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Catch it, Bin it, Kill it – the 2009 H1N1 and the role of media in risk communication and emergency risk planning

by on April 4, 2014

The H1N1 flu spreads in the same way as seasonal flu and the National Health Service in the United Kingdom alerts citizens to be careful when coughing, sneezing or touching surfaces, so further expansion of the illness can be prevented. (tarot1984:YouTube 2009, FLU.GOV 2014)

In 2009, the emerging infectious disease H1N1 or “swine flu” was discovered in Mexico, and by April 23 in 2010, 214 states and overseas communities and territories had reported at least 17 853 laboratory-confirmed deaths. (Smith et. al 2013:847) In cases of public health emergencies it is important that preparatory work (national and institutional) such as action plans regarding several possible scenarios, target groups and suitable channels of communications, have been made before any kind of outbreaks, so protective measures (both nationally and internationally) effectively will be practically fit into the situations if an eventual outbreak would occur. This means that risk communication systems (at both national and international levels) between authorities, the public health system, the public and a range of institutions are of main importance, both regarding preparation but also during an emerging crisis. (Pistol and  Streinu-Cercel 2013:164)

However, many obstacles exist regarding communication in connection to emerging pandemics, and the question is if the news media are playing positive or negative roles in these situations.

Fig. 1. A couple kissing while wearing masks against the H1N1. (Knight Science Journalism at MIT 2009)

News media – a key source for public information

Good risk communication is vital in an emergency situation since it demonstrates good leadership and ensures a stable public confidence in the central authority, reduces misinformation and spreads knowledge about how the public should respond to the crisis. (Johns Hopkins Bloomberg 2014, Pistol and Streinu-Cercel 2013:164) The news media´s framing of the story is shaping how the issues are going to be commonly understood by the public and therefore, news media play a prominent role in terms of informing about emerging health issues. (Smith et. al. 2013:847)

News media coverage “can link medical and public conceptualizations of health, turning medical findings into public knowledge and reveal risks not otherwise apparent” (Smith et. al. 2013:847) and therefore the ideal picture of a good risk communication during an emergency would be a sound cooperation between national health authorities/international organizations, local communities and news media, which would result in valid information being rapidly spread and constantly updated, which would increase the chance in reducing the negative effects of a pandemic. (Lutz 2013:9) Unfortunately, the reality is complex and this ideal picture far from common.

Fig. 2. H1N1 is a “respiratory disease of pigs caused by type A influenza viruses.”(Centers for Disease Control and Prevention 2012) It usually does not infect human beings, but in 2009 the illness spread quickly in several states.(Better Health Channel 2011, Wake up people! 2009)

Communication challenges

The news media policies and framing of health messages often differ from each other, depending on what state they operate in and this can give significantly different outcomes regarding public’s perception of risk and related behaviour. This might lead to either a positive outcome (the public responds to valid information, follow guidelines and, if possible, get vaccinated) or a negative outcome (valid information has not reached the public, the public does not follow guidelines and do not get vaccinated). (Sandell et. al. 2013) One clear example of this situation could be seen in Australia and Sweden during the 2009 H1N1 pandemic crisis, and the news coverage in connection to “public perceptions of risk as expressed through the uptake of vaccinations.” (Sandell et. al. 2013)

The two states do normally have a similar immunization rate, but during the crisis 2009 the rates showed completely different numbers. Sweden had 60% in immunization uptake, while Australia only had an uptake of 18%.The way of communicating the health messages through various of media channels had been quite the same in both states, but the Swedish and Australian news media had displayed the news in different ways. “In Australia, responsibility was predominantly reported negatively, blaming various organisations for a lack of information, compared to Sweden where responsibility was placed on the community to help protect public health. Furthermore, there was limited self-efficacy measures reported in the Australian media compared to Sweden and Sweden’s media was more transparent about the uncertainties of the pandemic.” (Sandell et. al. 2013) This shows that the attitude of the news media has a large impact in the state regarding health safety, but since the state is embraced in a modern, interdependent and complex international system, the national attitude and outcome also plays a significant role internationally, since pandemics easily become transnational and spread quickly because of a large number of traveling people. This highlights that “governments need to actively incorporate the media into pandemic communication planning” (Sandell et. al. 2013), not only to protect the state but also to protect the international system.

