One of the FEMA/Ad Council Listo.Gov Spanish PSAs.

One of the FEMA/Ad Council Ready.Gov English PSAs.

The Obama Administration has said that public readiness is a priority and has taken steps to strengthen the involvement of Americans in their own homeland security. However, officials acknowledge that there is still a ways to go. I present these proposals to help move forward citizen preparedness on a local, state and national level. I hope these suggestions can be a useful addition to the policy discussion and have submitted it to the Federal Preparedness Task Force. As always, I welcome your feedback:

1) CREATE CITIZEN PREPAREDNESS TASK FORCE — The lack of progress to date on public readiness and engagement underscores the need to develop new ways of approaching the issue. DHS Secretary Napolitano should create a Citizen Preparedness Outreach Task Force to assess the current state of public readiness and work on developing new approaches. At present, there is no clear social education analog to civilian emergency preparedness that can be easily pulled off the shelf so it will take some work to develop an effective program. In fact, the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism in its final report recommended the Administration make citizen engagement a priority. But Chairman Bob Graham told me that the ‘WMD Commission’ did not did not find anything suitable it could recommend, and that something new has to be developed.

2) BETTER DEFINE WHAT IT MEANS TO BE “PREPARED” “READY” AND/OR “RESILIENT” — An American Red Cross survey indicated that 93% of Americans are not prepared for disasters. The truth is that no one can be fully prepared, but there is a need to offer the public a clearer definition — including a minimum level — of preparedness. That might include creating a family communications plan and storing tangible supplies but also knowing more about potential threats that every American should know. That doesn’t mean overwhelming people with too much information, but making sure they are at least familiar with some basics. (For example, the first time citizens hear about a ‘dirty bomb’ from government officials should not be in the moments after one has been exploded.) In addition to the content questions, there is also a word meaning issue to deal with as well. The Obama Administration has been emphasizing the concept of societal resilience. Should emergency management officials be talking about citizen resilience in their communities rather than preparedness or readiness?

3) SUPPORT & REPORT ON STATE/LOCAL PREPAREDNESS EFFORTS — Provide adequate seed money for state and local government to bolster civilian preparedness programs and link the grants to performance. Encourage authorities to report publicly on their level of citizen preparedness and create metrics for better measuring civilian readiness. Find interested governors to take on leadership roles and create pilot models in their states. There is a need to employ both “bottom/up” and “top/down” approaches to disaster preparedness combining state, local and community leadership and citizen involvement with federal commitment and focus. Ensure that government authorities can competently respond to disasters but also more strongly emphasize the need for the public and local communities to be prepared and self-reliant, particularly in the first 72 hours after a disaster.

4) HIGHLIGHT & SPREAD MODELS FROM AROUND U.S. & OTHER COUNTRIES — There is a need to help promote and implement best practices from communities around the U.S. and draw, where applicable, particularly from British and Israeli experiences. One model may be the United Kingdom’s National Risk Register, which sets out publicly the government’s assessment of the likelihood and potential impact of a range of different public health, natural and terrorist risks. It is designed to increase awareness of the kinds of risks the UK faces, and encourage individuals and organizations to think about their own preparedness. The Register also includes details of what the Government and first responders are doing to prepare for those emergencies and the role of citizens in those plans

5) USE ‘CARROTS’ TO CHANGE PUBLIC BEHAVIOR – Provide a tax write-off for citizens to buy preparedness-related products as a way to promote participation and to signal governmental commitment. Encourage states to create tax-free periods as is being done in Virginia and Louisiana (and has been introduced in the New York legislature). Also, consider targeting assistance to citizens who cannot afford to prepare. The fact is that when we really want to change social behavior as a nation we do it through the carrot or the stick. The carrot is the preferable tool for this issue, but it needs to be used. And, thus far, incentives (and vegetables) have largely been missing from the preparedness effort, which helps explain the lack of progress. Similarly, preparedness disincentives in the law should be removed (ie. in some places, homeowners who retrofit their homes face higher tax assessments.)

6) BRING IN BUSINESS TO DEVELOP INTEGRATED ‘WIN-WIN-WIN-WIN’ PUBLIC PREPAREDNESS MARKETING CAMPAIGNS– Design and roll out a full service preparedness marketing campaign with help from the private and non-profit sectors. Galvanize business to take on disaster preparedness in the same way they have with disaster response, most notably in the aftermath of Hurricane Katrina (ie. big box stores, packaged goods manufacturers, bottled water companies, wireless industry). Work with companies in preparedness-related businesses to offer major discounts tied to citizens taking actual readiness steps recommended by Ready.Gov and local emergency management offices.

