CERC Transcript 07 12 2016

Zika CERC Discussion: CDC’s Community Emergency Response Team

Presenters: David Daigle

Date/Time: July 12, 2016 1:00 pm ET

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Operator:

Welcome and thank you for standing by. At this time, all participants are in a listen-only mode. During our Q&A session you may press star 1 on your touchtone phone if you would like to ask a question. Today’s conference is being recorded. If you have any objections, you may disconnect at this time. Now I’d like to turn the meeting over to David Daigle. Sir, you may begin.

David Daigle:

Thank you India and thank you all for joining us today for this Zika Crisis and Emergency Risk Communication Discussion. I am David Daigle and I’m pinch hitting for Barbara Reynolds, who is our CERC lead and our risk and communication lead here at CDC. And I have about 20 slides to go through and then we’ll go into Q&A. But before I go into the slides, I’m supposed to check and make sure that everybody has the slides. So if you’re hearing me but don’t have the slides, you can go to http:emergency.cdc.gov/cerc/zika and you should see a button on top of that page for the Zika CERC discussion. So that’s emergency.cdc.gov/cerc/zika.

And so with that I am - my normal day job is the Associate Director for Communication in the National Center for Immunization and Respiratory Diseases here at CDC. And the slides I have here today are really a combination of Barbara’s slides and the CERC team’s slides. And then I’ve added a few in, some lessons learned from some of my CERC deployments for I guess both most recently for Zika and dengue. So with that, let’s go to - I’m on the title slide now and I’m going onto the next slide. So the right message at the right time from the right person can save lives. And moving to the slide number three, this is really my slide. And I’ve learned that for effective infectious disease communication, there’s really six components that I like to think about. The most important is being prepared. I like to use principles of risk communication. I’ve learned that one has to think marathon and not sprint. It would be nice if it were a sprint, but I’ve found it best to consider this to be a marathon and prepare it that way. I have to be mindful of expectations. I have to account for fears from a variety of different audiences. And I think we need to address sources of potential confusion. So those are my six components.

And then I start with what I think is the most important and that is being prepared in advance. So and that’s actually all of the work we can do right now because we’re all in the advance of that first Zika local transmission. So let’s go to our next slide because that talks a little bit about what we can do in this advance phase or pre-crisis phase. We can be prepared with need assessments and checklists. We can foster alliances. We can develop consensus recommendations and even test messages. And when I think about like being prepared and some of the assessment checklist, I also think about templates for press releases where they - under the fostering alliances. Sometimes I think often we forget about our partners and stakeholders who are going to be so critical often to amplify our message and making sure that we bring them early on, especially in the planning phase, and don’t forget about them when we go from pre-crisis to crisis phase. We can test messages. It’s really nice if you can do that in advance. That does not - that’s often I think easier said than done. But a lot of this planning and most of the work you’ll find in that pre-crisis phase.

Go over to slide number six. It’s be best crisis management begins early on. We know what we can precipitate. We know what can precipitate the need for either rapid or crisis communication. No surprise -- a new study, new findings, an emerging disease or health threat like we’re seeing right now with Zika and saw previously with Ebola, a vaccine or medicine shortage or a recall, an infectious disease case or outbreak could - developments in the community or world, an accident or an attack. All of these will precipitate what we call rapid or crisis communication needs.

We also know to assess potential risks. And I think one of the key things we can do is get our public affairs and risk communicators involved very early on. We can also prepare and practice. And we’ve been talking about preparing and practice, but in some of the preparing and practice we’re thinking of the tabletops we can do. We can do tabletop exercises and we can pool our resources together, establish our networks -- all ways to prepare and practice in advance. Sound decisions, responsive and effective crisis communication -- we can all do this early on.

My next slide I’m on now is titled “Preparation Should be Geared Toward Being Able to Quickly Address”. I think most of us that have gone through a rapid or crisis communication situation know there are certain questions that are going to come up right away from a majority of our audiences. What’s happened? What’s going on? Who is affected? Why? How many? How bad is it? How badly were or could people be harmed? Are people like me or my family affected? Who is at risk? Why? How bad will or might things get? How can I protect myself and my family? And what’s being done to prevent more harm? And then we can have clear, responsive initial key messages to address this early on request for information or the questions that many of our audiences are going to ask right away.