Fig. 3. Some of the FDA (Food and Drug Administration) approved Swine Flu Masks (N95 Respirators) for use by the general public are 3M Particulate Respirator 8670F, 3M Particulate Respirator 8612F, Pasture Tm F550G Respirator and Pasture Tm A520G Respirator. Important to know is that many of the designer face masks are not approved for use during a pandemic. (WearaMask.org 2009, Jacques of all Trades 2009)

A journalist´s knowledge is of high concern

However, news media in democratic states are democratic tools and are meant to be critical towards authorities and therefore the responsibility to provide information and protect the system from humanitarian disasters should not only be put on the news media, but also governments, international institutions and organizations. Health authorities often lack in their work to effectively engage media in spreading the risk communication messages, often because they can not provide messages that are convincing and easily understood for the public. Also, they are unable to generate media attention without an immediate public health emergency, which prevents emergency preparation and disaster resilience. (Lutz 2013:9)

On the other hand, many journalists tend to be unfamiliar with pandemic health issues and unaware of the importance of emergency risk planning and do not take into account that health authorities sometimes have to base decisions on imperfect information, particulary in the early stages, when news coverage usually peaks. (Lutz 2013:9)

The problem with those peaks during the earliest days of outbreak is that the information include high levels of uncertainty and focus on the spread of the virus. When the information has started to become more stabilized and focused on the systemic or individual level response, the newsworthiness seems to have declined and the media interests have already waned (Smith et. al. 2013:851) and therefore there is a risk that the pandemic might continue and even increase because of ignorance. This could be seen globally among several news channels around the globe during the 2009 H1N1 pandemic. (Smith et. al. 2013:850)

Watch Staph Sergeant and his army of germs go bananas while trying to take over the world. But…do not fear. The PDI agents are here to save us all. This quite amusing US program for children is made by the Florida Department of Health and shows how to stop the spread of the H1N1 flu. (orchdept./Florida Department of Health:YouTube 2009)

Building on past experiences

However, highly critical and negative action from both the news media and the public may build on previous negative experiences and outcomes regarding for example vaccination. One example of that is the vaccine called Pandemrix which was used against the H1N1 2009. This vaccine should have been secure and effective according to for example the Medical Products Agency in Sweden (Läkemedelsverket 2012), but has been reported by American scientists to increase the risk or even cause narcolepsy (Science Translational Medicine  2013), which have been shown in for example Sweden were hundreds of children are suffering from narcolepsy after 2009 when they were vaccinated. (Svenska Dagbladet  2013, Dagens Nyheter 2013, Sveriges Television 2013)

It is yet too early to see if these negative consequences might show negative reactions among the public and the media in the future, but unfortunately there might be a risk. This shows that it is not only the communication that is of importance, it is also about what is being promoted and practically being given. If a vaccine is causing severe damage, there might be a high risk of an undermining of stable public confidence in the central authority, which can cause serious, destabilizing consequences in the democratic system.

Fig. 4. If people are going to follow the directions given in the future, the authorities must be able to ensure that a vaccination does not cause negative, non-reparable side effects. (Science Translational Medicine  2013, CBC News 2009)

Valid information and cooperation

The media coverage is of main importance in the work of preventing pandemics and can cause both negative and positive reactions. The negative reactions happen when the understanding of the vulnerable situation and the information is limited and blaming and sensational news are high. On the other hand, the positive reactions happen when there is a dynamic understanding and handling of the available information and that is why the news media should be included together with national health authorities / international organizations and local communities in risk communication and emergency preparation work. One suggestion is to do as the Canterbury District Health Board in New Zealand who involved producers and senior editors in monthly planning meetings. These meetings decreased shroud-waving, sensation and conspiracy theories and instead ensured that health officials and media leaders could discuss how and what information on health issues that was important to get out to the public. This kind of long-term, “planned engagement of the media, maximised the delivery of useful information to communities, compared with those where senior media leadership was not involved in the planning process.” (Lutz 2013: 9)

However, authorities have to make sure that what is being communicated and promoted to the public does not harm, otherwise there will be negative consequences in the future and an increasing risk of undermining a stable public confidence in the central authority, which in the end might cause a destabilized democratic system.

