Responding to Emergencies One Behavior at a Time

A group of Ebola response volunteers in Nigeria.

To improve the health and safety of people in the United States and around the world, we have to influence and change behaviors. It can be difficult to try new things, or stop old things as behaviors range from simple to complex, but one way to consider behavior change is to think of any change as a passive or active choice.

Public health practitioners must think about interventions in terms of the behaviors they are asking people to adopt, stop or continue. What would encourage someone to change what they are currently doing? Before you can influence someone’s behavior or change their choices about a behavior (risky or protective) you need to know how their judgments and decisions are made about that behavior in the first place.

Behaviors are rooted in traditions

During the Ebola response behavior change was critical to prevent people from getting sick and ultimately stop a disease threat. In the wake of the outbreak, communities in West Africa were encouraged to give up or change their traditional burial practices. Some of these longstanding rituals, like washing the body, proved dangerous because the virus can live on the skin of a victim after death. Communicators developed public health messaging to help change social norms and customs for burials. It was important to understand behavioral science and anthropology in order to communicate about safe burial practices in a way that would make people choose to change a behavior that was ingrained in their culture.

Behaviors are rooted in social 7 Things to Consider When Communicating About Health. Trust: Will people trust the information? Who is the best source to put the information out? Information: What information is necessary, and how will people find it? How much is enough, or too much? Motivation: How relevant is the information to the people we’re trying to reach? Environment: What are the conditions that surround and affect the audience? Capacity: What is people’s ability to act on the information? Are there barriers? Perception: What will the audience think about the information? What will inspire them to act on it? Response: How will people respond? What can we do to stay engaged with them and give them support as they take action?norms

The 2016 Zika virus outbreak is the first time in more than 50 years that a virus has been linked to serious birth defects. Due to the impact of Zika virus infection during pregnancy, social norms and perceptions around provider visits had to be addressed to alleviate concerns about the cost of screening. Clinicians were educated about the risks associated with Zika virus, how to prevent infections, and reporting suspected cases to their state, local, or territorial health departments and women were offered free clinical services, education, and access to Zika prevention kits.

Behaviors are rooted in beliefs

The fight to eradicate polio teaches us the importance of beliefs in behavior change during a response to a public health threat. Creating an effective polio vaccine was only the first step in the effort to eradicate polio. Of course an effective vaccine was necessary to prevent polio virus infections, but getting communities to accept the vaccine was equally important. Public health practitioners created messages that build on cognitive, developmental, and social psychology to persuade parents to bring their children into clinics to get vaccinated.

Behaviors inform preparedness and response

Responding to emergencies effectively requires combined expertise in many fields, including behavioral science. Epidemiology, for example, allows us to understand how many people have a disease and characterize the disease, while behavioral science identifies the role of human behavior and psychosocial factors. Behavioral science expertise can identify methods to communicate and design campaigns to change behavior that are culturally and socially acceptable.

It is important that we maintain humility when we try to understand why people do or think what they do. We often assume that we understand human behavior, but we must remain open-minded when working with people from all different backgrounds and cultures. Who’s to say that what our culture considers right and true necessarily translates to the same belief systems elsewhere? Thus public health ethics is also an important consideration when suggesting behavioral change interventions. When we are in situations that are particularly dangerous or stressful, our assumptions about other people’s behavior can lead to recommendations or actions that seem counterintuitive or wrong to them. Careful application of behavioral science is critical to any mission that seeks to improve public health and safety, here and around the world.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

10 Ways CDC Gets Ready For Emergencies

Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response
Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response

One of the best parts of my job is the opportunity to learn from a wide range of experiences. We have an obligation to not only respond to emergencies today, but to prepare for tomorrow by learning from the past. Our work extends to households affected by disease, communities ravaged by disasters, and U.S. territories battling new and changing threats. In fact, all over the world – we try to get ahead of, and manage, complex responses that touch many lives through ever changing circumstances. In an ideal world the health in every community would be at a level that would make recovery and reliance easier. The reality is that emergencies happen in all kinds of environments and populations.

The Public Health Preparedness and Response National Snapshot is our annual report that gives us an opportunity to showcase the work that we and our state partners do. The report reminds us that no matter how big the emergency, we need to work together to respond to the best of our ability—with the cards we are dealt.

Here are 10 ways CDC’s Office of Public Health Preparedness and Emergency Response worked to keep people safer in 2016 that can inform our work going forward.

1) Four Responses at Once: An Unprecedented Challenge

CDC experts continue to provide 24/7 monitoring, staffing, resources, and coordination in response to natural disasters, terrorist attacks, and infectious disease threats. In early 2016, CDC managed four public health emergencies at the same time through our Emergency Operations Center :

  • Ebola
  • Flint, Michigan, Water Quality
  • Zika Virus
  • Polio Eradication

See us in action:

2) A Complex Threat: Zika Hits the U.S.

