OUTBREAK COMMUNICATION: INTERNAL AND EXTERNAL CHALLENGES

Communication, in crisis time, that is when public services reach saturation point, is about information mapping and scene-setting. It is based on cross functional collaboration and coordination. It has as an objective to facilitate people’s exposure to data collected, in real time, on the ground, and is disclosed by readily accessible political leadership, via all channels. 

Challenges in getting the job right are numerous and dependent on multiple factors. The major constraint is very often internal, caused by the absence of proper internal communication frameworks. 

In 2014, the United States army played a pivotal role in containing the first Ebola outbreak in West Africa. President Obama’s announcement to deploy troops had a significant impact on the morale of the people of Liberia and of the surrounding region. 

Deborah Malac, US ambassador to Liberia reported: “The psychological impact was transformative to the Liberians. You have to understand the environment at that point in time: by July, August, September, there were dead bodies in the streets, in the ocean. People were afraid, they were despairing. The change was palpable within 24 hours of the president’s announcement.” 

The 101st airborne division airlift missions accelerated transport of medical practitioners, materials and supplies to areas affected. Mobile laboratories for disease testing were set up by army engineer corps and local healthcare workerswere given protective equipmentsand trained. Operation codenamed United Assistance greatly improved US brand image and reinforced its ties with West Africa. 

Nonetheless, Operation United Assistance had several flaws. US military staff, including Major General Steven Shepo, Vice-Director Joint Staff, identified weaknesses that often threatened the smooth day to day running of the operation, caused by a “gap in policy and planning”[1].

In his eyes, roles and responsibilities between different agencies on and off the ground were not clearly defined and this negatively impacted on progress, slowing down decision making, giving way to adhocism, during the operation. A framework similar to the US National Response Framework, with validation and prioritisation mechanisms, well planned inter-organisational strategy formulation and training schedules against pandemics was required for optimal results. 

Codification of policy and planning for health crises and pandemics” make support more effective, should the health system reach total saturation. 

World Health Organisation, a few days ago, communicated on an increasingly confident and resilient African healthcare service, having cured the last patient diagnosed with the Ebola virus, in Democratic Republic of Congo, in the second outbreak. Although Africa remains vulnerable, its institutions and non-government organisations are better prepared to face pandemic levels[2].

Lengthy threat assessment processes constitute another barrier. Time consuming consultations and discussions in crisis time can have drawbacks. The whole point of crisis is that business as usual is suspended. But most people still work their minds within the tramlines of business as usual.

Between the end of the 1980s and the late 1990s, Britain regularly faced cattle linked diseases, some highly dangerous as they mutated and proved contagious to humans. The regular response was to let the veterinary surgeons of the Ministry of Agriculture, Fisheries and Food lead the fight on the frontline. The Ministry, unfortunately, hesitated between vaccination and slaughter, torn by the responsibility of protecting British economic interests in the agricultural sector and food supply. Lack of preparedness gave way to a communication strategy that involved concealment, denial, understatements and bold reassurances. It backfired as the disease spread out of control[3].

In 2002, Tony Blair called in the British army during the foot and mouth crisis. A command centre was established, the military staff made sure they had sufficient capacity and rapidly moved alongside the veterinary surgeons, to meet the strategic objectives, revolving around confinement, surveillance, reporting and kill. Cabinet Office monitored progress. It provided the British public with a renewed sense of security[4].

Success in containing pandemics is about effective surveillance and reporting systems. Information technology use in crisis, being relatively new to most publics, captivate attention and create a sense of wonder that eventually help officials meet awareness campaigns’ objectives. 

In Pakistan, in Punjab, Governor Shahbaz Sharif handled a major outbreak of dengue, in 2011, via a mix of old and new techniques. His communication strategy was made up of daily meetings he summoned, at the crack of dawn, with relevant officials. And of a digital mapping and surveillance system developed by the Punjab Information Technology Board. Specific pools of stagnant water were identified and dealt with, with growing efficiency. 

After awareness campaigns proved inefficient, dengue tracking officials were given geotagging smartphones. The electronic tracking system fed, in real time, by data collected by frontline officials became more and more sophisticated with time. A digital dashboard allowed senior officials and political leadership to monitor progress and made it in turn visible to the public[5]. This not only made Sharif look in charge but also reinforced public trust in the administration’s capacity to deal with crises. 

However, with a more educated and vocal citizenry, savvy in the use of social media, public consent for hardline policies, especially in special circumstances, remain difficult to secure. 