The symptoms of swine flu are unusual tiredness, headache, runny nose, loss of appetite, diarrhoea or vomiting, sore throat and aching of muscles. It is especially important for people who have chronic diseases or any other serious illness to not become infected, so do as the piglet says and wash your hands and cover your nose when sneezing. (NHS 2012, nanobugsinc:YouTube 2009)

Bibliography

Pictures

Fig. 1. Knight Science Journalism at MIT (2009) Swine flu stories spreading, possibly faster than the virus (Online)

Available at: http://ksj.mit.edu/tracker/2009/04/swine-flu-stories-spreading-possibly-fas

Accessed: 1st of April 2014

Fig. 2. Wake up People! (2009) We interrupt this heat wave for the following news – just FYI (Online)

Available at: http://wendyworn.blogspot.co.uk/2009_07_01_archive.html

Accessed: 2nd of April 2014

Fig. 3. Jacques of all Trades (2009) Just saw my first H1N1 flu mask on the Metro. (Online)

Available at: http://jacquesofalltrades.tumblr.com/post/199109009/just-saw-my-first-h1n1-flu-mask-on-the-metro

Accessed: 2nd of April 2014

Fig. 4. CBC News (2009) Delivering doses:Will you get the H1N1 vaccine? (Online)

Available at: http://www.cbc.ca/news2/pointofview/2009/11/delivering-doses-will-you-get-the-h1n1-vaccine.html

Accessed: 2nd of April 2014

E-books and reports

Pistol, Adriana, Streinu-Cercel, Adrian (2013) RISK COMMUNICATION STRATEGIES USED IN THE 2009 PANDEMIC INFLUENZA A H1N1PDM. Acta Medica Transilvanica. dec2013, Vol. 18 Issue 4, p163-166. 4p. (Online) EBSCO HOST

Available at: http://0-web.a.ebscohost.com.emu.londonmet.ac.uk/ehost/detail?vid=9&sid=a01296ba-cd55-4d52-b0c2-e772d57707f0%40sessionmgr4004&hid=4204&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=a9h&AN=92741644

Accessed: 2nd of April 2014

Lutz, Peter (ed.) (2013) Recommendations on Effective Risk Communication for Public Health Emergencies and the Role of Social Media. Asia-Europe Foundation Accurate Scenarios Active Preparedness (ASEF-ASAP) Project, 3-4 June 2013 | Bali, Indonesia (Online)

Available at: http://www.asef.org/index.php/projects/themes/public-health/2870-effective-risk-communication-for-public-health-emergencies-and-the-role-of-social-media

Accessed: 2nd of April 2014

Science Translational Medicine (2013) CD4+ T Cell Autoimmunity to Hypocretin/Orexin and Cross-Reactivity to a 2009 H1N1 Influenza A Epitope in Narcolepsy. Sci Transl Med 18 December 2013: Vol. 5 no. 216 pp. 216ra176DOI:10.1126/scitranslmed.3007762 (Online)

Available at: http://stm.sciencemag.org/content/5/216/216ra176.full.pdf?sid=90ab67f1-1d77-43e1-9d7c-5778270f961d

Accessed: 2nd of April 2014

Smith, Katherine C., Rimal, Rajiv N., Sandberg, Helena, Storey, John D., Lagasse, Lisa, Maulsby, Catherine, Rhoades, Elizabeth, Barnett, Daniel J., Omer, Saad B., Links, Jonathan (2013) Understanding newsworthiness of an emerging pandemic: International newspaper coverage of the H1N1 outbreak. Influenza & Other Respiratory Viruses. Sep2013, Vol. 7 Issue 5, p847-853. 7p. 2 Charts, 1 Graph. (Online) EBSCO HOST

