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 BUILDING COMMUNICATION
CAPACITY TO COUNTER
INFECTIOUS DISEASE
THREATS

Proceedings of a Workshop

V. Ayano Ogawa, Ceci Mundaca-Shah, and Joe Alper,

Rapporteurs

Forum on Microbial Threats

Board on Global Health

Health and Medicine Division

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW
Washington, DC 20001

This project was supported by Contract No. GHN-G-00-07-00001-00, Contract No.

W81XWH-14P-0339, Contract No. 200-2011-38807 (Task Order No. 38), Contract
No. HSHQDC-15-C-00043, Contract No. VA250-16-P-1998, Contract No. DJF-16-
1200-P-0002127, Contract No. 1R13FD005335-01, Contract No. HHSN26300055,
and Contract No. HT94104-12-1-0009, between the National Academy of Sciences
and the U.S. Agency for International Development, the U.S. Army Medical
Research and Materiel Command, the U.S. Centers for Disease Control and
Prevention, the U.S. Department of Homeland Security, the U.S. Department of
Veterans Affairs, the U.S. Federal Bureau of Investigation, the U.S. Food and Drug
Administration, the National Institute of Allergy and Infectious Diseases/ National
Institutes of Health, and the Uniformed Services University of the Health Sciences,
respectively, and by the American Society for Microbiology, the Infectious Diseases
Society of America, Johnson & Johnson, Sanofi Pasteur, and the Skoll Global
Threats Fund. Any opinions, findings, conclusions, or recommendations expressed
in this publication do not necessarily reflect the views of any organization or
agency that provided support for the project.

International Standard Book Number-13: 978-0-309-45768-2

International Standard Book Number-10: 0-309-45768-8
Digital Object Identifier: https://doi.org/10.17226/24738
Epub ISBN: 978-0-309-45771-2

Additional copies of this publication are available for sale from the National
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Copyright 2017 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine.

2017. Building Communication Capacity to Counter Infectious Disease Threats:
Proceedings of a Workshop. Washington, DC: The National Academies Press. doi:
https://doi.org/10.17226/24738.
The National Academy of Sciences was established in 1863 by
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 PLANNING COMMITTEE FOR A
WORKSHOP ON BUILDING
COMMUNICATION CAPACITY TO
COUNTER INFECTIOUS DISEASE
THREATS1

JEFFREY S. DUCHIN (Chair), Health Officer and Chief,

Communicable Disease Epidemiology and Immunization Section
for Public Health, Seattle and King County, Washington
BARUCH FISCHHOFF, Howard Heinz University Professor,
Department of Engineering and Public Policy, Carnegie Mellon
University
JENNIFER GARDY, Senior Scientist, British Columbia Centre for
Disease Control; Assistant Professor, School of Population and
Public Health, University of British Columbia
RIMA F. KHABBAZ, Deputy Director for Infectious Diseases, U.S.
Centers for Disease Control and Prevention
RAFAEL OBREGON, Chief, Communication for Development,
United Nations Children’s Fund
JENNIFER OLSEN, Manager, Pandemics, Skoll Global Threats Fund
J. DOUGLAS STOREY, Director of Communication Science and
Research, Johns Hopkins Center for Communication Programs
JANET TOBIAS, Founder and Chief Executive Officer, Ikana Health
and Media

Project Staff
CECI MUNDACA-SHAH, Director, Forum on Microbial Threats
V. AYANO OGAWA, Associate Program Officer
T. ANH TRAN, Senior Program Assistant
JULIE PAVLIN, Director, Board on Global Health
Consultant
JOE ALPER, Consulting Writer

__________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning
committees are solely responsible for organizing the workshop, identifying topics,
and choosing speakers. The responsibility for the published Proceedings of a
Workshop rests with the workshop rapporteurs and the institution.
 FORUM ON MICROBIAL THREATS1

