CERC Transcript 07 19 2016

Zika CERC Discussion: Stigma and Community Hardiness

Presenters: Barbara Reynolds, PhD

Date/Time: July 19, 2016 1:00 pm ET

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Operator:

Welcome and thank you for standing by. At this time, your lines have been placed on listen-only until we open for questions and answers. To ask a question, you may press star 1 on your touchtone phone. Please be advised, today's conference is being recorded. If you have any objections, you may disconnect at this time. I would now like to turn the conference over to Dr. Barbara Reynolds. Please go ahead.

Dr. Barbara Reynolds:

Thank you Laura, and welcome everyone to today's CDC Discussion on Zika and Crisis and Emergency Risk Communication. We've got a couple of topics today that I'd like to cover and then open it up to discussion, and hope that you're forming some questions in your mind or something that you would like to add to the topic or whatever else that's going on.

For those of you who have been staying plugged into the Zika response, I think you know we've had a pretty busy couple - few days now. We announced the first sexual transmission from woman to partner with Zika. And then we are also investigating in Utah a transmission that we haven't quite figured out. The investigation is going on right now between the Utah Department of Health and the CDC of a family member who had not traveled but whose family member - and had developed Zika, and the family member who did travel was so ill that this elderly person actually died.

So I think that we know that at the - around the end of May, we were talking about we're in mosquito season. We would expect that things could happen in the world of Zika as we move through the warmer months here in the United States, and as you know, that have of course, there's still a lot of work being done Puerto Rico and other territories related to our Zika response for the U.S. I think that as I look forward to what could or couldn't happen around Zika and our response to it from a public health perspective that it's worthwhile to see if there's anything related to the concept of stigma that might be relevant for us as we think through where this could go and what could happen.

But I would not be who I am if I didn't start with the first slide of reminding everyone that the right message at the right time from the right person can save lives and reduce harm. And the whole reason we come together like this and we do the work that we do around communication is to try to provide people the information they need when they need it in a way that they can absorb it and act on it to protect themselves and their loved ones. So I think that everything that we learn along the way in relationship to crisis and emergency risk communication can make us that much better at doing it.

So if we want to talk about stigmatization, I'll go into a little bit of an explanation of what stigmatization is. I think most of us recognize it when we see it but I think sometimes some people can be confused that a stigmatization and being afraid of something that threatens us is the same things. And I don't want to get wonky on all of you but I want you to know that stigmatization is when we associate a threat with a person, a group of people, a place, an animal or an industry or product that doesn't present the threat itself. And so I'm going to have to take a little time to explain that but I want you to know that when we're stigmatizing, we're associating a threat with people or a place or a product or an industry where the threat doesn't exist but because it's associated with the threat, we think that the threat exists with this person, place, product or industry. I know that's kind of convoluted but we'll walk through it and see if it doesn't make sense.

The reason - when we talk about stigmatization, we need to recognize that people stigmatize because they believe that they can control the problem or the threat in some way through the stigmatization. So the stigmatizer, the person that stigmatizing something, thinks that that's offering them some level of control. And we have talked earlier about the psychology of a crisis and uncertainty is very difficult for people to absorb. The human species as - across all cultures has a great deal of trouble absorbing uncertainty. And so as we're striving in a situation where there may be more questions than answers, where things are changing and perhaps changing rapidly, and we have a little sense of that now as we're learning more about the Zika virus and how it effects and transmits to people. That there is a possibility that this uncertainty could cause someone to generalize the threat in a way, to attach it to someone or something where the threat doesn't actually exist. Or a product or a place, an industry, an animal or a population to be stigmatized, they need to be distinguishable, meaning you can't distinct - you can't stigmatize the entire general population. You have to stigmatize some subgroup of that population and they have to be a subgroup that can be recognized as different in some way. So you could do it by race or ethnicity, you could do it by age, you could do it by occupation if the occupation was obvious.

There are different ways that we might stigmatize a population subgroup. Once a threat is spread more evenly across a population, the stigmatization goes away. So recognize that situations that involve stigma especially when it relates to an infectious disease is often something that happens relatively early in a process when the threat, again, there's some uncertainty and not everyone is being affected equally by the infectious threat or the event that causes threats - stigmatization that causes a threat.