My next slide looks at the CERC model, the nine steps of crisis response. We want to verify the situation in step number one. We want to conduct notification in two. Conduct an assessment in three. Organize assignments in four. Prepare information and obtain approvals, number five. And then six we want to release information to the media, public partners through many arranged channels. Seven, we want to obtain feedback and conduct crisis evaluation. Eight is conduct public education. And nine is monitor events. And these are our nine steps of a crisis response in our CERC model.

All right. Some key risk communication concepts. We want to beware of the Holy Grail of risk communication. And this comes from Peter Sandman. And that is believing you can inform people, educate people, and/or motivate precautionary behavior without scaring anyone. Most of us are dealing with a wide variety of audiences and I think it’s impossible to have that magic message or that magic messaging that’s going to work for all our audiences. Communicating uncertainty -- we want to strive to create the same level of certainty in the audience as the information source. That is, not overstating or understating known and unknown.

You know, I’m kind of an old timer at CDS and I think back to when Rich Besser was our Acting Director and it was really a strange time for us because it was in between administrations and Rich Besser was acting. And then we had H1N1 and in Rich Besser’s first press conference here at CDC he basically stood up and said there’s a lot that we don’t know yet and a lot that we need to find out. And I always thought that was really a nice way of - sometimes it’s hard for our SMEs and researchers to admit that we don’t know something or that we’re uncertain. But I think it’s key that we tell our audience or let them know that there’s a lot for us to learn and we are. We don’t know everything right now. We’re going to learn more.

Anticipatory guidance -- we want to foreshadow that recommendations will likely change as new information emerges. Reduce audience perception of future changes as evidence of prior mistakes. With Zika and certainly what we saw with Ebola is that we learned a lot. I mean, we had seen Ebola in a different environment. We hadn’t seen Ebola in the US., and there was a lot that we were learning as we were going. And we need to let our audience know that, so that when we do evolve our guidance or we do learn more and change our guidance, that this is not viewed as something negative - that this is rather us learning more and then quickly going with the new guidance.

There’s often an adjustment reaction or period -- the OMG phase of learning about a new risk. A new risk can cause temporary overreaction, but it also creates an opportunity for teachable moments. Our audience is very engaged and this may be the time for us to communicate those clear, key messages we want them to take away.

All right. I’m going onto the second slide here on risk communication key points. We want to anticipate that exotic and unfamiliar threats often bring or foster a seemingly disproportionate amount of interest, attention and concern - even if it’s a very small actual threat. And I think back to Ebola in October of 2014 there were four cases of Ebola in the US. But if you think about the media reaction to those four cases and the coverage that was garnered by it, and this was an exotic and unfamiliar threat. We want to be very careful about assurances and offering reassurance and guarantees. This can come back to haunt us later -- and certainly did at CDC here for us. We can express and often lead with empathy and caring. And we can acknowledge early on that the possibility of rapid change, differences in actions as well as expert opinions, and the likelihood of things arising that aren’t easily foreseen. We’re going to have experts disagree and people just need to understand that, that that’s not always an earth-ending sign.

All right “Surviving the first 48 hours” on slide 11 here. Think about that quick assessment and that collection of facts. We want to think about actions to secure resources. Oftentimes we find that that huge crush of media interest and also not only media but many of our audiences have a great deal of interest and request for information, that we do need to scale up with either people - more communicators or phone banks or increased report to the web to get more information out faster. We want to think about media and the public response. We want to do a rehearsal if time allows and we’re in the right time. It would be ideal to do a rehearsal but once again that can be difficult. We want to alert key partners as appropriate. And this sounds like the beginning of a plan.

All right. I’m onto the slide titled “Communication Staff Responsibilities”. Command and control -- we need a leader with clout. Who’s going to be the first person that goes out that speaks the media? We have to think about the media response and who’s going to handle that. We have to think about public education of course and community engagement. We want to think about partner and stakeholder relations. And we talked earlier about how partners and stakeholders can amplify our message if we include them early and make sure they get our messages. We want to think about content and message development because we’ll be moving very rapidly. And the other thing I guess we want to think about too is if your organization uses the incident command system and how you fit into that. And are you familiar with the incident command system so that when you walk into that first I guess ICS or EOC -- Incident Command Structure and if you have an Emergency Operation Center like we do -- that you or your folks are not totally lost and they know where to go and what to do.  