DAVID A. RELMAN (Chair), Thomas C. and Joan M. Merigan

Professor, Departments of Medicine and of Microbiology and
Immunology, Stanford University
JAMES M. HUGHES (Vice Chair), Professor of Medicine and Public
Health, Emory University
LONNIE J. KING (Vice Chair), Professor and Dean Emeritus,
College of Veterinary Medicine, The Ohio State University
KEVIN ANDERSON, Senior Program Manager, Science and
Technology Directorate, U.S. Department of Homeland Security
ENRIQUETA C. BOND, Burroughs Wellcome Fund (Emeritus), QE
Philanthropic Advisors
LUCIANA BORIO, Acting Chief Scientist for Science and Public
Health, U.S. Food and Drug Administration
TIMOTHY BURGESS, Director, Infectious Disease Clinical Research
Program, Uniformed Services University of Health Sciences
DENNIS CARROLL, Director, Pandemic Influenza and Other
Emerging Threats Unit, U.S. Agency for International
Development
ARTURO CASADEVALL, Professor and Chair, W. Harry Feinstone
Department of Molecular Microbiology and Immunology, Johns
Hopkins Bloomberg School of Public Health
PETER DASZAK, President, EcoHealth Alliance
JEFFREY S. DUCHIN, Health Officer and Chief, Communicable
Disease Epidemiology and Immunization Section for Public
Health, Seattle and King County, Washington
EMILY ERBELDING, Deputy Director, Division of AIDS, National
Institute of Allergy and Infectious Diseases, National Institutes
of Health
JENNIFER GARDY, Senior Scientist, BC Centre for Disease Control,
Assistant Professor, University of British Columbia
JESSE L. GOODMAN, Professor of Medicine and Infectious
Diseases, Director, Center on Medical Product Access, Safety,
and Stewardship, Georgetown University
EDUARDO GOTUZZO, Director, Alexander von Humbolt Instituto
de Medicina Tropical, Universidad Peruana Cayetano Heredia
STEPHEN A. JOHNSTON, Director, Center for Innovations in
Medicine, The Biodesign Institute, Arizona State University
KENT E. KESTER, Vice President and Head, Translational Science
and Biomarkers, Sanofi Pasteur
GERALD T. KEUSCH, Assistant Provost for Global Health, Boston
University Medical Campus, Associate Dean for Global Health,
Boston University School of Public Health
RIMA F. KHABBAZ, Deputy Director for Infectious Diseases, U.S.
Centers for Disease Control and Prevention
STANLEY M. LEMON, Professor of Medicine and Microbiology and
Immunology, University of North Carolina at Chapel Hill
JONNA MAZET, Professor of Epidemiology and Disease Ecology,
Executive Director, One Health Institute, School of Veterinary
Medicine, University of California, Davis
JENNIFER OLSEN, Manager, Pandemics, Skoll Global Threats Fund
GEORGE POSTE, Chief Scientist, Complex Adaptive Systems
Initiative, Arizona State University, SkySong
DAVID RIZZO, Chair, Department of Plant Pathology, University of
California, Davis
GARY A. ROSELLE, Chief of Medical Service, Veterans Affairs
Medical Center, Director, National Infectious Disease Services,
Veterans Health Administration
JANET SHOEMAKER, Director, Office of Public Affairs, American
Society for Microbiology
JAY P. SIEGEL, Chief Biotechnology Officer, Head of Scientific
Strategy and Policy, Johnson & Johnson
PAIGE E. WATERMAN, Lieutenant Colonel, U.S. Army, Director,
Translational Medicine Branch, Walter Reed Army Institute of
Research
MARY E. WILSON, Clinical Professor of Epidemiology and
Biostatistics, School of Medicine, University of California, San
 Francisco; Adjunct Professor of Global Health and Population,
Harvard T.H. Chan School of Public Health, Harvard University
EDWARD H. YOU, Supervisory Special Agent, Weapons of Mass
Destruction Directorate, Federal Bureau of Investigation

National Academies of Sciences, Engineering, and Medicine Staff

CECI MUNDACA-SHAH, Director, Forum on Microbial Threats
V. AYANO OGAWA, Associate Program Officer
T. ANH TRAN, Senior Program Assistant
JULIE PAVLIN, Director, Board on Global Health

__________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and
roundtables do not issue, review, or approve individual documents. The
responsibility for the published Proceedings of a Workshop rests with the
workshop rapporteurs and the institution.
 Reviewers

This Proceedings of a Workshop has been reviewed in draft form by

individuals chosen for their diverse perspectives and technical
expertise. The purpose of this independent review is to provide
candid and critical comments that will assist the institution in making
its published Proceedings of a Workshop as sound as possible and to
ensure that the Proceedings of a Workshop meets institutional
standards for objectivity, evidence, and responsiveness to the study
charge. The review comments and draft manuscript remain
confidential to protect the integrity of the process. We wish to thank
the following individuals for their review of this Proceedings of a
Workshop:

Baruch Fischhoff, Carnegie Mellon University

Peter Klein, University of British Columbia
Rafael Obregon, United Nations Children’s Fund
Barbara Reynolds, U.S. Centers for Disease Control and
Prevention

Although the reviewers listed above have provided many

constructive comments and suggestions, they did not see the final
draft of the Proceedings of a Workshop before its release. The
review of this Proceedings of a Workshop was overseen by Georges
Benjamin. He was responsible for making certain that an
independent examination of this Proceedings of a Workshop was
carried out in accordance with institutional procedures and that all
review comments were carefully considered. Responsibility for the
final content of this Proceedings of a Workshop rests entirely with
the rapporteurs and the institution.
 Acknowledgments

The Forum on Microbial Threats staff and planning committee deeply

appreciate the many valuable contributions from individuals who
assisted us with this project. We offer our profound thanks to all the
presenters and discussants at the workshop who gave so generously
of their time and expertise. A full list of speakers and moderators
and their biographical information may be found in Appendix C.
 Contents

ACRONYMS AND ABBREVIATIONS

1 INTRODUCTION
Meeting Objectives
Organization of the Proceedings of a Workshop

2 PERSPECTIVES ON BUILDING COMMUNICATION

CAPACITY TO COUNTER INFECTIOUS DISEASE THREATS
Building Risk Communication Capacity: Can It Be Done?
Potential Challenges for Achieving Successful Communications for
Infectious Disease Threats
Perspectives of the American Society for Microbiology

3 LAYING THE FOUNDATION FOR EFFECTIVE

COMMUNICATION
The Building Blocks of Successful Communication Capacity
Learning from the Decision Sciences to Design Targeted Messages
Evidence-Based Methods and Evaluation Strategies
Goals for Risk Communication
Translating Risk Perception into Behavior Change
Sources of Information: Lessons from Communication in Liberia
Advocacy and Communication of Health Risks: Examples from
Tobacco Control
Discussion
4 ACHIEVING EFFECTIVE COMMUNICATION
Packaging a Story: Traditional Versus Digital Media
Responding to Misinformation and Rumors
Participatory Surveillance and Social Listening
Bidirectional Communication Platforms
Training the Trainers
Discussion

5 INTEGRATING DATA AND EVIDENCE INTO

COMMUNICATION STRATEGIES IN THE FIELD
Using Data to Refine Communication Strategies
A Bottom-Up Approach to a Successful Response
The Front Lines: Where Data Meet Reality
Discussion

