Dr. Josh Greenberg, School of Journalism & Communication

By Ariel Root

Communication is a crucial component of emergency response and crisis management. Warning imminently threatened populations, coordinating involved stakeholders, engaging community partnerships, and understanding public risk perceptions are all essential and effective risk communication strategies; they are also one of the more difficult challenges for any organization. Added to the complexities of different crisis event scenarios, the media can either help or hinder in times of emergency. Media organizations not only notify the public about risks, but they can also amplify fears and anxieties about health issues that may pose only a small threat. These controlled or amplified fears will influence how health officials have to understand, respond to, and manage different health risk scenarios.

Josh Greenberg is the Director of the School of Journalism and Communication and an Associate Professor of Communication and Media Studies at ĐÓ°ÉÔ­´´ University. His research examines media coverage of outbreaks and infectious disease risks; crisis and risk communication activities and strategies of key public health and industry actors; and the impacts of technology change on public health communication. His current projects focus on the ‘wicked’ communication problem posed by vaccine hesitancy, and the risk communication dilemmas associated with public health scares marked by high levels of scientific uncertainty, such as . Greenberg’s interest in these issues were piqued long before he became an academic, when he briefly worked for a public relations agency specializing in healthcare and witnessed “the powerful role of PR in our current healthcare environment, and the ways that communication both constitutes and troubles our understanding of health risk.”

Greenberg is the lead investigator of the Communication, Risk and Public Health Research Group, an interdisciplinary group involving faculty and graduate students at ĐÓ°ÉÔ­´´. He has served as an expert panel member for the Council of Canadian Academies and the U.S. National Academy of Sciences, and is a member of the World Health Organization’s Emergency Risk Communications Guideline Development Group. Greenberg has also worked as a research consultant to both national and community-based public health organizations across Canada and has advised federal government departments and agencies on strategic communication and public engagement.

Greenberg is an advisory board member of , a non-profit partnership of leading international practitioners, academics and consultants that work with governments and other organizations to communicate effectively during emergencies or other high risk events. In addition, he sits on the Advisory Board of , which fosters research, education, and issue campaigns that engage and empower the science community, while cultivating public and political demand for evidence-based decision-making—precisely what Greenberg identifies as one of the more challenging aspects of his research. Because he currently works “on issues involving debates among experts in epidemiology, virology, bacteriology,” it is critical that he understands the science of a variety of possible health risks. “I have no formal training in these areas of core science, but I do have a strong understanding of how actors with different types of scientific expertise craft and mobilize rhetoric to advance their views in what is an increasingly crowded and competitive communications environment.”

Greenberg thoroughly enjoys applying his knowledge and skills to a variety of topics of public importance and derives considerable intellectual and professional enjoyment from interacting with academics that work across the social sciences, humanities, and natural sciences, and interfacing with communication professionals. Because of his wide and varied interests, his research is often an “opportunity to collaborate with experts completely outside of my field, who share similar interests and concerns but approach them in different ways.” One project involves collaboration with a medical anthropologist and geographer, and another with international public health professionals. “These types of collaborations are highly intellectually stimulating and rewarding,” he says.

Greenberg say he couldn’t imagine himself doing anything else. “Sometimes I feel like I have the best job in the world. I have freedom to develop new research, to work alongside other scholars I admire, and to participate in academic and policy-oriented conversations about issues I think are really interesting and important.”

For Dr. Greenberg’s contact information, go here.

By Suzanne Waldman, School of Journalism and Communication, ĐÓ°ÉÔ­´´ University

How do we make decisions about which risks to take, and which to not take? Do we look at evidence about the likeliness of harm, or do we go with our gut feel? Do we trust science, or follow celebrity advice?

Why some people choose the risk of diseases for their children over the far lower risks of vaccination against those diseases, and how communication can help people make these decisions, was the subject of a recent workshop held at ĐÓ°ÉÔ­´´ University. It was the first such workshop by the Faculty of Public Affairs Professional Institute in Health Risk Communication. Workshop leaders were , Director of the School of Journalism and Communication, and , Director of The Warning Project, a non-profit organization specializing in risk and crisis communication.

While vaccination rates for serious childhood diseases remain relatively strong, some vaccine preventable diseases (e.g. measles, mumps, pertussis) are resurfacing due to rising rates of vaccine hesitancy. Opting out of vaccines or delaying vaccination schedules, once almost exclusively in pockets of religious communities, has become trendy in other communities. As measles outbreaks across Canada during 2013-2014 and the more recent outbreak that centered around Disneyland in the U.S. have shown, small reductions in vaccination rates can lead to the loss of “herd immunity,” imperilling vulnerable groups and individuals.

Timothy Caulfield

Yet as the workshop’s title “Vaccine Hesitancy: Combating a ‘Wicked’ Risk Communication Problem” indicated, there are no easy answers for the question of how to influence people’s risk decisions around topics like vaccination. , Canada Research Chair in Health Law and Policy and a Professor in the Faculty of Law and the School of Public Health at the University of Alberta, delivered the workshop’s keynote address. Caulfield reminded the participants that vaccination has become a victim of its own success, as parents who expose their children to the risk of childhood diseases due to their concerns about vaccination have rarely had to witness the ravages those diseases can wreak. Parents may also be unaware of the differences in scale between the risks of vaccinating and not vaccinating. For example, while the risk of a severe adverse event from a Measles-Mumps-Rubella vaccination is extremely low (1 in 1,000,000), contracting measles presents relatively high risks of complications such as pneumonia (1 in 20), encephalitis (1 in 1000) and other infections that can lead to long-term disability and death (</measles/>.

