CERC Transcript 08 02 2016

Zika CERC Discussion: First Local Transmission

Presenters: Barbara Reynolds, PhD

Date/Time: August 2, 2016 1:00 pm ET

---------------------------------------------------------------------------------------------------------------------

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.

Barbara Reynolds:   

Thank you, Laura, and welcome everyone to this week's Zika crisis and emergency risk communication discussion. We're kind of going back to the future. We know that we have some important developments happening here within the continental United States related to Zika this week. And, before that, we had decided that we were going to go back and look at what we need to do in terms of our planning for and communication around first local human cases of Zika or infections from Zika through mosquitos. What do we need to do in terms of our communication and planning? And I want to caution that although we now have, through the events that are unfolding in a neighborhood in Miami, Florida, our first infections and cases of Zika through mosquitos in the United States, that doesn't mean there isn't going to be a first wherever you are. And what's important to remember is that, yes, we now have a community and a state that's experiencing what it means from a communication perspective to go through this process. But when it shows up for the first time in your community, it's going to be your first and you may need to consider some of these actions also. And we have made it into the mid-part of mosquito season. And so we were just going to have to be more aware of the possibility that more of these things can happen. And we just don't know where necessarily or how, but planning for that communication is really important.

And if we go back to some of the discussions we had in April at the Zika summit at CDC or in some of the first discussions we had on our weekly series around crisis and emergency risk communication starting in May, one of the things that we emphasized is the idea of getting the community prepared for the possibility of Zika cases found through travelers or local transmission from mosquitos that have been infected through biting travelers that have come back into the area. We've also talked a little about some of the myths around Zika and Zika transmission. And to the extent that we can knock those down before the questions pop up in your community, I think all the better. So why don't we just go back and review some of the things we talked about in May around first local transmission.

And for those of you who are following along on slides, you know that I won't have this conversation without saying that the reason we do this and the reason we take the time to learn some techniques and think about planning around communication is because we know with certainty that the right message at the right time from the right person or organization can saves lives and/or reduce harm to people. So communication is an important component. I might be singing to the choir, but I think it's worthwhile to say it. And if I say this enough times, you might be able to repeat it just as easily in a situation where you're going to have to take a stand and make people realize that paying attention to the communication aspect of a response can be critically important in its success. And we have plenty of evidence where things have gone right and things have gone wrong accordingly.

I want to talk a little bit about what we have seen or not seen in populations who have had to confront the possibility of ill effect from Zika infection, including the possibility for serious birth defects in fetuses and babies who are born with infection from Zika. We have a mixed reaction in some cases. And I think it's worthwhile to talk about where that might be coming from. Sometimes I think we resist talking the hard facts, so to speak, about a public health condition that might be headed in the direction of your population or your community, because you think that it would be unnecessarily causing fear in that community. And there is mixed research out there, but I was just introduced this week to an article that was published in 2016 that says, don't be quite so afraid about bringing up issues that are bad news that may elicit fear in some people, because it, actually, in the long run helps the community that people in the community are not going to be wedded to a state of such a great anxiety that they can't do what they need to do. That, in fact, there is, again, mixed perceptions about fear appeals, and I don't think we should ever unnecessarily make people be afraid, but I also think that we have to help people confront the hard truth about the threats that they are facing at any one time. So with that said, I think it's important to understand that it is okay to start to tell people about some of the bad things that could happen in relationship to Zika. That doesn't mean that we should over emphasize one against another. We do know what those may be and especially for pregnant women what that could mean.

 At the same time, we need to understand that there are some people who may be at risk, but may be resisting taking the actions that they need to protect themselves or the community. And the question might come up, why is that? Why are people not doing the things that we think they should naturally want to do when they're confronted with a risk as some communities are in relationship to Zika? And I will tell you that one of the things that I have witnessed and I think that as a social psychologist I've delved into is the concept of denial, that sometimes when we think people should be afraid and they're not, it's because they're experiencing something called denial. And sometimes denial is generated out of an internal conversation that they're having with themselves without sometimes even recognizing it that basically goes like this, “Hmm. This is a new risk. I see that there might be a threat to people who are exposed to this risk, however I don't believe I have the means by which to protect myself from that risk, so I'm going to have to ignore it.” Now that's all sort of subconscious. They're not necessarily going through that process in a conscious way. But when people start to ignore a threat, it's because often they don't believe they have the efficacy to be able to confront that threat. So I think it's really important that if we are going to talk to people about things that could be headed their way in the community or might be evolving in real time in their community, but just at the beginning, that it's okay to talk about the bad things that are happening. But it's just important to tell people what they can do to confront that bad thing. And we need to make sure that when we're giving people advice that we acknowledge that we're asking them to do things that may not be easy, but point them in the direction to how they could go about doing it in the situation and praising people who are doing the right thing along the way.

