The explosion of social media – everything from social networking websites to blogs and broadcast text messaging – has changed the way in which public- and private-sector organizations design their procedures for the H1N1 influenza virus and seasonal flu communications planning and response. Especially in times of emergency, public-private partnerships in social media are integral to understanding emergent behaviors, creating social networks, reaching special-needs populations, and much more. The information and best practices presented in this article are based on the two-part webinar series, Social Media and Technology Breakthroughs: H1N1 and Seasonal Flu Communications, which was organized and conducted by Booz Allen Hamilton Inc. and the American Public Health Association.
Increasingly, federal public health and emergency management agencies are collaborating with high-tech companies – e.g., Microsoft, Google – to find better ways to communicate quickly and cost-effectively with the public during public health emergencies such as an H1N1 outbreak. For example, after the emergence of H1N1 in 2009, the U.S. Centers for Disease Control and Prevention (CDC) was poised to use that agency’s ever-expanding social media platform to increase public awareness and encourage healthy behaviors. Currently, approximately one-third of Americans under the age of 25 do not access any type of news source on a daily basis, hence CDC leverages text messaging in its social media outreach effort.
In February 2010, a Pew Internet survey reported that both teen and adult use of social networking sites has significantly increased. Of “wired” American teens, 73 percent now use social networking websites – compared to 65 percent in 2008 and 55 percent in 2006. Moreover, cell phone ownership is nearly ubiquitous: 75 percent of American teens and 93 percent of the nation’s 18- to 29-year-old population now have cell phones. Moreover, in the past five years, cell phone ownership has become mainstream even among 12-year-olds – increasing from 18 percent in 2004 to 58 percent in 2010.
Widgets, Buttons, Tweets & Other Educational Efforts
Because young people have been disproportionately affected by H1N1, public health officials have targeted teens and young adults as among the principal age groups to be vaccinated. However, that can be a daunting challenge, primarily because young adults and teens are the least likely groups to seek medical care – or, for that matter, to feel vulnerable to a health threat.
Outreach via mobile phone can target the specific audiences that are most likely to face a particular health concern – e.g., lower immunization rates. Moreover, reaching out, by use of social media and online social networks, to populations that might not pay attention to more traditional media (e.g., print and broadcast) is possible even in the midst of a disease outbreak.
Increasingly, organizations, both public and private, are tapping into the network capacity of social media using tools – e.g., mobile phones, widgets, streaming video, tweets – to promulgate timely, accurate, and credible information not only about the influenza threat itself, but also about the actions that can be taken to prevent its spread and mitigate its impact. For schools, CDC developed – in addition to traditional news events – a number of widgets and buttons that could be used on individual school websites, further extending the reach of the CDC message.
A Paradigm Shift in Emergent Behavior
By moving away from the traditional command and control approach, the public can and is more likely to work with health authorities to be active participants in communicating risk and best practices information in the face of threats such as H1N1. During an outbreak, what public-health practitioners and social scientists have labeled “emergent behavior” can be invaluable. In the case of an influenza pandemic, emergent behavior – or group cooperation – would be particularly useful because the threat is unpredictable, fast-changing, indiscriminate – and often, geographically ill-defined.
Nonetheless, for the first time in history – thanks in large part to social media and global communications networks – it is possible to directly foster the type of emergent behavior needed to respond to such outbreaks.
A true paradigm shift is likely to occur when existing networks – of, say, Twitter users or Facebook friends – become directly involved in disaster response. The exciting potential of the social media can and probably will be realized when the public is truly empowered, and the public becomes an active partner in preparation and response. The public will then no longer be merely receivers but, more strategically, transmitters and co-producers of reliable and actionable information.
Creating Networks Based on Common Need
Federal agencies and private industry recognize that social media can create networks based on common need and purpose. Formal as well as informal networks can spontaneously spring up when the need to connect arises – e.g., H1N1 outbreak. Tapping into those networks allows government and industry to go beyond the mere dissemination of messages to engaging communities as partners in remotely checking on the health status and needs of both family and friends.
Another population in great need of H1N1 vaccination and seasonal flu protection is the nation’s 8-12-year-old children. In a novel approach targeted to this younger audience, CDC created flu activities in a virtual world known as Whyville – an educational site geared primarily to preteens and younger children. The Whyville “menu” includes in-world vaccinations, a hand-washing activity for all who enter the Whyville site, and a vaccination “celebration” with a CDC flu expert.
To expand outreach to vulnerable populations such as those with no access to a mobile phone or landline, CDC partnered with a service called Community Voice Mail, a national network that connects more than 40,000 people annually to critical resources. CDC used the service to send almost 15,000 voice mail messages during the early months of the H1N1 outbreak. The service is closely integrated with social services agencies, which means that individuals and organizations accessing the messages are well positioned to follow up on health advice, for example, by being linked to a vaccination clinic.
