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27th Feb 2024

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ECDC chief Andrea Ammon: 'It's not just about slogans'

  • "The pandemic has shown that the remit of the ECDC expands quite a bit beyond the gathering of relevant data and the coordinating and communication of responses to that data." (Photo: ©ECDC 2020)
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European Center for Disease Control (ECDC) chief Andrea Ammon spoke candidly about how her organisation is preparing itself to help the EU be prepared for the next pandemic.

Ammon has been heading up the ECDC since 2017. Trained as a medical doctor, and specialised in public health, she is an alumni of the first cohort of the field epidemiology programme (EPIET) offered by the ECDC. She joined the organisation in 2005, building the European surveillance system, and slowly making her way to the top job.

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The ECDC was thrust into the spotlight during the Covid-19 pandemic, and since then has seen its mandate expand through new regulations.

Our conversation ended up revolving around communication, and what both the ECDC and the media could do better in — hopefully not anytime soon — the next pandemic.

EUobserver: I'd like to briefly talk about new regulations and changes to the ECDC mandate. Can you run me through some of the policy changes we've seen since the pandemic?

Andrea Ammon: The serious cross-border health threat regulation aims at regulating all the different elements connected to health emergencies. That starts with the surveillance, the laboratories, but then also the response to emergencies. So that's really the risk assessment and risk management package. Now, our regulation is really tailored for the ECDC, and it has a lot of cross-references to the serious cross-border health regulation.

So a lot of what is in the serious cross-border health regulation actually refers to us to our work. In principle, our mandate stayed the same as it was before, in terms of that we are dealing with infectious diseases. But some of the tasks have been specified. We have new aspects of our tasks. And then there are a few new elements in, for instance, of the EU reference laboratories that EU Health Task Force, the foresight and modelling, we look at determinants prevention and health system indicators. So there are a few new elements that have been added, as lessons learned from the pandemic.

What were some key lessons learned from the pandemic?

We must enhance our surveillance, and improve preparedness and risk communication. The particular emphasis now, which has been evolving in the past year, is the emphasis on the workforce. Every country has experienced the same scene — that the health workforce has massive issues. There are people leaving the service due to burnout, and we have the looming crisis of people going to retire in the next five to 10 years, without sufficient supply in the pipeline.

That is verging on labour communication, or maybe workforce policy, rather than infectious diseases.

Exactly. That is where our mandate and our influence is limited. Of course, we can advocate, and it's what I'm also doing. But in the end, the real turning of the tide can only be done with policy changes in the countries that we cannot do ourselves. Although we can of course provide training for people that would like to be specialised in public health. But we cannot change the salary structure, the career perspective, or the working conditions, that is something that has to happen in the international system.

That must be frustrating to see.

Well, when you come to work for an agency like this, you know where the remits of the mandate lie. And then you have to work within these remits and see how you can advocate for anything that you find important for the mandate.

That's really interesting. The pandemic has shown that the remit of the ECDC expands quite a bit beyond the gathering of relevant data and the coordinating and communication of responses to that data. So for example, on infectious diseases, into the realm of communication — the more 'soft' science of bringing across a certain scientific message or a way to evaluate risk for both public health officials but also for citizens. Has that changed the organisation a lot?

It has brought some changes, yes, especially in the way we do our work, not so much in the substance that we are dealing with. There is an article on communication that has actually not changed.

However, there are other elements in the regulation, which influenced the communication. For instance, our mission statement has been expanded not only that we identify, analyse and communicate threats to human health from infectious diseases, but we also make reports thereof available and easily accessible.

This 'accessible' doesn't mean that we put it free of charge on the website, but that it's also formulated in a language that politicians and policymakers understand. So here we have to change our communication.

We are a scientific organisation, and we have our scientific reports, but we have to now add a summary with key messages for public health decision-makers so that they can be used to actually implement and apply in public policy and practice.

Right. So messages like, for example, like 'flattening the curve', were successful, but I think maybe the communication around masking was slightly less successful.

Well, I think we have positive and negative examples, in abundance over the three years. I think it's not about slogans only. It's really about explaining. And that is why, when you have seen our lessons learned document, one of these four lessons that we put forward is Risk Communication and Community Engagement.

And I think this community engagement was something that really did not work very well in most places. People at one point during the pandemic had not understood why they still had to wear masks, stay at home, keep that distance, get tested, and so forth.

That is what I think our messaging should help. It should help local politicians explain this to the general population, but also then to specific populations, like young people, for instance.

What do you base best practices on? Is there actually a lot of science around effective communication during public health crises and community engagement? Is there something that you can fall back on?

Yes, there is. And that's the interesting part, that the fact that it hasn't been used to its full potential is not because there is no science behind it — there is science. But these scientists were not necessarily part of the crisis groups. More and more countries have recognised that scientists, risk communicators, ethicists and behavioural insight specialists should be part of the crisis team. And we have also now assembled a small team here at ECDC that deals specifically with that.

Risk communication is a very difficult thing to do I can imagine. Risk is dependent on a lot of variables, and bringing across a complex message is very challenging for the general public to understand. So for example, I didn't know the risks for someone over eighty when vaccinated are vastly different from those for a person over 60 who is also vaccinated. I think that tailoring specific messages like that must be very complicated.

Yeah, and I think that the risk communication has to evolve during the course of such a crisis, but it's important that it starts at the beginning with clarifications that everybody can understand.

At the beginning of the pandemic, these differentiations weren't even possible, because we didn't know about all these different risks to different people.

And that, I think, has to be very clearly said at the beginning. What is known, what is not known, where there is evidence and where there are decisions based on analogy with similar infections. I think people can understand that there is an evolving situation, so that the fact that one day, they hear one message, and the next day something else, is not necessarily interpreted as 'they don't know what they're doing.'

That touches on something else as well, because up to now, we're talking about proactive communication based on evidence. But another phenomenon that the pandemic showed was that the importance of reactive communication to counter explicit misinformation is also a huge part of public health communication.

That is true, part of this risk communication is also health education, in which the basics are explained to the population. In general, if we could increase the health literacy of the public, then misinformation would have a bit of a harder time getting through. But that is of course, not something that you can do in a crisis, that is something that needs to be built into the preparedness.

My background was in science journalism. And if I know one thing, it's that it's very hard to interest people in something that is not going on at that moment, but that might have importance later. Is raising the bar for public health knowledge among the citizens part of the next pandemic preparedness plan?

In my view, it should be a chapter in the pandemic preparedness plans that are now being looked at and reviewed. And in terms of people not being interested, we have to learn a bit from advertising, because in the end, it concerns them as persons. Moreover, we have health issues ongoing with mosquitoes, with climate change, with West Nile virus, with influenza, with measles. These diseases are there, and we could use each of these as opportunities to take aspects of health to help people become more in-depth informed.

Right. What role could the media play or what could they do better?

It's not just the media who could do better, but it's also from the scientist's side. Some initiatives have to go out in media briefings, so that it's not just a sensational story to report, but also to help inform the media so that they know where certain pieces of information fall into.

I think this is something that we probably will not succeed at one hundred percent. But you have to try your best and see what could reasonably be done to put out trustworthy information. Even when there is weak evidence there, so that people know that we are not fabricating things. And that is a reputation that you have to build in non-crisis time, so that you can count on this in times of crisis.

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