For example, individuals and families come into ‘big box’ stores with emergency communications plans (or fill them out in the store) and in return they would receive a significant discount on supplies or free products (ie. if you purchase a case of bottled water, you would get your emergency supply thrown in for free). And if a customer signed up to volunteer for CERT or the Red Cross Disaster Services, they would get a bigger discount. Mobile phone retail stores would be excellent settings for preparedness events/trainings to help people register for government emergency text/e-mail alerts. I’d also like to see an event/photo-op with kids teaching their parents about texting and its role in an emergency. Here again, the companies would offer customers extra free text/phone minutes for completing the preparedness step.

7) DON’T BE AFRAID TO TELL THE CHILDREN — Put more emphasis on educating young people on preparedness by piggybacking on other related school-based social education efforts, most prominently fire safety. The challenge is the both the decentralization of the nation’s education system and the already high curricula demands on teachers. Yet, an effective fire education program was implemented in the schools beginning in the 1970’s, and there would seem to be a perfect fit to integrate a preparedness module into that existing program. The federal government should work with state and local officials as well as fire and education officials to determine how best to accomplish that objective.

FEMA Administrator Craig Fugate recently suggested expanding the Community Emergency Response Team (CERT) program for young people. I believe that a decision to expand CERT-type training in the schools would be welcomed on a bipartisan basis.There should be more public briefings on how personal tech would be helpful in an emergency, before the emergency (including how Twitter, Facebook and one’s smart phone can be invaluable). Further, every governmental preparedness web site should add a cell phone and an extra battery (or other power source) to the basic components of their recommended disaster supply kit.  Many private companies are working on applications for citizen emergency communications. Those business efforts need to be integrated with official alerts (ie. the new iteration of the Emergency Alert System) and unofficial citizen-based social media (as well as the news media). Both the content and distribution channels of emergency communications are changing and new models need to be developed.

8 EMBRACE AND ACCELERATE PREPAREDNESS 2.0 – There is a need to better inform the public on the potential of 21st century personal technology to prepare for and respond to 21st century emergencies. We must make Americans more aware of the capabilities of the technology at their fingertips (ie. wireless devices, social media sites) in advance and integrate it into disaster planning and response. The public’s new ability to access and distribute information offers both an opportunity and a challenge to government authorities.

There should be more public briefings on how personal tech would be helpful in a crisis, before the crisis (including how Twitter, Facebook and one’s smart phone can be invaluable). Further, every governmental preparedness web site should add a cell phone and an extra battery (or other power source) to the basic components of their recommended disaster supply kit. Many private companies are working on content and distribution applications for citizen emergency communications. Those business efforts can complement official efforts (ie. the new iteration of the Emergency Alert System) and unofficial citizen-based social media (and well as the news media). One hugely promising initiative is CrisisCommons which over the past year has created groups of volunteers throughout the world to bring technology to bear on disaster response issues.

9) FIND POLITICAL, CELEBRITY PREPAREDNESS SPOKESPEOPLE – During the time that I have covered the topic of citizen emergency preparedness, one of the most surprising things I’ve found is that there is no major elected official who has taken the lead on the issue. It’s surprising for a number of reasons: natural disasters and terrorism dominate the headlines and will continue to for the foreseeable future; citizen preparedness is pretty much an unassailable, bipartisan, patriotic and community-building topic; and even the smallest interest in Washington has at least one political champion (but not public preparedness). And, with much to do, there is a great opportunity to have a positive policy and political impact. To some in the readiness community, the absence of star power on the issue has been one reason for the lack of public attention. Though celebrities have been eager to participate in fundraising efforts after catastrophes like the Haiti effort), there is no big star who is singularly identified as a spokesperson for emergency preparedness.

10) GIVE THE PUBLIC MORE INFO SO THEY CAN BETTER PREPARE & PARTICIPATE – There is a need to better inform the public when it comes to disaster preparedness so they can not only ready themselves and their families but also be part of the policy debate. Let me mention two areas briefly:

a) Weapons of Mass Destruction (WMD): In its report, the WMD Commission argues that the incoming Administration should make an effort to inform and engage the public on the subject of WMD’s. I agree. And, I suggest officials consider starting that process by defining (or redefining) what a WMD actually is. At present, it is most common to define a WMD for the public as a chemical, biological, radiological, and nuclear (or “CBRN”) weapon.

