Communicating in a crisis

Nobody working in the healthcare world has been able to ignore the outbreak of the Ebola virus in West Africa this past year. The disease – an infection that can lead to fever, impaired organ function, internal bleeding and death – has so far claimed the lives of more than 8,000 people since reaching epidemic levels in the summer of 2014.

Guinea, Liberia and Sierra Leone have been the worst;affected areas, although very limited cases have been reported in neighbouring countries Nigeria, Mali and Senegal, as well as in the US and Spain where healthcare workers have returned from volunteering in Africa.

The fight is made tougher by the lack of approved;treatments or vaccines for the Ebola virus and the WHO has backed the use of untested drugs, such as Mapp Pharmaceuticals’ ZMapp which has had some degree of success in the limited number people in which it has been used.

It isn’t just the disease that the healthcare community needs to be dedicated to fighting, however. What’s clear from the way the outbreak has been portrayed in the mainstream media, and the process in which aid efforts have been co-ordinated, is that there is a separate battle to provide well-researched information to the public and governments and to overcome the collective ignorance that accompanies any mass public health crisis.

In the US there were major information gaps for the government and healthcare providers

Without a clear message on a crisis this large there can be confusion, as seen in the media hysteria surrounding the danger of contracting Ebola in the US. Taking just the facts, the country has seen four cases of the disease, including two people who travelled back from West Africa and two care workers who provided care for the affected patients. At the time of writing the last reported case in the US was recorded on October 23, 2014 (with a discharge on November 11, 2014) and it seems that containment measures have been effective in preventing further infections.

However, news reports on US Ebola patients have created an unnecessary level of concern among the public, certainly in comparison to other health threats. For example about 600,000 people die of heart disease in the US each year, according to the Centers for Disease Control and Prevention, yet Ebola has taken the headlines.

Social media: a challenge and an opportunity

The issues with the way the recent Ebola outbreak has been portrayed are not new, however, and tend to be a part of any public health crisis that seemingly springs from nowhere.

Discussing the matter with Wendy Lund (pictured right), CEO of GCI Health and veteran of the healthcare communications world, she reflects on the similarities with the emergence of HIV in the 1980s and the ignorance and fear that AIDS was treated with for many years. But 2014 is a completely different world from 30 years ago and the rise of the internet and new communications technologies can be both a help and a hindrance during a time of crisis.

“Since we do have access to the internet and social media we do have an opportunity, and also an obligation, to help healthcare educators and public health figures to make sure people are fully educated on the disease and treatment and prevention measures,” says Lund.

“It’s critical that people have the right information. Communicators have an amazing opportunity to help dispel myths and falsehoods about disease by using the tools at their fingertips.”

Tools like Facebook, Twitter and YouTube may provide new means to share an informed message, but they just as equally also allow misinformation to spread across the world at the speed of light.

“In times of crisis, information can get around the globe in minutes, but many times that information is incomplete,” says Lund. “Here we have a situation where information was incomplete and coming from multiple sources. The government might say something, but consumers would often get conflicting information from other sources.

“With Ebola, the government’s slowness in getting out with a strong and central message and communications effort meant that other sources of information took precedence. Many were not fully educated about the disease, which made for a confusing situation that often heightened fears. “

Creating a cohesive message

The high-speed proliferation of information from a variety of sources – some more well-informed than others – meant a clear message about Ebola wasn’t able to be formed, something that Lund sees as a failing in the basics of a communications strategy.

“It goes back to some of the simple ways we learn how to communicate as young communicators, which is to understand what the key messages are, what the tools are and then making sure we have an agreed message in place that we can share,” she says.

“There wasn’t necessarily one cohesive message being formed. What I think we saw happen in the US is that there were major information gaps for the government and healthcare providers.”

A health crisis on this scale involves a lot of stakeholders, and all must work together to develop that core message. Lund says: “This goes well beyond the media and traditional advocates and goes into consumers and policy makers and people who can be creating conversations.”

This lack of a cohesive message didn’t just mean misperceptions in the risk of Ebola in developed countries but of the urgency for aid in the African nations affected by the outbreak. Lund argues that it might be necessary to rethink the way a disease outbreak is communicated, from that of a public health crisis to that of a natural disaster.

“I think people react very differently to natural disasters than they do to health crises,” says Lund, referencing an article that compared the relatively slow international reaction to the Ebola outbreak to the urgent aid sent to Haiti after the earthquake in 2010.

“When there is a tsunami or earthquake people say that’s out of my control – it didn’t happen to me so I can help. But with a public health crisis people look inward and think ‘My god am I going to get Ebola’. And that’s how we panic.

“It’s very important that people take a situation like what’s happening in West Africa out of the context of health and treat it like a natural disaster that needs the support of everyone. People have to focus outwards.”

The role of healthcare companies

Of course many healthcare organisations work with great dedication and responsibility to support countries affected by health crises, including the frontline health provision of Médecins Sans Frontières and the global strategising of the World Health Organization (WHO), both of which have taken a central effort in the fight to contain Ebola.

The private sector also has a role to play, says Lund, who notes that the recent outbreak is a “major rallying point for both pharma and biotech and hospitals and service providers and insurers and governments to come together”, united against a terrible disease.

Pharma firms are involved in several ways, including the development of new drugs and vaccines, with GSK, J&J and Merck all fast-tracked research programmes in partnership with the US National Institutes of Health (NIH). Several companies are also providing vital supplies and funding to help support aid efforts in Africa.

“I think pharma is rising to the challenge and it is wonderful that they are moving as fast as they can to make sure epidemic is contained and that proper preventative measures are in place to avoid transmission.”

The full impact of what pharma companies can do can only be seen when they work together, however: “There is great opportunity for public-private partnership and private-private partnerships,” says Lund. “For pharma this is an opportunity to rise to the occasion and work with each other. Companies can reach across boundaries.

“My feeling is that people need to think about doing things differently at this point and ask if we are doing everything in our power to do what we can. That’s when people will lose their thinking about competitiveness and I think there is, underlying, a very deep commitment from what I have seen.”

A ‘war’ on disease

The use of ‘war’ as an analogy is not a new idea, and its extreme imagery has certainly helped cement the ‘War on the Drugs’ and the ‘War on Terror’ into people’s minds, even if not always for the right reasons. But for Lund, when discussing a united front to contain and eradicate Ebola, a ‘war on disease’ may be the most appropriate way to think.

“When there is a war there is one message that emanates from the centre of government and people listen, and that has not happened here. The message was all over the place and that’s what made people fearful.

“As healthcare communicators we need to be at the frontline. We need to make sure we are leveraging and taking advantage of all those communications tools from all different crises we have dealt with and avoid misperceptions. At end of the day it’s making sure we are preventing bad information from getting out there.”