Are Health Communicators getting a “Bad Rap” on H1N1

Sometimes I wonder if public sector health marketers are being made to look like a bunch of incompetents ( “keystone cops “). H1N1 communications, at least in Canada, has been an unmitigated disaster and the big question mark is why is this happening? Many of the public health communicators I have had the opportunity to work with over 25 years are the best communicators you will ever meet. They are extremely professional, very experienced and are excellent communicators. Add to this that public health departments across Canada at all levels of government have been planning for this pandemic for close to three years. How with all this experience and planning can we have one of the worst communication screw-ups in the history of the public sector?

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Was it a coordination problem? Do we have too many levels of government involved in public health who speak a different language… is this our “Tower of Babel’?  Did the public health administrators responsible for H1N1 overrule communication advice from their communications people.  Did the political folks at all levels of government get involved in and refuse to take advice from their communication experts in public health? This will not be the first time this has happened. Did the media overplay the H1N1 story and panic Canadians unnecessarily? Did the original pandemic communications  plans and strategies get overtaken by panicked officials who over reacted to the situation?

Did the local public health administrators underestimate the potential for a larger population wanting the vaccine , even if they were not in the priority group? ( I won’t go into hockey players and people with money jumping the queue.).


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Understandably a mass vaccination of this type has never happened in anyone’s lifetime. The closest comparator is the polio epidemic in the 1950s where schools were the chief locations for inoculation. The target groups were school-age children not the general population. This  was a relatively easy task compared to H1N1.  However, there’s a lesson to be learned from polio inoculation… implementation was highly decentralized. Today, people are being funneled into too few spots as in a traffic jam when the on-ramps feed into a narrower highway. Where were the computer-modelers and experts  when we needed them?


H1N1 2

Some people suggested that the military should have taken over this operation as they are renown for handling crisis with precision and more important they have a chain of command. Yes a “chain of command” is that what’s missing in public health? Did it occur to us that maybe Canada with its layers of bureaucracy  is  not set up for managing crisis and emergencies.

Our Auditor General states in her most recent report that the federal government  has not moved quickly enough to get ready for pandemics, natural disasters and terrorist attacks that can cause major damage to the country.  She states that  the government still reacts to matters such as the H1N1 pandemic or major blackouts on a “case-by-case basis,” eight years after the Sept. 11 terrorist attacks in the United States highlighted the need to prepare for emergencies. She states the Department of Public Safety, created in 2003 to co-ordinate how different branches of the federal government work together in emergencies, has not carved out the appropriate leadership role.”Canada needs to have a planned and coordinated approach in place so that federal, provincial and municipal agencies know what part they will play in managing a crisis. AMEN!!!

A report of the National Advisory Committee on SARS and Public Health October 2003 in response to  the circumstances surrounding the outbreak of Severe Acute Respiratory Syndrome [SARS] provided a “third party assessment of current public health efforts and lessons learned for ongoing and future infectious disease control.”

Here is what the report  said 6 years ago:

“The Committee sees an urgent requirement for multijurisdictional planning to create integrated protocols for outbreak management, followed by training exercises to test the protocols and assure a high degree of preparedness to manage outbreaks ( That’s a mouthful). The SARS experience highlights the need to mobilize selected groups of skilled personnel into epidemic response teams . Last, the Committee determined that neither Health Canada nor most jurisdictions and institutions have developed sophisticated frameworks for risk communication during a public health crisis. The CDC has a comprehensive crisis communications training program that, in our view, bears close study and early adaptation by Canadian governments and institutions.

A key requirement for dealing successfully with future public health crises is a truly collaborative framework and ethos among different levels of government. The rules and norms for a seamless public health system must be sorted out with a shared commitment to protecting and promoting the health of Canadians. Systems-based thinking and coordination of activity in a carefully planned infrastructure are integral in public health because of its population-wide and preventive focus. They are also essential if we are to be effective in managing public health emergencies. Indeed, Canada’s ability to contain an outbreak is only as strong as the weakest jurisdiction in the chain of P/T public health systems. Infectious diseases are an essential piece of the public health puzzle, but cannot be addressed in isolation, particularly since in local health units, the same personnel tend to respond to both infectious and non-infectious threats to community health. The Committee has accordingly recommended strategies that will reinforce all levels of the public health system as well as integrate the components more fully with each other.

So after the SARS epidemic and a significant  report with many recommendations, did we learn anything? Keep in mind that this report was responsible for the creating of the Public Health Agency of Canada.

As usual I would love to hear from readers of this blog.


H1N1… an example of how not to do effective health communications

As someone who spent a quarter century in the health communications and social marketing field, I am flabbergasted on how ineffective the communications coming out of health authorities is on H1N1 /Swine flu.

One thing seems clear and that is the compelling need for reliable information, to understand the risks this virus presents, what to do about it and who to go to for help and advice.

Yes there is the WHO, many levels of government and others who are providing news and information via many channels: television, radio, toll-free phone numbers, the web, printed material, etc. Much of that information, though, is contradictory, inconsistent, and hard to understand and, in some cases unreliable. There are so many sources you don’t know who to believe. For example today I heard a news clip that many health professionals will not be taking the vaccine. What message does this send to the public? If health workers won’t take the vaccine … why should I?