The Commission report, however, focuses primarily on the dangers of biological and nuclear terrorism, both of which could be absolutely catastrophic. By contrast, a chemical or radiological (better known as a ‘dirty bomb’) weapon could be very serious but would likely not cause as much lasting damage. In fact, both a chemical and radiological attack would likely be a one-shot event seriously impacting those directly near the event, closer in result to a ‘traditional’ terrorist bombing. A nuclear bomb or biological incident, however, could have wide and long-lasting ‘mass destruction’ impact to humans, property and the society itself. We don’t want the public — and the nation as a whole — to overreact to some threats and underreact to others.

b) Risk: I think it may be one of the most important homeland security subjects for both the government and the public, because it highlights some of the tradeoffs involved in determining how to allocate the nation’s security resources and the role of risk management in making those decisions. This is a debate which should include the public. Right now, Americans aren’t engaged in the discussion over the security, financial, logistical and time tradeoffs involved in our own homeland security.

We need to introduce risk management into homeland security which would lead us to ask and answer important questions: What improves our security and resiliency? And what can be done at a reasonable social and financial cost? Those answers should come not only from policymakers but with the guidance of the public itself.

The public should be asked: How much risk do you want to pay for? How much inconvenience do you want to deal with? These are dilemmas we deal with everyday in our lives; we need to bring that same approach to homeland security and disaster preparedness. FEMA’s Fugate has since his days in Florida made the point that natural hazards turn into natural disasters because of man-made decisions on development, including ubiquitous golf courses: “You can tee off in Tallahassee and play through to Pensacola,” he likes to say.  ”Unless the public understands we need to change where we develop and live, it won’t matter.” It is up to elected officials to present those choices, including building codes, levies and insurance incentives.

11) ‘SEE AND SAY’ SOMETHING MORE – Build upon the initial success of ‘See Something, Say Something’ -type citizen information campaigns by providing the public with more specific guidance on how to assist law enforcement and, without giving away sources and methods, offering more feedback on the information they have provided. Law enforcement officials are concerned about societal complacency nine years since 9/11, but have not determined how to communicate to the public a more candid – yet calm and balanced – picture of the threat and how they can best help. The Department of Homeland Security is expanding “See Something, Say Something” nationally, which is a positive development. However, there is still a need to better explain to citizens their role, particularly at a local level. One important question is how much of what new information and training given to law enforcement about terrorism prevention should also be provided to the public.

12) MEDIA SHOULD COVER PREPAREDNESS AS WELL AS DISASTERS – While the press does wall-to-wall coverage on natural disasters and has covered practically every aspect of terrorism story closely, it has largely overlooked advance public preparedness. By contrast, during the Cold War, magazines ranging from Life to Modern Farmer dedicated entire issues to civilian readiness. Obviously, the press’ role is not to serve as a publicity arm of the government, but it is a topic that deserves more attention. And without more media coverage, it will be difficult to break through to the public. One great example of the press as a unique asset is the list of preparedness tips and lessons learned from the disaster survivors that was collected by the New Orleans Times-Picayune.

13) GOVERNMENT PREPAREDNESS OUTREACH NEEDS TO BE FAR MORE INTERACTIVE — Right now, if a member of the public has a question about the preparedness process, there is nowhere to go. And, as someone who does a lot of public outreach on street fairs, radio or in community meetings I hear a lot of questions from average citizens about emergency readiness — ie. Shouldn’t buildings have mandatory emergency drills? Shouldn’t everyone have a solar charger in your ‘go-bag’ to be able recharge a cellphone or radio? Shouldn’t you have an evacuation family meeting spot outside of the City in case there is major disaster? In case of an emergency, where should we go for information? The emergency management community on a national, state and local level must overhaul its public information operations to be able to address those questions directly and lead the public through what can be a challenging process to undertake.

14) ‘DO ASK, DO TELL’: MAKE “PERSONAL RESPONSIBILITY” MORE CENTRAL TO PREPAREDNESS MESSAGING — Instead of telling people to prepare because it is a responsibility (you need to do this), government has used a softer ask when it comes to trying to get the public to prepare. To me, the it is time to try to do more “telling” and less “asking”. I don’t believe the government should be afraid to explicitly tell the public that each of us can either hinder or help relief efforts by what they decide to do before and during a disaster. And, that it’s up to each of us to choose.

