HEALTH DEPARTMENT MESSENGERS STILL STUMBLE
26 Dec 2002
Source: New York Times, October 8, 2002.
THE DOCTOR'S WORLD
At the Health Department, the Messengers Still Stumble
By LAWRENCE K. ALTMAN, M.D.
WASHINGTON, Oct. 6 -- Providing information about an outbreak of communicable diseases -- quickly, candidly and in plain language -- is essential in gaining public trust, and in a public health emergency it can be a matter of life and death.
Accurate communication can be as important as the medical detective and laboratory work in preventing the spread of the disease because it prevents misinformation and rumors that can undermine confidence and produce panic in any outbreak.
Effective communication requires clear thinking and preparation. But if the performance of officials in a news briefing at the Department of Health and Human Services on Friday is any indication, officials have yet to fully remedy the communication problems that plagued the department in the anthrax bioterror attack a year ago.
When Tommy G. Thompson, the secretary of health and human services, misspoke about the initial case of anthrax in the bioterror attack last year, and other agencies under his charge did not provide reliable information quickly, many health workers and other people harshly criticized his leadership.
Mr. Thompson oversees the Centers for Disease Control and Prevention in Atlanta, which has acknowledged its failure to prepare adequately to communicate during the anthrax outbreak. In the first days of the outbreak, C.D.C. did not take the leadership in providing vital medical and epidemiologic facts to state health departments, practicing physicians and the public. Spokesmen for the centers said the information was supposed to come from Mr. Thompson's office.
The C.D.C.'s new director, Dr. Julie L. Gerberding, who took over in July, has vowed that the agency will improve its skills in communicating speedily what is known and not known about disease threats to the public. The pledge for new openness has encouraged journalists and health care workers.
Now the threat of smallpox's return in a bioterror attack is a major concern. Until it was eradicated in 1980, smallpox killed about 30 percent of its victims and scarred and blinded many of its survivors. Because the nation stopped routine vaccinations in 1972, tens of millions of Americans have no protection against the disease, and the immune status of those who were vaccinated is uncertain.
But the vaccine carries risk, so public debate about vaccinations is heating up.
Last Wednesday, Mr. Thompson's office sent an e-mail message to journalists to "strongly encourage" them to attend a briefing on smallpox on Friday at the department's headquarters here. The briefing would not "make news," the message said, but it would give reporters a chance to learn about the latest scientific findings about smallpox as well as logistical matters regarding vaccination and preparedness.
But the message was inaccurate. Among other things, officials at the briefing said they were recommending that smallpox vaccination eventually be made available to all American who want it, a recommendation that was a big change from previous policy and that was front-page news around the nation.
The day before, at a scientific meeting of the World Medical Association here, Dr. Gerberding said the government had learned from the anthrax attack how important it was to "communicate, communicate, communicate." The Friday news briefing, she said, would in part show Mr. Thompson's efforts to improve communications.
But in practice the new effort stumbled, from the big things to small ones.
Much of Friday's briefing centered on clarifying the options and what officials had recommended to Mr. Thompson and President Bush. But before reporters could question Dr. Gerberding about this unexpected news development, she suddenly left the stage, leaving two participants, Jerome M. Hauer, an assistant secretary of health and human services and director of the department's Office of Public Health Preparedness, and Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, to field the questions.
Dr. Gerberding's departure created another point of confusion. Many people in the audience concluded that she was urgently summoned by a White House staff member who had been listening to the briefing and might have been dissatisfied with something she said or did not say.
Not so, Mr. Hauer said in an interview after the briefing. Dr. Gerberding had to leave to participate in another briefing with the Environmental Protection Agency on West Nile fever, Mr. Hauer said.
But by then, the scheduling conflict had created its own confusion.
Also, reporters entering the auditorium at Mr. Thompson's headquarters on Friday afternoon passed packets about smallpox stacked on a table. The reporters were not allowed to take them until they were distributed after the news briefing began. So reporters were deprived of an opportunity to inform themselves before asking questions. But, as it turned out, the packets contained little new information and no summary of the messages the top officials were trying to make in the briefing.
When Mr. Thompson's office wants to get its message across, it often posts a transcript of news briefings hours within hours on its Web site, www.hhs.gov. Reporters and the public can often find needed information in the transcript. But as of Monday afternoon, no transcript of Friday's briefing could be readily found on the site.
Failing to deliver health information messages could be lethal in a real emergency. If a smallpox case occurs in a major city, for example, many people may flee. Yet that could be the worst situation. Overall public health would suffer because some of those leaving might be carrying the virus and spreading it to new areas. And those who have the virus may also suffer more because their vaccinations may be delayed as they travel to new places.
If Friday's performance is any indication, officials at the Department of Health and Human Services have a long way to go to get their communication skills up to speed.