By Tina Reed
Health & environment digital journalist, AnnArbor.com
Getting consistent health messages out in the world of the 24-hour news cycle was one of the leading challenges facing public health officials as the H1N1 flu pandemic news unfolded in the past year, a panel of experts said at Health Journalism 2010 conference.
"Communication in 2010 is a really tricky situation. The Secretary often said, ‘This is the first pandemic done in the age of the Internet'," said Anne Schuchat, director of the U.S. Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases.
"It wasn't just you all," she said. "It was blogs and social media and friends and neighbors, and all kinds of communication pathways. So we were, from the beginning, anticipating rumors as the kind of thing that we had to be on top of."
Schuchat was a member of the panel at Friday's luncheon session evaluating the U.S. public health response to the H1N1 flu pandemic.
It was almost exactly a year to the day since the Centers for Disease Control and Prevention first announced two children in the United States were sickened by the flu. That announcement kicked off a frenzy of media coverage about the flu virus which was quickly declared a worldwide flu pandemic.
But the pandemic behaved much differently than predicted and, at first, sparked a panicked demand for its flu vaccine, said moderator Maryn McKenna, an independent journalist based in Minneapolis. That demand for the vaccine later waned and the country found itself instead with huge surpluses.
While miscalculations by the United States regarding its vaccine supply and its approach to distributing it have been criticized, Schuchat said the public health response did show success in achieving high rates of at least short-term behavior change in the public. Millions of doses of vaccine were successfully distributed and may have contributed to the less-severe-than-expected pandemic, she said.
"A lot of this did go according to plan. We'd been doing exercises within our CDC family and the public health system at the state and local level, as well really figuring out how do we work as a team," Schuchat said.
While the CDC offered guidance, she said, the response seemed to work better being led from the local level where officials could take into account how much vaccine was available and what specific populations needed access in a given region, she said.
However, the pandemic also illuminated significant weaknesses in the U.S. public health system, panel members said.
Technology was only one factor that contributed to communication problems, said Jeffrey Levi, executive director of the Trust for America's Health.
Having local public health departments distribute vaccine using their own approaches also contributed to confusion, Levi said. Those departments had to develop vaccine distribution systems on the fly, but he questioned why the private sector's already-developed systems couldn't be harnessed more effectively.
Local health departments were also grappling with budget crisis while trying to ramp up against the H1N1 influenza.
The federal government has not given local and state health departments enough money for responding to emergencies like the pandemic, he said. The system was extremely taxed and needs more federal support if the country expects to respond better in similar situations, Levi said.
"I think we have to recognize the system started with huge shortages and major problems," Levi said. "[Health department's] budgets were being cut, people were being laid off. So whatever core infrastructure problems we had to begin with were exacerbated," he said.
Another core infrastructure problem lies with the manufacturing of flu vaccines which have been plagued by failures in its unpredictable biologic production process that can slow supply, panelists said.
It led to frustrations when anticipated yields of vaccine unexpectedly fell short of previously announced projections. It's one example of how keeping up with that 24-hour news cycle and pushing communication out too fast led to distrust of information when it turned out to be overly optimistic, Schuchat said.
In the future, government will have to be more careful in its messaging when it comes to expectations, she said.
More federal investment needs to be pushed into both improving the manufacturing and distribution process of vaccines in the future, panelists said.
Ultimately, there needs to be a universal influenza recommendation said Litjen Tan, Ph.D., director of medicine and public health for the American Medical Association and co-chair of the National Influenza Vaccine Summit.
Looking forward to the upcoming flu season, it would help address communication problems that arose with the H1N1 flu and lend itself toward more permanent behavior norms, such as regular hand washing or getting vaccinated, Tan said.
"I think it's going to be how well you communicate the message (everyone should be vaccinated) while still keeping an eye on those high priority populations that really, really must be vaccinated," Tan said. "So I think it's going to be messaging … to come to a unified way to move forward and get people protected next season."