When I teach about crisis and emergency risk communication and radiation for example, I have a situation where there was a community in Brazil that had been exposed to medical radiological waste and some of the people in that community - it was spread out because people didn't realize that they were passing along a product that was full of radiation and people started to get sick. A smart doctor figured out it was radiation poisoning but by that time, a number of people in the community had been exposed, some had gotten ill and a few had died. That entire community was stigmatized because of the fear of radiation regardless of whether they had been exposed to the radiological material or not. And it got so bad that people who had license plates from that community, if they left that community, people would throw rocks at their cars, would not provide them service, didn't want them to stay in their hotels. And the population finally resorted to asking the health department to give them certificates of non-radiation exposure so to prove that - to the people who were stigmatizing all people from that community, that they weren't a threat. So it doesn't have to be an infectious disease that causes that stigmatization but more often than not it is when we're talking about public health events.

So the stigmatizer has to believe they can control their risk exposure by stigmatizing, and they also - the people who - or place or whatever that is stigmatized has to be distinguishable. And for a product or a place or something to be stigmatized, it needs to be associated in some way with the threat itself even though it doesn't present the threat. So you can see where if you have an infectious disease that occurs within a certain population subgroup, that then anyone who can be identified with that subgroup would be lumped in as perhaps part of the threat even though they are not. And the stigmatizing behavior, so what does the stigmatizer do? They do something to distance themselves from whatever it is that they choose to stigmatize. I think I've said that word enough times for the entire presentation today but we distance our self. So we will shun people , we will push people away, we will want them to not be around us in some way, and stigmatizing can be a problem in a public health event in many ways and we're going to talk about that but first I'm going to give you some examples of stigma and explain why it is stigma.

So I can go way back to the late 90s and in the United States there were - there was an outbreak among school-age children of hepatitis A in a number of states and it was due to imported strawberries that made it into the USDA school lunch program. So it was very specific but the threat came from imported strawberries from one place that were processed and then put into the USDA school lunch program. We could even identify which batches of these strawberries were out there that could cause - frozen strawberries that could cause the problem. Well, as I responded to this threat in our communication, I was very careful to say that the threat came from frozen strawberries in the USDA school lunch program, that's where we found the threat to be. What happened was at that time, people stopped eating strawberries, strawberries of all kind from all places including fresh strawberries. And so the berry association, berry growers association was pretty disappointed with us at CDC because we were talking about the frozen strawberries and people generalized the threat to all strawberries and the fresh strawberries weren't being purchased or used because they were, “associated” with the threat. So people took a little bit of information and then determined for their safety to try to have some control over what they perceived as a threat, they stopped buying any strawberries. And it even went beyond strawberries to fresh berries of any kind where there was a drop in sales of blueberries and blackberries and all kinds of berries during that time and it was because people generalized the threat and stigmatized those little berries at the time.

I said that you could stigmatize a place. In 1997, when I was in Hong Kong for the first reported cases of H5NI bird flu, Avian Influenza, that it turned out that the majority of people who were becoming sick and dying were from, the domestic workers who were from another country who were working in Hong Kong. And so you would think oh, well, that other country would be stigmatized because there was an association to this other - this population group from the other country. And in fact, what I witnessed was that these domestic workers tended to congregate in a particular park there in Hong Kong on their day off. And it was interesting to see that people stigmatized the park. They didn't literally want to walk through that park because they thought that it was associated with the threat. Well, you know that walking through a park isn't going to expose you to Avian Influenza but at the time people thought that because these domestic workers went to that park, they didn't want to go to that park so they stigmatized the park.

During the West Nile outbreak in New York back in '99, we know that mosquitos carry West Nile and would infect birds and other animals including horses. Horses were hard hit with the West Nile virus. Well, now the horses don't cause or transmit West Nile to others but we found that Europe actually banned during that year U.S. horses from coming to compete in races in Europe even though West Nile was endemic in Europe. It already existed there. But they stigmatized our horses because they were associated with West Nile virus even though they weren't the way West Nile Virus was transmitted. It was transmitted through a mosquito.

