. Well, it is authority in a separate statutory scheme with no formal authority delegated to the Secretary DHS or even the President (I would argue Congress goofed on this one) and vests authority exclusively in the Secretary DHS. Well HSPD-5 made the Secretary HHS the lead for all domestic events and of course that was later modified by statute to supposedly clarify the PFO (Principal Federal Official) position in the NRP (now the NRF) and the FCO concept imbedded in the Stafford Act. I believe only one othe “National Health Emergency” has been declared since 2002. What is interesting is that inferentially the Secretary by inject parallels to floods and hurricanes seemed to be suggesting Stafford Act authority was triggered. My guess in NO that is not the case and would be a substantial precedent if so. [Note that I have long advocated formal amendment of the Stafford Act for just that purpose, among others–since there once was a declaration for the West Nile Virus outbreak in New Jersey].

What I really wonder is exactly what legal authorities or programs, functions, and activities the Secretary DHS and others think were triggered by the declaration. IN other words what is its substance or is it in the minds of the White House just a “warning” to the public and health officials. Warning and alerting and notification are all terms of art of course and substantial research exists on all these terms. For example, Cheyenne Mountain was closed by DOD because it never really had been in the last few decades a warning facility (despite what observers of Ferris Bueller–opps Mathew Broderick’s classic about the mountain might have seemed) and really only a notification center. Real reason, not much warning from off shore SLBM (Submarine Launched Ballistic Missiles– the ones the missle defense guys choose to ignore when arguing for more billions.) Okay enough dribble. I want DHS/HHS/CDC to tell US exactly what they are doing and why or why not. Don’t tell us no screening of airline passengers from Mexico tell US why that is not necessary, e.g. No more nitpicks today I promise. Hey I liked the Acting CDC guy why not make him permanent. Even better line up a federal plane to get Mike Levitt and Julie Gerberding back to advise the White House and Brennan–was he even in the briefing after being announced by White House that he would “give” briefing? If some readers wonder about the specificity of all this Cumming drivel it is because if the senior echelons of the federal government don’t know what they are doing it is unlikely that they can efficiently and effective direct their minions in a crisis. By the way I believe Bioterrorism has been played in several TOPOFF Execises and now was expected to be played in TOPOFF V (sorry National Level Exercise V)!

Comment by William R. Cumming

April 26, 2009 @ 6:42 pm

Media now reporting that Janet N. Secretary DHS declared the National Health Emergency. See comments above.

Also reporting that a Navy lab not WHO or CDC picked up on the type of virus and label first! Would be interested to know facts of how surveillance turned up this problem. Noting that HLSWatch as recently as April 21, 2009, was following story of different virus in Egypt. Thanks NAVY if true.

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