Communicating Infectious Diseases
in a Dangerous Decade
Risk Communication - The case of the novel
Coronavirus
Paul R Gully
June 26, 2013
Journalism and Media Studies Centre
The University of Hong Kong
MERS-CoV
• September 2012 to June 23, 2013
– WHO: 70 laboratory-confirmed cases including 39
deaths.
– Cases originating in the Middle East
• Jordan, Qatar, Saudi Arabia, and the United Arab Emirates
(UAE), including limited local transmission
• Imported cases: France, Germany, Italy, Tunisia, UK
• Local transmission: France, Italy, Tunisia, UK
– Epidemiology is as yet unknown
RISK COMMUNICATION
• Communication of information and analysis to
those who will have to make decisions, in
response to public health needs, for
themselves and/ or others during an acute
event.
• Includes the public, politicians and front-line
health care workers
• What to communicate, to whom, how and
when?
WHAT HAVE WE LEARNED SINCE SARS?
MERS-COV: A CASE STUDY IN RISK COMMUNICATION
1.
2.
3.
4.
5.
Who are the various players talking to?
Who is not talking and why?
The role of ProMED
The specific role of WHO and the IHR(2005).
Who is talking to the general public,
politicians and front-line health care
workers?
MERS-CoV: WHAT IS REPORTED AND
TO WHOM? (1)
• Government Agencies
– e.g., PHAC, US CDC, HPA, ECDC (factual information on
cases, risk of spread, guidance on preventing transmission)
– Little analysis of the results of biomedical research, and
the lack of epidemiologic data, except ECDC
– High level to general public, politicians and sometimes
health care workers
• Science reporters e.g., Helen Branswell, Maryn
Mckenna, Declan Butler,
– Interviews with government/ international organizations
and scientists
– Little analysis of significance of research.
– High level to niche audience of science watchers
MERS-CoV: WHAT IS REPORTED AND
TO WHOM? (2)
• Laurie Garrett:
– Analyses and overviews, credible and detailed but “the big one” bias
– Niche audience
• Bloggers: e.g. Fluwatch
– Rumours, unconfirmed information
– Useful “nudges”
– Unclear as to audience
• Scientists with a voice through the media: reporting of research
with risk pronouncements
– Unclear as to audience
• Academic units: CIDRAP
– Digests of information, some analysis
– Scientists/ practitioners
MERS-CoV: WHAT IS REPORTED AND
TO WHOM? (3)
• International Organizations: WHO, OiE
– Factual reporting and advice to countries
– High level to wide audience
• World Health Assembly reports and tweets
– High level policy issues: transparency, virus sharing
– High level to wide audience
• Bio-medical Journals
– Peer reviewed articles
– Science community
WHO IS NOT TALKING AND WHY?
• Kingdom of Saudi Arabia
– Reporting cases to WHO as per IHR requirements but no
reports on epidemiology despite much investigation and
assistance from outside experts including WHO.
– Report from last mission and WHO EMRO meetings
– Waiting for definitive results (confirmed by Dr Ziad
Memish – personal communication)
– ? Concerns about further loss of control over virus
– ? Concerns about risk of mass gatherings e.g., The Hajj
– Loosing credibility when silence is perceived as a lack of
transparency. Report of WHO mission, June 10, 2013 may
assist in regaining trust.
• Contrast with China and H7N9
THE ROLE OF PROMED
• ProMED distributes moderated reports from
scientists worldwide.
– Considering the experience of Dr Zaki
– Is the lack of communication from KSA as a result
of the initial story and the perceived loss of
control over the virus to the Erasmus Medical
Centre?
WHO AND THE IHR(2005).
• WHO informed early by the KSA and other
countries once the virus was identified and
diagnostic tests developed
– What information is WHO receiving as regards
epidemiologic investigations which are not made
public?
THEMES
• Public health reticence: where is the analysis of
risk relevant to “host” country, analysis of issues
such as perceived lack of transparency, and virus
sharing
• Scientists wish for attention: kudos and funding
• WHO secretariat need to respect wishes of
member states
• Hesitance by some countries to be transparent
• Void filled by science journalists
WHO IS TALKING TO THE GENERAL
PUBLIC ?
