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Crisis & Emergency Risk Communication Barbara Reynolds, Ph.D. Hong Kong H5N1 Outbreak, 1997. CDC Epidemiologic Investigation. Surveillance & Control. 1918 Pandemic Deaths by Age.

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Crisis & Emergency Risk Communication Barbara Reynolds, Ph.D.

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Crisis & Emergency Risk CommunicationBarbara Reynolds, Ph.D.

Hong Kong H5N1 Outbreak, 1997

CDC Epidemiologic Investigation

Surveillance & Control

1918 Pandemic Deaths by Age

Figure 2. "U-" and "W-" shaped combined influenza and pneumonia mortality, by age at death, per 100,000 persons in each age group, United States, 1911–1918. Influenza- and pneumonia-specific death rates are plotted for the interpandemic years 1911–1917 (dashed line) and for the pandemic year 1918 (solid line)

Jeffery K. Taubenberger* and David M. Morens†*Armed Forces Institute of Pathology, Rockville, Maryland, USA; and †National Institutes of Health, Bethesda, Maryland, USA

Communicating in a crisis is different

  • In a serious crisis, all affected people . . .

    • Take in information differently

    • Process information differently

    • Act on information differently

  • In a catastrophic event: communication is different

  • Be first, be right, be credible

What the public seeks from your communication

5 public concerns. . .

  • Gain wanted facts

  • Empower decisionmaking

  • Involved as a participant, not spectator

  • Provide watchguard over resource allocation

  • Recover or preserve well-being and normalcy






  • Prepare

  • Foster alliances

  • Develop consensus recommendations

  • Test message

  • Evaluate plans

  • Express empathy

  • Provide simple risk explanations

  • Establish credibility

  • Recommend actions

  • Commit to stakeholders

  • Further explain risk by population groups

  • Provide more background

  • Gain support for response

  • Empower risk/benefit decisionmaking

  • Capture feedback for analysis

  • Educate a primed public for future crises

  • Examine problems

  • Gain support for policy and resources

  • Promote your organization’s role

  • Capture lessons learned

  • Develop an event SWOT

  • Improve plan

  • Return to precrisis planning

Crisis Communication Lifecycle

5 communication failures that kill operational success

  • Mixed messages from multiple experts

  • Information released late

  • Paternalistic attitudes

  • Not countering rumors and myths in real-time

  • Public power struggles and confusion

Six Principles of CERC

  • 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.

  • Be Right: 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.

  • 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.

Six Principles of CERC

  • Express Empathy: Acknowledge in words what people are feeling—it builds trust.

  • Promote Action:Give people things to do. It calms anxiety and helps restore order.

  • Show Respect: Listen. 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.

Decisionmaking in a Crisis Is Different

  • People simplify

  • Cling to current beliefs

  • We remember what we see or previously experience (first messages carry more weight)

  • People limit intake of new information (3-7 bits)

 How Do We Communicate About Risk in an Emergency?

All risks are not accepted equally

  • Voluntary vs. involuntary

  • Controlled personally vs. controlled by others

  • Familiar vs. exotic

  • Natural vs. manmade

  • Reversible vs. permanent

  • Statistical vs. anecdotal

  • Fairly vs. unfairly distributed

  • Affecting adults vs. affecting children

Successful Communication


Accuracy of Information


Speed of Release







Sources of Social Pressure

  • What will I gain?

  • What will it cost me?

  • What do those important to me want me to do?

  • Can I actually carry it out?