We saw that during the SARS outbreak, both in China and Canada, that certain groups were stigmatized but what I saw in the United States which was really interesting is that people were stigmatizing anyone with - from Asian decent even though we were monitoring for travelers from the area where SARS was occurring. People weren't able to distinguish the difference between one Asian community and another and started to stigmatize. They also started to stigmatize China Towns within big cities here in the United States. Now the SARS threat wasn't from the China Town but it was associated with people where - who had become ill with SARS and so people stigmatized China Towns in their cities and stopped going to them. And I can remember the governor of Hawaii going to Honolulu's China Town to have dinner and to eat to try to make the point that it was okay to go to China Town.

And then during the H1N1 pandemic, early on we know that the first reported cases of H1N1 were in Mexico. And so we heard cases of migrant workers who were in the United States working were stigmatized and - meaning people wanted to distance themselves from these migrant workers because of H1N1. We also know that people thought that they should stop eating pork because at the beginning of H1N1, if you'll remember it was referred to as Swine Flu and so people thought that they could protect themselves from swine flu by not eating pork even though there was no correlation between those two things.

So stigmatization can and does often happen in infectious disease outbreaks. And let's talk just a little bit more about why people stigmatize. We know that they do when there's uncertainty and the threat is present. And so they believe that they can protect themselves and others around them by disassociating themselves with the sub-population, something that's distinguishable. I don't talk about stigmatization if it's happening just occasionally from one place to another, one person to another. Stigmatization happens in a social context. Meaning there has to be broad numbers of people within the community doing the same thing for it to rise to the level of stigmatization.

We know that people have different levels of threat tolerance or risk tolerance and some people will automatically do something extraordinary to try to protect themselves from a threat. But when the general population does it, when a larger number of people do it, then you're getting into a stigmatizing situation because there can be biases among people, ones or, you know, a few here, or a few there. But when the whole society, when you start to see an economic impact, when you are actually starting to see people be shunned in big groups in big ways that's when you're stigmatizing. So that said, if you start to see it a little bit, you may have to acknowledge it and start to manage it from a communication perspective before it gets bigger along the way.

So why would I spend time with you all today talking about stigmatization? I want to talk to you as a communicator but I also have to talk to you as a social psychologist and what I know from the research is that being stigmatized is not helpful to a larger community and it's certainly not helpful to that subpopulation that could be stigmatized. And historically, when stigmatization takes hold, often there will be the potential that the stigmatized population will not have the same access to resources. So you can see that you're making a vulnerable population perhaps even more vulnerable once that stigmatization takes hold. There is of course emotional pain associated with it - being stigmatized in a situation, and unfortunately, I will tell you that there are times when people who become so fearful of this generalized threat of these people who are associated but don't represent the threat itself, are not threating themselves, they are not infectious in that way, that physical violence can occur. So just be really aware of the fact that some very bad, negative things can happen if we allow stigmatization to take hold.

So what do we do if start to see stigmatization? We have to recognize that if the threat is real, then we have to say that the threat is real but it's not the people, it's the behavior, and so we need to correct faulty assumptions. If, you know, if for example, we have a group of people who travel, then we don't want to generalize or stigmatize all travelers. What we need to do is recognize that depending on people's behavior when they travel, they may or may not represent a greater risk. And so it's difficult because we don't always know whether people are doing things to protect themselves and others in a situation or not but just know that often times we want to take the short cut of suggesting that everybody, a whole population group is putting us at risk when really it's not, it's the behaviors of some people that may be putting us at risk. And we certainly can see that in a situation where there are aspects, things that people can do to protect themselves and others.

So as communicators, there's some things that we can do before, during and after a public health event that will help reduce stigmatization and some of these examples, I'm using from Avian Influenza, that's when we really started to talk to people about stigmatization. But it worthwhile to warn people, share your concerns with media if this is happening, scan for anything that might be stigmatizing in the way you're presenting the information. And then also, even afterwards, make sure historical products don't stigmatize in some way. I sometimes think that we're - we do some of this perhaps subconsciously so it's something that we have to be on alert for along the way especially when we do things from a historical perspective.