If indeed preparing for disasters is a responsibility of citizenship (which I think it should be), then it should been positioned that way. PSA’s saying that people are imperiling the lives of first responders and their fellow citizens, particularly the vulnerable (ie. the elderly, disabled) not to mention your own family might be treated with a little more urgency. Another potentially useful messaging approach was suggested to me by former Miss Utah Jill Shepherd who used citizen preparedness as her pageant platform. It can (and should) be included in the preparedness pitch that readying yourself and your family for disaster at home is a way civilians can contribute to the nation’s resilience and complement the work and sacrifice of those serving in the military. Preparedness may be the most important contribution most citizens can make to their nation’s security. Not only will civilians likely be the first on the scene of a major emergency, but the nation’s response will only be as strong as the readiness of the weakest link. We have entered the ‘pro-am’ preparedness era where the government needs to hand off some responsibility and the public needs to take it.

15) INTEGRATE EMERGENCY PREPAREDNESS INTO OTHER COMMUNITY ISSUES — Emergency preparedness is an important issue, particularly during crises. However, it has a better chance of becoming ingrained into American society if it is viewed as part of other preparedness topics that are a more central part of Americans daily life, including public health (immunization), security (Neighborhood Watch), infrastructure and climate change, part and parcel of just being ready for any situation.

For example, the global warming campaign can and should be a model for civilian emergency preparedness in a variety of ways. The two efforts are complementary and should be linked closer together in the public’s mind — and actions. In both, society is being asked to mobilize in order to avert or mitigate potential disasters, and both are part of strengthening the nation’s general national resilience. Yes, global warming has some skeptics, but so does emergency preparedness — ironically they are often not the same people which may conveniently add to its complementary synergy.

16) EXPAND EMERGENCY DRILLING OPPORTUNITIES TO PUBLIC –Increase chances for citizens to participate in disaster drills, which would help people focus on the issue and work through the key questions everyone should ask before a disaster (ie. How will you get information and communicate with your family? Do you know the emergency plan of your children’s school?). Most every top homeland security/emergency management official I have interviewed has told me that broader public disaster exercises would be helpful in a number of ways, but there has not been a concerted effort to expand drilling opportunities to the public.

17) DETERMINE BEST USE OF CIVILIAN DISASTER VOLUNTEERS – Craig Fugate said recently that FEMA would be reevaluating the Community Emergency Response Team (CERT). I think that as part of that review government and non profit officials should be looking at how best to recruit and deploy disaster volunteers. Post-9/11 and Katrina — as well as with international incidents such as Haiti — there has been great interest among the public to be involved in crisis response. A key question is how that asset should be managed. Should it be the government? The Red Cross? Other non-profits and faith-based institutions? Business? Or a combination of the four? One hugely promising initiative is CrisisCommons which over the past year has created groups of volunteers throughout the world to bring technology to bear on disaster response issues.

Fugate said that FEMA is considering major changes in the CERT program, including creating a shorter training course which could be offered to more Americans and significantly expanding training for schools and other youth groups in order to better imbed preparedness into society for the long-term. I’ve always felt that CERT training is less about the skills you learn and more about awareness about the community and the various emergency authorities (and identifying citizen crisis organizers in advance). To me, CERT is just basic citizenship training for the 21st Century, which I think every American should get a chance to receive. I might suggest that the smaller reduced curriculum be called something along the lines of “Citizen Resilience Training”.

18) ESTABLISH AN OFFICIAL PREPAREDNESS DAY — Create a National Preparedness Day to focus public attention before disasters, including briefing citizens, conducting drills, and filling emergency kits. A helpful model is Japan’s Disaster Prevention Day held on September 1st, the anniversary of the catastrophic 1923 Tokyo earthquake. Earlier this month, 670,000 Japanese participated in emergency drills around the country. China, since its 8.0-magnitude 2008 Sichuan Province earthquake, has also held two national disaster prevention days with nationwide drills.

If we as a nation feel it is really important for the public to develop emergency plans, it would be far more effective if everyone was doing that at the same time — rather than asking individuals to do it on their own. This ‘preparedness day’ would also be the time that we all asked the questions about planning then practiced and updated those plans. It would be useful for both responders and the public. I might suggest September 11th be made the U.S.’s official Day. It would seem to be appropriate to honor the memories of those who died by action, particularly something aimed at making sure America is never as unprepared again.

19) CREATE CITIZEN PREPAREDNESS OFFICE – Establishing a national citizen preparedness/resilience office to highlight and help coordinate efforts around the U.S. and ensure citizen preparedness remains a priority. Right now, there is not an identifiable place in the federal government that has responsibility for coordinating the public’s role in preparedness. Work with American Red Cross to create an effective advocate for the general public on emergency preparedness in the same way disabled and pet groups have done for the disaster needs of their communities over the past several years.

