A trip to Hong Kong in 1997 set CDC’s Barbara Reynolds, Ph.D., on a quest to answer the question, “How do you talk to people when the unthinkable happens?” The attack of September 11, 2001, and the subsequent intentional release of anthrax made answering that question a priority for CDC and public health.
In the late 90s, CDC had declared the world “past due” for a pandemic, just as the Avian Influenza H5N1 outbreak in Hong Kong was killing healthy young adults, reminiscent of the 1918 influenza pandemic. The severity of the outbreak ignited the people of Hong Kong and the world to ask tough questions of its public health leaders.
Magnitude of loss not seen in our lifetime
“How do you prepare people to manage loss at a magnitude we had never seen in our lifetimes? At the time, CDC was projecting that a severe pandemic could mean one million Americans would die from influenza. It was truly unthinkable,” Reynolds said.
When the dual tragedies of 9/11 and anthrax consumed the nation and public health, Reynolds saw the challenges that can descend when responding to the information needs of multiple stakeholders. “The need for information was voracious during these events. The public and affected population groups wanted answers, reassurance and consistency in what they were being told,” she recalled.
In 2002, with funding from the Department of Health and Human Services, Reynolds developed the Crisis and Emergency Risk Communication (CERC) framework. “What we have learned from previous events, including the anthrax event, is that the public can withstand ambiguity if they are allowed to follow the process health officials are using to find answers. The key is to tell the public, from the very beginning, what we know and what we don’t know. We must continue to explain that ‘things can and do change.’ A big dollop of humility and openness is crucial to effective communication,” she said.
Threats perceived on a personal level
“People perceive threats on a very personal level. When people become aware of a new threat, they ask themselves ‘What does this mean to me? What does this mean to my loved ones?’ While we have their attention, we should share what we recommend and where to go if they want to know more now, or later,” she said. Reynolds characterized the initial phase of the crisis communication lifecycle and described the five most common mistakes made in emergency communication to the public and how to counter them.
Expect the public to immediately judge the content of an official emergency message in the following way: “Was it timely? Can I trust this source? And are they being honest?” However, Reynolds points out that there are five common mistakes in crisis communication:
- Mixed messages from multiple experts,
- Information released late,
- Paternalistic attitudes,
- Not countering rumors and myths in realtime, and
- Public power struggles and confusion.
“You can help to avoid these mistakes by using the six principles of crisis and emergency risk communication, or CERC,” she said.
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. Don’t sit on factual information. If you do it will leave a vacuum that may be filled by people who do not have the public’s best interest at heart.
Be Right: There is a natural tension between being fast in sharing information and being accurate. The answer is to 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. Release accurate information quickly and be comfortable with the idea that people can tolerate getting reliable information in pieces.
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.
Express Empathy: Acknowledge in words what people are feeling — it builds trust. For example, one may say, “We understand this is worrisome.” Expressing empathy is the ability to “put yourself in someone else’s shoes and then acknowledging what they are feeling in specific words. It is not “I know how you feel,” it is a statement that captures, in words, the emotion they are feeling.
Promote Action: Give people things to do. It calms anxiety and helps restore a sense of selfcontrol. Give people things to do that they can actually carry out.
Show Respect: That means treat people the way you want to be treated — the way you want your loved ones treated. Avoid being paternalistic in your communication to the public.
These best practices and more are included in a free 250-page course book called, Crisis and Emergency-Risk Communication (CERC). “It was first and foremost a practical guide meant for communication professionals at all levels of public health and emergency response to help them empower the public’s decision making in a crisis. I wanted it to be accessible, down to earth, and still based on good science and research,” Reynolds said.
In the decade following the back-to-back crises of September 11 and anthrax, the CERC framework has taken hold across the spectrum of public health and emergency response. “CDC was committed to sharing the framework as widely as possible.
Today, it is an accepted foundation for risk communication during disasters of any magnitude,” Reynolds said. Today, thinking the unthinkable and preparing for it is the vital work of many. It’s helpful to know that there is now a shared pathway to communicating to people if the worst does happen.