How to report a disease outbreak or pandemic

How to report diseases
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Sensationalism is no substitute for sound science when reporting disease outbreaks, say Fang Xuanchang, Jia Hepeng and Katherine Nightingale.

A pandemic or large disease outbreak is always hot news, thanks to the race to research it, uncertain results, vivid details about treatment, attempts to prevent its spread and of course an element of fear.

The initial stages of an outbreak, especially, provide good opportunities for journalists. There are many researchers and doctors to interview, an abundance of news 'hooks' as health officials and researchers deal with the situation, and an unusual readiness of editors to run science stories.

But to report a disease outbreak responsibly, you must not only make sense of early reports and often hazy information, but also follow up the story comprehensively in the long term.

And this must always be done by applying critical thinking and taking a scientific approach. The science — together with the wider social and economic perspectives — is essential to producing good stories about pandemics.

Swine flu — influenza A(H1N1) — has already thrown up some classic examples of bad science journalism, such as Egyptian journalists reporting 'experts' saying that infected pigs could end up in the food chain as cheap beef (see Media and government to blame for Egypt swine flu chaos).

What follows is advice on how to avoid repeating these mistakes. The tips are all the more important in developing countries, where resources are scarce and the challenges of communicating important information are great.

In such countries, responsible public health messages are crucial to easing the burden of a disease on vulnerable health systems.

Get the basics right

First, give your audience the correct meaning of words they will frequently hear and read. For example, a 'pandemic' means a disease that has spread on a global scale, not necessarily that it is deadly. Scientists talk about the 'virulence' of a pathogen, but what does that mean to laypeople? Use straightforward, accurate explanations that are not alarming.

Health organisations may provide information and factsheets about the pathogen and the best ways of dealing with it. Government agencies should provide information about the number of cases in a country and, if appropriate, the number of deaths.

Try to report these details using your scientific knowledge. Does the death rate seem higher than that of other diseases? Is the pathogen a new strain of an existing foe or something new? The way you frame these facts can point your reporting in the right direction.

Key questions in the early stages

Often, a layperson's immediate reaction to hearing about a new disease is, "How will it affect me and the people I love?" No science journalist can answer this, but you can communicate the risk a disease poses.

First, you need to be familiar with recent research into similar diseases. For example, a knowledge of H5N1 bird flu will help to cover A(H1N1) flu, as much of the research (and researchers) — will also be relevant.

There are some key questions to bear in mind.

What do scientists know?

In the early stages of any disease outbreak, there will be many unknowns but there will often be a wealth of scientific knowledge about the type of pathogen or similar strains.

Pandemics and sudden disease outbreaks, by their nature, are usually caused by new pathogens — or at least new strains of them. Scientists won't necessarily know how they behave.

They do know a lot about influenza, so the current A(H1N1) flu outbreak is not too much of a mystery — though obviously no one can predict the future. But when SARS emerged in 2003, scientists knew very little, as it was a new virus.

Say what scientists do and don't know but try not to cause panic. Scientists don't necessarily need all the details about a pathogen to find a treatment that works, and it is unrealistic to expect scientists to have information about every possible disease at their fingertips.

When less is known, the possibilities are greater but it does not mean they are inevitable: A(H1N1) flu could combine with H5N1 bird flu but that doesn't mean it will.

How many cases will there be? How many people might die?

Researchers must model how many people they think could be affected or killed by a disease outbreak so that countries can prepare their health systems effectively. Be careful not to report predictions as certainties — that is sensationalist and does not give the audience any idea of how such models work. They are the best estimates calculated from a selection of factors and can only be as good as knowledge at the time.

Be cautious of certain scientists making sensational claims about large death tolls — the more serious the disease, the more money they may receive for their research.

So, always try to analyse the factors contributing to the estimates of death tolls — don't focus solely on the numbers.

Try also to keep a disease in perspective. Many reports about the A(H1N1) flu pandemic have failed to compare the disease's death toll with others that may have more of an impact.

With a new influenza pandemic there is a tendency to compare it with previous pandemics, particularly the most dramatic ones. Remember to report current outbreaks in the context of today's health systems and science.

For more about how to communicate risk see SciDev.Net's guide Communicating statistics and risk.

How is the infection passed on and what can I do about it?

State what is known about how the disease is spread and ask a scientist or public health official — or a range of them — to explain if transmission methods are unclear.

You should also report how it isn't spread. Industries can be damaged by people falsely believing a product is involved in disease transmission. Sales of poultry decreased at the height of the H5N1 avian flu scare because people wrongly thought the disease might be passed on by eating it.

You can give your audience information about how they can protect themselves, particularly with simple measures. With HIV, messages should be about practising safe sex; with influenza, handwashing.

Reporting what people shouldn't do can be almost as important. For example, there is little evidence that face masks can protect members of the public against flu. Companies may well be promoting products for which there is little or no evidence of effectiveness.

It is also important to avoid running too many stories. Important public health messages should not be lost because people are turned off by too many similar stories that don't seem to offer any new information.

Build trust with sources

Using reliable and informative sources will make your stories stand out, as well as helping you navigate the plethora of data, some of which can be conflicting.

Developing relationships with scientists who trust you is crucial. Regular conversations can bring new angles to stories, as well as inform you how they intend to follow up their research. In some countries, governments may try to hide the number of cases or deaths — as with SARS in China — so talking to scientists, particularly epidemiologists who should be tracking outbreaks, could be the only way to uncover the truth.

You can also return to the same sources to give you an idea of how the outbreak is perceived by scientists over time. If they are changing their minds about the severity of a disease then it is worth letting the public know.

It is also a good idea to build relationships with government sources. This can be difficult to do in developing countries. More information about building relationships can be found in SciDev.Net's guide How to report on science policy.

The long-term view

When the public gets most of its information about a disease from the media, they can be forgiven for thinking it has disappeared if the news stories dry up. While it is important not to overwhelm people, they should also know if there is still a threat.

Keep the key questions above in mind and try to see whether the answers have changed as new information comes to light.

In addition, the time after an initial flurry of coverage is an opportunity for in-depth reporting — assessing a government's response, for example, or looking at how research into the disease has advanced science in general (or whether vital resources have been diverted from other areas).

Tracking the development of any new drugs or vaccines against a disease can also be productive. In China, many resources were put into SARS vaccine research but the virus soon disappeared — and few questioned scientists about the return from this large investment.

The wider context

A pandemic or large disease outbreak is not just a scientific issue and you may find yourself covering economic and social topics you are less familiar with.

For example, China News Weekly has covered A(H1N1) flu more deeply by assessing the transformation of public health strategy in China since 2003, when SARS seriously impacted the health system and society in general. Articles have also compared China's approach with other countries, and society's progress in preventing and fighting disease.

Reporting on pandemics can mean dealing with social issues such as unprotected sex and multiple sexual partners, as with HIV, and inequalities in access to drugs. HIV also has economic implications because it has wiped out generations in some developing countries.

Think globally, act locally

Finally, a pandemic may appear remote to people far away from the first known outbreaks. But the WHO declared swine flu a pandemic less than two months after it began circulating widely and air travel has played a major role in transmission.

The challenge is to make a global story locally relevant. A case of the disease may not yet have occurred in your country, but you should be letting people know about it, what they can do to protect themselves and what the authorities are doing.

It is responsible to inform people in the possible path of a disease — but equally important to ensure that stories don't seem like a countdown to disaster.

Fang Xuanchang is the science editor of China News Weekly. Jia Hepeng is the editor-in-chief of Science News Bi-Weekly and former China coordinator for SciDev.Net. Katherine Nightingale is SciDev.Net's assistant news editor.