The Secretary and the End of the Blog

Today is June 27, the final day of the Pandemic Flu Leadership Blog. As of 6:00 pm EST, comments will be turned off and the contributing bloggers who have graciously given their time to this effort will no longer be able to post.

The site will be archived but will continue to remain accessible. The search function will continue to work, as will the social media tools (del.icio.us and Technorati) and all links within the site.

Secretary Michael O. Leavitt intended to post today to leave you with his perspective on the past five weeks of the blog, but unanticipated changes to his schedule did not permit him to do so. Therefore, Secretary Leavitt will post his final comments before the close of the week. We hope you will come back to read these concluding remarks.

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Creating a Non-Event

As a reminder, the questions that the breakout groups discussed were as follows:

– How do we mobilize members of our sector to get involved?
– Who are the most influential leaders within our sector?
– Which organizations are most influential?
– What types of programs and efforts are already underway that can be leveraged for this effort?
– Review and discuss the toolkit outlines and proposed content.

The groups reported out from the breakout sessions. There were two health care groups (most highly-represented sector) and one community, one employer and one faith-based group.

The first group, represented by Dr. Trish Perl from Johns Hopkins, focused on how health care professionals could get a message out to the public. The participants in the group included people from health boards, care givers, insurers and more. They question whether or not they are good at communicating, but think they can align with others to get the message out. They think that the messages need to be targeted: a nurse needs to hear a different message from a different source than a pharmacist, for example. There was a general consensus that the message needs to be clear about what they can do. They need to use multiple media, including peer to peer/word of mouth communications. The challenges to success were easy for the group to come by. Many people do not think this is a crisis: it’s vague and it’s out there. It’s not perceived as something that’s pressing. People’s minds are already cluttered and it’s not a priority. For example, cholesterol levels come to mind more quickly. Speaking bluntly, the group acknowledged that, if you’re not getting scored or graded on it, it may not happen. And it’s not a simple message. But, optimistically, there are opportunities. If this message could be successfully delivered, it could be a template for future responses, a lesson learned. The second opportunity is to communicate that this is for the common good, even though it’s focused on the individual.

The second health group managed to whip together a power point in no time to present their results and they chose to report out on the challenges and opportunities. It needs to be made relevant to them. There are many things that are severe and frequent. How can this be relevant to physicians so that they can make it relevant to their patients? Will they lose credibility by talking about it? They need to know the specific message and they, in fact, need to be part of developing the message. This is a long-term process. What are some of the opportunities? Tie the pandemic influenza to seasonal flu (as Dr. Bocchini suggested earlier), using discussion of flu to encourage preparedness. It would be good to make the message easy to use. “What should I say? How should I say it? How can I deliver it?”

The faith-based group was represented by Dr. Muneer Fareed, the Secretary General of the Islamic Society of North America. He talked about “assets and challenges”. “The asset we have is that they can become the ‘honest brokers’ between the public and political and government officials. We can provide better communications with families.” But there are always challenges. “Faith-based groups do not have equal means and equal access to resources. The challenge is to move those resources from those who have more to those who have less. Church-based groups are best positioned to do that.” He concluded by talking about the need for faith-based groups to also assess their existing rituals (sharing a chalice, a pilgrimages to high-risk areas of the world, etc.) as they might need to be adjusted in the case of an epidemic. Their motto? “Like minded citizens can be gathered in coalition for a common cause.”

The employer group spoke next, with Lawrence Pelham from Dupont representing the group. His take away? Big companies are further ahead than smaller companies. They know what needs to be done and are on the road toward making things happen. Smaller companies, however, have a much bigger challenge. They have more constrained resources and more limited skill sets among their employees. The group also discussed that there are liability issues around even talking about the issue. But the biggest challenge that the group thinks they will face is, “How do you get the employees’ attention in a way that is relevant to them? How do you convince them that a pandemic is important? How do you put in HR policies that will encourage the right behavior when, in fact, some policies encourage you to come to work when you are sick?” Finally, Pelham wrapped up by making it clear: It has to be about life or death or it has to be about money if you are going to convince senior management to take action.