6 A SYSTEMS PERSPECTIVE ON STRENGTHENING RISK

COMMUNICATION AND COMMUNITY ENGAGEMENT IN
DISEASE OUTBREAK RESPONSE
Risk Communication as a Core Capacity Under the International
Health Regulations
Strengthening Risk Communication: Coordination and Leadership
Discussion

7 WORKSHOP HIGHLIGHTS AND REFLECTIONS

REFERENCES

APPENDIXES
A STATEMENT OF TASK
B WORKSHOP AGENDA
C BIOGRAPHICAL SKETCHES OF WORKSHOP SPEAKERS AND
MODERATORS
 Boxes, Figures, and
Tables

BOXES

1-1 Workshop Objectives

6-1 Communication Strategies Often Needed in Countering

Infectious Diseases
6-2 Post-Ebola Lessons Learned Identified in 2015 World Health
Organization Stakeholders’ Meeting

7-1 Lessons Learned from the Workshop

FIGURES

2-1 As the delay between outbreak and risk communication widens,

the opportunity to control the outbreak diminishes

3-1 Connecting professionals with the public in creating a risk

communication plan
3-2 Different devices for communicating numbers visually
3-3 How risk can be translated into behavior change
3-4 Changes in the distribution of people in four risk perception
attitude framework groups
3-5 Effect of budget cuts to the Florida TRUTH campaign on
campaign-targeted beliefs
3-6 Effect of budget cuts to the Florida TRUTH campaign on
intentions to avoid trying cigarettes
3-7 Relationship between levels of education and recall of Wisconsin
smoking cessation ads

4-1 Global spread of vaccine sentiments following Japan’s

suspension of its human papillomavirus recommendations
4-2 Percentage of people who disagreed with the statement,
“Overall, I think vaccines are safe ”
4-3 Proportion of vaccine-related reports in the media categorized as
positive or neutral
4-4 Tweets about Zika vaccine tracked those with pseudo-scientific
claims
4-5 Fear of stigmatization over time after a nationwide anti-stigma
campaign in Sierra Leone
4-6 Improvement in following quarantine restrictions over time in
Sierra Leone
4-7 The public’s sense of progress as an indicator of controlling the
Ebola outbreak

5-1 Progression of the Ebola outbreak in Liberia

6-1 The World Health Organization’s integrated systems model for

assessing emergency risk communication capacity in joint
external evaluations

7-1 Responses to the question, “In one word, what do you think the
biggest challenge is with building communication capacity to
counter infectious disease threats?”

TABLES

3-1 Sources of Risk Communication on the Ebola Outbreak in Liberia

During the 2014 West African Ebola Crisis
3-2 Assignment of Blame for the Ebola Crisis According to Different
Media Sources
3-3 Multiple Sources Receiving Credit for Resolving the Ebola Crisis
According to Different Media Sources
3-4 Rumors About Ebola Circulating in Liberia

4-1 The Vaccine Confidence Project’s Rumor Diagnostic Tool

 Acronyms and
Abbreviations

ASM American Society for Microbiology

CDC U.S. Centers for Disease Control and Prevention

ERC emergency risk communication

ETU Ebola treatment unit

FBI Federal Bureau of Investigation

FDA U.S. Food and Drug Administration
fMRI functional magnetic resonance imaging

GTS Ground Truth Solutions

HPV human papillomavirus

IHR International Health Regulations

MMR mumps-measles-rubella

NGO nongovernmental organization

PEPFAR President’s Emergency Plan for AIDS Relief

SARS severe acute respiratory syndrome

SOP standard operating procedure

UNICEF United Nations Children’s Fund

WFSJ World Federation of Science Journalists

WHO World Health Organization
 1

Introduction1

Building communication capacity is a critical piece of preparing for,

detecting, and responding to infectious disease threats. The
International Health Regulations (IHR)2 establish risk communication
—the real-time exchange of information, advice, and opinions
between experts or officials and people who face a threat to their
survival, health, and economic or social well-being—as a core
capacity that World Health Organization (WHO) member states must
fulfill to strengthen the fight against these threats. Despite global
recognition of the importance of complying with IHR, 67 percent of
signatory countries report themselves as not compliant (WHO,
2015). This lack of capacity has grave consequences, as shown
during the West African Ebola epidemic that began in late 2013 and
killed 11,325 people according to the U.S. Centers for Disease
Control and Prevention3 (CDC). The lack of communication
infrastructure and procedures delayed the transmission of key
messages from public health and government officials to the public
(Bedrosian et al., 2016). Furthermore, poor mechanisms were in
place for the public to share questions, concerns, and fears with
public health authorities (Wilkinson et al., 2017). By investing in
communication capacity, public health and government officials and
civil society organizations facing similar crises would be prepared to
provide advice, information, and reassurance to the public as well as
to rapidly develop messages and community engagement activities
that are coordinated and take into account social and behavioral
dynamics among all sectors.
Various organizations, including CDC (2011) and WHO (2008),
have provided guidance on developing frameworks, standards,
protocols, and conceptual approaches to communicating critical
information during infectious disease outbreaks. Furthermore,
governments and nongovernmental organizations have developed
and implemented plans to address the gaps in communication
capacity during these situations. Despite the progress, many
governments have not streamlined, integrated, or translated these
approaches into effective practice and self-reported to lack the full
implementation of risk communication capacity as defined under the
IHR (WHO, 2016b). Moreover, some of these efforts have not been
replicated or tested in different outbreak scenarios and have not
considered the entire political, social, and cultural environment in
which communication occurs.

