In 2016 John Rainford, director of The (now defunct) Warning Project, presented at a workshop on building communication capacity to counter infectious disease threats. An important discussion, in general, but certainly in the years leading up to a global pandemic.
The context is important for us in the Immigrant and Refugee-serving sector not only because of the overall failure of public health communication (including translation and effective outreach to racialized and Newcomer communities), but because, as this workshop summary wrote: "People such as Rainford who work to build risk communications capacity repeatedly experience the incredible difficulty of balancing the tensions between excellent ideas and the translation of those ideas into a system that can provide reliable information to the people who need it. One of the tensions, Rainford explained, arises because the multiple audiences for risk communication have different ideas about what kind of information is important and how they understand that information.
As an example, he laid out a scenario in which a health organization has learned there was a serious problem with a single small batch of measles vaccine. The director of the health organization might be most worried about this news having a negative effect on an ongoing measles vaccination campaign and on broader public confidence in vaccine-based programs, but a mother is more likely to worry about the potential adverse reactions her child could experience from the vaccine. 'You have this dynamic in terms of what the director wants to say and what the mother needs to hear,' said Rainford. Although many people would agree that the proper target audience for risk communication would be the mother, the typical output from such a risk communication effort would be written at a level that the director and his or her colleagues can process, but perhaps the mother cannot."
Sadly, we did not appear to have learned from "the question of whether it is possible to build communication capacity to counter infectious disease threats. 'When we ponder, and we will over the next day and a half, how central communication of risk is to success, to protecting our people, to achieving our goals, it sounds a bit corny, but it is really not, can it be done—it has to be done,' said Rainford."
The lessons here are completely transferable not only to health-related risk communications, but to communication in general. In particular to vulnerable people. In different languages. As they increasingly negotiate misinformation and disinformation. We need to think beyond ourselves. As some say, we are not our audience. Or, when it comes to online communication, the title of this 2013 book says it all: "Don't Make Me Think: A Common Sense Approach to Web Usability."
We haven't taken these basics about simple communication to heart in most cases. We certainly didn't before or during the pandemic. But we can. As Rainford say, not because it can be done, but because it must be done.
I encourage you to watch his presentation (with plenty of CanCon) below.
I'm including a transcript below, as his comments are very much worth a read if that's your preference.
Machine-Generated Transcript
What follows is an AI-generated transcript of our conversation using Otter.ai. The transcript has not been edited. It may contain errors and odd sentence breaks and is not a substitute for listening to the audio.
Thank you very much. The organizers asked me to consider the question, risk communications capacity building, can it be done now, as the founder of an organization on which that's its central premise, I really, really hope so.
Informed by many of the people in this very room, alright, I think we have a sense of what this risk communication thing should be. All right, we have a sense of so many of its components and attributes. But for those of us out, toiling away to try to build this capacity, the one thing that we take away, over and over again, is just how difficult that is how incredibly difficult it is. I want to share with you just some thoughts and reflections on my own experience. And share with you what I hear in terms of the tensions and the dilemmas between the ideas of this excellence, and the actual translation into that in terms of providing the people that we care about the people that we serve the information that they need. So we do this little exercise during our workshops.
And we pose a very, very simple little idea, a Health Organization has just found out that there was a serious problem with a single and small batch of measles vaccine. Now, we asked them, What is the risk from the perspective of the director responsible? Is it the campaign is threatened? Is it legal liability, is that there will be criticism? Is it that the broader confidence will be threatened? Or is it adverse reactions. And what we see in terms of patterns, this is pulled from our example of the chief medical officer of health Caribbean, more often than not, they're most concerned about the campaign and the broader success of vaccination programs. So of course, with that, as the risk, we think about messages, like vaccines are crucial. Vaccines save lives. Vaccines are a cornerstone of our health system.
And then we asked the same question, but this is what is the risk from the perspective of a mother about to get their kid vaccinated, same five choices. And what you see over and over again, of course, it's just adverse reactions. So you have this dynamic in terms of what that director wants to say. And you have this dynamic of what that mother needs to hear. And they're not on the same page. We finally say, in terms of achieving your objective, who is more important, the director or the mother, now, there's always a couple of directors in the room, they vote for themselves. But the vast majority of people realize it's that decision maker. Okay, that decision maker is the key.