20) BUNDLE CITIZEN PREPAREDNESS PROPOSALS TOGETHER INTO “CITIZEN PREPAREDNESS INITIATIVE” – For too long, well meaning public preparedness efforts have gotten lost or have been ignored by the public. That’s in large part because they have not been packaged and presented as being specifically directed to citizens. But if the government would assemble these small disparate proposals listed above into an overall citizen preparedness package it would have a better chance of getting attention and gaining some traction. Ultimately, making inroads on citizen preparedness is less a matter of money than it is of focus and attention.

Administration officials announced that an H1N1 vaccine is expected to be ready in October and that more vulnerable populations, such as school age children, pregnant women and individuals with underlying illnesses will be the first in line for vaccination. There was also an announcement of increased federal funding for state and local preparedness initiatives and the launch of a one-stop government website, Flu.Gov. Particularly interesting for this blog was that much of the discussion focused on getting the public ready and informed — whether it be family preparation, school/workplace policies, mass vaccination and risk communications.

I thought it would be helpful to outline some of the key issues/questions regarding the public that were discussed during the Summit. In addition to attending the panels, I spoke to officials to find out what they want the public to do as well as their concerns, obstacles and challenges in getting Americans prepared by the Fall. (I videotaped a few interviews and include them below.) This is a long post; I hope it’s useful.

At the Summit, federal officials offered a clear message to the public to start preparing for a possibly more lethal H1N1 outbreak in the Fall. However, they are still working out the policy and logistical questions that citizens would face in the event of a serious outbreak. The gathering was an opportunity for local officials to ask questions, provide input, and relay on-the-ground concerns to the feds as they will ultimately be responsible for implementation in their communities. The Summit addressed many of the concerns raised by the experts that I spoke to and blogged about earlier this month, though the answers are still being worked on.

Cabinet secretaries Arne Duncan, Janet Napolitano and Kathleen Sebelius listening to their boss, President Obama, speak to the Summit via phone from Italy.

To get an overview of the Summit (in addition to this blog post), you can check these articles: New York Times‘  “Obama Warns Of Return Of Swine Flu In The Fall”, the Associated Press’ “Swine Flu shots at school: Bracing for a Fall return”, or for a state/local perspective the Rutland Herald’s “State Officials Attend H1N1 Summit”. You can go to Flu.Gov for the Summit press release and panel schedule. The Health and Human Services’ (HHS) social media Twitter feed, FluGov, live tweeted the Summit with a guest blogger, David Hale. Heidi Splete of Medical News Net also tweeted the proceedings. You can also check the #09fs Twitter tags to read about activity both at the conference and in the blogosphere. There was also a conference call during the day in which top officials answered some good questions from bloggers around the country, including Greg Dworkin from Flu Wiki and Daily Kos, Mike Coston of Avian Flu Diary, and Sharon Sanders of FluTrackers.com. A transcript can be found here. Videos of the sessions are available here.

The day began with cabinet secretaries Kathleen Sebelius, Janet Napolitano and Arne Duncan along with White House Homeland Security Advisor John Brennan speaking to a standing room crowd at NIH’s Natcher Conference Center. President Obama called in from Italy where he was attending another summit, the G-8. (Ironically, he was in the town of L’Aquila, the site of a recent natural disaster, last year’s earthquake). After the initial plenary, there were panels and smaller breakout sessions largely focusing on schools, work place issues, vaccine distribution and communications. The focus was on examining the lessons and experiences from the Spring — what worked and what didn’t — in a largely open, self-critical manner.

Federal officials outlined their initial plans and raised the questions that they are currently trying to figure out (e.g. what should school closing policy be?); it was both a briefing for state and local officials and a way to bring them all into the planning process. In addition, the day served as somewhat of a pep rally for health leaders across the nation who have had a challenging spring and may have an even tougher autumn and winter. It was also a way to get media and public attention that H1N1 was not going away as a problem, and that the government was still on the case.

I thought I would highlight a few of the overarching themes I heard throughout the day regarding public preparedness for H1N1:

* Preparing Not Scaring — In his remarks, President Obama said: “We want to make sure that we are not promoting panic, but are promoting vigilance and preparation.” And throughout the Summit, speakers looked for ways to underscore the seriousness of the potential situation (”We’re planning for the worst case scenario”, “It’s a deadly threat”, “Time is of the essence” were some of the phrases used), but in the same breath emphasize that to date the illness has largely displayed only mild virulence. The hope is that the public is able to hold  that balance in their minds going forward. One of the goals of the Summit was to get Americans’ attention that H1N1 was a threat (and underscore their responsibility to prepare) without frightening them. Towards the end of the day, Sebelius summed up the message: “It’s not about panicking people or striking fear but motivating Americans to prepare.” That approach is useful not only for pandemic preparedness but emergency preparedness in general.

