Holy smokes! My very good friends at NACCHO have finally taken the plunge. I’ve known for a while that they were on Twitter (@NACCHOAlerts and @NACCHOMeets), and that they’ve been big supporters of mine (and Gerald Baron’s Crisisblogger, apparently).

But now, they’ve got their own little H1N1 blog. The posts are signed by Caroline Dobuziniskis. The way the blog page is set up, it looks like there should be more blogs in the future.

Congrats to Caroline and NACCHO. Glad to have you in the deep end of the pool. Keep up the great work.

All of NACCHO’s communications activities, including their blogs, social media presence and publications, can be accessed here.

Thanks for the updated link, Caroline.

Lately, my feed reader has been buzzing with the stylings of a new-to-me blogger. Hailing from Oakville, Ontario, Canada, Patrice Cloutier’s blog, Crisis Comms Command Post, has been doing some really interesting work on crisis communications blogging.

His latest, Is it time to review how PIOs work and JIC structure?, looks at an idea about JICs that I’ve been toying with a lot lately. Specifically, what is the main function of JIC? Is it to coordinate media messaging? Or to massage and enhance the “common knowledge” of an event?

Being someone who has never sat in that traditional media coordination seat, I’ve never been a huge champion of the idea that writing press releases and setting up press conferences should be the main outcome of a JIC. I was always much more interested in the ability of a roomful of PIOs and PA folks finding and taking the prevailing interpretation of a situation and melding that to one that benefits the government agency (or private company) that is charged with the response; as opposed to the latter, where a roomful of PIOs and PA folks is responding to the media’s interpretation of a situation in which they happen to be responding.

This is a bit off the beaten public health preparedness track, but I’ve been focusing so much on crisis comms work lately that it seemed a natural time to pass this blog along to you all. If you’re really looking to loop this back to the conversation at hand, in a pandemic situation, say something like an outbreak of novel H1N1 influenza, what is the role of the PIO? Would a JIC be necessary or beneficial ? What would it do?

I’ve argued that a JIC would be a great idea for such a situation, if only to seek out an respond directly to rumors and half-truths that would dissuade people from taking adequate precautions to prevent the spread of the virus. Is that what your PIO is doing? Should they be?

In any case, check out Patrice’s work here.

• Fort Hood Shootings: News Orgs Put Twitter Lists to the Test
  For Twitter fans, this last week has been one of discovery. Twitter rolled out the ability to group other Twitter accounts into lists, and then share those collected lists with the world. Seems pretty cool, but when gunfire rang out at Fort Hood, Twitter lists became an important, real-time news aggregator. This great article from social media blog Mashable, points out some of the best collected lists.
  (tags: twitter socialmedia crisiscommunication)

Better bloggers than me say that you need a catchy title to your posts – something that will stir conversation and get people’s dander up. I can’t imagine that this one won’t.

By now, I’m sure you’ve all heard about the latest. And if not, I’m sure it will hit the national press soon enough. Several large Wall Street firms have begun receiving H1N1 vaccine from NYC Department of Health and Mental Hygiene to distribute through their employee health units to high-risk employees. Apparently, BusinessWeek broke the story here.

Once that happened, hue and cry. A sternly worded letter from the former NYC Health Commissioner and current CDC Director, investigations are being called for, Senators are writing letters, the whole nine yards.

Rightly or wrongly, I think that NYC DOHMH, CDC and Wall Street are going to get raked over the coals for this. CDC and Wall Street can take care of themselves, but NYC DOHMH will probably come out of this the worst of the three, and they’re the ones least at fault, in my opinion.

Besides all that, I think that giving H1N1 vaccine to large employers with on-site healthcare infrastructure is not the part we should be upset about. In fact, I’m surprised that this hasn’t happened other places already, and I’m positive that it will happen again, and more times, across the country. Maybe not bankers next time, but maybe large manufacturers, etc.

Why?