So it's sometimes not that they haven't heard us. They've heard us, but they don't believe that they have the efficacy or the ability to do it and they may start to feel a little hopeless.
And one of the things I'm concerned about is when we overemphasize the idea that just the tiniest bit of standing water could be a breeding ground for the particular mosquitos that carry Zika. And I've heard people talk about, you know, a bottle cap full of water, you know, a bottle cap of standing water could do this. I think if we're trying to initiate a productive conversation with our community, I'm wondering if that is really the image that we want to leave with them.
Because I think that if that were the only thing, that if I thought somebody was expecting me to be able to manage my environment to the point that there was not even a bottle cap full of standing water around me, I would feel kind of hopeless. And perhaps I wouldn't take any action, because I would think it wouldn't make any difference. So we need to give people an opportunity to learn more about what the risk is and to learn about things that they truly can do to help reduce their risk. And sometimes if we're trying to go for perfect, we're not going to get there and may lose people along the way.

On the next slide, we're talking about the crisis communication plan. By now I hope that anyone who is in a community where there is these particular mosquitos are circulating in the mosquito season that your communication plan might be well on its way. But I think it's important to go back and look at that in the reality of what you're seeing happening in other areas and is your plan going to stand the test of time? I also think it's an important point in time to go back and revisit partners you may have been talking do about this and reaffirm the commitment among the people who will be working on this. Look to see if you really think you have the resources that you need to address this along the way. And when we talk about resources, one of the things I want to emphasize is not - we'll get to this a little later, but that we do have communication resources at CDC that are available to you, but also just generally in terms of the response that CDC has something called a CERT. And that's a CDC Emergency Response Team and I know I'm using a lot of CERCs and CERT in this. But CERT with a T is the CDC Emergency Response Team. That is a concept that has existed before Zika, but we have CERT teams standing by, prepared to go out to work with a community, state or local authority when asked to do so after there is confirmed local transmission of Zika. And it's important to recognize that that team is there to help with an extra set of helping hands and with some expertise that they can bring to bear on the topic. They're not meant to replace the public health and other experts that are there in the community, but they are there to help. And there is literally a roster of people who have volunteered to be available within 12-24 hours to go out and support a community who is looking for some extra help. And part of that CERT team - they have subject matter experts on viral diseases, on pregnancy and birth defects, on mosquito control, laboratory issues.

But for this conversation I want you to know that the CERT team also will come with communication subject matter experts if requested and there is belief that they could be helpful.
And these communications people would work with planning and input and local implementation campaigns to communicate the risk of Zika, virus infection and to emphasize personal measures that the public can take to decrease their risk for infection, disease or adverse outcomes. They're ready to help local and state health authorities with pressing queries, messaging regarding investigations, and then any kind of ongoing communication, making sure that we have consistency with the messages as they come out from CDC and in the local community. So I want you to be aware that that resource exists. And if you're the communications lead for your community in the public health arena, that if there is discussion of a CERT team from CDC coming, speak up and let them know if you need communication resources from CDC. Of course, we're always prepared to work with you from Atlanta. And that person that would show up on the ground would be there working with us back here in Atlanta.
But we want you to know that that is a resource available to you along the way.

 As we talk about the crisis communication life cycle, I talk about different phases of communication in a crisis situation. And I have a hard time and I've never figured out quite the way to show it on my model. And that is in resolution space, I talk about opportunity to educate a primed public for future crises. And I have that as if that's after you've already had the crisis. And the reason I say I have a hard time with my model is because right now when we have a community who is dealing with the first local transmission by mosquitos of Zika, your community, if you're not that community, has the opportunity, because you're public may be primed to pay attention to what's going on. And at that time, you have an opportunity to build some rapport with the community and instill some confidence in them that you are prepared and willing to give them information that they may be seeking at this time. So even though it may not be happening in your community right now, you can take this opportunity to be prepared for it happening in your community and talk to people about the what if’s. What if this were happening in our community? What would this look like? What would we be saying? And talk to the public, again, if they're interested.

When I was talking about fear and why people don't take action, for someone to be fearful, two things have to happen. They have to believe that the threat is personal to them. And oftentimes they have to believe - not everyone, I'm making generalizations, but oftentimes people have to believe that the threat is imminent. It could be that for the first months now when CDC and organizations around the world have been responding to Zika epidemics in the Americas and in the Caribbean that people may have - they may know what Zika is, that it's a new disease spread by mosquitos, but they may not know much more, because they don't believe that the threat is imminent to them. Now we have our first local transmission by mosquitos of Zika within the continental United States. This may be an opportunity in your community to bring back the conversation. Because they may feel that the threat is more imminent in this regard. So don't allow this time to pass without taking some time to think about what you can do to communicate to people right now about their particular risks related to Zika. It's also an opportunity to help overcome some of the misperceptions that might be out there about Zika and about what the risks are or are not and what people can or cannot do to protect themselves from mosquitos and Zika, which can be transmitted.