MEETING OBJECTIVES
To learn about current national and international efforts to develop
the capacity to communicate effectively during times of infectious
disease outbreaks, and to explore gaps in the research agenda that
may help address communication needs to advance the field, the
Forum on Microbial Threats of the National Academies of Sciences,
Engineering, and Medicine convened a 1.5 day workshop on
December 13 and 14, 2016, in Washington, DC. This workshop
brought together stakeholders at different levels of outbreak
detection, preparedness, and response. They reviewed progress and
needs in strengthening communication capacity for dealing with
infectious disease threats for both outbreaks and routine challenges
in the United States and abroad. An ad hoc committee with
members Jeffrey S. Duchin (Chair), Baruch Fischhoff, Jennifer Gardy,
Rima F. Khabbaz, Rafael Obregon, Jennifer Olsen, J. Douglas Storey,
and Janet Tobias planned the workshop. The workshop featured
invited presentations and discussions that aimed to meet the
workshop’s objectives (see Box 1-1).4
In his welcome to the workshop attendees, David Relman, the
Thomas C. and Joan M. Merigan Professor at Stanford University,
noted that the forum members have been discussing the essential
role communication plays in the prevention, detection, and response
to microbial threats and have sought to organize a workshop to
discuss key problems and strategies around this important topic for
several years. “We view these topics as fundamental to the business
of translating theory and research and development into policy in the
realm of emerging infectious disease,” said Relman. Jeffrey Duchin,
health officer and chief of the Communicable Disease Epidemiology
and Immunization Section for Public Health in Seattle and King
County, Washington, added that the high-level goals of the
workshop were to highlight the benefit and importance of cross-
disciplinary contributions in this area and to examine opportunities
and challenges for building improved communication capacity and
capability.

BOX 1-1
Workshop Objectives
Examine the key elements of communication capacity
necessary to address infectious disease threats, including
scientific foundations for effective communication;
roles of scientists and health professionals, the community,
and media;
evidence-based methods for designing, pretesting, and
evaluating communication strategies; and
multisector support for investment in these capabilities.
 Examine the current state of science regarding public
engagement and trust, the understanding of risk and health-
protective behaviors, and behavioral responses, including
the cognitive, affective, social, and economic factors
shaping health-related decision making;
the roles of persuasive versus nonpersuasive
communication;
the roles of traditional and digital media;
proactive and reactive management of misinformation and
rumors; and
bidirectional communication platforms, both to engage the
public and to generate data.
Assess the implications of the 2005 International Health
Regulations (IHR) and lessons learned from recent
outbreaks.
Discuss research needs, opportunities, and barriers for
collaboration among, across, and within the epidemiology,
biomedical, and social and behavioral science communities.

ORGANIZATION OF THE PROCEEDINGS OF A

WORKSHOP
In accordance with the policies of the National Academies of
Sciences, Engineering, and Medicine, the workshop did not attempt
to establish any conclusions or recommendations about needs and
future directions, focusing instead on information presented,
questions raised, and improvements recommended by individual
workshop participants. Chapter 2 outlines different perspectives on
the challenges and opportunities of communicating infectious
diseases threats. Chapter 3 lays out the scientific foundation for
effective communication, drawing from the fields of social,
behavioral, and decision sciences. Chapter 4 discusses effective
communication in practice during an outbreak. It delves into
approaches in packaging stories, managing misinformation and
rumors, leveraging participatory surveillance and bidirectional
communication platforms, and training journalists and other
communicators on the ground. Chapter 5 presents the role of data
and evidence in the field, using lessons from the recent Ebola and
Zika outbreaks. Chapter 6 covers strengthening communication and
community engagement efforts in disease outbreak response from a
systems level. It describes the gaps of the international normative
aspects of risk communication under IHR and the elements needed
to implement communication capacity from a systems-strengthening
perspective. Finally, Chapter 7 reports on crosscutting themes and
possible strategies in building communication capacity to counter
infectious disease threats.

__________________
1 The planning committee’s role was limited to planning the workshop, and the
Proceedings of a Workshop has been prepared by the workshop rapporteurs as a
factual summary of what occurred at the workshop. Statements,
recommendations, and opinions expressed are those of individual presenters and
participants and are not necessarily endorsed or verified by the National
Academies of Sciences, Engineering, and Medicine, and they should not be
construed as reflecting any group consensus.
2 Available at www.who.int/topics/international_health_regulations/en (accessed
February 13, 2017).
3 See www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa (accessed February
23, 2017).
4 The full statement of task is available in Appendix A.
 2

Perspectives on Building
Communication Capacity to
Counter Infectious Disease
Threats

To provide some context for the workshop’s presentations and

discussions, John Rainford, director of The Warning Project; Maryn
McKenna, an independent journalist and author; and Stefano Bertuzzi,
chief executive officer of the American Society for Microbiology (ASM),
provided their perspectives on the challenges and opportunities in
communicating infectious disease threats to the public in a manner that
protects public health.

