Listen up, health officials – here’s how to reduce ‘Ebolanoia’

An epidemic disease such as Ebola brings suffering to more than those who get ill or die. Social and economic threats can actually outstrip the medical ones. The outbreaks of SARS in 2003, for example, cost the world economy some US$40 billion, partly as a result of highly disputed travel bans. Epidemic diseases nearly always also lead to stigmatisation and ill treatment of groups associated with the disease. And because there are always people who are especially scared, epidemic diseases can cause social disruption by people who do such things as flee cities, swamp doctors and health services while well, and stockpile food or medicines. We can’t entirely eliminate these costs, but we can minimise “Ebolanoia” by addressing fears and directing people to positive actions. Here are some of the risk communication lessons our health officials and political leaders should be mindful of when they engage with the public about Ebola

Lessons from an online debate about measles-mumps-rubella (MMR) immunization

OBJECTIVE: To provide strategies for immunization advocates on how best to participate in online discussion forums about immunization. METHODS: Content and thematic analysis of an online discussion forum held following the national screening of a documentary about the measles-mumps-rubella (MMR) vaccine and autism scare. A subsample of branches containing more than 20 posts was analysed. Each distinct message (a "post") was coded for the author's manifest position on immunization, author type, topic, and evidence presented or sought. RESULTS: From 103 distinct branches there were 1193 posts sent over a 3½h period. We selected the 13 longest branches containing 466 posts from 166 individuals. One third of these individuals were explicitly critical of MMR immunization and one third sought information. The remainder were ambivalent but seeking no information (5%), supportive (14%), or unstated (15%). Among five author categories, only 4% identified themselves as health professionals. Topics included alleged adverse effects of immunization (35%); autism spectrum disorders treatment and causes (31%); vaccine ingredients (12%); a conspiracy (9%); immunization policies (8%); and measles, mumps or rubella (4%). Scientific concepts of evidence failed to compete with lay concepts and personal anecdotes prevailed. CONCLUSIONS: Health professionals and other advocates of immunization should engage in similar types of post-broadcast online discussion forums in a planned and strategic manner that accounts for the decision processes of lay people. This involves expanding and diversifying the support base of people contributing to the forum; setting the agenda; introducing messages known to influence behaviour; not overselling vaccination; and avoiding personal attacks

Communicating about risk: strategies for situations where public concern is high but the risk is low.

In this article, we summarise research that identifies best practice for communicating about hazards where the risk is low but public concern is high. We apply Peter Sandman’s ‘risk = hazard + outrage’ formulation to these risks, and review factors associated with the amplification of risk signals. We discuss the structures that determine the success of risk communication strategies, such as the capacity for early communication to ‘capture’ the dominant representation of risk issues, the importance of communicating uncertainty, and the usefulness of engaging with communities. We argue that, when facing trade-offs in probable outcomes from communication, it is always best to choose strategies that maintain or build trust, even at the cost of initial overreactions. We discuss these features of successful risk communication in relation to a range of specific examples, particularly opposition to community water fluoridation, Ebola, and routine childhood immunisation

Media ethics and infectious disease

The traditional mass media is a necessary safeguard of human security, yet it can also threaten that security. The mass media has been a primary mode of disseminating information and encouraging debate and critique on important social and political issues. It has and does thus possess the potential to encourage public participation in decisionmaking and to encourage civic values such as personal responsibility, law-abiding behaviour and generosity (Hodgetts et al. 2007, Keane 1991). In a time of crisis, such as an outbreak of infectious disease, it offers unparalleled capacity to communicate with the broad span of highly differentiated publics and to swiftly disseminate information and directions critical to reducing harm or resolving the crisis. Yet the mass media as it currently exists can also perpetuate half truths, negative stereotypes and simplistic thinking. It is guilty of major omissions on such a broad scale as to render public and policy responses deeply incapacitated when it comes to confronting complex social problems (Downing et al. 2004, Chomsky and Herman 1988, Curran and Seaton 2009). In worst-case scenarios, especially where the mass media is closely tied to a particular set of political interests, this may profoundly threaten human security

Media ethics and infectious disease

The traditional mass media is a necessary safeguard of human security, yet it can also threaten that security. The mass media has been a primary mode of disseminating information and encouraging debate and critique on important social and political issues. It has and does thus possess the potential to encourage public participation in decisionmaking and to encourage civic values such as personal responsibility, law-abiding behaviour and generosity (Hodgetts et al. 2007, Keane 1991). In a time of crisis, such as an outbreak of infectious disease, it offers unparalleled capacity to communicate with the broad span of highly differentiated publics and to swiftly disseminate information and directions critical to reducing harm or resolving the crisis. Yet the mass media as it currently exists can also perpetuate half truths, negative stereotypes and simplistic thinking. It is guilty of major omissions on such a broad scale as to render public and policy responses deeply incapacitated when it comes to confronting complex social problems (Downing et al. 2004, Chomsky and Herman 1988, Curran and Seaton 2009). In worst-case scenarios, especially where the mass media is closely tied to a particular set of political interests, this may profoundly threaten human security