So just know that it doesn't matter where you are in the flow in the crisis communication life cycle. There are things that can be done and we should take advantage of it. There is recent research that actually shows the effort that government organizations or response officials make in speaking to the community in advance of a risk, that it goes to increasing trust by that community in those messages. Because, frankly, you want to be out there telling people something and then consistently tell them that. So tell them the same thing, even before the event happens, so when it does happen, it'll reinforce what you're saying in the time. CDC has published a lot of information and plans for what steps local authorities, state authorities and the federal government should be taking when there is local transmission in a community. And it's worthwhile to go back and look at those, if you don't and have some familiarity about what we're doing. Because one of the best things we can do is tell people we're thinking about it, we have thought about it. Here is what we believe is the right approach at this time, taking into account that plans have to be adjusted as we learn more and we're learning more about Zika every day.

We know without question that any information in a crisis or emergency is empowering to people. And one of the things I caution is that it's important that we get out there early with information when people are paying attention, because if you don't, there may be people who do not have the public's best interests at heart who will take advantage of that in a situation. So it might be worthwhile to, again, dust off any plans that you put together earlier in the spring and look at them in the face of what we know today and see if those plans and materials are still consistent along the way. One of the things that we recognized here at CDC is that in my very offices that it is summertime. People go off on vacations, they're away for a day or two and do we have the backup that we need? And I know that as you go into state and local health departments, for example, that it's very difficult to find those backups along the way. But we need to think about it. If this happens and I'm not here, who is going to be able to take this on and will they know what they need to know to move this forward? And as much as we'd all love to always be where we are needed when a crisis occurs, that doesn't always happen.

So we need to plan accordingly. We need to know what the public will be asking from us when those first announcements of local transmission occur in your community. And, of course, the most important questions are the, are my family and I safe? What have you found here that will affect me? And what can I do to protect myself and my family? And then, without question, they're going to ask, can you fix it? And that's a big question, because this is not an easy fix when we have no vaccine, no treatment for Zika. We have some members of our population who are at greater risk than others. It's a complex environment for an emergency response and we need to consider that also as we go forward.

I talk every once in a while about a concept called vicarious rehearsal and I think it's worthwhile to revisit that as we're looking at, you know, in our first week with the local transmission within the continental United States. Vicarious rehearsal is just the idea that people through mass communication channels are being exposed to a potential threat. And at that time, they're assessing what people are suggesting should be done for that threat and determining whether it's a viable option for them or not along the way. And to the extent that we can reach those people who are doing vicarious rehearsal and helping them see where it works for them that they can do what needs to be done to protect themselves and others, I think it's worthwhile to consider it.

And like no other emergency response that I've been involved in, this is a case of where we have a part of our population, pregnant women, who are at greatest risk for adverse outcomes through their pregnancies because of Zika with very specific populations. And we need to help the community understand their role in protecting this subgroup of the population. And so that's going to take some time to help people and we need to reward people who are doing the right thing by acknowledging whatever they've done, whatever effort they've put into helping us by using insect repellant for three weeks after they return from an area where Zika is being transmitted. Or by faithfully cleaning and emptying standing waters in their community. Whatever they're doing, they need to be recognized for doing that.

What I'd like to do now, Laura, is go ahead and open it up for discussion and question. I would expect that there's a lot that we could go in many different directions, but I just wanted to give you a taste of some of the things that we can talk about in relationship to the possibility of local transmission by mosquitos within your community and what we should be thinking from a communication perspective. So, Laura, if you want to open it up for questions or discussion, I think it's a good time.

Operator:      

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

Barbara Reynolds:   

Thanks, Laura, and as we're waiting for someone to queue up to make a comment or ask a question, I'm just going to go continue with some of the slides and emphasize that we do have six principles of crisis and emergency risk communication. I'd like you to memorize right message, right time, right organization or person saves lives. But I'd also like you to remember these six principles. Be first, be right, be credible, express empathy, promote action, and show respect.
And these are foundational principles that when we're developing our communication messages can be very helpful. So Laura, do we have any questions or comments?

Operator:      

Yes, we do have a question from Jamie Bash. Your line is open.

Jamie Bash:  

Hi. Thank you for taking my question. We've been focusing a lot on the Florida case, which is absolutely timely and relevant. I do have a question. For Oregon, obviously, we're at low risk, but it's going to be more of interest to our news media what comes out of the Utah case. Is there any indication when we might have more information so that we can start planning messaging around the Utah case?