Singapore’s government found a way around the aforementioned problem via what can be deemed as ‘white coat effect’ communication. Experts are their preferred tools to engage their public and in outbreak communication, they become political leadership’s ideal strategic partners. Prime Minister Lee Hsien Loong recently innovated.

On January 31, a month after the outbreak in Wuhan, while Singapore’s first victims were being diagnosed, PM Lee, back from a diplomatic trip, chose to meet the press at Singapore’s National Centre for Infectious Diseases. His statement and its location, especially, is self-explanatory. 

“There are a lot of good questions. I do not need to answer all of them because I think some of them belong to the Ministers that are handling but let me say why I am here today. We have been watching the new coronavirus outbreak in China for some time as soon as the first news came out. We have actually been preparing for a situation like this ever since we had SARS in 2003, 17 years ago. We have built up our institutions, our plans, our facilities, our stockpiles, our people, our training because we knew that one day something like that would happen again. So, when this thing came about, in a way, it is a shock, but it is not a surprise.”[6]

The target audience is not just Singapore’s public here but any interested party, tourist or business person. The infrastructure, trained professionals and technology within speak for themselves. His message is clear and can be summed up in one word, preparedness. 

Yet he admitted to the following on February 08: 

“But in the last few days, we have seen some cases which cannot be traced to the source of infection. These worried us, because it showed that the virus is probably already circulating in our own population. This is why we raised the DORSCON to Orange yesterday, and are stepping up measures.” 

And on March 12, thanked his fellow Singaporeans on “responding calmly and responsibly” as behaviour changed. 

Tensed, healthcare professionals, also under pressure, defend each other, often, through benchmarking against other countries. We have seen it in France. Critical against successive Italian governments, French doctors and mainstream media pointed to the weaknesses of the Italian healthcare system and condemned Italian practices, quarantining people in open spaces, inflating national ego to gain reassure and also address political leadership regarding the need to keep investing in medical equipments, infrastructure and research[7]

The objective in benchmarking, is to reassure and reignite national pride in institutional capacities to contain and eliminate the disease. 

Credibility is a complex phenomenon. It has to do with trust which is itself gained through consistency in action. And as alarming events give way to extreme behaviours in the public, effectiveness of actions taken become increasingly evaluated in the light of international best practices, and less in perceived honesty.

There are no safe zones in crisis. 


[1]Joint Coalition and Operational Analysis, Joint Staff J-7, Operation United Assistance: A DOD Response to Ebola in West Africa, 2016, https://www.jcs.mil/Portals/36/Documents/Doctrine/ebola/OUA_report_jan2016.pdf

[2]Dr. Ibrahima Soce Fall, World Health Organisation, “End in Sight, but flare up likely in the Ebola outbreak in the Democratic Republic of Congo “, World Health Organisation (Website Newsroom), 06 March 2020, https://www.who.int/news-room/detail/06-03-2020-end-in-sight-but-flare-ups-likely-in-the-ebola-outbreak-in-the-democratic-republic-of-the-congo

[3]World Health Organisation, Outbreak Communication, Best Practices for Communicating with the Public during an outbreak, Report of the WHO Expert Consultation on Outbreak Communication held in Singapore, 21-23 September 2004, https://www.who.int/csr/resources/publications/WHO_CDS_2005_32web.pdf

[4]National Audit Office, The 2001 Outbreak of Foot and Mouth Disease, Report by the Comptroller and Auditor General, 21 June 2002, https://www.nao.org.uk/wp-content/uploads/2002/06/0102939.pdf

[5]World Bank Group, Improving Public Sector Performance, Through Innovation and Inter-Agency Coordination, Case Study from the Global Report, Using Smartphones to Improve Public Service Delivery in Punjab, Pakistan, http://documents.worldbank.org/curated/en/833041539871513644/122290272_201811348011007/additional/131020-WP-P163620-WorldBankGlobalReport-PUBLIC.pdf

[6]Prime Minister’s Office, Singapore, PM Lee Hsien Loong’s doorstop interview with local media at National Centre for Infectious Diseases, 31 January 2020,https://www.pmo.gov.sg/Newsroom/PM-Lee-Doorstop-Interview-at-NCID

[7]Quotidien, Invités- Coronavirus : On débriefe les annonces d’Emmanuel Macron avec Patrick Pelloux, 09.03, 12 mars 2020, https://www.tf1.fr/tmc/quotidien-avec-yann-barthes/videos/invites-coronavirus-on-debriefe-les-annonces-demmanuel-macron-avec-patrick-pelloux-et-david-revault-dallones-36893401.html

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