‘Damned if you do, and damned if you don’t’: communicating about uncertainty and evolving science during the H1N1 influenza pandemic

Abstract

During the 2003 SARS outbreak in Toronto, Canada, communication with the public was poorly executed by health authorities. Key problems included mixed and unclear messages, widespread public confusion, and attributions of incompetence toward health officials. Subsequently, Canadian health officials developed pandemic plans that included specific sections dedicated to communication. Plans counseled a strategy of transparent risk messaging to give people the information they need and build public trust. When the H1N1 influenza pandemic arrived in Canada in 2009, these plans were put to their first test in a major public health event. However, many of the same problems that existed during SARS arose again during pH1N1. This study investigates the dissonances between the ideals and reality of communication during pH1N1 based on analyses of two data sources: (1) key informant interviews with senior health officials (n = 28) from federal and three provincial (Alberta, Manitoba, Ontario) health jurisdictions in Canada; and (2) focus groups (n = 15) with general population Canadians (n = 140) in Alberta, Manitoba, and Ontario. Discussions with participants showed that even with a transparent communication approach, aspects of the pandemic, such as its 'risk' and the complexities of the immunization campaign, proved difficult to convey without causing public confusion. Members of the public often resorted to their own inventories of knowledgeusually those related to seasonal influenzato interpret and make sense of pandemic messaging, but these did not guarantee accurate understandings. The inherent uncertainty of a real-time pandemic was also a difficult concept to communicate to a public with little prior experience of such an event. While transparent communication was intended to build trust, resulting confusion fueled a loss of confidence in health officials. A more 'reasoned' approach to transparency needs to inform future pandemic communication and further research is required to determine how to refine such an approach. ARTICLE HISTORYDuring the H1N1 pandemic in Canada, health authorities across the country implemented pandemic plans which emphasized the importance of communicating with the public in an open,

From SARS to pandemic influenza: the framing of high-risk populations

“…Risk communication of 2009 pH1N1 and the associated vaccine campaign was generally perceived as confusing by the Canadian public, due to mixed messages, perceptions of the pandemic risk, and the resulting immunization campaign (Driedger et al 2018). Effective risk communication strategies must acknowledge scientific uncertainties and appreciate that public perceptions of risks are often quite different from scientists and government regulators (Leiss 2004).…”

“…Effective risk communication strategies must acknowledge scientific uncertainties and appreciate that public perceptions of risks are often quite different from scientists and government regulators (Leiss 2004). Perceptions of risk, as discussed, are depended on locus of control such that individuals at high risk, who are vulnerable and powerless due to the social gradient of risk (O'Sullivan and Bourgoin 2010), may reframe, mistrust, lose confidence in the risk information provided (Driedger et al 2018). Perceptions of powerlessness in the face of a pending emergency may provoke xenophobia (blaming other groups), blaming institutions, or disengagement (Driedger et al 2018).…”

“…Perceptions of risk, as discussed, are depended on locus of control such that individuals at high risk, who are vulnerable and powerless due to the social gradient of risk (O'Sullivan and Bourgoin 2010), may reframe, mistrust, lose confidence in the risk information provided (Driedger et al 2018). Perceptions of powerlessness in the face of a pending emergency may provoke xenophobia (blaming other groups), blaming institutions, or disengagement (Driedger et al 2018). Public responses during a pandemic require modification or adoption of specific behaviours including handwashing hygiene, vaccination, and social distancing.…”

“…Public responses during a pandemic require modification or adoption of specific behaviours including handwashing hygiene, vaccination, and social distancing. The element of trust between the public and health agencies is a significant factor in public behaviour change such as vaccination (Driedger et al 2018).…”

Public health emergency response coordination: putting the plan into practice

“…Others have challenged the plan's ability to successfully structure emergent and complex operations during disasters and emergencies (Boin and 'T Hart 2010;Brooks, Bodeau, and Fedorowicz 2012;Comfort 2005;Kapucu 2006;Marcum, Bevc, and Butts 2012;Michelle, Maier, and Jardine 2018;Schneider 1992). Clarke (1999) called response plans 'fantasy documents' because they are often 'not functional in the sense of serving as blueprints for coordination and action, but are functional in the sense of asserting to others that the uncontrollable can be controlled' (p. 16).…”