I would like to say that for Zika and our response to Zika, that if anything should be stigmatized, I would suggest that what we need to stigmatize are mosquitos and not people, not places, not products but mosquitos. And so I was in the Adirondacks last week doing some hiking and I did use my insect repellent for lots of reasons, and I thought, well, you know, if I see a mosquito, I'm probably not really worried about Zika. But I was okay with stigmatizing those mosquitos up there anyway whether they're the ones that carry Zika or not, I don't want to - I don't really want to cut them any slack. So I guess I was stigmatizing a little bit because I was associating the threat with mosquitos that may not be the threat carrying mosquitos.

So if we're going to stigmatize around Zika, let's just stigmatize the mosquitos and let everybody else off the hook along the way. I'll ask, open it up for a discussion if you have any questions around stigma. It's not as complex as I think some have - sometimes as I'm trying to explain- it seems but I do want to warn you that there are times when we want to call something stigmatization when it really is an association with the threat itself, they do represent the threat. So be careful along the way. So I wasn't stigmatizing when I cautioned about frozen strawberries in the school lunch program. Now the fact is, maybe not every strawberry in the frozen, you know, lot of frozen strawberries carried hepatitis A but it was close enough to the threat that it was reasonable to try to avoid it. So trying to avoid a threat is - there's nothing wrong with that. Trying to avoid the threat by avoiding everybody that somehow is associated with the threat or everything somehow associated with a threat, generalizing the threat is when things become more difficult.

And I want to take just a moment because we talked about how stigmatization could be difficult in a community and perhaps compromise people in some way. I now want to turn to the idea of community hardiness. We were going to talk about that a couple weeks ago and we ran out of time. Community hardiness is an important component of helping people recover from an event. It's basically the idea of resilience on a community level and that's our ability to bounce back from something that happened. And as you start to take stock of your community, and I think it's worthwhile when we're planning for events, to think through what are the pluses and what are the minuses in this community. So what helps us, what protects us and what makes us more vulnerable? And we sometimes think that a community that is resource poor, economically poor, is a community that won't be able to be resilient, won't be able to bounce back but that's not always the case. There is more to community hardiness or resilience than just resources, and it's worthwhile to think through what some of those differences might be.

So we need to look of course at socio economic status, again, cautioning that it doesn't necessarily go one for one. Sometimes you may have a community that is so used to not having to rely on itself, not understanding how to do things without a lot of resources that when those resources become scarce, they have a tougher time of dealing with the scarcity. So just understand that. How many community-based organizations do you have and are they equipped to help people in a crisis situation? What's the healthcare capacity? I think this is an important one, social stressors. So what's going on in your community right now that could cause their, the community to have a harder time coming back. Political strife is one of those things and anything that gets in the way, anything that creates conflict within the community absent the threat could make it harder for the community to come together in the threat. And I say could, not necessarily will because sometimes if people need to come to together to overcome a larger threat, then some of these other social stressors will fall away but they will pop up again at some point.

And then political and civic perspectives. So Albert Bandura who offers the social cognitive learning theory and talks a lot about efficacy did research around group efficacy and he was able to identify what he refers to as learned helplessness. And some of that comes from this belief that I am here and you are supposed to come help me instead of thinking through, I'm here, what I can I do to help myself. And so it's worthwhile to think that through for a community is, is there some learned helplessness going on or are they prepared to help themselves in the situation?

What is really interesting is that some of the research indicates that mental toughness is actually more important in crisis situations sometimes than physical toughness, and I just want to throw that out. So statistically, vulnerable populations in crises, the ones who are less likely to survive a crisis are obviously young children and women but that isn't across the board. What we find is that people who have mental toughness, who really do believe in their ability to survive an event may have the resilience necessary and the coping mechanisms necessary to protect themselves in the crisis situation.

Okay Laura, what I'd like to do is go ahead and open it up for any questions that people may have, or if they'd like to discuss these two topics, stigmatization or community hardiness, and if questions or comments on that or whatever else might be on your mind.

