Posted: October 12, 2014
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Article SummaryReporter Elise Viebeck of The Hill emailed me on October 10, asking for input to an article she was writing on “how the CDC is struggling to control the media narrative on Ebola,” especially what she called “the balancing act they face between maintaining public calm and pressing for a greater response to the epidemic.” I replied that same day with the email below, outlining “three themes for CDC’s Ebola messaging that I think are not coming across well enough yet”: that Americans are resilient; that there is a huge amount we don’t know yet about Ebola; and that the biggest threat is the possibility of seeing similar epidemics in other parts of the developing world. Elise’s story made some use of the first two themes.

Three Priorities for Ebola Messaging

(an October 10, 2014 email in response to a query from Elise Viebeck of The Hill)
Elise Viebeck’s October 12 article drew from this email.

Here are three themes for CDC’s Ebola messaging that I think are not coming across well enough yet.

1. Americans are resilient. It’s natural that we’re going through a period of intense interest and even fearfulness about Ebola. But people aren’t panicking. Most people are going about their normal lives, talking about Ebola around the water cooler or the kitchen table.

Crisis communication experts sometimes call people’s temporary over-reaction to risks of which they are newly aware an “adjustment reaction.” Adjustment reactions aren’t just natural. They are also useful. They’re an emotional rehearsal for the possibility that things could get worse, and a reason to seek out information and figure out how best to cope. And dismissing people’s adjustment reaction as panic isn’t just inaccurate. It is contemptuous and harmful. If officials don’t trust the public to learn alarming information without panicking, the public will not trust officials to lead them through difficult times.

2. There is a huge amount we don’t know yet about Ebola. There has never before been an Ebola epidemic anywhere near this big; Ebola has never before appeared in developed countries. We have made some mistakes as we learned, and we will make more mistakes as we learn more. And we have sometimes sounded much too confident, given the real uncertainties that surround some aspects of this disease.

Officials who over-stress that “we know how to deal with this” set the public up to become shocked and mistrustful when errors occur. Acknowledging uncertainty and predicting errors, on the other hand, prepares the public to roll with the punches. As CDC Director Jeff Koplan said during the 2001 anthrax attacks: “We will learn things in the coming weeks that we will then wish we had known when we started.” The key in crisis communication is a confident tone married to tentative content – helping the public bear high uncertainty by showing that you can bear it too.

One specific error that badly needs to be acknowledged and corrected is the false belief that Ebola sufferers very quickly become too sick to be out and about transmitting the disease to others. That may usually be true. But we have now seen Ebola sufferers whose early mild symptoms (low-grade fever, for example) led healthcare practitioners to send them home – and led the sufferers themselves to shrug off their disease, thinking: “It must not be Ebola because I can still function.” In West Africa, some infected healthcare workers have even continued working and intimately socializing after becoming symptomatic – and in the process have transmitted Ebola to others.

Other uncertainties have aroused unnecessary public alarm as a result of excessive confidence on both sides. For example, the angry, anxious, polarized debate among experts over whether Ebola could become truly airborne, spreading like measles, has come across as:

“It could” versus “It couldn't – so don't talk about it.”

If it continues at all, this discussion needs to be much more respectful:

“I’m worried that it could, though we all agree it’s very unlikely” versus “I agree with you that it could, but I think it’s very very very unlikely.”

3. The biggest threat of Ebola, dwarfing even the horrific epidemic in West Africa, is the possibility of seeing similar epidemics in other parts of the developing world, from Mumbai to Mexico City, from Karachi to Cairo. That’s the worst case we’re most worried about: Ebola “sparks” igniting in a dozen cities that lack the public health infrastructure to extinguish them. No one knows exactly what that would mean, but its impacts would surely include major supply chain disruptions, a global economic crisis, and massive political destabilization – and many more sparks landing in the developed world.

Events in Dallas have taught Americans of all political persuasions that they need to think hard about the pros and cons of measures like border temperature checks and mandatory quarantines – for returning volunteers as well as for visiting West Africans. But the borders that should matter most to Americans are not America’s borders. Developed countries like the U.S. (and Spain too) can put out the Ebola sparks that reach them, period. It will cost some lives and much money and effort, but we can do it, as often as needed. Despite Nigeria’s surprising success in extinguishing one such spark, which infected “only” 19 other people and killed “only” eight of them, we are less confident that developing countries can do it over and over again.

What if an Indian guest worker in West Africa goes home to visit family in a crowded slum, and brings the virus home with her? What if a soldier from an African Union country completes a tour of duty in West Africa, and brings the virus home with him?

There are only two permanent solutions to the Ebola crisis: finding, manufacturing, and mass-distributing a vaccine; and breaking the back of the West Africa epidemic by isolating sufferers from their potential contacts. It is unclear how long either will take, or even whether either is doable. While we try, we must buy time by doing what we can to suppress sparks. This raises daunting ethical and political questions as well as technical ones – values questions, not just medical questions. That is why ordinary people need to know what’s at stake and get involved.

CDC Director Frieden said it beautifully a recent interview: “So we had two exports in the first 2,000 patients. Now we’re going to have 20,000 cases, how many exports are we going to have?”

There are a lot more themes that are also contenders – and a lot more to be said about each – but these would be my top three right now.

  List of Ebola Risk Communication articles.

Copyright © 2014 by Peter M. Sandman

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