* Giving The Public An Information Inoculation: “Be Prepared To Be Surprised” – Secretary Sebelius said that when it comes to this flu we should all “be prepared to be surprised.” It was a phrase repeated throughout the day. New Centers for Disease Control (CDC) Director Thomas Frieden noted in his remarks that influenza is among the most unpredictable of illnesses. As an example, many speakers mentioned that in most of their pandemic plans there was the expectation that the flu (most likely Avian) would come from another part of the world rather than just south of the border. And as a result, we would have more time to prepare. John Brennan called it a “very dynamic situation” with a lot still unknown. I think there is great value in putting that word out in advance to the citizenry in order to sensitize them to expect — and not be shocked — by change, and that we need to be prepared for whatever eventuality and be able to turn on a dime. It is almost as if this Summit was the first round of an information vaccination protocol which hopes to build up resistance and resilience in each of us by the Fall.

* Help Wanted: Leading & Listening – Officials repeatedly said that they did not have all the answers and would need to engage all aspects of society, including the public, to help them in preparing and responding to an H1N1 outbreak in the Fall. “We can’t do this alone,” Sebelius said. Brennan offered an honest but reassuring “we don’t have all the answers, but we’re committed to finding them.” Obama ended his remarks by saying: “If there are any issues we haven’t raised, please let us know.” I think that this kind of leading and listening — we’re doing all we can but we can use your help and input — is a winning communications strategy. As part of that approach, Sebelius urged state and local officials in the audience to convene ‘mini-summits’ at home; that sounds like a good forum to engage and involve the public.

The National Institutes of Health, site of the H1N1 Summit

* Top-Down & Bottom-Up — Most of the decisions in a pandemic are made by local and state authorities, but they need clear guidance on tricky issues that have far reaching effects (e.g. when to close schools) from the federal government. One of the goals of the Summit was to get everyone in public health on the same page. To me, this top-down and bottom-up approach echoes the optimal manner of dealing with other emergency preparedness challenges: most disasters are local responsibilities but there are things that only the federal government can do and say in a crisis. In the case of the Spring H1N1 outbreak, information was coming not only from feds but also from other governments and even an international body, the World Health Organization. In this era of unfamiliar, potentially serious threats as well as a new media environment, local officials cannot do it alone. It needs to be both the grass roots and tree tops working together.

* You Can’t Spell TEAM Without DOE, DHS, HHS, ASTHO, ETC. – One of the challenges I have found in the area of emergency preparedness is that it tends to blend different disciplines — emergency management, health, public safety, critical infrastructure — that have different languages, approaches and org charts but which must work together on challenging issues, sometimes in a crisis situation. Having the three top Cabinet officials jointly oversee this Summit underscored the need to deal with H1N1 across agencies and stove pipes at all levels both vertically and horizontally. Brennan called it a “team approach,” and you did feel that spirit in the Natcher building on Thursday.

* Not A Waste No Matter What Happens In The Fall – Secretary Napolitano made the important point that the preparation that government, business, schools and the public undertake for H1N1 will be useful even if the flu turns out to be not to be severe. Preparing for a pandemic will only increase the public’s (and in turn the nation’s) resilience going forward for other emergencies. Again, this is an idea — preparation is worth the time because it will come in handy sometime for something — that is the rationale for all citizen emergency preparedness. I would suggest that H1N1 citizen preparation be integrated into activities for the Department of Homeland Security’s National Preparedness Month this September. In fact, I would urge federal agencies involved in citizen preparedness to consider tying their communications to the public in this area more closely together. For example, many of the same preparation and response recommendations for a pandemic would be made for a bioterrorism attack (obviously, there are differences: washing your hands may be effective for the former but not the latter.)

* Using Viral Media To Take On A Virus (Thanks for that headline to Chris Thoman) – Social media played an important role in the government’s H1N1 public education efforts in the Spring and that will only increase in the Fall. In addition to the comprehensive Flu.Gov site, Secretary Sebelius announced a new H1N1 video PSA contest (YouTube announcement below) with a prize of $2500, hoping to tap the “creative ideas of average citizens and young Americans.”

HHS Secretary Kathleen Sebelius announces new 2009 Flu Preparedness PSA Contest.