Operator:      

Thank you, and at this time, if you'd like to ask a question, please press star followed by 1 on your touchtone phone. You'll be prompted to record you name for proper registration. Your name is required to introduce your question. Once again, if you have a question, please press star 1 and record your name clearly when prompted. One moment please.

Dr. Barbara Reynolds:        

While I'm waiting for any questions or discussion, I want to go back and talk a little bit about stigmatization and the need to bring that to the attention of media. I think that that's really a worthwhile discussion to have and I know that we've been encouraging people who are preparing for the possibility of local transmission by mosquitos of Zika in the United States proper that they might want to start to work with partners including the media. And I think this is a topic area that might be of interest to with media and get them thinking about it ahead of time so that they can also be an asset in terms of helping you discourage this possibility of stigmatization within the community.

Operator:      

And we do have a question from Colleen Ranky. Your line is open.

Colleen Ranky:         

Hi, thanks. This is about stigmatization. We had a situation here where we were seeing a spike in syphilis in a couple of counties in the border between North and South Dakota that happened to be a reservation. So we were very careful about making sure that we identified Sioux County, not the Sioux Tribe or not the reservation itself, but at some - and that was because of stigmatization, we didn't want the people down there stigmatized because there was an outbreak in their community. And it - we didn't think it would be necessarily accurate either. We wanted people to seek treatment even outside that community. So anyway, at one point, one of our employees was misquoted and the newspaper published an article about how there was syphilis on the reservation. And we had, you know, we'd been working with tribal leaders to craft the message and it was really difficult to get ahold of them and - because they were furious - get a hold of them and say, you know, this was - this was not us, this was a mistake, we will do what we can to correct it. And really we didn't actually pursue the newspaper that had misquoted but we kept on message. So every time we talked about the outbreak, it was Sioux County, Sioux County, Sioux County and we found that media tended to go back to that. Instead of the tribe, they started saying county again. So I'm just - I'm wondering if there might have been some other way to either prevent it from happening in the first place or to react to it in a situation like that where there's been a misquote and that causes the stigmatization?

Dr. Barbara Reynolds:        

Right. So I feel you for you only because in different situations I've experienced the same thing where you've thought about it ahead of time, and you did, which was really good that you recognized the potential and you were working with tribal leaders anyway on this and still the problem happened. It's uncanny that you're telling us this story after I just said, you know, I think it's worthwhile to talk with the media ahead of time. So I think if I were going to learn a lesson from this, what I would suggest is make it clear to the reporters when you're talking to them that you're being distinct, that you're making the distinction that it is Sioux County for a reason. And if you have any kind of rapport with your community, unless they are looking for conflict and controversy where it doesn't need to be, I would expect them to respect that distinction along the way. As long as you had some kind of, oh, I don't know data or evidence to suggest that it isn't limited to the Sioux Tribe but to the county. I would bring it to their attention. And if it had been me, I would have pursued a correcting that quote with the reporter, and -or even going so far as to say on the off chance that I just one time failed to say Sioux County, I want you to know what I meant was Sioux County and I would like that to be distinguished.

It's good that through repetition you were able to overcome it in real time by other people saying it but it was - I have to commend you for having thought about it at all and then making the effort to try to overcome it as it did happen. But I - yes, I think sometimes a little bit of prevention ahead of time might help in the long run. And I think that most journalists are respectful of, you know, of a community's wellbeing that they would go along with that. I - your opinion on that would be interesting to me.

Colleen Ranky:         

Well, we have some reporters who I think would be receptive but we've also got, you know, the Native American population is our largest ethnic group, minority group and so there's just stigma attached to it anyway.

Dr. Barbara Reynolds:        

Right.

Colleen Ranky:         

And I think that that kind of catches the reporter's eye. But I do appreciate your comments because we were - we really struggled with what to do. Do we emphasize it by having it corrected or do we just let it pass? And it was a dilemma for us but I like the option of doing that prior contact. That sounds like a good idea to me.

Dr. Barbara Reynolds:        

Yes. And I honestly think that if the damage has already been done, that it's worthwhile to go ahead and ask for the correction if for no other reason than to prove to your tribal leaders and members of the tribe that you really did not intend for that to happen. It can be really damaging when it's attributed to someone who's an official trying to do the right thing. It can be really hard to overcome so...