All right. I’m onto the next slide here, number 13. And this is titled “Leaders and Subject Matter Experts Should Always Assume”. And we talked earlier about this being, you know, it would be nice if it were a sprint but more often than not it turns out to be a marathon . I think just here at CDC there was recently we were activated for four different responses at one time. I think it was Ebola, Polio, we were active for Flint, Michigan, and also Zika. And so --at different levels -- but some of these, Ebola, and some of these responses turn into marathons rather than sprints. So we have to think about this when you’re allocating your resources and you’re working toward a future that this won’t be over this weekend. It would be nice, but in most cases not. Regardless of our efforts, there will be negative headlines, critical stories, and crises bring outrage and then media cover outrage. I can’t tell you how many of our SMEs, you know, they see that first really negative story or that negative angle or that really scary headline and they don’t often have thick skins. They have very thin skin and so letting their subject matter experts know that now every story is going to be about how great our organization is, that there are going to be people who write negative stories, and getting them ready for that in advance.

And for us, timelines are critical. We’ve learned that we need to establish a timeline very early on. For CDC, I think we do this because we know that we’ll be testifying and that there will be hearings. We also know that as that response moves on there will be the stories. Initially they’ll cover, you know, how many cases and what’s going on but sometimes the stories as we move further down the line, they take a who’s to blame angle or what went wrong. And having that timeline to show what you did when you did it, a timeline that everybody agrees on, is very helpful.

I’m on slide 14 now and this talks about the Initial Phase. We want to express empathy. We want to simply inform the public about risks. We want to establish an organizational spokesperson credibility. We want to provide emergency courses of action. And we want to commit to communicate with the public and stakeholders. Reputations are made or broken here. You know, I was looking at something and I saw a quote by Tony Fauci. Tony Fauci from NIH talks about we in the public health sector must be crystal in articulating exactly what we know and what we still need to know about the threat and then helping people to understand how this new risk compares to the risk they willingly assume every day. And I thought Tony did a nice job of laying that out.

And moving onto slide 15 here, and this is we need to quickly provide the basic information. Often we move so fast now, especially on the media front as far as requests for information and requests for about what’s going on with the response that we need to prepare very quickly and be very nimble. I’m onto the next slide. And there are four things we can anticipate. We should anticipate the purpose and goals of our communication and messages during the crisis. The communication philosophy approach you’ll be likely to use during the crisis. I’m hoping that we can all be on the same sheet of music. If we’re going to take a very proactive approach or we’re going to do a reactive or response to query approach, we should be agreed on that philosophy. And at CDC, we’re never in this alone. We have all kinds of partners -- local and state partners and we also have HHS and DHS and other agencies who are above us or lateral. So we all have to coordinate to make sure that we all share that same philosophy or approach.

We have to anticipate that news media interests and potential stories at the start and as things evolve. We know with the news media initially they’ll want to know what’s going on and if there’s a case count or sickness and death count. They’ll want that. But they’ll also focus later on on the differences. If we have differences in opinion among experts or between our communications or projections, they’ll look for change - what’s being done. Is there a change in the recommendations? So think about responsibility. Who is to blame? How could this have happened? And they’ll think about how fast are the actions being taken. Are we working hard enough? So it’s good to anticipate the early questions we will get in the media. But we also have to think as it evolves, where are they going to go. And the fourth thing here is likely questions that media, policy makers, and the public will have -- especially initially. But also considering that as the response evolves, those questions will evolve as well.

All right. “Six Principles of CERC”, and this is slide 17. We want to be first. If the information is yours to provide by organizational authority, do so as soon as possible. If you can’t, then explain how you are working to get it. We want to be right. We want to give facts in increments. Tell people what you know when you know it, tell them what you don’t know, and tell them if you will know relevant information later. We want to be credible. Tell the truth. Do not withhold to avoid embarrassment or the possible panic that seldom happens. Uncertainty is worse than not knowing. Rumors are more damaging than hard truths. And I think most of us in communications have had to deal with rumors that are spurred by misinformation or a lack of information.

I’m onto slide 18 now and this is ”Six Principles of CERC” continued. We want to express empathy. Acknowledge in words what people are feeling. It builds trust. We want to promote action. Give people things to do. It calms anxiety and helps restore order. And we want to show respect. Treat people the way you want to be treated, the way you want your loved ones treated always - even when hard decisions must be communicated. Uncertainty is worse than not knowing. Rumors are more damaging than hard truths.