Marguerite Wente in her article yesterday in the Globe and Mail states “swine flu overkill (SFO) is a serious illness caused by saturation media coverage and repetition of the word “pandemic.” I’m not one to minimize the horrors of the H1N1 virus, which can be unpleasant and even fatal. But please, people. Can’t we get a grip? The CBC has been covering swine flu as if it were the biggest natural disaster since Hurricane Katrina. The newspapers have been full of drama about whether there will be enough vaccine, whether it’s arriving fast enough, and if not, who’s to blame. Ordinary citizens are feverishly researching the ins and outs of adjuvants, and wondering if they should drive to the next town so their kids can be vaccinated right away. Meantime, a lot of people have said the hell with it. It’s hard to blame them. Ever since the spring, when the World Health Organization declared swine flu to be a “pandemic” – after just 144 deaths – SFO has been running rampant. Ordinary pandemics kill at least a million people worldwide. Swine flu has killed around 5,000 people, including 86 in Canada. Worldwide, ordinary seasonal flu kills 700 to 1,400 people a day.”(According to the World Health Organization, fewer than 5,000 people have died around the globe from this variant of swine flu. In any normal year, influenza causes between 250,000 and 500,000 deaths worldwide.)

In the Southern Hemisphere, the winter flu season is now over. In spite of dire predictions, only 185 people died from swine flu in Australia – considerably fewer than the roughly 3,000 who succumb to seasonal influenza in that country each year. And no, it wasn’t because the population was immunized. Australia’s vaccination campaign against swine flu took off last month. Last week, U.S. President Barack Obama declared swine flu a national emergency after about 1,000 Americans died. Yet according to the Centers for Disease Control, roughly 50,000 Americans die every year from seasonal flu – without any politician paying much attention.

So, is this an example of overkill? Is it a case of “the boy crying wolf”. When a  real pandemic hits, which could happen, will people listen? Is the SFO responsible for half of our population saying they won’t take the vaccine? Sometimes “over-communications” can work against the health communicators who day after day are “hammering out” the message. And the more they hammer the less confidence people have towards the vaccine. Is this effective “crisis or risk communications?

As Wente states “everybody loves a good health scare. Remember BSE? Infected cows were going to turn our brains to mush. Then came SARS. In 2003, one widely quoted British expert predicted that it could turn out to be more lethal than AIDS. The final death toll from SARS was 774 – about one day’s worth of flu victims. Then came deadly birds. In 2006, David Nabarro, a top WHO official, warned that avian flu could kill 150 million people. The White House’s avian flu response plan projected that as many as two million Americans might die and one leading influenza researcher warned that a pandemic might kill half the human population. To date, the worldwide death toll from avian flu is 262 ( Wente dd not mention West Nile Virus and the Ebola-virus.)

Are we blowing the H1N1 out of proportion? I also wonder if the health authorities have a Marketing and Communications plan that comprehends the need not to over communicate and ensure that everyone in the health field is on the same page and that we get consistent messages that don’t contradict each other. Where is the coordination between federal province/state and municipal/regional governments not to mention others in the health field? Ironically, the more the public hears about how important it is to get the shot, the more skeptical it gets. According to sources, in the U.S., only half the population plans to get it, according to surveys, and a third oppose it for their kids. In Canada, 51 per cent of us are saying we won’t bother – up from 38 per cent in July.

Wente points out that “all these health crisis  have a lot in common: a legitimate concern that’s blown wildly out of proportion by various interest groups, including scientists and public-health agencies, whose warnings are then amplified by the media. Politicians have no choice but to respond in kind, just in case. This outbreak has followed the usual course. The President’s Council of Advisors on Science and Technology recently predicted that there might be 30,000 to 90,000 U.S. deaths from swine flu, peaking in mid-October. (That would be a week ago.) To date the U.S. death toll has barely reached a thousand, but the President has declared a national emergency anyway.”

Our organization is presently involved in working on an Immunization program where we are trying to convince parents to immunize their children. You wouldn’t believe, all the anti-vaccinationists, including a former Playboy bunny, who are trying to convince parents not to immunize their children.   – People who believe that vaccines cause autism or brain poisoning. The H1N1 epidemic of coverage also feeds a growing sense that the risks are overblown and these anti-vaccinationists are coming out of the woodwork and spouting their nonsense to a gullible audience who does not know who to believe.

Also have you tried going to a website from a health authority to download credible information on H1N1 flu. Good Luck.

As Wente states in her article: “As for me, despite my SFO, I’m definitely going to get the shot. Although I’m in a low-risk group, the last thing I want to do is wind up in hospital, where MSRA, C. difficile, and other hospital-acquired infections kill around 8,000 Canadians a year. My advice is that whatever you do, stay out of the hospital – or you might get really sick.”

If you are a health communicator or marketer, I would love to hear from you. Oh yes I will get the flu shot, something I have done for the past 5 years.