Waging the Swine-Flu PR War

Swine flu isn't going anywhere. At least not yet. The latest government stats show 46 states reporting widespread H1N1 activity, and while the virus has been relatively mild in many patients, some are getting very sick. More than 1,000 Americans, including almost 100 children, have died from H1N1, and more than 20,000 have been hospitalized, a number that will almost certainly increase in the coming weeks. Last weekend, as anxious parents lined up to get vaccinations for their kids, President Obama declared the virus a national emergency.

From the moment it hit this spring, H1N1 has been a PR emergency, too. Facing a novel and unpredictable strain of the flu, the government went into full disaster mode, flooding the airwaves with warnings and convening press conferences with top health officials. From the start, the government's communications team faced a series of challenges: How do you educate the public without alarming them? How do you sell a new vaccine to parents, many of whom are already wary about giving their kids so many shots? How do you get the facts out and combat massive misinformation on the Web? In years past, long before we were all glued to our TVs and iPhones, posters and pamphlets educated Americans about infectious diseases. Today, the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC), in partnership with the White House and other government agencies, have gone viral with online seminars (or "Webinars"), text messages, podcasts, Twitter, Facebook, Flickr, and YouTube. The CDC has partnered with WebMD on a flu blog, written in part by a CDC medical epidemiologist. Since April, the CDC has signed up 30,000 fans and friends on Facebook and 1 million followers on Twitter, and it has sent out 244,000 flu updates to H1N1 e-mail subscribers. CDC's social-media group sprang up about two and a half years ago, says Ann Aikin, CDC's social-media team leader for emergency communications, and "it has ballooned since then." Earlier this year, after the CDC team worked with HHS and the Food and Drug Administration to get info out about a salmonella outbreak caused by peanut butter and peanut-containing products, it was tapped to become part of the government's official emergency-response team. "The first event that's come our way [as part of the emergency-response team] is H1N1," says Aikin.

Despite the government's efforts, public polls show mixed opinions about H1N1 and the new vaccine. According to a Harvard survey released in early October, only about one third of the public said they saw the H1N1 vaccine as very safe "generally for most people to take." And in a poll published by The Washington Post this month, 52 percent of people surveyed said they are "a great deal" or "somewhat" worried that they or someone in their household will be infected with H1N1—up from 39 percent polled in August—but only half of all parents said they plan to have their children vaccinated. Public opinion is all over the map. Plenty of Americans are worried enough to take action, lining up for hours outside mobbed clinics, but others are suffering from swine-flu fatigue: they're tired of the headlines, they're not all that concerned, and they don't want a shot, thank you.

Today, nobody hesitates to blog, post, and chat about all of this, which makes much of the H1N1 information on the Web strongly opinionated or blatantly wrong. The vaccine is a plot by Big Pharma to make money! The vaccine hasn't been tested! The vaccine is toxic! Headlines like "I'm Scared to Vaccinate My Kids for Swine Flu" abound. On top of all this are the non-FDA-approved sprays, supplements, and masks, many of which may be bogus. "The Internet has completely changed the game," says Kris Sheedy, a communications director with the CDC's National Center for Immunization and Respiratory Diseases. "We know that it can be really difficult for people to decipher what's a credible source and what's not."

The government has been largely proactive rather than reactive in its approach, because it doesn't have the resources to monitor and correct every bulletin-board message or blog post. "If we took that approach, we'd spend most of our time policing," says Aikin. Instead, public-health officials track daily media and monitor Internet sites to get a sense of what people are thinking about H1N1 and how effectively the government is getting its message out. When it became clear that rumors were spreading about mandated vaccines and dangerous adjuvants (immune boosters that are sometimes added to vaccines), for example, officials corrected these misunderstandings in the "Flu Myths and Facts" section of flu.gov, the government's influenza Web site. The truth: some hospitals and local health departments are requiring the vaccine for health-care workers, but the shot is otherwise voluntary. And while certain countries are adding an adjuvant to their H1N1 vaccine, the U.S. is not.

The government is going animated, too. HHS used Elmo for a PSA that teaches kids to sneeze into their elbows, and it funded a special episode of Sid the Science Kid, a PBS show for preschoolers, that debuted this week. The plot features Sid and his preschool buddies dancing and singing and getting their flu shots. Lyrics: "It might hurt a little, but it's going to help a whole lot!" Executive producer Lisa Henson says she and her colleagues were already interested in doing a show on the topic, but it was HHS's sponsorship that allowed them to produce it on a pushed-up schedule in time for flu season.

In the end, much of this information, accurate and not—the chatter on blogs, the listserv rumors, the government tweets and PSAs and e-mails—spills over to the people whom patients tend to trust the most: their family doctors, who are essential in clearing up misconceptions. "The clinical-practice community is obviously critical because they're interfacing with patients and parents who are asking questions," says Dr. Bruce Gellin, director of HHS's National Vaccine Program Office. Physicians say they're spending much of their time now untangling incorrect or scary information. "The biggest concern expressed by parents," says Dr. Christina Flannelly, a pediatrician in Raleigh, N.C., "is that the H1N1 vaccine is too new and rushed out, so it's not going to be good." Flannelly's response: "It's made the same way as the seasonal flu vaccine." Dr. Marjorie Curran, chief of the pediatric group practice at Boston's Massachusetts General Hospital, says she sees a huge range of reactions among patients. "We go from patients who are ready to beat other people over the head to get the vaccine to patients who are convinced the vaccine's going to kill them," she says. "I spend a lot of time trying to make people calmer."

That's become complicated now that the government's pro-vaccination message has come up against a disappointingly low supply of vaccine. Officials are trying to assuage Americans' fears. "We are now in a period where vaccine availability is increasing steadily, but far too slowly. It's frustrating to all of us," CDC Director Dr. Thomas Frieden told reporters late last week. A few days later, HHS Director Kathleen Sebelius made the rounds of the morning news shows, conceding that early projections about vaccine availability were "overly rosy," but adding that eventually there'll be enough vaccine for everyone who wants it. When asked how she'd advise those who've tried unsuccessfully to get a shot, she said, "I want them to come back." It seems like a simple message, but keeping that message out there is an ongoing challenge.

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