And then I’m looking to slide 19 here. So more information on risk communication and Zika, we have the CDC website and then there’s a Zika communication resources. There’s CERC resources. We have an emergency risk communication training in Atlanta scheduled from August 10th to 12th. And there’s actually an Emergency Partners newsletter. And of course there’s also an email you can do for questions. And if you want I’m happy to give my email as well. I’m at DRD4@cdc.gov. So I’m onto the next slide here, which I think is my time to either answer your questions or do my best to find out the information and follow up with you. So India, I think I’m ready for questions now.

Operator:

Okay. If you would like to ask a question, please press star 1 and record your name when prompted. Once again, that’s star 1 and record your name. One moment for our first question.

We do have questions queueing up. It’ll just be one more moment.

David Daigle: 

No worries.

Operator:

And our first question comes from Yvonne Garcia. Your line is open.

David Daigle:

Hi, Yvonne.

Operator:

Ms. Garcia are you on mute?

Yvonne Garcia:

Sorry. Hi. I just wanted to ask real quick, based on this communication model here - risk communication model - how did you or not find it different with respect to working in Sierra Leone with the Ebola outbreak?

David Daigle:

Yes, that’s a great question Yvonne. I had gone out - I went out for Ebola four times but Sierra Leone was slightly different because we were there for the vaccine. And so it certainly was a crisis because Ebola was going on, but we were actually doing a more, I would say it was more of a campaign. And of course, you know that well because you were at Sierra Leone at the same time. So I’d say there were many of the principles of CERC certainly stayed true. So we weren’t into a crisis like we’re thinking we might see with that first local transmission of Zika here in the US. But I do think that certain - some of the CERC model - I always think of be first, be right, be credible. In most every communication situation I’m in, it’s always paid off. Whether it’s really a CERC situation or not, some of the principles stay true. India I think we’re ready for the next one.

Operator:

Our next question comes from Jill Oviat. Your line is open.

Jill Oviat:

Yes, hi. Can you hear me?

David Daigle:

I can, Jill. Go ahead.

Jill Oviat:

Great. Yes, I was wondering if you could just talk about how you think Zika is being covered right now in the United States by the media and, you know, whether this model that you’re talking about here, the six principles, how effective that has been with getting accurate information out to the public.           

David Daigle:

That’s a great question Jill. And, you know, I think there’s many parallels that we’re seeing, what we saw with Ebola that we’re also seeing with Zika. And you think back to 2014, we had a huge outbreak of EV-D68 that was really hitting children hard. And there was a really high case count. But Ebola was starting up at the same time. And I think about all the coverage that went to Ebola and even domestically before we had cases in the U.S. And it does go back to that I think sometimes that fascination with a very exotic disease or a disease we wouldn’t expect. And it does seem to garner more coverage than it should, based on the sickness and death.

So I think we’re seeing that a little bit with Zika now. The other day we’re seeing - I don’t know about you, and I do watch the Zika coverage. I see a great deal of coverage. And there are certainly a lot of interesting twists and we’re learning a lot about Zika. So a lot of the coverage is warranted. But I still wonder if we’re more fixated on Zika than we should be because it is an exotic or new disease in the U.S. And then I have found that those six principles that have always served me incredibly well. I’ve gone out many times on deployment and that first 48 or 72 hours can be so difficult when everything’s very confusing and the media’s - there’s so many demands for information. But I have really - it’s really kept me in great shape when I’ve gone out. And I would encourage you guys to take a hard look if you haven’t already - and many of you probably have - and you’ve probably gone through a crisis situation. And I do know that they can be very helpful. And give them a relook, a review if you haven’t in a while.

Thank you Jill for your question.

Jill Oviat:

Okay thank you.

Operator:
And that was our last question. However, if you’re just joining us and you have a question, please press star 1 and record your name. Thank you. And there was a question that’s just come in.

David Daigle:

All right. So we wrap it up.

Operator:

Excuse me. I’m sorry. One question did just pop in.

David Daigle:

No worries.

Operator:

Thank you. It’s still processing. One moment, please. I’m sorry.

David Daigle:

No worries, India.