Colleen Ranky:         

Right.

Dr. Barbara Reynolds:        

I think I would have taken the chance to go ahead and ask for the correction because the people were already upset.

Colleen Ranky:         

Right. And we had worked with the Indian Affairs Commission here and...

Dr. Barbara Reynolds:        

Oh.

Colleen Ranky:         

They were very tied into the fact that we were very conscious of not using, you know, the terminology, and they really supported us when the do - the poo hit the fan. So that was really good but we had a prior relationship with them.

Dr. Barbara Reynolds:        

Right, yes. I actually had something like that happen when I was in Hong Kong back for the H5N1 Bird Flu and I went really hard at trying to get the media outlet to correct the record. And I literally went to the CDC website and posted something on our website as a correction because it was going to take so long for this particular magazine to get a correction out because it would have created a - was creating an international incident and it was so important for us to be able to get it corrected. So you have to take a - the temperature of your community in terms of how far you go to it but if you really did feel that you were misquoted or - not you but your official was misquoted. And you felt that it was going to really set back what your public health efforts were, don't forget that you have the power of correcting the records yourself in your own channels and you can bring that to the attention of the media outlet if they are resistant to working with you.

Colleen Ranky:         

Thank you.

Dr. Barbara Reynolds:        

So to sort of put them on notice.

Colleen Ranky:         

Yes.

Dr. Barbara Reynolds:        

Yes. But again, thank you for thinking about it and that's a very interesting example that we can all learn from.

Operator:      

Thank you. And once again, as a reminder, if you have a question, please press star followed by 1. The next question comes from Judy. Your line is open. And Judy, please check your mute feature, lift your handset.

Kitty: 

Hi, you might have meant Kitty. Hi. Thank you for sharing so much today. I was wondering regarding the new case that was in New York City, is that going to be acknowledged in the fact sheets that there can be female transmission sexually also? We're wanting to share more information in our county but I want to be sure it gives everything when we're making copies. It should also...

Dr. Barbara Reynolds:        

Yes, so I'll tell you again, it's an interesting as our Zika response unfolds and we learn more about it, we're going to have to adapt our materials accordingly. And I do understand that they are being adapted so you can expect that they will be happening on our materials here. And it's good for you to be thinking about doing that too. I don't know if you take advantage of our content syndication ability where we - you can have your website front facing, it's your website, but that you link through us to our content. So when we update it, it automatically updates on your website too. So you might want to look into that, you can find more about that on our CDC website.

Kitty: 

Okay. And I was wondering, because we learned - verbally we're telling people that the DEET needs to be at least 30% but it just says insect repellent on the literature that I've seen.

Dr. Barbara Reynolds:        

Okay.

Kitty: 

Or a lot of the literature.

Dr. Barbara Reynolds:        

Good question, and in fact that gives me the opportunity Kitty, to mention to people, I try to give you some little tidbit about misinformation or something that we need to correct among the public. And I've been told by our research people who do an environmental scanning looking for things that are being discussed about Zika that there seems to be a lot of discussion on some social media sites about the potential of using perfumes with essential oils as a way to repel mosquitos. And I just want to stress to all of you as you see that and pass it along, that we don't have any research or evidence that a perfume made of essential oils is going to repel mosquitos. And since perfumes are typically worn by women and we are very concerned about women who could be exposed to Zika when they're pregnant, that they know that that may not be what they need.

If you go to the CDC Website around preventing mosquito bites, we have some basic information on there and then a link that goes over to EPA. So what we recommend is EPA-registered insect repellents. They have a very handy tool for any person to use to help them find the insect repellent that works best for them, and it has to do with how long do you think you're going to be in a place where there might be mosquitos. And they say specifically that the higher the amount of DEET in the insect repellent, the longer it lasts. And so it really is a calculation of how long do you think you'll be out there, and there are some examples and actual name brands for illustration on the website. So there's more information there, we might just refer to EPA-registered insect repellents or insect repellents including DEET but you can get more specific.
So I don't have a specific percentage but just note that the higher the percentage, the longer it will protect you, and that might be something you want to pass along.