Barbara Reynolds:   

Yes, Jamie, that's a really important question. I can imagine that you're feeling that the Florida coverage has eclipsed what is a very interesting situation in Utah. And I will tell you, honestly, I do not have any updates on that and I can't tell you with certainty when we will. I would expect that if we have important updates that those updates will be shared through Utah. It is, obviously, theirs to track. And then it would be published in the Morbidity and Mortality Weekly Report, the MMWR. I don't know if you're familiar with it or not, but I would say we have now a number of articles in there being published in real time around the Zika situation. So I would expect it to be covered there. But I'd certainly be happy to see if I'm missing something. It's hard when you have a big response going to keep track of every aspect of it. And, if you want to send us an email at certrequest@cdc.gov, we'll follow up with you on that.

Jamie Bash:  

Yes, thank you. We are watching Utah and the MMWR, but thanks for updating us on what you do..

Barbara Reynolds:   

Certainly.

Jamie Bash:

...didn't know about that.

Barbara Reynolds:   

Okay, Laura, do we have any other questions or comments?

Operator:      

We have no further questions, but, again, as a reminder, if you do have a question or comment, please press Star followed by 1.

Barbara Reynolds:   

Okay. While we're waiting to see if anybody else wants to jump in with a question about being prepared in their community for local transmission, I'd really like to emphasize for those of you who this might really begin to feel even for you that it could be imminent, that there are so many communication resources available to you at CDC. A lot of the information itself is broken down on the website according to specific categories of interest or responsibility. But also, if you just go to communication resources off the Zika site at cdc.gov/zika, there are - I was just on it in anticipation of this call and I'm just so impressed with how much information is there.  And it's packaged in ways that can be really useful for you in the community, so you don't have to start over. And something as simple as a Zika 101. And we've talked about in our planning for Zika in the community of trying to get out into the community and talk to them about this. And I don't know if you have a speaker's bureau, if you have a, you know, some of your officials going out into the, you know, civic events or something like that. But it is really a resource for you to pick up pieces of information and share it.

 And I know that we have had people from communities that have dealt with mosquito born outbreaks before of Dengue and Chikungunya. And they talk about the need to go door to door, to have door hangers, to have information sort of put out there in the old fashioned way. When you're talking about the kind of transmission where you have a very clear area where the transmission is occurring, you're probably not going to be using just mass media. You're going to be talking to people in a more one on one or intimate way, handing out fliers or something like that. And the CDC risk communication resources for Zika are a really rich place to start to think about it. And, of course, you can always take these materials and make them your own in different ways. But there are materials there to get you started, if you're not. And, again, I recognize that over the years of working with some incredible communications people at the state and local level that you don't have the amount of resources for communication that we might have here at CDC. And so it's always going to be a little stretch for you to get started, but this is the place to do it. So Laura, do we have any other questions or comments?

Operator:      
Yes, we have one just coming in. One moment please.

Barbara Reynolds:   
Sure.

Operator:      

And we have a question from Lisa Patrick-Mudd. Your line is open.

Lisa Patrick-Mudd: 

Thank you. Hi. This is great information, thank you. I'm curious if there's been any updates regarding funding from Congress to help local departments with these outreach efforts. I mean if we're talking about going door to door, that's going to require a lot of resources. Do you have any information about that?

Barbara Reynolds:   

So, Lisa, I know that CDC just put out a press release today that talked about additional funding. I don't know if it was funding for communication parts of it, but I do know that additional funding is headed. I don't have an update specifically on any other bigger components of the funding, but I think we all recognize that there are - there's a lot of work yet to be done and if it's your community next who's facing a first local transmission that there will be a lot that will be needed. I also want to emphasize, so Lisa, this is a good opportunity for me to do that, to emphasize again the CERT team, the CDC Emergency Response Team for Zika that - don't hesitate to include a request for communication support if that does happen, if the team is being sent out so that we can help you and also help you identity ways to get the job done when it needs to be done. Okay, Laura, do we have any other questions or comments?

Operator:      

We have no further questions.

Barbara Reynolds:   

Okay, good. Well, next week - oh, before I forget, I want to emphasize that we would like to cover topic areas that are of interest to you. We did get one in that I know we're going to address next week. We're going to talk about culture. We're going to talk about managing some of these topic areas in Spanish next week. But if you have a topic area you want to cover specifically around crisis and emergency risk communication within the context of the Zika response this year and where we are right now, don't hesitate again to contact us at certrequest@cdc.gov. And for those of you who go to the website, we do have additional resources available to you and a way to sign up so that you can get updates from us through our emergency partners’ newsletter. So I'll leave it at that for today. And look forward to talking to you all next week. Thanks, Laura.

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.