Because public health departments have been charged with distributing hundreds of millions of courses of vaccine, and they can’t. They simply don’t have the infrastructure. Not enough manpower, not enough drivers, not enough cars, not enough refrigerators, not enough forms, not enough databases, not enough data entry folks, not enough vaccinators, not enough anything. And then along comes a company that says, we have 10,000 people working for us. Give us vaccine and we’ll take care of all of them and their families. Free of charge. Set it and forget it. Take your time and concentrate on the poor, the destitute, the infirm, the non-English speakers, the unemployed, the sick. That’s what public health departments do best anyway.

Boy, I’ll tell you how good that must look to an overworked overwhelmed public health department. And if New York City is doing it? If the best funded and best staffed health department in the country is doing this, I can assure you that other cities, counties and states are doing it.

So, let’s examine the real problem here. The real problem is the same problem that Trust for America’s Health yells about every November. It’s the same problem I’ve yelled about before. After thirty years of budget cuts, hiring freezes, matching grants, new spending only, supplement not replace, preparedness only, first on the chopping block, public health is little more than skin and bones. Public health departments can’t do their job on a normal day, let alone when 10 to 15% of the public is showing up at emergency rooms, vaccine is rolling in and out of the building all day every day, the media calls, the conference calls, the reporting requirements. Imagine all that. And then along comes a company that says, we have 10,000 employees people working for us…

What we’re witnessing is no more than the absolute failure of the United States public health system.

After decades of being stretched and chronically underfunded, after warnings that someday something’s gonna happen, after  letting the infrastructure rot, it finally did happen. A real public health emergency. And the CDC and HHS said that it was a local matter, and we’ll give you all the vaccine you need—more even–, but you’ve got to handle all of the boots-on-the-ground stuff yourself. And the states and counties dusted off their panflu plans and diligently crafted public information messages, and scheduled flu shot clinics and told their surveillance guy to ramp it up for a bit until we get a handle on things. And then they found that none of our previously developed messages worked. And then they had to cancel all of their flu shot clinics cause they didn’t have any vacccine. And then the surveillance guy collapsed from working 12-hour days for 2 months straight. And when the vaccine finally showed up, they only got a third of what they were promised. And then the contract nurses they hired to help out didn’t show up to work and somebody had to cover for them. And then along comes a company that says, we have 10,000 employees people working for us…

In a perfect world, would I be appalled by this turn of events? That Wall Street got their flu shots first? Absolutely disgusted.

But this is far from a perfect world. And while the priority groups were set for a good reason, the fact of the matter is that folks in those priority groups have to catch the flu from somewhere, and I’ll bet that some of them catch it from bankers. Vaccinating everyone decreases the incidence of disease; it decreases the chances that that pregnant woman, or that child, or that asthmatic, will catch the flu. And really, isn’t that the ultimate goal? To keep people from getting sick? When you’re fighting with one hand tied behind your back, do you question who it is that just gave you a baseball bat? No, you grab it and swing for the fences and hope for the best.

The valuable lesson we’ve all learned today? Underfunding public health is the same as undermining public safety. And not in some bioterrorism/emergency preparedness way. In a people get sick and die from a natural disease kind of way. In a traditional public health can, has, and will save lives kind of way.

• A Nation Battling Swine Flu, and Short Vaccine Supplies – NYTimes.com
  An interesting article about vaccine delays, and how that affects HHS' credibility during this campaign. I have some thoughts on this, and hopefully will find a chance to write them up.
  (tags: vaccine hhs h1n1)

Last week, a judge in New York state issued a temporary restraining order against a New York State directive ordering all health care workers to receive both H1N1 influenza and seasonal flu vaccines. Even the Reveres posted on the matter (and subsequently posted on something I’ve thought was a great idea for years, except instead of stickers, I say they should be forced to wear masks).

Now, I’m about as far from a lawyer as you can get, so take this with a grain of salt, but I thought that mandatory vaccinations weren’t a new idea:

See Jacobson v. Commonwealth of Massachusetts.