CDC scientists and responders were activated in CDC’s Emergency Operations Center, where they combed through research, developed and distributed diagnostic tests, and provided on-the-ground mosquito control and education to protect people at higher risk for the virus, including pregnant women and infants.

3) Right Resources, Right Place, Right Time

CDC’s Strategic National Stockpile is ready to send critical medical supplies quickly to where they are needed most to save lives. The stockpile is the nation’s largest supply of life-saving pharmaceuticals and medical supplies that can be used in a public health emergency if local supplies run out.

Last year, we helped conduct 18 full-scale exercises and provided training for 2,232 federal and state, local, tribal, and territorial emergency responders to ensure that systems for delivering medicines are functioning well before they are needed in an actual emergency. We continue to work with our federal, state, local, and commercial partners to make sure every step of the medical supply chain – from manufacture to delivery – is coordinated.

4) State and Local Readiness

CDC connects with state and local partners to provide support and guidance, helping every community get ready to handle emergencies like floods, hurricanes, wildfires, or disease outbreaks.

This year, we created a new process to evaluate how well state and local jurisdictions can plan and execute a large-scale response requiring the rapid distribution of critical medicines and supplies. Through this program, we conducted assessments of 487 state and local public health departments. The information from these assessments will be used to help improve the ability to get emergency supplies quickly to those who need them most.

5) Cutting-Edge Science to Find and Stop Disease

To protect lifesaving research, CDC experts in biosafety and biosecurity conducted approximately 200 laboratory inspections and thousands of assessments of those who handle dangerous select agents and toxins like anthrax, plague, and ricin to keep these materials safe, secure, and out of the hands of those who might misuse them.

CDC’s Laboratory Response Network (LRN)l also develops and deploys tests to combat our country’s most pressing infectious and non-infectious health issues, from Ebola to Zika virus to opioid overdose. The network connects over 150 labs to respond quickly to high priority public health emergencies.

6) Protecting Our Most Vulnerable

CDC supports efforts all across the country to help those who may not be able to help themselves when a crisis strikes. Some populations, like children, older adults, and others with functional and access needs may need extra help during and after an emergency.

From planning for the 69 million children who may be in school when disaster strikes to the millions of Americans who need to make sure prescriptions are filled, medical equipment is working, and help arrives even if power is out and roads are blocked, it’s up to us to protect our most vulnerable in emergencies.

7) Emergency Leaders: The Future of Incident Response

When every minute counts, we need people who have the knowledge to step in and take immediate action. Learning and using a common framework like the CDC Incident Management System helps responders “speak the same language” during an event and work more seamlessly together.

CDC experts train leaders from around the world—25 countries in 2016—through an innovative, four-month fellowship based at our Atlanta headquarters. Lessons learned from this course were put to work immediately to head off an outbreak of H5N1 influenza in Cameroon.

8) The Power of Preparedness: National Preparedness Month

Throughout September, CDC and more than 3,000 organizations—national, regional, and local governments, as well as private and public organizations— supported emergency preparedness efforts and encouraged Americans to take action.

The theme for National Preparedness Month 2016 was “The Power of Preparedness.” During our 2016 campaign , we recognized the successes of countries and cities who have seen the direct benefits of being prepared, looked at innovative programs to help children and people with disabilities get ready for emergencies, and provided tips for home and family on making emergency kits.

9) Health Security: How is the U.S. Doing?

As part of the Global Health Security Agenda, teams of international experts travel to countries to report on how well public health systems are working to prevent, detect, and respond to outbreaks. In May, a team made a five-day visit to the U.S. to look at how well we’re doing.

In the final report, the assessment team concluded that, “the U.S. has extensive and effective systems to reduce the risks and impacts of major public health emergencies, and actively participates in the global health security system.” They recognized the high level of scientific expertise within CDC and other federal agencies, and the excellent reporting mechanisms managed by the federal government.

10) Helping YOU Make a Difference

Get a flu shot. Wash your hands. Make a kit. Be careful in winter weather. Prepare for your holidays. Be aware of natural disasters or circulating illnesses that may affect you or those you care about. There are many ways to prepare, and in 2016 we provided the latest science and information to empower every one of us to take action.

Every person needs knowledge to prepare their home, family, and community against disease or disaster before an emergency strikes. Whether it’s how to clean mold from a flooded home, how to wash your hands the right way, or how to use your brain in emergencies, our timely tips and advice put the power of preparedness in your hands. From the hidden dangers of hurricanes to the heartbreaking dangers of flu, there are steps we can all take to stay safe every day as we work toward a healthy and protected future.

