October 6, 2015

Washington D.C. Capstone Forum

The following synthesis of the 2015 Idea Lab was published in the Journal of Domestic Preparedness:

Reimagining Epidemic Communications

In the first week of December 2015, professionals involved in epidemic preparedness at the national level participated in a forum convened by graduate students from Emerging Leaders in Science and Society (ELISS), a leadership development program hosted by the American Association for the Advancement of Science (AAAS), in Washington, D.C.

In the wake of the 2014 Ebola crisis in West Africa, and the uncertainty over whether the disease could spread to the United States, epidemic preparedness emerged as a pressing challenge for many communities. Moreover, the Ebola crisis highlighted a specific need for more coordinated communication that balances trust, fear, and accuracy.

To address this need, ELISS fellows convened local stakeholders at four locations – Seattle, Washington, Palo Alto, California, West Lafayette, Indiana, and Philadelphia, Pennsylvania – to discuss challenges faced and communication strategies implemented by their communities in the event of an epidemic crisis. Then, fellows presented insights from these local forums in Washington, D.C., at ELISS’s “Re-imagining Epidemic Communication Strategies” forum to share information and ideas between the local and national levels and to create new channels and strategies for communicating health information during an epidemic crisis.

ELISS’s forum convened stakeholders from government agencies such as the U.S. Department of Health and Human Services, and nonprofits such as the National Association of County and City Health Officials (NACCHO). The goals were to learn how different communication strategies have been used in epidemic response and preparedness at the national stage, and how they can be implemented to maximize collaboration across cities and government organizations. Together, stakeholders identified and discussed four overarching issues, summarized here.

Challenges While Collaborating With Local Stakeholders
The fact that epidemics start as, and often remain, local events creates barriers to collaboration and potential conflicts between different levels of government – namely city, county, state, and federal agencies. In some parts of the country, the idea of adopting federal guidelines is highly problematic at the local level, even for epidemic events, whereas other areas demand more federal intervention than is present currently. Jurisdictional politics can aggravate these issues. For “new” diseases like Ebola – where fears are high and knowledge limited – the temptation exists for local elected officials to act fast, without waiting for guidelines backed by the Centers for Disease Control and Prevention that currently require significant time to be issued.

Juggling between these various levels of government and different types of expectations appears to be a challenge at the federal level. In addition, not all federal agencies have direct relationships with county and municipal health departments, even though collaborating with associations like NACCHO helps. One possible step forward would be to build a working group across government levels to provide guidance on social media use for epidemics, which might tackle the main issues, mitigating public fears while building medical expertise on the disease.

Bidirectional Flow of Information Between Federal & Local Stakeholders
Since epidemics begin locally, hospitals and other healthcare facilities are often the first to observe evidence of a growing health crisis. However, preparedness does not need to be exclusively local. Higher-level organizations, like federal agencies, can push information to communities before an epidemic emerges to help generate a better outcome. Simultaneously, local organizations can ensure they are looking for information in the right places. During the AAAS forum, fellows reported that many local stakeholders in their communities need more information and materials from federal agencies to help them communicate. In practice, it seems that some of the resources local stakeholders want already exist and are underutilized. The following practices might help bridge this gap:

-Ensuring that federal materials are well advertised and easily accessible from a local stakeholder’s perspective (while officials in D.C. might understand how all the agencies fit together, many local organizations do not); and

-Choosing relationships strategically to promote better information penetration – for example, frequently interacting with hospital liaisons would be strategic since they are a major point of contact.

Community Compliance With Issued Recommendations
All forum attendees agreed that it is not enough for messages and information to be available. In order to be effective, they must also inspire action. Decision-making cannot be treated as a purely logic-based or information-based activity. Rather, communication strategies employed by organizations should factor in emotional decision-making. Importantly, people have to both understand and trust a message in order to comply with it. To understand patterns of compliance, agencies need to learn which individuals and institutions people trust for health information.

In addition to trust, considering barriers to action like motivation, time, money, and accessibility allows for programs and messages to be designed around these constraints. One key challenge faced by both local and national stakeholders is how to identify and recruit trusted individuals to disseminate information, particularly to reach those who mistrust governments. An important solution would be to use research from anthropology and other social sciences to inform messaging strategies and to identify gaps.

Additionally, strengthening the ability of local institutions – for example, banks and libraries – to serve their communities as information sources can help. Furthermore, using celebrities as a funnel for disseminating government-approved messages more widely can help reach a variety of populations. However, agencies should be wary of reinforcing the idea that celebrities are a good source of accurate information. Therefore, strategies must be devised to ensure that celebrity partnerships encourage trust in expert information.

Strategies for Building Trust Among Different Stakeholders
A common theme that emerged is that trust is essential to communication during epidemics. However, it is crucial to acknowledge and engage in systemic trust buildingbefore a crisis. Lack of early engagement and relationship building can lead to misinformation and heightened fears, which in turn can have disastrous outcomes during epidemics. Moreover, trust is something that is gained over time. Local and national stakeholders agreed that trust should be built at individual and community levels as well as within and across government and public health organizations.

One key practice is developing a culture that allows relationships across organizations to remain strong even when individuals leave their roles. Trust grows as one proves value, and establishing information-sharing protocols ahead of time fosters dissemination of accurate information while minimizing misinformation. Working with trusted messengers can also help build long-term trust – for example, working with cultural brokers within hard-to-reach communities, and educating children through the school system so the messages reach their families.

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We would like to thank the members of our Advisory Committee for their input:

  • Meredith Lee, Data and Innovation Specialist at Homeland Security Advanced Research Projects Agency
  • Megan Reeve, Program Officer, Institute of Medicine
  • Patrick Rose, Director, Pandemic and Catastrophic Preparedness at National Association of County and City Health Officials
  • Angela Schwartz, Strategy and Innovation Officer, Centers for Disease Control
  • Kate Stoll, Senior Policy Adviser, MIT Washington Office
  • Sam White, AAAS Science and Technology Policy Fellow at National Institutes of Health