Between sessions I spoke to Richard Besser who, as Acting Director of the CDC, earned widespread praise for his leadership during the Spring outbreak. I asked him what the public should be doing now to prepare for the Fall (n.b. the button on my Flip camera was sticking so the video continues a little bit beyond the end of the actual interview, and I haven’t yet learned how to edit — but I will soon):

Dr. Richard Besser advises the public what to do regarding the H1N1 Flu.

As Dr. Besser, who heads the CDC’s Coordinating Office for Terrorism Preparedness and Emergency Response, says on the video, officials are now reassessing school policy. It is one of what are called “community mitigation” steps. One of the nation’s leading public health policy analysts, Jeff Levi of the Trust for America’s Health, told me last month that the U.S. does not have in place the social and economic policies that can support the significant public health recommendations which might be necessary in a serious outbreak. During the Spring, there were numerous reports of citizens with flu symptoms who went to work because they would not be paid or feared losing their job. Similarly, the costs of closing schools — in child care needs or school lunches — turned out to be more significant than expected (in Chicago, for example, 80% of public school children are eligible for a federally subsidized meal at school).

I thought I would take a shot below at outlining the big policy and implementation questions that the public should know about:

Do School Closings Work? — “We’re reassessing” was a reoccurring comment when it comes to the decision on schools and H1N1. There was a consensus among most speakers that the school closing policies need to be clearer in the Fall than they were in the Spring. Typical was the comment of Belinda Pustka, superintendent of Texas’ Schertz-Cibolo-Universal City Independent School District, during one of the panels which was addressed to the feds: ”What I need from all of you is an idea of when it is best to close, when it is necessary to close and when it’s not.” New York City Assistant Health Commissioner Marci Layton said her department is currently surveying schools to determine the economic impact of the closings and see what kids did with their free time (going to the mall wasn’t going to help stop the flu). On another panel, a Chicago school official said the city only closed two schools but instead focused on “exclusion” (ie. keeping sick students home) rather than closing while a Texas educator  said he felt that their district shutdowns were effective in slowing the flu’s spread. Federal officials are now, in the words of Secretary Napolitano, “working the problem.”

One thing I think that needs to be part of the approach is that the public should be included in the discussion over the effectiveness of school closings and other community mitigation steps, such as preventing large gatherings and distributing masks. It is my sense that most Americans believe that closing schools and other mandates were effective in slowing the virus. If that is not true, then the mythology should be debunked so in the Fall there will not be public calls and pressure from political leaders for measures that are really useless and disruptive.

Another goal of the Summit was to bring in grass roots practioners to offer feedback from the spring. One speaker, Mary Pappas, the school nurse at St. Francis Prep in Queens, New York, diagnosed the Big Apple’s first H1N1 case in April. In her comments, she highlighted the value of student cellphones in quickly alerting their parents about the news from school (and recommended every school have a registry of the mobile numbers of all parents). And she drew laughs when she offered this ‘from the trenches’ tip on what she told students: “If it’s wet and not yours, don’t touch it.” (By the way, the often unsung school nurse received a lot kudos during the day.)

Will Workplace Plans Work? — While the H1N1 did not have as much impact on business as it did in schools this Spring, that might change this Fall. At the Summit press conference, I asked Napolitano about what the government was doing in regard to businesses and their employees, and what citizens should be doing and asking in their workplaces. Her answer is below:

Secretary Napolitano answers a question I asked at the Summit press conference about business/employee preparedness for H1N1.

While bigger companies often have contingency plans, will smaller companies be able to cope? You could never expect a seamless private sector net, but it seems as if there might be significant holes which could be very problematic during a major outbreak. In addition to reaching out to big companies and trade groups, I think the government will have to use a robust bully pulpit, putting societal pressure on the private sector that in the event of a significant crisis sick leave and telecommuting, where possible, is the norm.

Another potential vulnerability in the planning was raised during one of the sessions by Paul Jarris, executive director of the Association Of State & Territorial Health Officers (ASTHO): undocumented workers (a worry in other disaster responses as well) not wanting to volunteer to participate in a vaccination program and how that could impact the H1N1 public health effort.

Will A Mass Vaccine Distribution Work? – Officials say that they hope to have a vaccine in October (though it may take longer) and will embark on a voluntary vaccination distribution program. A big concern among some experts I spoke to is the scope. How will such a mass vaccine be distributed? Will the public have concerns about participating? Will there be ample supply? Will October be early enough? Federal officials acknowledged that the logistics of the vaccination program will be a Herculean challenge with schools, medical facilities and other retail locations possibly having to dispense both 100 million-plus doses of regular winter flu vaccine – and H1N1 shots. “We know a mass vaccination program of even modest scale will involve extraordinary effort on your part,” Sebelius told the Summit.