BUILDING RISK COMMUNICATION CAPACITY:

CAN IT BE DONE?
People such as Rainford who work to build risk communications
capacity repeatedly experience the incredible difficulty of balancing the
tensions between excellent ideas and the translation of those ideas into a
system that can provide reliable information to the people who need it.
One of the tensions, Rainford explained, arises because the multiple
audiences for risk communication have different ideas about what kind of
information is important and how they understand that information. As an
example, he laid out a scenario in which a health organization has learned
there was a serious problem with a single small batch of measles vaccine.
The director of the health organization might be most worried about this
news having a negative effect on an ongoing measles vaccination
campaign and on broader public confidence in vaccine-based programs,
but a mother is more likely to worry about the potential adverse reactions
her child could experience from the vaccine. “You have this dynamic in
terms of what the director wants to say and what the mother needs to
hear,” said Rainford. Although many people would agree that the proper
target audience for risk communication would be the mother, the typical
output from such a risk communication effort would be written at a level
that the director and his or her colleagues can process, but perhaps the
mother cannot.
Deciding on the timing of when to engage in risk communication
creates another tension, one between effectiveness and caution. A typical
disease outbreak, Rainford explained, proceeds along an epidemiologic
curve, and as the delay between outbreak and risk communication
lengthens, the opportunity to control the outbreak grows smaller (see
Figure 2-1). With an immediate response to the first signs of an outbreak,
the opportunity for control is large. However, when Rainford asks
audiences if they would communicate a serious emerging risk when the
potential is first identified or when all of the details are confirmed, 70
percent of the people say they would wait until the full details are
confirmed. He did note, however, that he is starting to see an attitudinal
shift on this point. The World Health Organization (WHO), for example,
recently declared that the Zika virus is guilty until proven innocent of
causing birth defects. “This is a step forward,” he said.
Although guidelines, policies, techniques, trainings, and professional
norms and standards are the foundations of capacity building, Rainford
said he also wanted the workshop participants to consider some “softer”
dimensions of risk communication. One dimension is performance
measurement, in which the “softness” comes from how one defines
success or failure. As an example, he discussed the work he did as part of
Canada’s response to an outbreak of severe acute respiratory syndrome.
“We failed at so many levels and were criticized at such an extreme level,”
said Rainford. However, when the government asked 10,000 people in
Toronto to go into self-quarantine, they complied. Was that risk
communication effort a success or failure? The answer, he said, was that
the public’s trust in the government was never broken, and although
criticism was substantial, the real performance measure was whether the
public followed the government’s guidance. The lesson, he said, is that
“we need to consider carefully what success and failure might be.”

FIGURE 2-1 As the delay between outbreak and risk communication widens,
the opportunity to control the outbreak diminishes.
SOURCE: Rainford presentation, December 13, 2016.

Other soft dimensions involve striking the right balance between

knowledge generation and knowledge translation and convincing
leadership of the strategic advantage of better risk communication. “We
see so often in capacity building that we generate systems, models,
techniques, and guidelines—they bubble up through the system, they get
to the corner office, and they stop because those people are not on
board,” said Rainford. As a final thought, he considered the question of
whether it is possible to build communication capacity to counter
infectious disease threats. “When we ponder, and we will over the next
day and a half, how central communication of risk is to success, to
protecting our people, to achieving our goals, it sounds a bit corny, but it
is really not, can it be done—it has to be done,” said Rainford.

POTENTIAL CHALLENGES FOR ACHIEVING

SUCCESSFUL COMMUNICATIONS FOR
INFECTIOUS DISEASE THREATS
The recent West African Ebola outbreak was centered in three countries
—Guinea, Liberia, and Sierra Leone—with 10 cases reported in the United
States. Eight of those individuals—seven medical or relief workers and
one journalist—were infected outside of the country, and one of those
eight infected two additional health care workers in the United States.
McKenna explained that the low risk of the disease spreading to the public
did not stop some unusual Ebola-related incidents in the United States,
including the following:

Boston, Massachusetts, closed a subway station when someone called

9-1-1 and reported a Liberian woman hemorrhaging on the platform.
In fact, she was Haitian and was vomiting.
The Greenville County, South Carolina, public school system
announced it would screen every new student for Ebola before
allowing the students to enroll in school.
In Hartford, Connecticut, a family had to file a lawsuit to get their
third-grade child into school after the school banned the child because
the family had taken a trip to Nigeria, which lies five countries away
from where the Ebola hot zone was located.
In Rochester, Minnesota, emergency medical personnel arrived to help
a flu victim from Somalia in full biohazard gear because the dispatcher
could not tell the difference between Somalia and Mali; the U.S.
Centers for Disease Control and Prevention (CDC) had issued a travel
warning for the latter.
The Stokes County, North Carolina, Board of Education forced an
assistant principal to stay home for a 21-day quarantine period
because she had been to South Africa, which is 5,000 miles south of
where the Ebola hot zone was located.
 “I’m sorry to say [these incidents] all contain the same lesson, which is
not that Americans are bad at geography, but that the mass public was so
alarmed by the idea of Ebola that they refused to listen to or could not
absorb the details of how you actually contract Ebola,” said McKenna.
“Therefore, the public felt a perception of risk of Ebola that was orders of
magnitude greater than what their actual risk here in the United States
was.” This perceived risk was true, despite many public health authorities,
including the directors of CDC and the National Institutes of Health, and
widely read and respected journalists, telling the public repeatedly that
the public was not at risk for becoming infected with Ebola.
In retrospect, she said, it should not be surprising the public so
profoundly misunderstands medical subjects given the persistent belief
among sizable segments of the population that vaccines cause autism and
that antibiotics can treat viral infections. A Wellcome Trust study based on
a series of lengthy interviews with members of the public revealed some
of the reasons people persist in seeking antibiotics (Good Business, 2015),
including the need to feel validated. “Warnings about [antibiotic]
resistance made them feel like they were being manipulated by the
authorities,” McKenna explained. She noted the recent election illustrated
vividly something that people in the infectious disease world have known
for years: consumers of news sometimes feel free to choose their
opinions and the facts they believe.
Efforts to communicate risk about infectious disease threats do have
one thing going for them, said McKenna. “The public loves scary
diseases,” she said. “When we talk about diseases, the public is disposed
to listen.” People may draw the wrong conclusions and they may
overreact, but they pay attention to officials they believe have authority.
The challenge, she said, is twofold. The first challenge is to put people
with reliable information into a position where the public will listen to and
believe the message they need to hear. The second challenge is to
communicate risk and information in language the public already uses.
“This is not the language that we use, that you use among yourselves, or
that you use when you are speaking to me and people like me,” said
McKenna. Speaking in jargon and insider language is something everyone
with expertise in a field does, she said, but delivering messages the public
will receive and understand requires resisting that tendency.
 PERSPECTIVES OF THE AMERICAN SOCIETY FOR
MICROBIOLOGY
Since 2006, an ASM program has worked on strengthening the capacity
of laboratories to detect infectious diseases such as HIV, tuberculosis,
malaria, and others in 23 resource-limited countries across sub-Saharan
Africa, Eastern Europe, Central Asia, and Southeast Asia, said Bertuzzi.
This program, which received funding under the President’s Emergency
Plan for AIDS Relief (PEPFAR), has trained more than 3,000 individuals on
emerging infectious diseases and has mentored more than 300 laboratory
staff, benefiting close to 1,000 institutions in the 23 PEPFAR focus
countries (IOM, 2013). One of ASM’s goals for this initiative, Bertuzzi
added, has been to become the hub of trusted and authoritative
information for both health authority directors and the public.
Recently, ASM has been advocating for the nation to establish an
emergency fund to address emerging biological threats such as Zika. The
purpose of this fund, said Bertuzzi, would be to avoid “reinventing the
wheel” every time a new threat emerges, as was the case when Congress
tried to find money to tackle Zika. ASM also helped establish the
Antimicrobial Resistance Coalition to facilitate communication among
agencies, nonprofit organizations, and other key actors. “We take the One
Health approach that brings together various environmental, zoonotic,
and human components because we are all part of the same ecosystem,”
said Bertuzzi. As part of the coalition’s activities, ASM will convene a
meeting of health attachés from the embassies in Washington, DC, to
offer the organization’s support to develop national action plans for
dealing with emerging microbial threats.
ASM is also developing a digital platform on microbiology that will
include a section specific to infectious disease threats. The organization’s
goal is for this site to be the authoritative and trusted source of
information as described by McKenna, one that will provide information
that everyone will be able to understand. ASM members will vet the
information and contribute commentary for this Micro Now digital
platform. A new online magazine, Germ Theory, will have the goal of
focusing the microbiology community on the issue of emerging infectious
disease threats.
 3

Laying the Foundation for

Effective Communication

“Risk communication is a bridging domain of research and practice, where

the biomedical and the social and behavioral sciences come together,” said
Douglas Storey, associate director at the Center for Communication
Programs at the Johns Hopkins Bloomberg School of Public Health, when
introducing the next section of the workshop, which discussed some of
the foundational research on effective communication and decision
science and examined the current state of science on understanding of
risk and health-protective behaviors from both the United States and
international contexts. The seven speakers who provided their insights
were Baruch Fischhoff, the Howard Heinz University Professor at Carnegie
Mellon University; Angie Fagerlin, inaugural chair of the Department of
Population Health Sciences at the University of Utah and a research
scientist at the Salt Lake City Veterans Affairs Center for Informatics
Decision Enhancement and Surveillance; Gary Kreps, university
distinguished professor and director of the Center for Health Risk
Communication at George Mason University; Noel Brewer, professor of
health behavior at the University of North Carolina at Chapel Hill; Rajiv
Rimal, professor and chair of the Department of Prevention and
Community Health at the George Washington University Milken Institute
School of Public Health; Monique Turner, associate professor and assistant
dean at the George Washington University Milken Institute School of
Public Health; and Jeff Niederdeppe, associate professor of
communication at Cornell University.

THE BUILDING BLOCKS OF SUCCESSFUL

COMMUNICATION CAPACITY
Fischhoff listed five important questions to answer when thinking about
building communication capacity to deal with infectious disease threats:

What information do we need to communicate about infectious

diseases?
What science do we need to acquire that information?
What people do we need to apply that science?
What organizational structures do we need to coordinate those
people?
What commitments will it take to make that happen?

