Strategic Use of YouTube During a National Public Health Crisis: The CDC’s

Strategic Use of YouTube During a National Public Health Crisis: The CDC’s Response to the 2009 H1N1 Flu Epidemic

Presented to:

The Executive Team

Centers for Disease Control and Prevention

Prepared by:

The Business Communications Consultants Team

November 7, 2012

MEMORANDUM

TO: The Executive Team of Centers for Disease Control and Prevention

FROM: The Business Communications Consultants Team of Centers for Disease Control and Prevention

SUBJECT: The Strategic Use of YouTube During a National Health Crisis: The CDC’s Response to the 2009 H1N1 Epidemic

DATE: November 7, 2012

Here is the report, requested by your team on October 12, on the Centers for Disease Control and Prevention (CDC) strategic use of YouTube, and other social media platforms, during their risk and crisis communication campaign for the 2009 H1N1 influenza epidemic. This report examines how efficient social media was at communicating information to the public along with the CDC’s traditional media coverage during the epidemic.

Overall, the risk and crisis communication campaign during the H1N1 epidemic met great success, along with CDC’s relatively new approach of using social media to communicate with the public. The CDC’s central focus on social media was posting informative videos on YouTube. Some videos gained millions of views and, others failed to reach hardly a thousand. To achieve greater success with communication on YouTube different strategies can be implemented into the CDC’s social media communication. Posting on YouTube attracts people to a site containing false information that can appear to be credible. Therefore, the CDC needs to focus on preventing the spread of false information throughout social media from other sources. Increasing public communication through social media will increase and strengthen the CDC’s direct communication with the public. Establishing a presence on social media before a health crisis can help gain a larger following. More research should be focused on social media trends and adapting to different technologies. The CDC should stay consistent with the content format that performs best. Much consideration should also go into when videos are posted on YouTube.

The team appreciates the opportunity to evaluate how efficiently social media accompanied the risk and crisis communication campaign during the H1N1 epidemic. The information about the topic provided to the team by the CDC was a tremendous help during the study of this topic.

The team hopes this report will help assist in improving future communication through social media. Particularly, focusing on strategies that will improve the CDC’s YouTube channel. The team can be reached through email at bus.communication@CDC.com, at any time and with any questions and concerns following the report. The team looks forward to discussing the findings of the report and collaborating to improve the social media sector of future risk and crisis communication campaigns.

EXECUTIVE SUMMARY

During the H1N1 influenza epidemic, the Centers for Disease Control and Prevention (CDC) had to navigate a relatively new form of communication, social media. The social media platform YouTube is the CDC’s most desirable form of communication when distributing information through social media to the public. The purpose of this report is to (1) assess the CDC’s use of social media in their risk and crisis communication campaign during the H1N1 epidemic and, (2) find strategies to improve upon the CDC’s communication techniques on social media.

Proposal

From the findings in the report we recommend, applying the following strategies when communicating through YouTube and other social media platforms:

Consider the negative effects of directing people to social media, where inaccurate information can easily be spread.

Enrich communication on social media between the CDC and the public, by opening the comment section on YouTube videos posted. Officials from the CDC can then directly answer people’s questions in a reasonable amount of time.

Establish a sizable social media presence on various platforms that complement one another to create a large following before an emergency health event.

Keep current with social media trends and adapt to new technologies.

Consistently post simply formatted YouTube videos, which the public favors, to help maintain high viewing numbers.

Understand when to post content and when to refrain, post information that is only relevant to the state of the health crisis.

Risks

Centering our focus on the social media aspect of our risk communication campaigns for future health crises will be an adjustment to the public health staff. Social media is still a relatively new concept within our organization. Therefore, developing programs to help our communication strategists become more knowledgeable in social media trends and posting strategies will help them overcome many learning curves, when adapting to this relatively new form of communication.

Recommendations

Focusing a sizable amount of our communication to the public on social media does not require a large budget, as it is a cost-efficient form of communication. However, these strategies are relatively new concepts and should be implemented as soon as possible as a health crisis can strike the nation at any given time. Acting immediately to improve our social media communication strategies, will lead to more people accessing crucial information in the wake of a health crisis.