See school required vaccinations. (see Zucht v. King)

To me, the Jacobson case (while obviously ridiculously outdated) is comparable. In the face of a communicable disease outbreak that is actively causing excess disease and death, the state compelled one of its citizens to receive a vaccine that would protect the lives of those around them. Jacobson objected, and was forced to receive the vaccine in the interest of the PUBLIC’S HEALTH. Given that he was not performing head of bed procedures  on immuno-compromised patients or pregnant women, he actually had a better argument than nurses and healthcare workers against receiving the vaccine.

So what to do?

For me, I see no problem with mandating vaccination for influenza. Every year it’s proven to be safe. And for those that have a religious or philosophical objection, they can apply for an exemption. The exemption would require signing a document affirming that vaccines are the best way to prevent influenza transmission and that their refusal to receive a vaccine may permit the transmission of the potentially fatal disease in the healthcare setting. To wit, the healthcare setting, in order to protect itself from the liability that their employee is exposing them to, should require the worker to be masked while on the grounds of the campus (or office, etc.). Am I being unreasonable here?

Again, I’m no lawyer, so for a more reasoned approach on the matter, an anonymous (not me) letter was published earlier this year calling for a twenty-first century Jacobson v. Massachusetts (PDF direct download).

• Flu Data Shows Concerned Health Officials, Skeptical Public
  I try not to put too much political stuff on this site, but this is a really interesting post by a phenomenal flu blogger.
  (tags: pandemic h1n1 vaccine)

I’ve been thinking a lot about H1N1 communications lately.

I’ve yet to find a person that has spoken crossly about the CDC’s ongoing public information campaign, especially their work in social media. Don’t get me wrong, I don’t want to be that guy; I’m not looking to knock the work that CDC has done. Truly, I think they’ve done a great job. I can only hope that if I ever have to do something similar, I meet with the same level of success.

The thing is, I don’t know what a poor job would look like. I’m a firm believer that success is defined by failure, and vice versa. I don’t know if CDC, or any other public health public information folks, are doing a good job or a bad job because I don’t know what that looks like.

There’s a cool post on a blog that I found through Twitter called Walking the Path: Smashing Silos and Encouraging Collaboration in Health Marketing Communications. One particular post stood out to me. In this post, the author thinks the CDC did a good job on educating people about H1N1 by utilizing social media, but is dropping the ball on spurring people to action. Specifically, lots of people aren’t planning on getting the vaccine, which anecdotally seems like the case to me, too.

Is that what failure looks like?

Is it possible that H1N1 public information campaigns are more than just education campaigns? Is there a second component to H1N1 communications, one of convincing people to act?

One of my good friends, Ike Pigott, blogging at Occam’s Razr, posted recently on something similar. He noted (in a really cool post about using Posterous to develop a streaming information hub–really, check it out) that people are more willing to act when something is relevant to them. He likens relevance to local-ness, and I think he’s on to something. This might be why CDC’s efforts at getting people to get the shot aren’t working. A campaign written for a nation won’t help to get Jane Q. Public to get her kids vaccinated. One of the commenters  on the Path blog above also noted that social media is a great way to do this, though difficult.

By providing local information that’s pertinent to the intended audience and providing a method for direct feedback and a way to ask questions, local health departments can work to spur people to take the next step.

I think that’s the next phase in H1N1 influenza communications (or at least it should be). Move away from bullhorn risk communications. Begin engaging with your community. Right now, the best way I can think of to do that is to use social media tools — at the local level.

CDC should be offering webinars on how LHDs can set up Twitter accounts and how to record YouTube videos. The CERC folks should be developing curriculums to teach PIOs how to write using a social media voice. Health Commissioners should be scheduling live chatroom “office hours” where citizens and residents can ask them to address specific worries from the public.

I guess, then, I’m not saying CDC has failed in their H1N1 communication efforts. They’ve handled the first phase extremely well. Kudos, really. I think that believing they can  continue to communicate the same way going forward, in this second phase, is their failure. And there’s absolutely nothing they can do about it. The fact is, the CDC is just not equipped to act as a local presence everything, nor should they be. Pandemic influenza is, and has always been, a local emergency that just happens to occur everywhere. The response, by definition, should be locally coordinated.