For more ways we are helping protect America’s health, check out the new National Preparedness Snapshot.

To find out more about the issues and why this work matters, visit our website.


The Power of Preparedness

The Power of Preparedness. National Preparedness Month 2016.

Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response
Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response

If there were one thing I’d wish for, it would be the ability to predict when and where the next infectious disease outbreak would occur and stop it before it starts. I can’t do that. And neither can anyone else.

At this moment, in addition to combating Zika in the United States and polio in Nigeria and Pakistan, we’re putting out the last embers of Ebola in West Africa, stomping out cholera in Tanzania and Kenya, and fighting yellow fever in Angola. We’re keeping vigilant for the re-emergence of H5N1 influenza and Middle East respiratory syndrome, and monitoring chikungunya, dengue, monkeypox, Lassa fever, measles…the list goes on.

It’s a lot to do. And these are just the diseases we know about. The brutal fact is that there are diseases we haven’t discovered yet. They’re out there, waiting to expose the cracks in our systems – to find the places where we aren’t watching, the areas where we aren’t prepared. And we can’t know the potential danger.

Finding – and filling – the gaps

The fact is, if you leave an opening – any opening – disease will find it. This is why it’s critical to have strong public health systems in place before emergencies happen. We can do more to recognize what causes outbreaks, respond to them faster, and bring them under control more effectively.

Around the world and at home, we need to know the level and types of disease that are normally present, so we can detect when there’s a change that requires our attention. We need safe laboratories that can rapidly diagnose the cause of illness close to the source. We need emergency operations centers that can bring experts together quickly to make decisions. Until we have these things, there will be gaps.

And where there are gaps, there is the potential for disaster. The unexpected eruption of Ebola in West Africa showed us this clearly. Before that there were others: HIV raged undetected for a decade; SARS spread to 37 countries across three continents in four months; Anthrax drew the world’s attention to the threat of intentional releases of lethal pathogens.

The human and economic costs are dear. SARS killed nearly 800 people and cost an estimated $40 billion. Ebola has killed over 11,000 people and cost billions. The potential costs of Zika to the lives of our children are unfathomable.

The value of being prepared

Each day, we continue to learn by doing. Every disaster teaches us how to do better the next time. We are seeing results, both here at home and in countries around the world.

We know that preparedness can stop unexpected health threats, even when the disease is fast moving and deadly. Take Nigeria as an example: with a highly trained team of disease detectives and an emergency operations center at the ready, Nigeria was able to thwart Ebola’s spread in Lagos and elsewhere in Nigeria, stopping the outbreak at 20 cases and averting a potential public health catastrophe.

Cameroon’s emergency operations center was recently able to head off an outbreak of H5N1 influenza by activating within 24 hours of notification. Through investments in training and preparedness, they have dramatically improved their response times – just one year ago, it took that same center eight weeks to respond to an outbreak of cholera.

At home, our flu program serves as a gold standard for how to be flexible and responsive in an emergency. When H1N1 influenza hit, we were able to act faster and more effectively through systems we already had in place for vaccine shipping, coverage, and monitoring. The outbreak response also demonstrated how we can work effectively across sectors – across CDC, between levels of government, and with global partners like the World Health Organization and ministries of health.

Despite these successes, nearly 70 percent of countries remain unprepared to handle a public health emergency. That’s a scary number – and a lot of vulnerable people.

Building well for the future

We cannot accept the status quo; we must put our investments into work that will make the world a safer place for us all. In doing this, we must first believe – as I do – that it is possible to create positive change and get results.

In a time when what pops up in one corner of the world can find its way across the globe in a matter of hours, we all have a responsibility to each other to be prepared.

We cannot take this responsibility seriously enough.

More resources to learn about global preparedness:

Read our other National Preparedness Month blogs:

What Global Polio Eradication could mean for your Health Security



Globalization has brought global health right to our door-step. In a world where everything from global trade to international travel is on the rise, the infectious disease threats of one region of the world can easily become public health threats present in your own backyard.

While it is often the unfamiliar and rare diseases that are thrown into the public spotlight as global health security threats, infectious diseases of all types can be a danger to public health—even a virus that has not been present in the United States for over 30 years, like polio.

“Scenarios for polio being introduced into the United States are easy to imagine, and the disease could get a foothold if we don’t maintain high vaccination rates,” explains CDC’s Dr. Greg Wallace, Team Lead, Measles, Mumps, Rubella, and Polio, Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases. “For example, an unvaccinated U.S. resident could travel abroad and become infected before returning home. Or, a visitor to the United States could travel here while infected. The point is that one person infected with polio is all it takes to start the spread of polio to others if they are not protected by vaccination.”