INTRODUCTION

There is no doubt that social media is an efficient way to communicate information, even during an epidemic. In mid-April 2009, a new strain of influenza (H1N1), originally from Mexico, first showed up in California and later swept across the United States and threw the whole country into chaos (Walton et al., 2012). The virus spread readily between crowds and was highly contagious and possibly lethal, causing 477 deaths, including 36 children under 18 years old (Walton et al., 2012). At the same time, the spread of the virus has led to the interruption of information channels. The public desperately wanted to obtain accurate information about the epidemic, which further plunged the people into a panic. The Centers for Disease Control and Prevention (CDC), under such a situation, founded the Emergency Operation Center and the Joint Information Center to ensure information was propagated smoothly (Walton et al., 2012)

At the time of the H1N1 outbreak, the CDC designed a “YouTube-centric” information distributing structure (Walton et al., 2012). In 2009 the rate at which people used social networks was significantly increasing. Facebook had more than 200 million users (Zuckerberg, 2009), while YouTube had over 100 million users (comScore, Inc., 2009). These social media tools and sites disseminate personalized messages, enhance outreach efforts, and build a communication infrastructure based on open information exchange (Schein, 2009). After preliminary social research, the CDC chose YouTube as the center of information dissemination because its users are mainly composed of women aged 25-54 who have strong ties to the populations most at risk for complications from the H1N1 virus— children and the elderly (Ignite Social Media, 2012). During the pandemic, the CDC posted a series of videos on YouTube explaining the symptoms of H1N1 and how to prevent it, ensuring that American citizens received the correct information about how to prevent themselves from catching H1N1 successfully.

In the following paragraphs, our team will interpret the CDC’s social media communication strategies from the aspects of our report’s purpose, scope, source, and methods, to understand whether CDC’s strategies are reasonable and effective in controlling the spread of H1N1 in the United States of America.

Purpose of the Study

In response to the H1N1 influenza epidemic across America, the CDC’s risk and crisis communication campaign implemented the use of social media, primarily YouTube, to help inform and educate people globally about the virus. The purpose of this report was to examine and determine how successful social media was at accompanying traditional forms of media when informing the public about H1N1 and devise strategies to improve social media communication.

Scope of the Study

The report focuses on the CDC’s strategic use of YouTube during the national health crisis of the H1N1 epidemic. With a particular focus on the following topics:

The catastrophic effects the H1N1 virus had across the nation (epidemic).

The CDC’s research-based approach of using YouTube and other social media platforms to provide information to the public.

Strategies used to enhance social media communication to accompany traditional forms of media during a health crisis.

Discusses the execution of the CDC’s plan to post informative videos about H1N1 on YouTube.

Evaluates how well the CDC’s social media sector of the risk and crisis communication campaign performed during the H1N1 epidemic.

Analyzes the CDC’s social media sector of the risk and crisis communication campaign during the H1N1 epidemic.

Source and Methods

The report is based upon the case study entitled “Strategic Use of YouTube During a National Public Health Crisis: The CDC’s Response to the 2009 H1N1 Flu Epidemic” which is composed by Laura Richardson Walton (Ph.D., APR), Holli H. Seitz (MPH), and Kathleen Ragsdale (Ph.D.). In the case study, there were external resources, such as from the Centers for Disease Control and Prevention, from other medical and non-medical professionals. The team also did independent research and found credible secondary information to help complement the case study.

Body

Background The Centers for Disease Control and Prevention (CDC) is a federal agency within the U.S Department of Health and Human Services. The CDC employs more than 15,000 staff that are primarily responsible for public health (Centers for Disease Control and Prevention, 2010a). Before the H1N1 outbreak, the CDC’s emergency communication function had been responsible for responding to the outbreak of severe acute respiratory syndrome (SARS), health issues related to Hurricane Katrina (2005), and the containment of tuberculosis (2007) (Walton et al., 2012). The CDC’s leader Richard Besser-former Director of the Coordinating Office for Terrorism Preparedness and Emergency Response noticed the opportunity to share knowledge quickly and effectively with the public before the H1N1 outbreak, on social media (Walton et al., 2012). 

The first wave of the H1N1 outbreak began in April of 2009, peaked during May and June, and declined in early August (Walton et al., 2012). During this time, 477 H1N1-related deaths occurred in the U.S (36 were children under the age of 18) (Walton et al., 2012). The second wave of H1N1 peaked in October 2009, during this time 49 states reported H1N1 cases within one week (Walton et al., 2012). October marked the launch of the H1N1 vaccination campaign led by the CDC (Walton et al., 2012). This campaign had the intent to encourage stakeholders to take the needed steps to protect themselves and others against H1N1 (Walton et al., 2012). In a national health crisis, the CDC leaders must develop a solution to ensure the general public is informed efficiently and effectively.