Journalists' views about reporting avian influenza and a potential pandemic: a qualitative study

Background: The mass media is a key component of any public communication strategy for influenza or other respiratory illnesses, but coverage can be variable. In this study we explored the factors that influenced journalists’ coverage of avian influenza as a model for coverage of a potential influenza pandemic. Methods: This study involved semi-structured interviews with 16 journalists from major Australian print, radio and television media organisations reporting on avian influenza and pandemic planning. Journalists, including reporters, editors and producers, were interviewed between October 2006 and August 2007. Thematic analysis was used to draw out major lessons for health communicators. Results: Coverage of avian influenza was influenced by a small set of news values: catastrophic potential, cultural and geographic proximity, unfamiliarity and uncertainty. Lack of novelty and the absence of compelling images led to a decline in coverage. Journalists expressed concerns about the accuracy and impacts of reporting, but saw as critically important, their primary role as informants. They hence emphasised the importance of journalistic independence. Journalists all intended to continue working in a pandemic. Conclusions: Health experts need to adapt their timetables and resources to journalists’ needs to improve their mutual communication. In crisis situations journalists communicate with the public efficiently and effectively but expert and journalistic views on the role and content of coverage may diverge in the post-acute, reflective phase of a crisis.Australian Research Council Linkage grant with part-funding from Sanofi Pasteur

Understanding non-vaccinating parents' views to inform and improve clinical encounters: A qualitative study in an Australian community

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objectives To explain vaccination refusal in a sample of Australian parents. Design Qualitative design, purposive sampling in a defined population. Setting A geographically bounded community of approximately 30 000 people in regional Australia with high prevalence of vaccination refusal. Participants Semi structured interviews with 32 non-vaccinating parents: 9 fathers, 22 mothers and 1 pregnant woman. Purposive sampling of parents who had decided to discontinue or decline all vaccinations for their children. Recruitment via local advertising then snowballing. Results Thematic analysis focused on explaining decision-making pathways of parents who refuse vaccination. Common patterns in parents' accounts included: perceived deterioration in health in Western societies; a personal experience introducing doubt about vaccine safety; concerns regarding consent; varied encounters with health professionals (dismissive, hindering and helpful); a quest for the real truth'; reactance to system inflexibilities and ongoing risk assessment. Conclusions We suggest responses tailored to the perspectives of non-vaccinating parents to assist professionals in understanding and maintaining empathic clinical relationships with this important patient group

Thrombin-induced CCN2 expression as a target for anti-fibrotic therapy in scleroderma

Scleroderma (systemic sclerosis, SSc) is a fibrotic disease for which there is no therapy. CCN2 (connective tissue growth factor, CTGF) is a marker and mediator of fibrosis. Previously, it has been shown that thrombin induces CCN2 expression in fibroblasts. In a recent fascinating report, Bogatkevich et al. (Arthritis Rheum 60:3455–3464, 2009) show that dabigatran, an inhibitor of thrombin action, blocks the overexpression of CCN2 by scleroderma fibroblasts and reverses the contractile phenotype of these cells. These results strongly suggest that dabigatran may be a potential antifibrotic drug for the treatment of fibrosing diseases such as scleroderma

On the presentation and relevance of laterality: a study of psychosis

A discussion of concepts of lateralization and handedness is followed by an examination of the three-way relationships between lateralization of brain function, level of function, and schizophrenia. It is proposed that conventional examinations of such relationships, using lateralization indices, can be unenlightening or even misleading, and that alternative approaches are preferable. Support for this thesis is sought in analyses of data from two UK national birth cohorts. The author's process of gathering data on psychiatric outcomes is presented in detail. Previously-published findings in this data, employing laterality indices, are presented and their shortcomings discussed. Several alternative approaches to examining the relationships between measures of functional lateralization and level of function are developed, including a novel application of the method of principal curves, and a three-dimensional presentation of function as height over a 'laterality surface'. This latter approach is applied to a number of measures of function in the cohort datasets, including measures of cognitive ability, social success and psychiatric illness, including schizophrenia. The benefits of this method of presentation over previously-published presentations are discussed in the context of several contemporary hypotheses that touch upon the relationships between functional lateralization, cognitive function and schizophrenia