I spoke to Anne Schuchat, director of CDC´s National Center for Immunization and Respiratory Diseases, after a breakout session about what the citizens need to know about the vaccination program. (My camera stuck on this video as well so the end runs on a bit beyond the interview.)

Dr. Anne Schuchat talks about what citizens should know about the H1N1 vaccination.

Can Public Risk Communication Work As Well Again? — Though the federal government’s communications throughout the Spring outbreak was widely applauded, there were some issues being discussed at the Summit for the Fall. In her remarks, New York City’s Marci Leyton said that improvements were needed in getting messages out to the “non-afffected” (ie. the ‘worried well’ who jammed hospitals); reaching citizens in higher risk groups (e.g. pregnant women, asthma sufferers) who required treatment; as well as better explaining policy differences between local/state government actions and CDC  recommendations (whether that be on schools, N95 masks or public gatherings). It is a challenge: one local official said that the key for health officers in the field and the public is “communication, communication, communication” from federal officials, but that the communication needs to be “meaningful, quick, accurate”.

In the day’s last panel, Barbara Reynolds, a CDC communications adviser and Dr. Besser offered some very interesting communications advice for the state and local officials based on the experiences of the Spring. Among their recommendations: be first; be right: don’t be afraid to give out information in chunks (Reynolds said Twitter had made it more acceptable to parcel out information in stages since you only get 140 letters); be credible;  be empathetic; give people things to do; don’t give out mixed messages; don’t be paternalistic. Don’t treat people like children (”invite public into the process”) counter rumors and don’t turn down media requests. Besser, a pediatrician by training, said he spoke at press conferences as if he was talking to a parent in his office. He said you should acknowledge the public’s fear and uncertainty but then turn it into planning and action.

I had met Dr. Besser last year in Atlanta during a pandemic training session at NIH, and I had participated in a mock press conference as a reporter to test officials like him who might have to brief the media in the event of a pandemic. And in fact, one of the stakeholders that will be central to the communications challenge but did not get mentioned much during the Summit is the media (both mainstream and ‘new’). There is obviously no way to fully coordinate or manage the press’ coverage of H1N1. But the more knowledge and information the media has, the less likely it will stoke panic among the public. I imagine that officials will be briefing them soon on the same issues that were discussed at the Summit.

I asked Rear Admiral W. Craig Vanderwagen, who has been the HHS Assistant Secretary for Preparedness for the past three years, for his take on how citizens should be preparing for the Fall:

Dr. Craig Vanderwagen speaks about how the public and its institutions should be dealing with H1N1.

I also asked Paul Jarris, who oversees the state health officers association, what he recommended to the public in advance of the Fall. He said it should begin with some extra supplies:

Paul Jarris from ASTHO talks about making sure Americans are prepared for a possible H1N1 outbreak.

The value of the Summit may have been best summed up to me by California Public Health Officer Dr. Mark Horton (below) who said he had come across the nation with low expectations thinking that it would be just a bunch of public health officials talking to each other but he was struck by how much he learned.

Dr. Mark Horton, California’s Public Health Officer discusses the H1N1 Summit.

The challenge going forward, however, is not only to educate and persuade the public to prepare but it is to make sure that the institutions — ie. schools, businesses, public health and other government areas — are set up to make it easy for the public to do so. One way will be to have the kind of discussion with the American people that occurred at NIH on Thursday. This blog will continue to cover this unfolding story and the work being done on the federal, state and local level on behalf of the public. If you have comments or questions, I’d love to hear them.

And why am I mentioning this in a citizen preparedness blog? Because I believe that there are a couple key financial and publicity elements in the City’s anti-smoking initiative that I think are instructive for developing effective campaigns for public emergency preparedness. For example, the City is:

*increasing the cigarette tax to hit smokers where it (in the short term) really hurts

*giving away free nicotine patches (at about $60 a patch) to make it easier for them to start stopping

*and creating a special day to consolidate public and media attention

Like smoking, civilian emergency preparedness requires a major change in public behavior. It will not happen unless the government gets really serious and takes advantage of some of the levers it normally uses when it wants to change public behavior (as the City is doing in its anti-smoking effort). We need to be willing to utilize financial incentives — such as tax-free holidays on emergency supplies — to get people to prepare. And I have suggested that similarly there is a need to pick one day for everyone to focus on preparedness.