Yet statistics on how the risks of contracting diseases are far higher than the risks of vaccinating rarely changes minds on their own, as Caulfield pointed out. He referred to the well-known failure of the “information deficit model” of risk communication: the idea that people will change their minds or behaviour if they are simply supplied with solid, expert information.

In part the problem is that there is so much information out there, people don’t know which information to trust. Caulfield’s new book “Is Gwyneth Paltrow Wrong ĐÓ°ÉÔ­´´ Everything?: When Celebrity Culture and Science Clash” explores how the culture of new media has amplified a situation in which we may be as willing to trust non-expert celebrities as medical experts. As Caulfield pointed out, it is relatively easy for a celebrity to prey on the public’s fears about vaccination with a completely unverified anecdote about a side effect. One of the workshop participants, Robert Pless, Medical Advisor in vaccine safety with the , pointed out that while scientists attempting to be rigorously accurate can appear to waffle, those advancing pseudoscience have no trouble speaking with passion and absolute conviction that makes them more convincing even when they are wrong.

Caulfield also proposed the way the media amplifies scientific studies with sensational but indeterminate results that may later prove definitive make science seem unduly conflict-ridden and rife with uncertainty. For example, the Lancet’s publication of Andrew Wakefield’s small and ultimately fraudulent study connecting the measles vaccination virus with autism in 1998 received massive media coverage, leading to sustained decreases in immunization rates and the return of measles disease. As Caulfield explained, the Wakefield study led to an “availability cascade” where the connection between vaccination and autism was reinforced in people’s minds as they heard about it over and over again. That the study was subsequently shown to be fraudulent and retracted by the Lancet could not undo the damage of the original publication. Caulfield also pointed to the need for the scientific community to improve its own structures of accountability to reinforce public trust in expert positions on crucial matters such as disease control.

Following Caulfield’s keynote presentation, the question of the how to communicate the contrasting risks of vaccine preventable diseases and vaccinations was the topic of ongoing discussion at the conference. Risk communication strategies such as: 1) incorporating graphics that display evidence more clearly; 2) using plain language and narratives to complement evidence; 3) expressing empathy towards people with concerns about vaccination; and 4) acknowledging rather than dismissing the small risks of vaccination, were all proposed as part of best practices. As , Canada Research Chair in Environment and Health Risk Communication and Professor at the University of Manitoba’s Department of Community Health Sciences put it, communication about vaccination can be seen as “a cake where the facts are only some of the ingredients.” noted the need for communicators to move beyond cerebral arguments about probabilities, and to speak in an emotionally compelling way that engages people’s feelings about risk. As well, because vaccine hesitancy is a “wicked problem” with numerous causes and difficult to solve, there is no one-sized-fits-all solution. A variety of communication strategies are needed for different communities and different circumstances.

Consistency in risk messaging about vaccination is nevertheless required. Driedger, who has researched risk communication in general populations and in Metis communities, especially around the pandemic H1N1 influenza vaccination campaign in 2009-2010, proposed that consistent and yet subtly diverse types of messaging needs to come from three levels: 1) a centralized national clearing house like the ; 2) local public health bodies in touch with the specific character and needs of their communities, and 3) individual medical practitioners.

By the end of the workshop, the group determined that resources were most needed at the third level, to help physicians and other front line medical professionals learn to communicate about vaccines to their patients according to guidelines developed collaboratively between the Provinces and Territories and the Federal level. Several of the speakers presented research showing a large majority of people turn to their doctors before other sources for guidance about vaccines. Providing professional development opportunities where doctors can learn effective vaccine communication strategies was judged by the group to be the best route to raising vaccination rates. Allison Fisher, another workshop presenter, from the  proposed that teaching simple communicative moves to doctors such as opening up conversations about vaccination during a mother’s pregnancy, framing the idea of vaccination positively, and inquiring into the basis for concerns, can go a long way towards getting vaccine-hesitant patients on board.

A hopeful note was struck by , Medical Director of Immunization and

Tara Hills spoke out in favour of vaccines after her family was quarantined with whooping cough. Photo CBC.

Vaccine Preventable Diseases at Public Health Ontario. Deeks has detected a change in public attitudes around vaccination, where people are growing more aware of the risks of non-vaccination and more skeptical of anti-vaccination arguments. She pointed to a recent blog post that circulated widely on Facebook by an Ottawa woman whose who came to regret her decision not to vaccinate her seven children according to the recommended schedule when they all developed pertussis, even after she had already changed her mind about vaccination and had initiated a catch-up schedule for them. As she wrote on her blog, “my family is living the consequences of misinformation and fear.” ()

Finally, the workshop explored the question of whether a “hard line” should be taken in how public health professionals communicate the risk of non-vaccination. A growing sense that not vaccinating ones child/children against serious diseases is irresponsible because it raises the risks to one’s own children as well as others emerged as a position on which most participants agreed. Yet whether framing vaccination as a social responsibility will prevail as a viable communication strategy was something none of us at the workshop could foresee with certainty.

Graph image courtesy of renjith krishnan at 

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