Now, what we do is we build our risk communication strategies, around the mother, or around the director. The classic example of what we actually do is in the literacy rates, or levels of what we produce, and everybody in this room knows, all right, we're shooting for grade six, in high risk events may be great for maybe grade three. What do we do? We produce material that the director and their colleagues can process, but perhaps the mother can. Many of you will have seen this little exercise as well, we've done it since I was with the World Health Organization, I believe they still do. But we map out your typical infectious disease outbreak, right? Here's an Epi curve, you got infected, you got time. And everyone knows that if we have a delayed response, our control opportunity, the amount of people we can save the amount of people, or cases we can prevent is very small. But ideally, we have a rapid response. And now all of a sudden, our control opportunity is massive. And everyone sees this and they're like, Yeah, that's what I want to do. That's my job. And then we ask that group again. Now, when would your organization communicate a serious emerging risk? Immediately, when a potential threat is identified, or after all the details are confirmed? All right. And we see this rich, poor, east west, north south, we see the same pattern emerging over over again.
We see 70% of people pointing to when full details are confirmed, and only 30% saying what a potential risk is identified. Now, the problem is that rapid response is communication, every single time it is warning, it is guidance, it is advice. It is not separate from our response, it is central to it. And if we wait for all details to be confirmed, is it closer to this or to that there is real life implications of these risk communications choices. But this uncertainty dilemma I am seeing change. I don't know about you, but when I saw the public health, emergence, Health Emergency of International Concern declared, based on the possibility, something, that idea of guilty until proven innocent, I almost fell off my chair. We don't do things like that. Now, some might argue that reaction was to counter the delayed reaction in the Ebola response. But I also think that we're starting to understand and embrace uncertainty, not to eliminate it, but to manage it.
And that's a step forward. But very quickly, I want to say that guidelines and policies and techniques and training, and capacity building and professional norms and standards are all the foundations of capacity building. But in my experience, there's some softer dimensions that I want to throw on the table for your consideration about what I think really matters. And that's performance measurement. Standard, of course. But more importantly, what is success and failure because we can't have performance measurement. If we don't really know what success or failure is.
I'll give you an example. From my own experience in SARS, Canada. It was a risk communications Gong Show. We failed at so many levels, and were criticized at such an extreme level. It was a difficult time. But then we asked 10,000 People in Toronto to go into self quarantine. And they did. Now you could say, well, Canadians just do what they're told. That's true. How do you get 20 Canadiens havin fun out of the pool? Come on, guys get out of the pool.
But besides that, what I knew was that the trust was never broken. Criticism was large. But the real performance measure was whether or not people followed our guidance. So I think we need to consider carefully what success and failure might be. We've got to rebalance our resources between knowledge generation and knowledge translation, that sounds wildly self serving from someone focused on Knowledge Translation.
But I worked with a client recently, and they were very concerned that people were going to another source for information. All right, the client, I won't say where it was, but it's a very large place, and it's very cold. And they were worried that people were going down to the US Centers for Disease Control for their advice. And that was threatening to them for good reason. So they asked me to find out why.
One of the things I found was an org chart for that said program. And they had a robust group of world leading experts producing this material. And they had an equally large, robust set of experts, doing something with it, through social media, through adaptive listening, through all of these different behavioral change techniques and X areas of expertise that we know will take that work, and do something special with it. Finally, if there's one thing that I think really matters, it's the convinced leadership of the strategic advantage of risk communications.
We see so often in capacity building, that we generate systems and models and techniques and guidelines, and they bubble up through the system and they get to the corner office. And they stop. Because those people aren't on board. The point at which however, people understand that this is going to serve their interests, whatever they may be, we're going to see our capacity building XOR efforts, Supercharged.
But with that, let me just close by saying considering the question, can it be done? When we ponder and we will over the next day and a half how central communication of risk is to success to protecting our people to achieving our goals? It sounds a bit corny, but it's really not can it be done? It has to be done. So I'm looking forward to learning much from the people gathered in this room. Thank you very much