Trust and Mistrust

  • Stakeholders judge the response to an issue or crisis based on trust

  • Trust is the natural consequence of promises fulfilled

  • Mistrust is an outgrowth of the perception that promises were broken and values violated

  • CDC fulfills trust by combining our best science with strong ethics and values

Consequences of mistrust

  • Health recommendations ignored and disease and death go up

  • Demands for misallocation of resources

  • Public health policies circumvented

  • Opportunists prey on others in the “trust gap”

  • Fiscal and medical resources are wasted

    We can’t accomplish our mission

Causes of conflict: perception by either party of

  • Superiority

  • Injustice

  • Distrust

  • Vulnerability

  • Helplessness

 Stages of Values Disputes

  • Feels threatened (you survive or I do)

  • Situation becomes distorted (they are evil)

  • Rigid explanations for own behavior (we’re protecting people from quacks)

  • Conflict becomes self-identity

Dealing With Angry People

Anger arises when people. . .

  • Have been hurt

  • Feel threatened by risks out of their control

  • Are not respected

  • Have their fundamental beliefs challenged

    Sometimes, anger arises when . . .

  • Media arrive

  • Damages may be in play

Deescalating conflict with “them”

  • Seek input early

  • Seek common principles

  • Approach the process fairly

  • Acknowledge emotions, appeal to reason

H1N1 outbreak April 2009

  • CDC had been on the hunt for a pandemic influenza virus for nearly half a century

  • Between 1997 and 2009, pandemic planning included communication planning

  • With H1N1, CDC used social media widely for major outbreak

Crisis Communicator

Richard Besser led the United States’ top public-health agency as swine flu broke out on its doorstep. And his communication shaped the early days of a pandemic

CERC Communication Principles

  • In his office at ABC News in New York, Besser talks about the principles he looked to when talking about the H1N1 pandemic. He refers to a CDC pamphlet on crisis and emergency risk communication with the subtitle: 'Be First, Be Right, Be Credible'.

    • 13 January 2010 | Nature 463, 150-152 (2010) | doi:10.1038/463150a

Social Media: Crisis Role

Social media in a crisis: the good

  • Need to be where people are

  • Leverage unique characteristics of emerging channels

  • Tailored health messages

  • Facilitates interactive communication and community

  • Empowers people in making health decisions

Social media . . . Good & bad

  • Provided rich choices to support CDC’s desire to communicate with, not to, the public in a more personal and targeted way. (good . . . )

  • What was essentially unknown was whether the use of social media during the H1N1 outbreak would work to increase or decrease the public’s trust in CDC’s recommendations and response. (bad . . . )

CDC H1N1 Social Media

  • Buttons & Badges


  • eCards

  • Image Sharing

  • Micro-blogs (Twitter)

  • Mobile

  • Online Videos

  • Podcasts

  • RSS Feeds

  • Social Networking Sites

  • Text Messaging Pilot

  • Widgets

Buttons and Badges

  • Add a button to your Web site. Let your Web site visitors know how to stop the spread of novel H1N1 flu and where to get more information about novel H1N1 flu.

  • Choose a novel H1N1 flu Button in English

  • Choose a novel H1N1 flu Button en Español

E-Cards H1N1

  • Keep your friends, family and coworkers informed. Send them tips for staying healthy and avoiding the flu by washing their hands. Visit the CDC Health-e-Cards site today to send a loved one an eCard.

H1N1 Image sharing

  • View and share novel H1N1 flu images from the CDC Flickr site

CDC Mobile Web site

  • Your Mobile Source for Credible Health Information

  • CDC's health information is now available on your mobile device. Visit on your mobile phone or PDA for information on seasonal flu, H1N1 flu, public health emergencies, and more.

Public Inquiry

  • CDC National Contact Center

    • Representatives are available 24/7 to answer your questions in English and Spanish. For up-to-date information about novel H1N1 flu and hundreds of other health and safety topics:

    • Call: 1-800-CDC-INFO (1-800-232-4636), TTY: (888) 232-6348, English/Spanish, 24 Hours/Every Day


  • Postal Mail:Centers for Disease Control and Prevention1600 Clifton Rd,Atlanta, GA 30333U.S.A.

Trust is needed first before someone will:

Feel able to rely upon a person (organization),

Take reasoned risks, and

Willingly cooperate and achieve a goal.