The information to communicate to the public could include how severe

a particular disease is, how transmissible it is, where it is found, how
effective various protective measures are, and how practical those
protective measures are given personal and family circumstances. The
public also needs to know which sources of information to trust and when
news is real or fake, Fischhoff added. The public health community has its
own information needs, such as the beliefs and concerns of the
populations they serve, what resources they have, whom they prefer to
get their information from and what their trusted information channels
are, and what their experiences have been in past situations.
The science of communication design, said Fischhoff, is well developed,
and starts with an analysis that identifies the facts relevant to the choices
people face and then proceeds to descriptive research to determine what
people believe and want. The results from those activities inform the
design of measures to fill the critical information gaps, and evaluation
then measures whether the resulting intervention works. This process is
repeated as necessary, he explained, given that no intervention works
best at its first iteration. “The science base for learning about the public’s
needs is vast,” said Fischhoff, who noted that the National Academies of
Sciences, Engineering, and Medicine have contributed greatly to that
science base (Fischhoff and Scheufele, 2013a,b; NRC, 1989). “The
question is really about capacity building or how to use that science base,”
he said.
Deriving the information the public needs to know often involves
integrating knowledge from diverse sources and helping experts
synthesize that information in the most authoritative yet understandable
manner possible (Morgan, 2014). One common approach to eliciting
information from experts on the uncertainty of something happening,
Fischhoff explained, is to ask them the same question two different ways
to test whether their judgment is sufficiently coherent (Bruine De Bruin et
al., 2006). He noted that in 2014 the National Academies held two
workshops on characterizing and communicating uncertainty as it pertains
to the risks and benefits of pharmaceuticals (IOM, 2014) and gain-of-
function research (IOM and NRC, 2015).
Applying the science and executing a plan require involving people with
a range of expertise, said Fischhoff. Domain specialists need to provide
information on all aspects of a disease and any control mechanisms, he
explained, and analysts then need to reduce the “firehose of information”
from the domain experts into a form relevant to the different intended
audiences. Experts from the social sciences, behavioral sciences, and
humanities provide guidance on the needs of those intended audiences so
the content experts can address those audiences with some
understanding of who they are. Application professions train the content
experts, prepare materials appropriate for specific audiences, and oversee
the plan. A coordination mechanism is needed, Fischhoff said, so that
everyone involved can provide input at each step, but in the end, the final
authority rests with the experts in each of these domains.
With regard to the organizational structures required to coordinate all
this activity, Fischhoff said structures are needed to connect professionals
with other professionals within and outside their own disciplines, as well
as to coordinate interactions within the public audience. Two key points
here, he said, are that the public must be consulted throughout any
communication effort and findings need to be communicated to all
stakeholders (IOM, 1999). He referred to a Canadian process for risk
communication (Fischhoff, 2015) that solicits audience feedback between
every stage of developing that effort (see Figure 3-1) as an example that
could be an effective organizational structure.
 Evidence and preparation, Fischhoff highlighted, are two commitments
needed to take advantage of the science, assemble the public, and
organize them to address the situation. The U.S. Food and Drug
Administration (FDA) published a report in 2011 that discussed the
commitment to evidence in risk communication (Fischhoff et al., 2011).
Each chapter in this FDA report summarizes the science of a particular
topic, such as health literacy, shared decision making, and practitioner
perspectives; offers best guesses about the practical implications of the
science; and shows how to evaluate communications for little or no
money or for a larger amount of money commensurate with the personal,
organizational, and political stakes riding on effective communication.
A commitment to preparation, Fischhoff explained, requires developing
consultative relationships with the public and among professions and
leaving enough time to make use of those relationships. He added a
commitment to preparation also requires having pretested communication
modules for specific classes of information and resources for expert
elicitation, message testing, and tracking public response. Forcing a
project out the door simply because of a deadline most likely means that
something will not have been done correctly. Fortunately, said Fischhoff,
infectious disease threats have a particular set of characteristics that a
modifiable and reusable structure can address without having to start
from scratch for each new threat.
 FIGURE 3-1 Connecting professionals with the public in creating a risk
communication plan.
SOURCES: Fischhoff presentation, December 13, 2016; reprinted with
permission, from Fischhoff (2015). Copyright 2015 by American Association
for the Advancement of Science.

FDA has developed a strategic plan for risk communication (FDA Risk
Communication Advisory Committee, 2009) that attempts to balance
moving too early and raising a needless alarm and moving too late and
missing an opportunity to reduce mortality and morbidity. FDA, said
Fischhoff, has recognized that it does not know the public audience very
well. This type of document addresses building baseline capacity within an
organization, but a need also exists to prepare surge capacity that brings
in external resources, particularly people who are not on the front lines at
all times and who have time to think about these types of issues. As an
example of surge capacity, Fischhoff mentioned the Applied Psychology
Unit at the United Kingdom’s Medical Research Council, which was a
collection of external experts who conducted behavioral research and
stood ready to help British agencies and stakeholders.
Summarizing his presentation, Fischhoff said the science of
communicating well about infectious diseases exists and is often used
effectively. Communicating well about infectious diseases, he stated,
requires diverse forms of expertise and trusted relationships. He added
that providing the resources and organization needed to address routine
challenges and disease outbreaks requires strategic leadership.
When asked what he thought the biggest challenge to successful risk
communication was, Fischhoff replied that the biggest challenge was not
letting the problem get out of control. “Research suggests that you can
explain most things to most people if you have not lost control of the
problem,” he said. “But once the problem gets out of control, then you
have other people grabbing the microphone who have other agendas and
you have misinformation that gets out.” As examples of what can go
wrong, he said the climate change community and nuclear power industry
made the mistake of believing that their story would tell itself. Capacity
building that views communications as a two-way process and includes
trust-building activities can enable organizations to get out in front and
stay ahead of problems, Fischhoff added.

LEARNING FROM THE DECISION SCIENCES TO

DESIGN TARGETED MESSAGES
One story Fagerlin shared that McKenna did not mention in her list of
inappropriate actions triggered by the West African Ebola crisis was that
of a bridal shop in Akron, Ohio. This shop closed after 30 successful years
because one of the nurses later diagnosed with Ebola had visited the shop
in October 2014 to help her bridesmaids try on dresses. The store worked
with officials to do a deep clean and reopened, but when the owner
closed the store for good, she said the public thought of her store as the
Ebola shop. “This is a great example of the difference between people’s
feelings of risk and their actual risk, how that disconnect can affect their
decision making, and the consequences that result from that decision
making,” said Fagerlin.
The goal of risk communication, she said, is to have people’s
perceptions and feelings of risk match the actual risk they experience.
How the public perceives the risk of influenza is another example, albeit in
the other direction. In this case, said Fagerlin, many members of the
public do not perceive there to be much risk; hence they do not get flu
shots, even though the risk of consequences from influenza are
substantial.
Many people in the public health community, when confronted with a
disease, try to learn as much as possible and then try to communicate all
that information to the public, she said. Fagerlin noted that the
consequence of that approach—of appealing to the director instead of the
mom—is providing too many details, and the typical layperson does not
know which details are important. However, she added, paying attention
to which details to communicate and what words to use can create quality
messages that can shape the resulting emotional response to risk. For
example, a study she participated in found that people felt more at risk
when messages used the words “H1N1 influenza” instead of “avian flu”
and were more likely to want to get the vaccine. “A two-word difference
affected people’s willingness and interest to get vaccinated,” she said. This
study also found that talking about the typical symptoms of influenza had
a bigger impact than discussing the most severe symptoms on people’s
risk perceptions and their willingness to vaccinate. One finding contrary to
what many experts believe was that people want communications to be
certain and to not acknowledge the uncertainty of a situation.
Fagerlin and her colleagues also looked at the effectiveness of three
devices for communicating risk visually: a picto-trend line, a dot map, and
a heat map (see Figure 3-2). The heat map and dot map were largely
equivalent in their effectiveness at conveying risk, though the heat map
was slightly better at increasing the people’s understanding of how many
individuals contracted influenza and died. The picto-trend line was not
useful in this case, so she suggested avoiding its use.
 FIGURE 3-2 Different devices for communicating numbers visually.
SOURCE: Fagerlin presentation, December 13, 2016.

