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social gatherings, and healing practices, through cultural sensitivity and joint problem solving, thus interrupting disaster transmission; and enhancing the cultural competency of health workers seeking to bring the benefits of evidence-based care and infection control. Social science—the study of collective human behavior and beliefs within their larger historical, political, and economic contexts—is emerging as critical to fully informed health security policy and practice. As some key reports and reviews argue, social scientists—knowledgeable about human interactions, economic exchanges, political ideologies, religious beliefs, value systems, and historic context—complement those thought leaders who have more typically informed disease outbreak preparedness and health security efforts, including medical, epidemiological, governmental, financial, and operational experts.43,44,46 49 Risk Communication WHO and other public health organizations have developed updated guidelines for emergency risk communication that are applicable to highly transmissible respiratory diseases. Yet, communication with the public, partners, and intermediaries as well as between key organizational stakeholders continues to be an important area for strengthening preparedness. Without strong, accurate communication efforts, no amount of planning, intervention, or response is likely to be highly effective in the response to a pandemic involving a high-impact respiratory pathogen. In Communicating Risk in Public Health Emergencies, a WHO guideline for emergency risk communication policy and practice, a well-reasoned and evidence-based approach to risk communication has been developed.103 Nonetheless, experience with recent outbreaks, such as Ebola, indicate that further improvement is still needed in the actual implementation of these and other state-of-the-art guidelines.104,105 Although risk communication is featured in the Joint External Evaluation tool,66 high-level reports and reviews for global response organizations show a need for greater commitment to prioritizing risk communication to the public and trusted partners as a key response element in its own right, rather than as an ancillary component of other public health efforts. Many of the highlevel reports reviewed for this study acknowledged the importance of risk communication, but relatively few described clear strategies, approaches, or priorities with respect to communication with the public. As countries strive to apply leading-edge recommendations for risk communication in the context of more localized, naturally occurring outbreaks, they should also recognize the added complexities with a global outbreak from a high-impact respiratory pathogen— one that could arise naturally or from a lab accident or a deliberate attack. These contextual elements—for example, the whole world is at risk, how do we attribute where this came from, who is to blame—will likely complicate crisis and emergency risk communication. Apart from having to employ effective public education to dampen people’s impulses to shun affected individuals or groups during the outbreak for fear of disease, for example, authorities may also need to provide frequent updates on any investigation into the outbreak’s origins and advise against lashing out against others who “look like” they may have spread the disease (in the event of a naturally occurring pandemic) or those who might be presumed perpetrators (in the case of a biological attack).106,107 In the case of a newly emergent pathogen for which novel countermeasures are urgently produced, a host of risk communication dilemmas may arise--for example, how to inform peoples’ choices about uptake when they fear a seemingly “rushed” drug or vaccine, how to elicit public confidence in decisions about the allocation of a very scarce life-saving countermeasure, and how to avert the uptake of fraudulent, life-threatening alternatives when access to the real beneficial countermeasure is impossible.108 50 Communication with the Public One of the goals of public health communicators is to successfully engage with the public to increase understanding of risks and investment in protective activities. Effective communication with members of the public will enable informed decisions and responses that are more supportive of vital public health activities. It includes timely, understandable, and transparent communications that link to protective actions and self-efficacy. However, communication efforts with members of the public are not always easy and may require changes in current approaches. The US CDC has developed Crisis and Emergency Risk Communication (CERC) training and tools that can provide public health organizations with the foundational principles and practices of crisis and risk communication with the public.103,105 Communication and the establishment of trusted lines of communication between the community and public health is a vital component of effective public health response. Partners/Intermediary Groups Risk communication also includes communication with and through intermediaries such as trusted on-the-ground partners and the news media in order to leverage their capacity as amplifiers of appropriate risk and protective action messages.109 Although there are many fundamental differences between these different groups, they both act as message mediators and require dedicated time and effort to build relationships and partnerships over time. By proactively widening and reinforcing partnerships with community, faith-based, and healthcare organizations, public health communicators have a ready conduit in future disease outbreaks. Furthermore, these trusted partners may also act as advocates during times when public trust in public health is low and misinformation is rampant. Similarly, established and strong relationships with the news media can help to ensure the right messages get to members of the public. Communication Between Response Groups, Governments, and Other Stakeholders Communication between the private and public sectors is a vital component of an effective outbreak
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