Hands-On Health, Viral Marketing, Repetition & Milling
Private-sector initiatives are gaining notoriety as well. The innovative thinking and strategies of companies such as Microsoft include harnessing the power and reach of both online and offline media via such outlets as MSNBC, the MSN website, and MSN Health and Fitness.
Additionally, the company created the H1N1 Response Center, where visitors can make an assessment that answers the question, “Could I have H1N1?” The goal of the project, launched in October 2009, was, and is: (a) to provide users with timely and relevant content; and (b) to enable consumers to gauge their own symptoms and receive guidance by using an H1N1 self-assessment service. At the end of the assessment, users could update their Facebook status to let others know whether they are ill and/or to encourage friends to make their own assessments. Integral to this constant flow of discourse and information is the notion of “milling,” or the sharing and confirming with others what was learned from trusted sources.
To promote and sustain milling, the same or similar content is repeated through multiple channels, via multiple media.
Although no magic bullet exists for managing these relationships and outcomes without actually being in control, staying actively engaged is critically important while the message is spreading. Content must be updated, sources verified, and network participants must have easy access to resources that carry credible advice and illustrate ways that people can help the response. One example: Microsoft’s Vine program is designed to help individuals and groups manage their social networks and enable structured conversations between individuals and organizations. For example, when H1N1 emerged in April 2009, the Mexican Ministry of Health portal was overwhelmed. With few social media tools available, the site could not handle the Mexican public’s demand for information. Within 10 days of the H1N1 outbreak, though, Microsoft helped produce a site that was able to handle one million hits a day.
Early Detection and Early Prevention – Google Flu Trends
Google Flu Trends (GFT) – a complementary tool available to public health officials for estimating current flu activity in near real time – is a further example of harnessing the power of an engaged public to help authorities do their jobs more effectively. In the case of H1N1 and seasonal flu, GFT identified and tracked the relationship between the number of people searching for flu-related topics and the number who actually had flu symptoms.
Intuitively, the public, with its many sub-audiences, are rich resources for health data, particularly considering the fact that an estimated 90 million American adults search online for health information. Those searches provide a rich and, in many cases, untapped resource for health communicators to direct prevention and health-related messages to key targets.
The search-based query estimates are not designed, though, to replace the traditional surveillance that provides most demographic data and detects specific pathogens. However, a sudden increase in online search queries from a particular region does have the potential to spur public health officials to investigate whether a threat actually exists in that region – and, if so, to quickly respond.
How Best to Leverage Both Power and Opportunity
To briefly summarize: As of December 2009, over 80 percent of the U.S. population – i.e., an estimated 300 million people or more – were mobile phone subscribers. Moreover, according to the Pew Research Center’s 2010 Mobile Access Survey, approximately 38 percent of users access the Internet on their mobile device. However, the two mobile activities in which most people are engaged are: (1) taking pictures on their phones (76 percent); and (2) sending or receiving text messages (72 percent). In fact, text messaging in the United States now registers an astonishing 4.3 billion SMS every day.
These and other recent statistics make it clear that it is no longer a matter of whether to use, but rather how to use mobile phone technologies, and social media, to leverage the power and opportunity to communicate to diverse audiences before, during, and after an H1N1 outbreak, if one were to occur. To keep up with the accelerated pace of information exchange, social media must be an integral part of broader communication strategies, and increased flexibility, as well as repetition, to ensure that key messages are consistently delivered, reinforced, and updated. Hence, ongoing collaboration, keeping abreast of emerging tools, and constantly testing and applying best in-field practices will ensure social media are integral to broader public-private partnerships.
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Timothy Tinker
Timothy (Tim) Tinker, DrPH, a nationally recognized expert in risk and crisis communications, is a senior associate and director of Booz Allen Hamilton’s Center for Risk and Crisis Communication, which provides a broad knowledge base of best practices and tactics to effectively plan for, respond to, and recover from emergencies and disasters. Before joining BAH, he was senior vice president (2001-2007) of Widmeyer Communication, where he formed a national and global network of risk and crisis communication experts to assist such major federal agencies as the U.S. Department of Defense, the U.S. Department of Agriculture, the U.S. Environmental Protection Agency, and the U.S. Centers for Disease Control and Prevention. Before entering the private sector, he had a long and distinguished government career, as chief of communications and research at the Agency for Toxic Substances and Disease Registry, a sister agency of the Centers for Disease Control and Prevention in Atlanta, GA. He received his doctorate from University of Texas Health Sciences Center.
Marko Bourne
Marko Bourne is a principal at Booz Allen Hamilton and a DomPrep40 advisor. He is leader of both the company’s FEMA market team and its Emergency Management and Response practice, and has more than 27 years of experience in: emergency services; emergency management; policy, governmental, and legislative affairs; and public affairs. Before joining Booz Allen Hamilton he was FEMA’s director of policy and program analysis (2006-2009) – and, earlier, director of business development for homeland security (2004-2006) at Earth Tech Inc./Tyco International. He also served as acting director of the DHS National Incident Management System Integration Center and as deputy director of FEMA’s Preparedness Division (2003-2004).