There’s a really interesting article on the front page (right now) of the New York Times about flu incidence rates across the country. For anyone who knows that flu incidence differs from state to state, county to county, city to city, and even neighborhood to neighborhood, this article will only surprise in how well it bears this maxim out. For everyone else, though, it’s a telling introduction into what flu planners, public health workers and PIOs have to deal with this season.

Flu is not like other public health preparedness topics. It does not plume and modelling its spread is notoriously difficult. An inefficient mode of transmission, combined with inconsistent replication does not make for a very linear progression of disease spread. Now add to that equation the idea that disease severity differs from person to person, ranging from hospitalized to any of a range of symptom presentations to essentially asymptomatic presentation, and you begin to get an idea of how hard it is to track flu. (That’s one reason why I’m so excited about Google Flu Trends – it allows people to self-identify flu symptomatology without forcing them to “commit to sickness” by going to the doctor’s office.

So, why is this important? Because with variability comes problems. In an athrax situation, everyone exposed has to take the same precautions; over time, while the danger to those exposed increases, the potential pool of exposed people decreases as the epidemiology of the situation improves. Same thing with a conventional attack: the number of exposed is finite, and the number of potentially exposed goes down over time. Flu situations are different, (especially mild flu situations), because too aggressive response seems out of place for a flu that, in the eyes of the public, isn’t that big a deal. Too timid a response, and you run into the same problem. (Not all infectious diseases are like this, a smallpox case could never be “under-responded to”

In a situation like ours, how do PIOs reconcile a national media that is pushing a “deadly flu” scenario, but there’s no flu in your city (like NYC, according to today’s article), and most of the country this past spring? How do you take years of pre-positioned message templates that spell out gloom and doom (mostly because of H5N1), and whip something together real quick, for a disease whose epidemiology changes daily, and for which CDC keeps changing their recommendations?

It seems a bit disingenuous to call oneself the only public health preparedness blogger out there and not blog about the biggest activation of public health preparedness programs across the US. While it would be easier to not say anything for fear of inferring what I spend nine hours a day doing, it’s not helping advance the state of those programs or efforts, and frankly, I’ve got too much to say.

So, I’m back(?).

The biggest thing I’m depending on is this fancy-dancy WordPress iPhone app that will let me blog whilst sitting in Schuylkill traffic. The only trade-offs are that I won’t get as much homework done, posts won’t have pictures, and they’ll probably be a bit shorter. At the very least, it’ll help get all of this commentary and these ideas out of my head.

Like all good serials that take the summer off, I trust that you remember where we left off last season. No sense in me walking you through the events of the last four months as you’ve probably lived them, especially if you’re reading this blog. And if not, the major dailies have catch-up pieces pretty regularly anymore.

The hot topic in certain circles yesterday had to do, obviously, with H1N1 vaccine (yes, I sold out and am no longer calling it swine). Specifically, folks are chattering about what’s happening in Indiana and Tennessee. Both states not only announced that they are receiving vaccine, but have also released where the first doses would be going.

This is unusual, and cause for out-sized discussion, because no other state, county or city that I’ve heard of is announcing that information. My first thought when hearing about the announcement was to shake my head. Did they not think that the media would swarm those sites and the public would demand they get the vaccine first?

And then I thought about what I always preach here, be transparent and trust in the public. And that’s just what they’re doing. They’ve told the public, before anyone asked or there was any outcry, exactly what was going on, and trusted that they would be satisfied with the explanation that more was on its way, and everyone would have their opportunity to get a vaccine.

This situation reminds me of a post from the Crisisblogger, writing for Emergency Management Magazine, that I read this morning. Mr. Baron talks about what Dave Letterman is going through right now, and while chastising his, erm, lifestyle choices, he notes that Letterman’s decision to admit what happened on national TV, may have restored some people’s respect for him. Transparent, trust the public.

Time will tell if either decision was the right one, though (putting aside Letterman) at least IN and TN are trying something different – something that has the chance to rebuild faith in government. Kudos!