The community group wrapped up the presentations, with the report out coming from Linda Daily from the United Way. “Yes, we would like to be engaged in this army to communicate the importance of pandemic preparedness. But there are constraints of time and resources and conflicting interests.” The group determined that there needs to be more than the tool kits. They need to build their skills in order to be messengers. They need training. And, while they recognize that information is important, changing attitudes is more important. “HHS should be clear about what they are asking us to do and they should work in coordination with their public health officials.” The group want this process to be kept apolitical or nonpartisan. All who can prepare should prepare so that providers can focus on the most vulnerable. Among the most vulnerable, we need to be culturally sensitive. Finally, we need to think about Y2K. Many people saw that as a non-event. But maybe it was because of all of the preparations – many invisible to the public. Let’s create another “non-event.”

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Panel Discussion

My partner is covering the question and answer session following the panel, but let me try to wrap up what the panel presenters said.

As a reminder, the presenters included Russell M. Nelson, MD, PhD, The Church of Jesus Christ of Latter-day Saints; Dennis Roche, FedEx; Greg Dworkin, MD, Flu Wiki & Flu Wiki Forum; Joseph Bocchini, MD, American Academy of Pediatrics; and Susan Crosson-Knutson, The International Association of Lions Clubs.

Greg Dworkin was the first panelist to speak and shared with the room that his initial interest in the topic of pandemic flu was generated by his children. As many of you know, he currently serves on his local and city pandemic preparedness committees and made it clear to the room that whether or not a pandemic will happen is not a question among his peers. “We look at pandemic flu as something that happens.” He shared the story behind the creation of Flu Wiki, how he and his fellow editors stepped in because there were no government resources online for pandemic flu. The initial idea was to look at what other countries were doing to plan for pandemic flu. He made it clear to people that the people online are the same people that are in the community. “They don’t think that government has all the answers, so they look to each other to pool what they know.” The conversations online reflect the thoughts and concerns of the broader public and should be mined by others. They do not presume to have all the answers, but they do know to ask the right questions.

Dr. Joseph Bocchini of the American Academy of Pediatrics, which represents more than 60,000 physicians and sub-specialists, spoke next. The mission of AAP is to help with prevention of disease and to protect the well-being of children and, therefore, think it is important to be involved in the policy planning for pandemic influenza. Bocchini said that children will be the most vulnerable in the pandemic flu and will also be transmitters, bringing the disease home to their family and are actively working with HHS and CDC. Parents will need to address the issue of school and day care closings as well as how to take care of children when they are ill. Bocchini spoke about some of the resources they have developed, including information about pandemic flu on Red Book Online. As far as pediatricians, some are personally prepared and some are not, but physicians are trusted providers of information to families and can make parents aware. His idea? When doctors give annual flu shots, they should use the time to talk about pandemic flu preparedness.

Susan Crosson-Knutson from the International Association of Lions Clubs spoke next about the Clubs’ long-standing commitment to encouraging their members to give back to their community. They recently launched the Lions Alert program, which encourages Lions around the country to prepare for an communicate with each other in the case of an emergency.

Next on the panel was Russell Nelson from The Church of Jesus Christ of Latter-day Saints (which has 5 million members), who blew the room away with his list of 8 things that the Church has done to create a preparedness system. As he said, “The church may be in the position to contribute to national preparations.”

This is what they have done:

1) Urged members to store food, clothing, water and a small financial reserve for a three months through a pamphlet that is available in 23 languages.
2) They have created storehouses for people in need, who cannot store their own stockpile.
3) They have pre-positioned supplies in areas of high risk throughout the U.S. and in other countries.
4) To facilitate communications, they have created a network within each local congregation (which they call wards) so that every family can be contacted from a central location, using the Internet and short wave radio.
5) They have agreements with the Red Cross and other health organizations to use church meeting houses during a time of emergency.
6) They have a central, indicating the assignments of key personnel so that operations will continue during a disaster.
7) They regularly communicate about pandemic preparedness to local church leaders and urge them to teach it to others.
They regularly publish articles about family and personal preparedness.

Finally, Dennis Roche from Fedex talked about the fact that it was his Chairman, President and CEO, Frederick W. Smith who recognized that pandemic flu had a huge potential to wreak havoc on their global business and so they established a task force for planning. But their business infrastructure will nevertheless make it difficult. They have 275,000 employees, which will be difficult to track in case of an emergency. They are currently working on developing one common human resource policy that addresses all employees fairly, including some unique things, like what they did with Katrina (e.g., temporary reassignment) and are continuing to have more intense discussions about some of these ideas.