1960 photograph of a nurse caring for a victim of polio inside an Emerson respirator, also known as an “iron lung” machine.
1960 photograph of a nurse caring for a victim of polio inside an Emerson respirator, also known as an “iron lung” machine.

Today, the average American’s experience with the polio virus does not expand far beyond the black-and-white images of iron-lungs and children in leg braces from our history text books, and the vaccinations received as a child.

The polio virus was the most feared disease of the 20th century, and ravished the United Stated during the late 1940s through early 1950s—crippling nearly 35,000 people in the U.S. each year. Today the U.S. has remained polio-free for over 30 years, thanks to effective vaccines and the high coverage of people who have been vaccinated. Still, the poliovirus is a contagious disease and the threat of polio anywhere means that polio poses a threat everywhere.

Global efforts to end polio worldwide began in 1988 with the launch of the Global Polio Eradication Initiative (GPEI), and have seen great success in the majority of the world. Today 80% of the world’s population lives in polio-free areas. Despite the tremendous successes, three countries still have not interrupted the transmission of wild poliovirus—Afghanistan, Nigeria, and Pakistan. As long as polio remains present in these countries, it presents a threat to children worldwide. Global Polio Eradication Initiative Facts

The goal of global polio eradication is to ensure that polio ceases to infect any persons worldwide. Global eradication will save billions of dollars and prevent the paralysis of nearly 200,000 children each year.

In order for the final push towards polio eradication to be achieved, sensitive and timely disease surveillance must be able to detect where the polio virus could still be present. Surveillance allows for polio cases to be accurately identified, and for the transmission of the virus to be traced. Identifying where cases of polio virus are occurring and how the virus is being spread is a crucial component of stopping the poliovirus altogether.

All countries are at risk of importation of polio until it is eradicated completely from the globe. To achieve the final push towards global eradication of polio, CDC’s Emergency Operation Center (EOC) remains activated to coordinate CDC’s response.

Since December 2, 2011, approximately 545 workers have supported CDC’s polio eradication efforts in the EOC and in the field. Of these, 172 workers have completed 876 field deployments to Angola, Chad, Cote d’Ivoire, and other areas. In addition, the EOC has provided enhanced capacity to scale up in-country technical expertise and support for polio surveillance; planning, implementation, and monitoring of polio vaccination campaigns; strengthening routine immunization; and improving management and accountability.

Polio incidence has dropped more than 99 percent since the launch of global polio eradication efforts in 1988, but until the final push is made the eradicate polio globally, every country remains at risk. For every one case of polio, 200 more kids are unknowingly infected. CDC continues its close collaboration with partners, including the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), Rotary International, and the Bill and Melinda Gates Foundation to ensure a coordinated global and country-level response to make the eradication of polio a reality.

Learn more about the latest progress towards polio eradication worldwide, in CDC’s latest MMWR: Tracking Progress Towards Polio Eradication—Worldwide 2013-2014.


Remembering The Pre-Vaccine Era: The Diseases of Childhood

Many of us of a certain age have vivid memories of the “diseases of childhood.” We remember missing weeks of school, sky-high fevers, spots and pox, cheeks so puffed from mumps that eating was impossible, for days. Our mothers, for … Continue reading »

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Polio in Pakistan – Collateral Damage of the War on Terror

Thanks to the CIA using fake vaccination programs (something they claimed to have stopped doing earlier this year) in the terrifying “War on Terror” the Taliban banned polio immunizations since 2012. It should come as no surprise that the Taliban is perfectly happy to violently enforce this ban. Not only are polio cases increasing in Pakistan, but more 60 healthcare workers have been killed trying to administer life saving polio inoculations.

They are among the more than 60 polio workers who have been killedsince the Pakistani Taliban banned polio immunization in 2012…The edict by the Islamic militants to ban immunization was in response to the CIA’s setting up a fake hepatitis vaccination campaign in Pakistan. The covert operation was part of an attempt by the U.S. spy agency to verify whether Osama bin Laden was holed up in the city of Abbottabad. – Jason Beaubien, NPR

*Hat tip to Xeni Jardin at BoingBoing.

Filed under: This Mortal Coil Tagged: BoingBoing, CIA, immunization, Jason Beaubien, Linkonomicon, NPR, polio, Taliban, terrorism, Vaccination, Xeni Jardin

Vaccine Memories: From Polio to Autism

Salk_Thank_You“April 15 – Polio Vaccine Perfected!!!!”

So wrote my mother in 1955, on the “Baby’s Health Record” page of my baby book. I unearthed it a few days ago while looking for some old writing clips.

Just a …

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