After the SRAS and the H5N1 avian influenza, the outbreak of the new influenza A/H1N1 highlighted the importance of communication in pandemic preparedness and response. The uncertainties regarding the emerging disease and the difficulty in predicting its evolution made decision-making delicate. The fear of creating panic, on the one hand, and the desire to promote the necessary behavioural changes from the public, on the other, was a balance that proved at times difficult to keep. Some national authorities were accused of fear-mongering, or on the contrary of downplaying real existing risks in order to reduce anxieties. The eagerness to demonstrate political action resulted at times in unnecessary if not problematic measures being taken, on the grounds that populations needed to be reassured (closing of borders, culling of pigs). The experience of past crises also proved to be a double-edge sword: lists and routines of actions and communications existed and were ready to be used, but they simultaneously had to be adapted and changed, and such changes in turn had to be explained. A need thus emerged for “flexible, flipside communication”, or in other words a communication strategy based on the idea that “today the recommendations are such, but tomorrow they could and will certainly sound different. So keep listening”.

On the positive side, the crisis demonstrated achievements, such as a high level of transparency and efficient communication strategies by the WHO, the (US) CDC, and other actors. If a close and thorough study of the experience of the new influenza remains to be written, the A/H1N1 outbreak has raised issues and lessons that are common to any global public health crisis communication strategy.

The first lesson, which now seems to have been widely acknowledged but may not yet be fully implemented, is that communication not only matters, but is key to the successful management of any crisis.

This being acknowledged, the second lesson is that communication should be first and foremost about “horizontal communication”, i.e. about the getting together of decision-makers from different sectors and organisations to exchange information and analyses through transparent processes and to coordinate their responses to maximise impact. Within one given country, how do different ministries and agencies coordinate to respond to a public health crisis? At the global level, how does the WHO play its coordinating, and information-pooling role, how does it rationalise the global response? What options exist to improve such communication processes?

The third lesson underlines the importance of “vertical communication”, between decision-makers and the public, and “transversal communication”, amongst members of the public. Often, fear of panic and the desire to “reassure” dominate the strategies to manage public health crises. This can lead to discourses fostering anxiety or on the contrary disinterest, rather than the development of a social space nurturing behavioural change and preparation. What options can we think of to circumvent such a paradox? Could and should public health communicators rely more on bottom-up strategies (empowerment of the public) or “transversal communication”?

Finally, the rise of new media (one needs only to think of twitter) has already revolutionised public health communication. What are the innovative trends and options currently being developed to improve global public health communication? What can we learn from such experiences?

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