The CDC’s Formative Research Developing a set of crisis and emergency risk communication guidelines specifically tailored to address an epidemic influenza event was part of the CDC’s planning for the likelihood of an epidemic influenza event (Walton et al., 2012). Because the CDC realized that H1N1-related public health messaging was complex, the center’s communication department decided to distribute online video health messages via YouTube to reach as many people as possible (Walton et al., 2012).

The Centers for Disease Control and Prevention (CDC) had to produce H1N1 messaging acceptable for the channels quickly and swiftly. Before the H1N1 pandemic, the CDC had spent time and resources developing generic epidemic and seasonal flu messages for social media (Walton et al., 2012). In a quick response, the CDC altered pre-existing messaging for use in the H1N1 social media campaign when the H1N1 outbreak began initially (Walton et al., 2012).

Strategy

The CDC’s primary goal during the H1N1 outbreak was to “reduce transmission and illness severity and provide information to help health care providers, public health officials and the public address the challenges posed by the new virus” (CDC, 2010c). Within the response team of the CDC, the staff developed a communication strategy that can accurately and efficiently provide public information regarding H1N1 (Walton et al., 2012). Providing information regarding the virus was extremely important in the effort to end the epidemic. Communication strategists within the CDC are seeking to optimize the power of social media platforms while maintaining traditional media strategies. Traditional strategies include a 24-hour contact center (CDC-INFO), media relations, health alert network email, factsheets, flyers and brochures, and a dedicated H1N1 website (Walton et al., 2012). The mix of these listed traditional media strategies combined with social media complement each other and allow the CDC to obtain maximum reach and impact with its clear and consistent message. (CDC, 2010c).

 

The CDC uses three core values when defining its message: “be first, be right, and be credible” (CDC 2010d). These values are applied to the mission of sharing information regarding preventative measures, symptoms, and treatment options (Walton et al., 2012). To ensure the maximum audience is reached, the CDC must ensure they use diverse media tools and platforms including Twitter, Facebook, and YouTube- YouTube is the primary means by which CDC focuses its efforts. The integrated communication approach allowed the CDC to use tools across all platforms. For example, a link to a YouTube video can be posted on the CDC’s Facebook and Twitter accounts to enable the reach of a diverse audience (Walton et al., 2012). The CDC also seeks to translate key materials into multiple languages in order to ensure maximum reach (Walton et al., 2012).

Execution

The spread of H1N1 has put citizens in a state of panic. The CDC’s strategy was to respond and build a channel through social networks to spread correct information and provide knowledge. On April 22, 2009, the CDC Emergency Operations Center was activated (Walton et al., 2012). Two days later, the center uploaded a series of videos about H1N1 and its symptoms on YouTube (refer to appendix A), which was a primary means plan in the CDC’s strategy (Walton et al., 2012).

Aiming to efficiently share relevant and essential knowledge on H1N1, the CDC relied on a straightforward YouTube video production. Most of the videos were shot from a close or extreme close-up angle to show a CDC official explaining the symptoms of H1N1 or how to prevent it effectively (Walton et al., 2012). As reflected by the number of viewers of the video, this “no decoration” production method effectively presents necessary information asynchronously (Walton et al., 2012). Meanwhile, the names and titles of CDC officials are often mentioned in the lower-third of the YouTube videos to identify the main speaker and their official role in response to the H1N1 epidemic (Walton et al., 2012). This was an effective nonverbal communication strategy used to reinforce the credibility of CDC and build trust with people (Walton et al., 2012). As the pandemic continued, the CDC shifted the focus of its videos on how best to prevent people from contracting H1N1. They published the “Happy Hand Washing Song” and “I Never Had the Flu” that educated people on how to prevent themself from contracting H1N1 (Walton et al., 2012). With only 12,000 views on these YouTube videos, the CDC realized that users paid more attention to simple and concise information over a fancy production (Walton et al., 2012).

 There is no doubt that YouTube videos played an essential role during the H1N1 epidemic. The videos covered the latest updates about H1N1 and what people should be aware of during an outbreak. After constant emphasis from the CDC, the US citizens were informed about H1N1 and how they should respond. This information reduced the level of panic and assisted in helping the virus to be brought under control quickly.