Operator:

And our question comes from Amy. Your line is open.

Amy Reel:

Hi, David. It’s Amy Reel.

David Daigle:

Hi, Amy.

Amy Reel:

Hey. I was wondering if you could talk a little bit about the clearance process for some of the messaging.

David Daigle:

Got it.

Amy Reel:

And how CDC gets that through quickly. Obviously there’s an expedited timeline when you’re in a crisis response mode. So I’m just curious how CDC handles that, really.

David Daigle:

That’s a great question. In fact, one of my notes - and I forgot to include it in the talk - was, you know, an abbreviated clearance proves. And oftentimes - and you know well from your - gosh you went through quite a few of these in Indiana - that there is a great need to move some material very quickly through clearance. I can’t tell you, it’s so frustrating to tell reporters when they want an interview or they want information and you have it but it hasn’t been cleared and you’re waiting for somebody to clear it. And oftentimes our subject matter experts or the people in charge don’t understand that we’re getting pushed very hard by reporters or other audiences for this information. And it’s already done but it’s just a matter of getting it through your clearance. I, probably like most communicators, hate the idea of holding information to go through clearance. We do have and we are able sometimes to work in abbreviated clearance here at CDC. I think we’re doing better at recognizing that there will be a great demand for information and that demand - they’ll want that information incredibly quickly - almost simultaneously as things are going out.  Obviously we don’t want to put, you know, if it’s a developing situation we want to be careful what we put out and say what we know. But we do want to put it out quicker than let’s say we would normally. And here at CDC we have a very I would sometimes call a very tough clearance system. But there are times when we recognize that we do have to move things quickly. And there are ways to do an abbreviated clearance here. And especially when we go into the Emergency Operation Center and the Joint Information Center with the communication arm of that. So I’d say yes, clearance can be a real issue, especially an organization like CDC. But sometimes the folks who are very smart -- our incident managers and our senior communicators -- will work an abbreviated clearance realizing that demand for this information is great and people expect it a lot faster than we would normally provide it. I’m sure you saw that in Indiana for both MERS or for your HIV injectable outbreak.

Amy Reel:        

I did. Yes. Thank you. That’s good to know. Yes, I mean, you know, obviously it can create some I don’t know, a little bit of contention among…

David Daigle:

Yes.

Amy Reel:

…people.

David Daigle:

I don’t know about you but I hate telling reporters, you know, I can’t do that interview yet because it hasn’t been cleared. Or, you know, you can’t provide that information because it just makes us look - I hate that answer. So to me, I think it’s up to us as communicators to push our SMEs and work on the process so that if we have to gear up and speed it up, we can do that.
And we train our subject matter experts to understand that we’re going to have to do this faster.

Amy Reel:

Yes. That’s great. Thanks, Dave.

David Daigle:

Thank you.

Operator:

And we did have some more questions come in. Our next question comes from Grace McGovern. Your line is open.

Grace McGovern: 

Hi. I think my question just us related to the last question, which is, you know, be first, be right, be credible. And you’ve got your expert matter people and you’ve got your political people.

David Daigle:

Right.

Grace McGovern: 

So sometimes it’s very hard to - I think you kind of answered it. Maybe at some point you can share the training that you give to your experts who…

David Daigle:

Yes.

Grace McGovern: 

…kind of really spend a lot of time being sure that they’re being right but maybe they need to be a little less detailed. And then there’s also the political people and sometimes…

David Daigle:

You know, and Grace that is a - gosh, you are so right. That’s a battle we fight. Our subject matter experts - and I love them to death - but oftentimes they want to put information out in what I call the Lancet or a scientific publication and they want to wait for all the data and they want it to be exact. And if we’re in a response mode for a crisis, we really have to be able to be first and be right. And sometimes that means giving them the information we have. And so it really is I think it’s on us as communicators to push our subject matter experts and help them understand that you’re not writing for Lancet. This is for let’s say the New York Times or your local media that’s pushing for answers and pushing for very basic information. And we need to provide what we can. And you’re right - the political too is a huge battle to fight because oftentimes they’ll want to manage it. And you know your audiences better than so sometimes it’s pushing against them too saying look, we need to put this out to this audience. And so it is very difficult and oftentimes communicators, we’re caught in the middle between the demands from the media or our partners or stakeholders and then like you say the subject matter experts or the politicians. So it’s a very difficult position but I think we need to fight that good fight and try to get that information out as quickly as we can. And that’s a great question, Grace.

