During epidemics, pandemics, natural or environmental disasters, the problem of communication is one of the primary issues to deal with, and scientists and stakeholders know this well. It is a two-sided issue: communicating risk without creating any alarms, and an effective communication between persons who manage emergencies.

In this sense, many steps forward have been realized and many others are being made. In any case, there is a huge awareness in Europe concerning the need of a better health risk communication. The changing paradigms of public communication during infectious outbreaks are the core of TELLME Project (Transparent communication in Epidemics: Learning Lessons from experience, delivering effective Messages, providing Evidence), a collaborative project co-funded by the European Union's 7^th Framework Programme, which worked on these topics for three years. And on December 4-5, had its final conference hosted in Venice, with the intervention of national and European institutions that took part in the project.

The project

TELLME’s main purpose was to develop new protocols for health communication, based on scientific evidence, to be applied when there are infectious disease outbreaks. It combines public health, social sciences, behavioural sciences, political sciences, law, ethics, communication and media. The aim was to develop original communication strategies regarding complicated messages and advice based on uncertainties, also addressing vaccine-resistant groups. Just visiting the project website, we realize that a considerable amount of activities have been done during these three years. Let us try to summarize here the main points that emerged from interventions during the final conference held in Venice, thus representing the lesson taught by TELLME experts.

Risk communication is not synonymous with public relations

In this sense, Anat Gesser-Edelsburg, from the School of Public Health of the University of Haifa, presented a new communication model of epidemics, based on the interaction of all the stakeholders involved, including the end user. "We need a new universe of discourse," said Gesser during her Venetian speech. This new scenario consists of the following key components: the public sphere, segmentation, mass media, social media, opinion leaders, scientific research and stakeholders, which means Government and institutional actors (policymakers), pharmaceutical industry and commerce, community-based public institutions and infrastructures, and civil society organizations.

Researchers suggest that risk communication requires a multi-layered approach that takes into consideration technological, cultural and social developments. "The purpose of this model is to avoid the communication chaos we found ourselves stuck into, in the past," Gesser said. "For a long time we thought that communication was the equivalent of an injection of correct messages in public, while now it is being increasingly recognized that the public can no longer be regarded as an empty vessel to be filled, but must be involved and transformed into a communication partner. "

We must act on primary care staff

A good health risk communication do not involve just communication officers. It includes everyone, especially primary care staff. In this sense, TELLME experts have created two e-learning courses for primary care staff, both approved by the experts of the European Centre for Disease Prevention and Control. The first course offers a huge number of basic health information on infectious diseases such as influenza or SARS, along with several guidelines on how to talk about these issues with patients and citizens. The second course, specific to Ebola, has been reviewed by the National Institute for Infectious Diseases Spallanzani in Rome, and was credited for training courses by the Italian federation of associations of doctors and nurses (FNOMCeO and IPASVI).

Social media can help a good communication

As reported by Annet Gesser-Edelsburg and Alexander Talbott during the final conference, social media can fuel misinformation exponentially but, at the same time, they can also become a powerful vehicle for good practices. Especially if the online presence is built before the occurrence of an outbreak. Many healthcare professionals use social media to exchange clinical information, search for, discuss career opportunities, and engage in discussion on the latest health news and research. TELLME has taught us to invest also on these people. Twitter viral power, for instance, was highlighted in a scientific paper claiming that in the space of 30 minutes the rumour of riots in a Birmingham children's hospital gained momentum through the process of re-tweeting a dramatic but erroneous tweet.

Vaccines are still a crucial point

Vaccination hesitancy and refusal is still diffused and represents a great risk in case of pandemics and epidemics. A study published on December 12^th by Anat Gesser-Edelsburg, Yaffa Shir-Raz and Manfred Green on the Journal of Risk Research is clear on this point. The authors examined vaccination hesitancy or refusal following the 2013 polio outbreak in Israel and highlighted the difficulty of framing the subject of vaccinations as a preventive measure, especially when the prevention is for society at large and not to protect the children themselves. It concludes that the public’s risk perception is based on a context-dependent analysis, which is something the communicating body must understand and respect.

As already emphasized during a previous conference by Barbara De Mei, from the Italian Institute of Health, the goal of a vaccination campaign should not be “how to convince people”, but “how to facilitate the access to vaccines”. Which means that communication must facilitate the mother's choices. How? Through new communication models that had to be integrated with more traditional ones, in order to strengthen the communication skills of those engaged in the field of vaccination.

Ten golden rules of risk communication

TELLME experts have elaborated ten golden rules for proper and effective risk communication that summarize their results and observations:

1. Organisations cannot afford to simply be reactive; they must build a social media presence before a crisis, to create a sense of online community with the public and develop key followers.
2. Health risk communication is NOT a one-way message system. The aim is for an interactive two-way process for the exchange of information and opinions between individuals, groups and institutions.
3. Plans must be comprehensive and flexible in order to deal with the unpredictable and changing nature of a pandemic.
4. Timing is important. Early communications will help to avoid speculation and false reporting.
5. Outbreak communication needs to contain credibility, accountability, transparency and honesty.
6. Organisations must take a proactive stance in establishing an authoritative presence on social media sites to build a community presence before a crisis happens.
7. Monitoring social media and trending topics allows to ensure you have a stake in the conversation and can adapt to the changing information needs of the community.
8. Appealing to healthcare professionals is critical. They need to be targeted not only to pass messages on, but also to act as ‘vaccination ambassadors’; if social media is to be adopted as a serious crisis communications tool by them, organisations need to quantify and integrate the value of social media as a mean of spreading public health messages.
9. Online communities must be considered as a key resource. Social media appears to encourage pro-social behaviour, which means users share useful information with each other; thus contributing towards the collective body of information and knowledge.
10. The effectiveness of outbreak communications relies greatly on meeting the information needs of various key stakeholders, including risk groups such as pregnant women and the elderly.