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Question about Seroprevalence Studies

Kim Crady RN, we asked Greg Dworkin to ask your question of Dr. Gerberding and he managed to make it happen.

Here you go:

Have there been any results of seroprevalence studies conducted over the past several months? Are people affected by H5N1 and how can the public get that info from credible sources?

The studies being done right now are not showing s from people who are asymptomatic with H5N1. There are a low number of people who have been exposed without symptoms, but most people who have been exposed or infected are showing symptoms. The information will be unfolding as each new outbreak occurs. We’re in the intitial stages of implementing a comprehensive ecological study to get integrated pictures of transmissions. It’s a high priority for us over the next several months.

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Candid Leadership

Julie Gerberding just wrapped up her presentation. Let me do my best to share with you what she said. Her focus was on the importance of communication in public health. As we said before, this is not a transcript. Some comments are direct quotes, while other comments have been paraphrased.

She opened her speech by talking about the fact that she loves to go into the communities and to reach into the grassroots to find out what people are doing. She recently met with community officials in Springfield, Missouri and was impressed by the work of the local faith-based organizations to promote pandemic flu preparedness. But she knows that most communities are not prepared and are not yet taking pandemic flu seriously. She impressed upon the people in the room that it was their role to help take the message to those communities.

Since September 11 (not – Dr. Gerberding started on the job on September 1, 2001), the CDC has moved from dealing with urgent – and current — realities to urgent threats. Because of her belief that communication is the success factor in public health efforts, the CDC has developed a new center for health marketing.

Gerberding believes that, “The frame of communication has changed. There are good things and there are things that are challenging. Did anyone ever think that Secretary Leavitt would be blogging? I bet the citizens of Utah would never think that would happen.”

She told a story of her own “foray” into Second Life. She wasn’t sure if she could use a government computer to do so, so she was at home, creating her avatar. But she didn’t like the first avatar she created because she was “ugly and wearing bad clothes.” So, she set out to undress the avatar – and her computer crashed! She had to get someone on the phone to ask for their help, “There’s a naked avatar running around on Second Life.”

So, what are the good things about the change in the “frame of communication”? Media is “perpetual and participatory” (and a few other things that I didn’t manage to jot down). “Everyone is a reporter and everyone is a publisher. Everyone can voice their opinion.”

But what are the more “challenging” things? “The negative is that things are unedited. Things are very fast and editors have less and less control. You don’t know who is the source. Information is not verified and sometimes it’s not true. There are things that are downright unethical and dangerous. We are being bombarded with more information, but the credentialing and usefulness is questionable. Hopefully over time that will evolve. People have high expectations. People want us to be perfect and personalized and transparent and fast. And, everyone in this room knows, speed is a difficult thing for those of us in government.”

Dr. Gerberding talked about the challenge of translating the language of health science in a way that engages people in preparedness. “Scientists aren’t always the best communicators. It’s like watching someone speak a foreign language. They have a tendency to default into their comfort zone (of speaking in scientific terms). They aren’t good at it and they don’t necessarily think they should be doing it.”

She also spoke about the failure, in public health communications, to talk about the emotional and the subjective, a problem with early HIV/AIDS education.

“If there’s a flu pandemic, people should be afraid. If you’re not afraid, there’s something wrong with you psychologically.”

What else will work? According to Gerberding:

– Give people more control and they will be more engaged.
– Validate their emotional response.
– Engage people in their own social environments and they are more likely to be successful.
– Provide candid leadership. Admit emotions. “One of the things that made Giuliani credible on September 11 was that he showed his emotion. He said it was unbearable, which is how the rest of us felt.” (This should not be perceived as her endorsement of him for president, by the way.)
– People will be motivated to care for their families. They may not do it for themselves, but they will do it for their families.
– Care about the people you are talking to and let them know it. They will dismiss you if you if you do not.
– Tell the truth. Share your dilemma.

There will a lot of naysayers, but, in the case of a pandemic influenza, everyone will be a spokesperson for pandemic influenza.

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