Grace McGovern: 

Yes. So maybe for our future call we can talk about…

David Daigle:

Yes, and by the way if you have any great ideas, we’d love to hear them because I think we could do this better. I know we can do it better here at CDC, so yes, I’d love to hear any ideas that you guys have.

Grace McGovern: 

That was it.

David Daigle:

Thank you, Grace.

Grace McGovern: 

Thank you.

Operator:

Our next question comes from Allison Welski. Your line is open.

David Daigle:

Hi, Allison. You might be on mute. Are you? Allison do you want to…

Allison Welski:

I think I was just, yes I was on mute for a little longer than expected. This next question I think actually speaks to some of the questions that just preceded. How difficult is the negotiation between SMEs and putting things into plain language? How do you expedite it…

David Daigle:

Yes.

Allison Welski: 

…to be first and to be credible?

David Daigle:

That’s another battle. You’re right. And you know what makes me personally very angry is if you’re -- and you’ve probably heard this as a communicator -- they say, “I don’t want you to dumb this down.” And that just…

Allison Welski:

Exactly.

David Daigle:

It makes me so angry because we’re not dumbing it down. What we’re doing is making it appropriate for our audience. And so - and my subject matter experts, unless they’re writing for Lancet or something, they figure I’m dumbing it down. No, you’re not dumbing it down. And so we do fight that battle here and we take plain language very seriously.

Allison Welski:
 
Yes.

David Daigle:

And we have some great communicators who work on it. But it can be a battle with some of your SMEs because I’ll look at a press release that they’ve drafted or they’ll provide some input to it and I just literally cannot understand it. And then so you’ll…

Allison Welski:

No.

David Daigle:

…come back with a plain language version of that and they’ll begin the battle with you. And so what they have to do is I talk appropriate for an audience rather than plain language and I don’t let them get away with dumbing it down. But you’re right - that is a great battle that often we fight here.

Allison Welski:

Thank you so much, Dave.

David Daigle:

Thank you. Good question.

Operator:

And our next question comes from Yvonne Garcia. Your line is open.

Yvonne Garcia:

Yes. Hi, Dave. One more question. So you’ve been talking about some of the internal, you know, issues, complications. But what about, since you’ve travelled all over the world, do you have any advice for people who need to work with foreign governments and the health departments?

David Daigle:

You know, I think if I go out on a CERC team or deployment, I usually try to spend the initial time just listening and watching because first of all, you know, oftentimes there’s this perception that if you deploy on the team that you’re there and you can fix everything and you’re there to solve the problems - which is never the case. So when I deploy, I like to go in and just listen for a while and try to quietly figure out what’s going on. You know, every ministry of health or health department, whether it’s state or local, they’re all different. I mean, we share some of the same fights. I think all of us are fighting against clearance issues, against plain language issues. We all fight those issues. But the dynamics of the personalities are very different. In Sierra Leone, you know, we were dealing - we have a very good person, Doctor Samai. And he was a great advocate for what we were trying to do. Sometimes it’s finding that person to work with and partner with to get what you need done. But usually I find myself - and Amy will tell you this - I don’t go in with the idea that we can fix everything. We’re there to help or support the communicators on the ground. And if there’s some area that they need a surgeon or some area that would need help and we can bring it from CDC, that’s kind of the tact I take, you know, that whatever you need, let’s see if we can help you do it because really it’s not just the state or local. It’s often a national or international issue.

Yvonne Garcia:

Thank you.

Operator:

And that was our last question.

David Daigle:

All right. Well thanks for your help today, India.

Operator:

You’re welcome.

David Daigle:

I should say thanks to everybody for joining. Do I just sign out now or how does that work Hailey or India?

Operator:
You just let us know that the conference is ended and we’ll give a closing speech.

David Daigle:
All right. Well I think this ends our conference for today. Sorry, I’m a first timer. Once again, we have great information on the CDC website both on CERC and Zika and there are a lot of resources and I’d encourage you to give that a look. And thanks everyone for joining us today.

Operator:      
Thank you for calling. Your conference has ended and you may disconnect. Once again, your conference has ended and you may disconnect. Thank you for joining.