Evaluation

On August 10, 2010, The World Health Organization and International Health Regulations Emergency Committee declared that the H1N1 influenza pandemic was over, along with the H1N1 epidemic in America (CDC, 2010c). After the H1N1 epidemic, the CDC described their response to the health crisis overall as “complex, multi-face and long term” (CDC, 210b). It was estimated by the CDC that “its risk communication campaign resulted in 403 million impressions from articles placed in print and internet news media outlets alone” (CDC, 2010b). Afterward, the CDC reported how efficient their communication through social media was during their overall successful risk and crisis communication campaign during the H1N1 epidemic:

The CDC Facebook increased by 55,000 followers (CDC, 2010d).

The CDC emergency profile on Twitter had 1.2 million followers by the end of the epidemic (CDC, 2010d).

The 24 YouTube videos focusing on H1N1 on the CDC’s YouTube channel saw over 3 million views in total (CDC, 2010b).

 

 Although the CDC saw a substantially large social media response to their posted information, they cannot report on the individuals that obtained inaccurate information about H1N1. The CDC focuses solely on informing Americans about diseases and viruses that pose a risk to their health.  Anyone can write and record what they please on the internet, factual or not. Social media platforms are designed to be a space where anyone can have a voice. The CDC did little to report on what their plan was to overshadow misinformation and attract people to their news outlet on YouTube. In a poll done by Gallup, out of 1,012 American adults, 42% thought it was “not likely at all” that their family or themselves would contract H1N1 in the height of the epidemic in May 2009 (Morales, 2009).

Figure 1: “How Likely do you think it is that you or someone in your family will get swine flu (H1N1)?” (Morales, 2009).

The results of this survey are significantly influenced by nonfactual information that was being spread on non-traditional media platforms during the epidemic. If most people in this surveyed group followed the CDC information posted on traditional and non-traditional media platforms, they would have known that they are indeed susceptible to the virus. Although the CDC strived to release their information first, the internet has many sources posting information constantly, whether the information is up to date or not. The CDC also establishes its credibility well, but the internet often masks reality. Anyone can establish false credibility to their claims on social media. Although the CDC was attracting more people globally through YouTube to their informational H1N1 videos, they drew people closer to misinformation.

 

The number of individuals who reached out to the CDC-INFO contact center through traditional forms of media was high but substantially lower than the number of individuals viewing their content online;

141,772 calls from the general public

47,311 emails from the general public

23,268 clinician phone calls

13 handwritten letters (CDC, 2010d).

The CDC had more public interaction during the epidemic on social media. However, the CDC has their YouTube comments turned off on their informative H1N1 videos, limiting the public to ask questions through social media. Fewer people are reaching out to the CDC directly through traditional forms of communication, and more are turning to social media instead. Due to this, it is more likely that people can stumble across misinformation when looking for answers to their questions on social media that the CDC has closed themselves off to answer. In essence, although the CDC, did a good job of attracting people to YouTube, they did little to prevent people from diverging to other, possibly false, sources on the site.

Analysis and Discussion

The case study backs up the CDC’s assertive reaction when responding to global risks to the public, which must be “strategic, broad-based, responsive, and highly contingent” (Reynolds & Seeger, 2005). The case study contains crucial information for comprehending the CDC’s response to the H1N1 epidemic. While the CDC continues to use more traditional communication methods, the study highlights the importance of making important public health messages available to the broader public via YouTube (Walton et al., 2012). With over three million views, it was clear that many people were interested in learning more about the 2009 H1N1 epidemic on YouTube (Walton et al., 2012). It also underlines the importance of the public health community’s willingness to adapt to the changing nature of information transmission in the face of new media and innovative technology.

The CDC continues to be a reliable source of public health information. It recognizes the need to broaden its strategic communication boundaries to embrace new media by opening accounts in various social media domains and developing the best practices for using social media for public health communication. Their YouTube guidelines propose that health communicators develop material for specific demographics in populations. During the national health crisis, the CDC used a relatively new technology, YouTube, to communicate a consistent public message to a diverse mass audience (Walton et al., 2012).

RECOMMENDATIONS AND CONCLUSIONS

The primary purpose of this report was to identify a communication channel that would offer timely and precise information to the nation concerning the outbreak. The key findings of this study were as follows:

YouTube was one of the fastest means of communicating information to the public. It was clear that many people have adopted technology and can use it in accessing information materials related to health compared to the traditional means of communication.

The CDC realized that after three weeks of posting the information about the outbreak on social media, public health units had already accessed the information and became aware of the epidemic, which indicated that many public health organizations were also willing to adapt to new technology (Walton et al., 2012). Therefore, this made it easier for the CDC to send their messages to these organizations quicker and with fewer costs.

The CDC also found that videos with graphics and cartoons sent after the first wave had passed were not as effective as those with straightforward messages.