Social media and trust building

Social media and trust . . . Our intuition

  • Public suspicions of scientific experts and government are increasing

  • Nonetheless, trust and credibility are essential elements of persuasive communication.

  • In fact, the more people know about efforts to openly share accurate information, the more they trust the government or industry as the source.

Before we got started . . .

  • CDC made the conscious decision to maintain its scientific integrity in its messaging through these new media (e.g., it used simple but still formal language not jargon)

  • and also to respect the norms of the social networks it joined.

Facebook entries: shot or no shot?

  • Male: Never had any flu vaccination for 10 years and never had any problem...UNTIL last month I give it a try..BIG mistake, first time feeling sick like a dog...tsk tsk...talking about conspiracy theory by Ex-Governor J Ventura was talking about...

  • Female 1: baaaa baaaaa Amazing how many of you are clueless. I would swear that you are being paid to post your nonsense here. By whom? I can think of a few possibilities.hmmmm Oh and my uncle just got his h1n1 shot and got sick with the flu within 1 weeks time. Go ahead baaaaaaaaaaa get that shot.

  • Female 2: what flu did he get sick with? was it confirmed h1n1? If he got sick within a week his inoculation was too late, it takes 2 weeks before the antibodies make you immune to the virus. Makes me sick how many people think the flu vaccines are killing so many people and causing autism. Now there is the conspiracy. Go take a microbiology class, and an anatomy and physiology class. Stop reading junk science articles.

CDC Tweets targeted & quick

  • RT @FluGov: Be Advised of New Spam Myth in Circulation. CDC has NOT implemented a vaccination program requiring registration.

  • RT @CDCFlu H1N1 Flu Vaccine -- Why the Delay? Watch a new CDC video to find out how flu vaccines are made:

  • RT @CDCFlu Anyone with asthma is at higher risk for flu-related complications. Learn more:

Benchmarking:Top Federal Twitter Profiles

CDC Audiences Use Social Media

  • Those who use social media on

    • Have higher satisfaction ratings (84 out of 100) than those who do not use CDC social media tools (79 out of 100)

    • Are more likely to return and recommend the site to others than those who do not use CDC social media tools

    • Rate CDC as more trustworthy that those who do not use CDC’s social media tools

The good: Trust, transparency & participation in government

  • Pilot to measure TTP in government

  • CDC scored higher than other Fed agencies/benchmark

  • Largest difference for collaboration online

The ugly

  • Crass, anonymous discussions (stigmatization, xenophobia, conspiracies . . . )

Swine Flu #1 Google in News Category, 2009

  • Google News - Fastest Rising

  • swine flu

  • susan boyle

  • jon and kate

  • adam lambert

  • rihanna (chris brown)

  • new moon

  • inauguration

  • michael jackson

  • nadya suleman

  • missing link found

CDC Earthquakes Web site

Page Views for January 1st through 24th

Search terms focus on earthquake preparedness and response.

Large spikes in traffic over norm.

Professional guidance getting heavy traffic (wound management, crush injury, etc.).

Many Spanish speakers visiting site.

Haiti Earthquake Web

CDC Earthquake PSAs and Podcasts provide messages about what you can do to protect yourself and your family before, during, and after.

To subscribe to this and other CDC podcasts, visit the CDC Podcast Subscriptions page.

Earthquake PSAs and Podcasts


  • “trust is the natural consequence of promises fulfilled.” Social media helped CDC to fulfill a promise to provide fast, accurate, and credible information to the public that recognized their emotional stake in the event and respected their need for autonomy and individuality.

Face the Media

Working with the Media

  • What is news?

  • Messenger

  • Message

  • Method of delivery

What is news?

  • Change or controversy

  • Black or white, not gray

  • Crises or opportunities

  • Entertain versus inform

  • Individual versus group/officials

Information sought by media

  • Casualty numbers, condition, treatment

  • Property damage

  • Response and relief activities

  • Resulting effects (anxiety, stress)

  • Questions are predictable

Define your agenda

  • What’s your goal?

