Putting plans into practice: the challenges of communicating risk, uncertainty, and evolving science during the H1N1 pandemic in Canada

Background: The SARS outbreak in Toronto, Canada, in 2003 was characterized by significant communication failures on the part of health authorities. Key problems included mixed and unclear messages, widespread public... [ view full abstract ]

Background:
The SARS outbreak in Toronto, Canada, in 2003 was characterized by significant communication failures on the part of health authorities. Key problems included mixed and unclear messages, widespread public confusion, and attributions of incompetence towards health officials. To better prepare for a future public health crisis, Canadian health systems developed pandemic plans that included specific sections dedicated to communications. These sections endorsed a risk communication strategy that sought to build public trust by communicating transparently about the uncertainty and evolving science that attends such a scenario. When the H1N1 influenza pandemic struck Canada in 2009, these plans were put into action.
Methods:
Researchers concentrated on the federal and three provincial (Alberta, Manitoba, Ontario) health jurisdictions in Canada. Within these respective jurisdictions the data sources included: 1) a document review of the pre-pandemic plans and the post-pandemic evaluations of response efforts; 2) key informant interviews (n=28) with senior health officials, including Chief Medical Officers of Health, communications directors for provincial or regional health organizations, Chief Executive Officers of health authorities, and managers of public health and emergency planning offices; 3) and focus groups (n=15) with general population Canadians (n=130).
Results:
Data showed that although significant improvements were made, many of the same communication problems that existed during the SARS outbreak appeared again. Uncertainty was difficult to translate into plain language for communication purposes. The constantly changing information about particular aspects of the response campaign, especially the vaccine, became difficult for the public to follow over the many of months the pandemic. Constantly changing information came across to the public as mixed and unclear messages, which reflected poorly on officials’ performance.
Conclusions:
The risk communication theories and strategies outlined in pandemic plans were challenging to implement in real time, and the public's understanding of the pandemic and associated response plans suffered as a result. Notably, many people found it difficult to follow along with evolving scientific information, and many were also unaccustomed to processing the kinds of risk and uncertainty-based messaging that they encountered. Inter-pandemic phases, including seasonal influenza campaigns, should be used to increase the public’s ability to grapple with pandemic uncertainty and evolving science, as well as to improve health officials' ability to communicate such concepts in ways that the public can understand.