• The general public and their representatives,
politicians, and front-line health care workers
hould be primed, in case we want them to act,
to either protect themselves or to adhere to
health protection policies.
– Will these audiences listen before there is a crisis?
– Will credibility be built up or maintained with
more detailed, on going, widely distributed
analyses?
– Who will fulfill this role?
WHAT DO WE NEED TO
COMMUNICATE(1)
•
•
•
•
Modes of transmission
Likelihood of transmission
Morbidity and mortality
Actions to be taken to control risk with risk
analysis, including infection control
• Very challenging at present given lack of
knowledge, SARS is being used as a proxy
WHAT DO WE NEED TO
COMMUNICATE(2)
• Analyses of political/ policy issues
– Virus sharing/ intellectual property
– Lack of epidemiology
• For H7N9 and perhaps MERS CoV
– Effectiveness of anti-virals for treatment
– Vaccine effectiveness and likely supply issues
WHY COMMUNICATE
• The success of public health action depends
on cooperation of the public
• Cooperation may be obtained if the
immediate threat is great enough
• Otherwise depends on trust that has been
built up prior to an event
• Trust can be easily lost through lack of
transparency
HEADLINES
• “The coronavirus conundrum: when to press the
panic button” The Guardian, Feb 14, 2013
– “We have become very good at detecting risk,
but it's impossible to know if this latest virus
will be another SARS or disappear”
• “After SARS: A New Virus in Saudi Arabia
Underscores the Need to Police Disease in
Animals” Time. March 19, 2013
• Tweet Laurie Garrett
• " Hard 2 explain contagion poten. w/out being
HEADLINES
• New coronavirus with “pandemic potential”
sparks global surveillance efforts CMAJ April 4,
2013
– “A novel coronavirus (nCoV), with what one Canadian
researcher calls a “very alarming” death rate, has
triggered rapid research efforts to determine where it
came from and where it may strike next. Two
Canadian research teams are among those involved in
the global response”
HEADLINES
• “Nature’s Bioterrorist Agents” Slate. April 10,
2013
• “From SARS to H7N9: will history repeat itself?”
The Lancet. April 20, 2013
• “New Diseases and National Transparency: Who
Is Measuring Up?” Wired. May 2, 2013
HEADLINES
• “Transparency Unlocked: More New Saudi
Coronavirus Cases Reported Quickly” Wired. May
4, 2013
• “Saudis bring in outside help on coronavirus,
including Toronto SARS expert” CP. May 8, 2013
• “Even though work has been done since that time,
the world is not ready for a large, severe outbreak”
“This is an unusual global situation” Keiji Fukuda.
May 22, 2013
• “The Politics of Virus Hunting” CBC. May 23, 2013
HEADLINES
• “WHO: Scientific red tape mars efforts vs. virus”
AP. May 23, 2013
• “MERS cases likely around globe, found in Saudi
because country tests: official” CP. May 30, 2013
• “Administration declares Mideast flu a public
health emergency” The Hill. June 4, 2013
• “Saudi paperwork demands delay work to
research to find MERS source: CDC” CP June 7,
2013
SUMMARY
• There has been a lot of coverage of MERS-CoV in the
mainstream media, science media, and social media.
• The messages are confusing
• There has been low key communication from
government agencies outside of affected countries.
• There has been little analysis of the issues that the
public is mostly likely to demand answers on if
threatened.
• Most media coverage has probably not been seen by
the general public.
CONCLUSION
• There is an analysis and discussion gap, that
needs to be filled so that the public, politicians
and health care providers can understand the
issues that appear as controversies in the
media and trust in disease control
organizations can be built and or maintained
WHO HAS THE RESPONSIBILITY?
• Proposal:
– Objective is to build and maintain trust in disease
control organizations and governments
– Set up a group, virtual or otherwise, that
• Analyses, day to day, science, media, official statements and
opinions
• Analyses and discusses controversial issues so that they can
be understood by politicians and the general public
• Recognizes the role of WHO, disease control organizations,
departments of health, Governments and the media
(science and popular) to provide facts and report on
analyses of individuals, governments or agencies
paulrgully@gmail.com