  • Who’s the audience?

  • What’s the audience outcome?

  • What’s your message?

Developing good messages

  • Simple—pay attention to length of sentences and numbers of syllables in words

  • Clear—be wary of convoluted phrases and assumptions about audience knowledge

  • Support statements of belief, judgment, calls for action with supporting facts

  • Headlining—state your conclusion first

Your public messages in a crisis must be:







The STARCC Principle AGAIN!


  • Set-up

  • Problem

  • Action

  • Result

Preparation Saves Jobs

  • Anticipate the hard questions

  • Answer the hard questions before they are asked

  • Written Q/As for consistency and Internet

    • headline sentence

    • supporting facts

    • background

How To Work With Reporters

  • Reporters want a front seat to the action and all information NOW.

  • Preparation will save relationships.

  • If you don’t have the facts, tell them the process.

  • Reality Check: 70,000 media outlets in U.S. Media cover the news 24/7.

Tools To Reach the Public Through the Media

  • Press conferences

  • Satellite media tours

  • Telephone news conferences

  • E-mail listservs and broadcast fax

  • Web sites/video streaming

  • Response to media calls

Pitfalls for Spokespersons

  • Use of jargon

  • Humor

  • Repeating the negative

  • Expressing personal opinions

  • Showing off your vocabulary

Sensational or Unrelated Questions

“Bridges” back to what you want to say:

  • “What I think you are really asking is . . .”

  • “The overall issue is . . .”

  • “What’s important to remember is . . .”

  • “It’s our policy to not discuss [topic], but what I can tell you . . .”

Watch Out For . . .

  • Machine gun questioning. Reporter fires rapid questions at you. You respond, “Please let me answer this question.”

  • Feeding the mike and the pause. Seldom will dead air make scintillating viewing, unless you’re reacting nonverbally. Relax.

  • Hot mike. It’s always on—always—including during “testing.”

Watch Out For . . .

  • Reporter asks a sensational question and gives you an A or B dilemma. Use positive words, correct the inaccuracies without repeating the negative, and reject A or B if neither is valid. Explain, “There’s actually another alternative you may not have considered,” and give your message point.

Television Interview Tips

  • Drive out monotone. The more practice, the less fear and the greater the prospect that animation will reappear in the voice.

  • Don’t look at yourself on the TV monitor.

  • Look at the reporter, not the camera, unless directed otherwise.

  • Do an earphone check. Ask what to do if it pops out of your ear.


Avoid patterned suits, stripes, and checks.

Button double-breasted suits; unbutton single-breasted suits. Sit on your coattails.

White or light blue shirts are the most conservative, serious shirts.

Neckties should be somber. Do not “advertise” a product or point of view on your tie—you know what they are.

What To Wear on Television

What To Wear on Television


  • Urgent: Wear knee-length socks darker than your suit. You lose credibility with a “skin shot” of your legs when your pant legs creep up.

  • Be clean shaven.

What To Wear on Television


  • Tailored clothes work best.

  • Urgent: Short skirts kill credibility as quickly as short socks on men.

  • Neutral colors and less pattern work best.

  • Wear dark shoes.

  • Avoid jangles.

  • Wear regular makeup. For women who never wear makeup, consider color on the lips.

What To Wear on Television

Men and Women

  • Neat, trimmed hair is best.

  • If your skin is shiny under the lights, ask for powder. Men, don’t forget powder for the top of your head.

  • If you can take off the glasses without squinting, take them off. Consider nonglare glasses if you must wear them.

Effective Nonverbal Communication

  • Do maintain eye contact

  • Do maintain an open posture

  • Do not retreat behind physical barriers such as podiums or tables

  • Do not frown or show anger or disbelief through facial expression

  • Do not dress in a way that emphasizes the differences between you and your audience

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