Available at: http://0-web.a.ebscohost.com.emu.londonmet.ac.uk/ehost/detail?vid=6&sid=a01296ba-cd55-4d52-b0c2-e772d57707f0%40sessionmgr4004&hid=4204&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=a9h&AN=89854481

Accessed: 2nd of April 2014

Web pages

Better Health Channel (2011) Swine flu (Online)

Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Swine_flu

Accessed: 1st of April 2014

Centers for Disease Control and Prevention (2012) Information on Swine Influenza/Variant Influenza Viruses. (Online)

Available at: http://www.cdc.gov/flu/swineflu/

Accessed 1st of April 2014

Johns Hopkins Bloomberg: School of Public Health (2014) Risk Communication Strategies for Public Health Preparedness. (Online)

Available at: http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-public-health-preparedness/training/online/riskcomm.html

Accessed: 2nd of April 2014

Läkemedelsverket (2012) Pandemisk influensa A(H1N1), vaccinet Pandemrix och antivirala läkemedel. (Online)

Available at:

http://www.lakemedelsverket.se/OVRIGA-SIDOR/Den-nya-influensan-H1N1/

Accessed: 2nd of April 2014

FLU.GOV (2014) H1N1 (originally referred to as Swine Flu) (Online)

Available at: http://www.flu.gov/about_the_flu/h1n1/index.html

Accessed: 2nd of April 2014

NHS (2012) Swine flu (H1N1) – Symptoms (Online)

Available at: http://www.nhs.uk/Conditions/pandemic-flu/Pages/Symptoms.aspx

Accessed: 2nd of April 2014

Sandell, Tiffany, Sebar, Bernadette, Harris, Neil (2013) Framing risk: Communication messages in the Australian and Swedish print media surrounding the 2009 H1N1 pandemic. (Online)

Available at: http://sjp.sagepub.com/content/early/2013/07/19/1403494813498158.abstract )

Accessed: 2nd of April 2014

WearaMask.org (2009) FDA Approved Swine Flu Face Masks (N95 Respirators) (Online)

Available at: http://www.wearamask.org/fda.html

Accessed: 2nd of April 2014

Online news articles

Dagens Nyheter (2013) Vaccinerade löper större risk för narkolepsi. (Online)

Available at:http://www.dn.se/nyheter/vetenskap/vaccinerade-loper-storre-risk-for-narkolepsi/

Svenska Dagbladet (2013) Pandemrix länkat till narkolepsi. (Online)

Available at: http://www.svd.se/nyheter/inrikes/pandemrix-lankat-till-narkolepsi_8031664.svd

Accessed: 2nd of April 2014

Sveriges Television (2013) Tänkbar förklaring till narkolepsi. (Online)

Available at: http://www.svt.se/nyheter/vetenskap/orsaken-bakom-narkolepsi

Accessed: 2nd of April 2014

Film

orchdept./Florida Department of Health (2009) Protect! Don’t infect!: Germ Wars. (Online)

YouTube

Available at: http://www.youtube.com/watch?v=jDwrTJ9qqPM

Accessed: 2nd of April 2014

tarot1984 (2009) UK Swine Flu Ad – Catch It, Bin it, Kill It (Online)

YouTube

Available at: http://www.youtube.com/watch?v=zT9fxhrjoQc

Accessed: 2nd of April 2014

nanobugsinc (2009) H1N1 Influenza: AKA Viral Socialite (Online)

YouTube

Available at: http://www.youtube.com/watch?v=fGBNZYEdtKg

Accessed: 2nd of April 2014

 

 

 

 

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One Comment
  1. This is an incredibly detailed and thorough discussion of the influence of the media on public health scares, which is based on an extensive amount of research and is very nicely illustrated. The discussion of national variations, especially the comparison of Sweden and Australia, is fascinating.

    However, for all of its merits, it could be significantly improved by relating it to the main themes and literature of the module. What does this case tell us about the issues we have been exploring in the seminars? Please try to tie this discussion more closely to the conceptual and theoretical issues examined in the lectures. I’d like to hear your thoughts about what this case tells us about the place of news corporations in global communication structures and processes.

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