Asia Biobusiness (ABB) ran a pre-conference workshop on “Risk Communication—Effective Communication in High Stress, Biothreat & Bioemergencies” at the 8th A-PBA Biosafety Association Conference in Kuala Lumpur, Malaysia. Twenty enthusiastic participants, all new to risk communication, took part in a three-hour interactive session focussing on biorisk communication during outbreaks of emerging infectious diseases, and the use of risk communication in promoting safety, especially in research laboratories.
From the workshop and the conference as a whole, it is clear that a tremendous amount of work is being done in the area of biorisk (encompassing biosafety and biosecurity) in the Asia-Pacific region by a whole range of agencies (from governments to IGOs and NGOs). Strategic frameworks, such as this one by WHO, have been developed to address challenges in biorisk management in laboratories. Resources are being pumped into initiatives via regional and national biosafety associations, alongside knowledge transfer for research personnel on the front line of the fight against disease agents that pose a serious hazards to workers if not properly controlled.
The challenges these workers face are mounting, particularly in the face of emerging biothreats, such as novel flu viruses, and familiar, yet devastating ones, such as tuberculosis (TB). As Dr Paul Huntly from Riskren in Singapore pointed out during his pre-conference workshop on “Working Safely with TB,” the number of samples for testing at resource challenged laboratories (often in rural areas) is exploding, yet effective protocols and controls for managing hazards are simply often not in place. TB labs are being tasked with more hazardous procedures (resistance testing etc) to take the load off from central labs in big cities, all of which are increasing the likelihood of serious consequences, should control measures and procedures prove inadequate.
Risk Communication Imperative
Whilst there are considerable efforts, the lack of attention to the value of effective communication in any of these precautionary initiatives is an immediate concern. There was no plenary session at the conference on communication, and no mention on how to effectively communicate to different audiences about risks, about uncertainties. These two elements of risk communication are important components in advocating long-term preventative behavior. It was a significant omission, one that regrettably mirrors the priorities that biosafety organizations are following at present. Much of the efforts are in developing protocols, SOPs and harmonized standards. Communications take the form of extensive printed manuals that may or may not be read, and certainly may not be understood by all those facing the hazards in laboratories. Such linear missives are general at best, they make no allowances for an individual’s perception of threats, their magnitude or probability, or the perceived effectiveness or cost of precautions being taken at the facility where the individual works. These variables are essential to established models of self protective behaviour.
Systems and procedures are of course necessary, but unless these make a real (behavioral) difference on the ground, efforts go to waste. The weak link here is the lack of attention to how this material is going to be communicated to make meaningful change, to even approach the age-old problem of how to make people act to protect themselves from harm?
This question occupies a central role in health promotion, occupational safety, natural hazard preparedness, and indeed safety in the laboratory. Written manuals oversimplify the process, and even if they are based around accepted models of preventative behaviour (such as Rogers’s Protection Motivation Theory [see also Maddux & Rogers, 1983]), their exhaustive, asynchronous nature pits them against many of the precautionary advocacy delivery theories that risk communicators regularly employ in making messages resonate personally with receivers. The precautionary advocacy effort must be viewed as a dynamic process, and like ‘genuine’ risk communication, embrace dialogue and engagement over a long period of time for actual decision behaviour to adhere to the ideals outlines in SOPs and manuals. Simply churning out laboratory manuals and thinking “job done” is unrealistic and ultimately, irresponsible. As presented at the conference from attitudinal survey work in Pakistan, a shocking percentage of laboratory workers surveyed there had absolutely no idea as to the perceived threats they were facing or how to manage them. To make matters worse laboratories are prone to under-report laboratory acquired infections (LAIs), making evaluation of the state of the problem difficult. Such failures of integrity point to gaps in organizational trustworthiness that add to the challenges for workers in their evaluation of efforts to adopt preventative behavior.
At the same time, efforts must be made to make precautionary efforts more culturally sensitive. As reflected during the ABB workshop, one of the greatest challenges facing risk communication in the region, particularly for outbreak or pandemic communication, is the need to incorporate principles of intercultural communication into communication of risk. This is a new area, more research needs to be done in Asia-Pacific, but given the emerging importance of values in risk communication—the cultural cognition approach—it is clear that culturally centred messages will be far more effective in promoting action where it is needed most, in the rural, resource poor labs of Asia.
One of the greatest challenges facing risk communication in the region, particularly for outbreak or pandemic communication, is the need to incorporate principles of intercultural communication into communication of risk
Addressing Denial in Outbreak Communications
One final area, highlighted during our workshop, where best practices in risk communication can make a huge difference is in outbreak communications, particularly in addressing past failures dating back to SARS and avian influenza. Denial of risk and uncertainty appears to be the de facto position of governments when faced with risk communication dilemmas. Most of the governments in the region were guilty of denial of outbreaks (sources of disease) during the swine flu outbreak and most were also poor at acknowledging uncertainty and the difficulties in surveillance. Denial turned quickly to over-confidence and over-reassurance, such bravado proved a false dawn in the management of the risks and in meeting the needs of an anxious public. The effects on public trust of these propaganda tactics will be tested during the current H7N9 outbreak, should such spread beyond China’s borders.