Credibility

The CDC needs to implement strategies that make their videos different from others, such as logos on the screen and their official names for credibility to avoid false information spreading under their name.

Communication Research

They also should adopt various new technologies that will help them reach more people in multiple places. The CDC should also use Facebook and Twitter to reach more people from all over the globe.

Research

The CDC should also conduct further research to determine how to use social media for public announcements to determine what they need to improve in their social media productions.

Risk Management Actions

The CDC needs to think about the other information people are accessing on YouTube and the repercussions of incorrect information spreading throughout social media communities. The CDC is a credible source however communicating through social media platforms attracts people to resources full of false information and people may feel as though the CDC credibility and other sources on the site are at the same level.

Social Media Communication Actions

Allow more access for the public to ask questions directly on social media. With social media gaining more popularity as a communication tool over traditional forms of media. Opening the comment sections on the H1N1 YouTube videos, with workers directly from the CDC actively answering, will limit people from turning to other, possibly not credible, sources for answers to their questions.

Social Media Actions

Establish other social media platforms that accent the CDC YouTube account before the event of a health crisis. With more established forms of public communications, such as Facebook and Twitter, information can reach more people across the globe. Different social media platforms attract different demographics of people. Being present on multiple social media forms helps information educate more people. 

Research and continually, keep up to date with the latest social media trends and current technologies. Invest more time into researching trends that are successful in social media communication. Joining new social platforms will help gain an earlier online presence in the digital space. Adapting to new technologies, through which social media is used, can help the CDC stay current.

Communication and Marketing Actions

Follow a simple format when posting videos on YouTube. Short videos that deliver information in a simplistic format performed best during the H1N1 flu epidemic. The videos that took a less simplistic approach with higher-level production value, such as animation, did not perform as well. The public wants to be informed, not entertained. It is crucial to keep in mind that the target audience for the videos is mainly adults. Implementing a simple logo that will appear at the beginning of every video can also help keep the format of the videos consistent.  

Post content that is current and relevant at the time of posting. It is unnecessary to produce and post a new YouTube video that covers monotonous facts that are already well known at the end of a health crisis.

REFERENCES

Chappell, B. (2012). 2011 social network analysis report – Geographic – Demographic and traffic data revealed. Ignite Social Media Agency.

https://www.ignitesocialmedia.com/social-media-stats/2011-social-network-analysis- report/

Centers for Disease Control and Prevention (2010a). CDC Fact Sheet. http://www.cdc.gov/about/resources/facts.htm

Centers for Disease Control and Prevention (2010b, June 16). The 2009 H1N1 pandemic: summary highlights, April 2009-April 2010. http://www.cdc.gov/h1n1flu/cdcresponse.htm

Centers for Disease Control and Prevention (2010c, August 11). 2009 H1N1 Flu. http://www.cdc.gov/h1n1flu/

Centers for Disease Control and Prevention (2010d). 2009 H1N1: Overview of a Pandemic. http://www.cdc.gov/h1n1flu/yearinreview/yir8.htm

Morales, L. (2009, May 7). Americans split on media coverage of swine flu. Gallup.com.

https://news.gallup.com/poll/118258/americans-split-media-coverage-swine-flu.aspx

Reynolds, B., & Seeger, M. W. (2005). Crisis and emergency risk communication as an integrative model. Journal of Health Communication, 10, p. 43-55.

Schein, R. (2009). LITERATURE REVIEW ON EFFECTIVENESS OF THE USE OF SOCIAL MEDIA A REPORT FOR PEEL PUBLIC HEALTH.

https://www.peelregion.ca/health/resources/pdf/socialmedia.pdf

Walton, L.R., Seitz, H.H., Ragsdale, K. (2012, May 13). Strategic Use of YouTube During a National Public Health Crisis: The CDC’s Response to the 2009 H1N1 Flu

Epidemic. Case Studies in Strategic Communication, 1, p. 25-37.

YouTube surpasses 100 million U.S. viewers for the first time. (2009, March 4). Comscore, Inc.

https://www.comscore.com/Insights/Press-Releases/2009/3/YouTube-Surpasses-100- Million-US-Viewers

Zuckerberg, M. (2009, April 8). 200 million strong [Weblog post]. http://blog.facebook.com/blog.php?post=72353897130

APPENDIX A

A timeline of the YouTube videos posted by the CDC in correlations to the H1N1 influenza American epidemic and global pandemic between the years 2009 and 2010 (Walton et al., 2012).