1. Build trust
As the foundation for effective outbreak communication, the most critical
objective is to build, maintain, or restore public trust in those responsible
for managing the outbreak and issuing information about it. This primary
importance of trust was found to be true across cultures, political systems,
and levels of economic development.
Trust derives from public perceptions of the motives, honesty, and
competence of authorities. Public confidence that a government or agency
is acting first and foremost to safeguard health will influence compliance
with recommended control measures and thus hasten outbreak
containment. Trust in the honesty of authorities and confidence that no
disconcerting facts are being downplayed or concealed reduces public
anxiety during the inevitable uncertainties of an outbreak. Confidence that
the authorities are competent and in control further helps prevent reactions
that exacerbate an outbreak’s social and economic impact.
2. Announce early
Early announcement of an
outbreak is the best strategy. Since human behaviours nearly always play
a role in outbreak spread, early announcement contributes to early
containment in a situation where every day counts. Equally important,
early announcement wins public confidence that authorities are openly
reporting what they know when they know it, setting expectations that
information will not be concealed.
smallpox, poliomyelitis, human influenza caused by a novel virus subtype,
or SARS must be reported immediately.
The first communication about an outbreak is often the most important.
Because of the very nature of outbreaks, the announcement will be a
newsworthy item that comes as a surprise, captures media and public
attention, and has great potential to alarm. How that initial announcement
is handled – when the spotlight is most intense – is likely to colour the
reception of all subsequent messages. Delayed announcement of an outbeak
creates the impression that officials are concealing information and may
be more concerned about preventing public anxiety and loss of income
from trade and tourism than protecting public health. The resulting loss
of trust, right at the start, can prove impossible to regain.
3. Be transparent
Transparency characterizes the relationship between the outbreak
managers and the public. Transparency can be defined as communication
that is candid, easily understood, complete, and accurate. In general,
greater transparency results in higher trust. Transparency provides many
benefits, including showing how even at a time of uncertainty and many
unknowns, outbreak managers are systematically seeking answers. Since
transparency can also reveal management shortcomings, it provides a
strong incentive for deliberative and accountable decision-making.
Transparency also has limits, as some information, such as confidential
patient data, should not be made public for ethical reasons. The key is to
balance such concerns against the public’s right, need and desire for reliable
information. Establishing the limits of transparency may vary from
outbreak to outbreak, but if transparency limits become an excuse for
secretiveness, the likely result will be a loss of public trust.
4. Respect public concerns
The public is entitled to information that affects their health and the health
of their families. Public concerns should be treated as legitimate, explored,
and respected as a force that will influence an outbreak’s impact. Early
risk communication was didactic, setting out the facts, telling the public
how it should react, and then describing any other reactions as “irrational”.
Today, effective risk communication is viewed as a dialogue between
technical experts and the public.
Transparency has limits, as some information should not be made public for ethical
An outbreak gains the attention of many different publics – those at risk,
patients and their families and neighbours, the media, researchers,
community leaders, trade partners, and tourists – and affects them in
many different ways. Outbreak communication works best when the views
of all these publics are considered when decisions are made about what to
say and how to say it. Once decisions are made, partners should strive to
present information in a coordinated and consistent way. In announcing
decisions early in an outbreak, the press will be helpful, especially if outbreak
management is transparent. But journalists can quickly turn adversarial
if they feel they have been deceived.
5. Plan in advance
Planning is essential for effective outbreak communication and yet it is
rarely done. Outbreak communication planning must be a part of outbreak
management planning from the start. Under the emergency conditions of
an outbreak, communication cannot be ideally effective when its principles
are considered only at the last minute in the rush to release information.
At the same time, however, outbreak communication that is not planned
in advance is not necessarily doomed to failure. As noted during the
consultation, many countries affected by SARS had no communication
plans in place, yet communicated very effectively with the public. Others
made major mistakes – and paid dearly; these could have been avoided
had the communication issues been considered in advance.