Kitty: 

All right, I saw that some of it has said as least 30%, okay. Thank you so much.

Dr. Barbara Reynolds:        

Sure. Thank you.

Operator:      

Thank you. Once again, as a reminder, if you do have a question, please press star 1 at this time.

Dr. Barbara Reynolds:        

While we're waiting to see if anybody has a comment about anything I guess related to our Zika response and the stigmatization or community hardiness, and some of these tools are available to you if you go to the CDC Website and just type in CERC or emergency/CERC, we have a number of tools up there and some of those tools might be useful in helping you manage some of these concepts along the way.

And I would be remiss if I didn't finish up this afternoon with a little discussion about trust and mistrust. And I want to stress that mistrust is an outgrowth of the perception that promises were broken and values violated. And I'm stressing it again this week in part because there is some uncertainty, we are learning as we go. We know much more about the Zika virus and how it affects humans today than we did four months ago but there's still more learning to be done and we're going to have to be flexible. And we'll have to be careful to remember that it's not unreasonable when we're talking to people and the possibility is that what we're telling them today might have to be tweaked in some way. So remember to start the conversation with based on what we know now. And that's just one little way that we can try to reinforce the perception of trust because if we're speaking with too much certainty in a situation where there is uncertainty, then we're violating their values in terms of their ability to trust us in the situation. So, Laura, do we have any more questions or comments?

Operator:      

Yes, thank you. We have a question from John Silcox. Your line is open.

John Silcox:  

Hi. Thank you, Barbara, for the presentation. I just wanted to ask in regards to stigmatization, one of the mosquito species that we're concerned about as a potential vector for Zika is the Aedes albopictus mosquito which is more commonly referred to in our region as the Asian Tiger mosquito. That's what a lot of our mosquito biologists refer to it as. And I was wondering do you see any issues with that as potentially being a stigmatizing term?

Dr. Barbara Reynolds:        

I see exactly what you're saying, the other problem with that though is it's pretty hard to get Aedes albopictus to roll off your tongue. And I would suggest if we could refrain from using Asian Tiger, that that's okay, though I will tell you there's probably a generation of people who know it as the Asian Tiger mosquito because of its threat with yellow fever and dengue and other things. So I - that's a hard one, that's a hard one. All things equal, I prefer that we didn't use the term but at the same time, if people are familiar with it and they can understand it through that term, maybe what you can do is a gentle movement away from Asian Tiger.

So when we were trying to move to H1N1 instead of using Swine Flu in 2009, even though it started out as Swine Flu, and there were biological reasons why it wasn't a good name even though it started out that way. We would say H1N1and then Swine Flu. When we're trying to talk about bovine spongiform encephalitis, you know, we would say in parenthesis, mad cow, and then after a while, you could use BSE and people didn't have to hear mad cow to understand what it is. So you might wean people away from it that way so that they have time to get used to the term Aedes albopictus. I would try that if I wanted to be careful about it. I think that most people when they hear Asian Tiger, they know that they're - we're talking about a type of mosquito and it's a mosquito that was recognized in that part of the world. So I don't know if it would necessarily stigmatize Asians and I don't really think we have to worry about tigers too much being stigmatized. And that was a joke, John.

John Silcox:  

Thank you for the response. I appreciate it.

Dr. Barbara Reynolds:        

Sure.

Operator:      

And at this time we have no further questions.

Dr. Barbara Reynolds:        

Okay. Well, I think we've had the opportunity to discuss a little bit about stigmatization, and I'll be interested to hear if any of you see anything that's going on in relationship to Zika that could be stigmatizing, feel free to reach to us at CERC@request - I'm sorry. CERCrequest@CDC.gov and we can pass some of that information along to others as it's useful to help us. And remember, if you do get involved in something where you think based on your assessment that it could be stigmatizing, there's nothing wrong with reaching out to the media and give them a heads up that there is that possibility and see if they can't work with you to correct it. And we'll - we look forward to talking to you all next week. Thank you.

Operator:      

Thank you. This does conclude today's conference, we do thank you for your participation and you may disconnect your lines at this time.