Fagerlin noted that, of the three choices, participants in the study liked
the heat map best, a key finding given that aesthetics can play a
significant role in getting people to pay attention in the first place. In the
social media age, when information sharing is important, people are more
likely to share something they find aesthetically pleasing, she said. “As
long as different approaches are equivalent in terms of knowledge, risk
perception, and behavioral intentions, I think it is important that we ask
people what they like and do not like so that we can communicate farther
and wider,” said Fagerlin.
Persuasion can be a critical risk communication tactic for influencing
behavior, but persuasion using social norms can be tricky, said Fagerlin. As
an example, she explained that telling people that almost half of all
American adults do not vote does not inspire people to vote. In fact, she
said, it has the opposite effect because it absolves them of the guilt of not
voting. The same is true for immunization: trying to inspire people by
using the concept of herd immunity to get them to contribute to that
common good has the opposite effect.
One promising risk communication tactic is to target messages and the
media for conveying those messages to reach specific groups of people.
“How we communicate should differ based on the audience that we are
trying to reach,” said Fagerlin. However, in this age of informatics and
social media, message targeting should be more sophisticated than basing
it on broad categories such as sex, race, or ethnicity, added Fagerlin.
Given that Google can pop up ads based on what someone searches for
on Amazon, Fagerlin wondered how the public health community could
make the same type of highly targeted connections.
Fagerlin briefly discussed message evaluation, and how many
investigators, including herself, use survey measures to assess knowledge,
risk perceptions, behavioral intentions, and satisfaction with messages.
However, she said, surveys may not be the best approach for evaluating
messages, and as an example she discussed the results of a study on the
effectiveness of various public service announcements intended to get
smokers to call a quit line (Falk et al., 2011). In this study, Falk and her
colleagues had participants watch several professionally created television
ads and asked them which would be more effective at getting people to
quit smoking. A second group of participants watched the same ads while
the researchers monitored the participants’ brain activity by using
functional magnetic resonance imaging (fMRI). When these ads ran on
California television stations, the fMRI results accurately predicted which
public service announcements would be the most effective; the survey
results had no predictive power. Although testing every message using
fMRI is not feasible, it points to the importance of using other
physiological and ecological measurements, such as how long people look
at messages and how often they share them, said Fagerlin.
She noted in closing that it is imperative to think about who the
audience is and to talk to that audience before launching a campaign.
Using new services such as Amazon Mechanical Turk, Knowledge
Networks, and Survey Sampling International, she suggested, is a
relatively simple and quick means to test various strategies with intended
audiences.

EVIDENCE-BASED METHODS AND EVALUATION

STRATEGIES
Although he describes himself as a big believer in the power of
communication to address major health problems, Kreps said many
misconceptions limit its effectiveness. Perhaps the biggest misconception,
he said, is that communication is easy to do well. “I think people try to
come up with relatively simple, broad, encompassing, and powerful killer
messages to address major complicated health issues, and sometimes
they work, sometimes they do not, and they often make things worse,”
said Kreps. He stressed that with infectious diseases, for which the
situation can change quickly and there are many risks and issues involved,
it is particularly important to communicate in ways that are most
meaningful to the populations that need information and that provide
them with information they can use.
Strategic, evidence-based risk communication is a critical component of
a strategy to achieve that goal, said Kreps, and he encouraged the
workshop participants to develop the kind of strategic communication
activities described in his presentation. What happens more often than
not, he said, is that well-intentioned public health communicators forge
ahead with limited data on how effective messages will be at reaching
their intended audience, if the audience is even paying attention to the
messages, and whether the messages are influencing behavior. Instead,
he added, they need to be asking the following questions before
launching yet another messaging program that may or may not
accomplish anything:

What do we know about how well the programs we have developed in

the past have worked and how well the programs we want to develop
in the future will work?
How effective have we been at reaching different people, and how do
they respond?
What has happened in the past that would encourage us to use similar
or different strategies in the future?
Have there been any unintended consequences from past efforts that
made matters worse, such as triggering unrealistic fears?
Have past efforts provided people with the support, encouragement,
and reinforcement they need to take action or change behavior?

Above all, he said, it is important to be honest about whether anyone

paid attention to past communication programs. “Much of the research
shows that risk communication and public health communication in
general often have extremely limited exposure,” said Kreps. “This is not
the primary place that people want to focus their attention, and they
often will hear some little tidbits about the danger but not a lot about the
recommendations.”
One problem, he added, is that many people design risk communication
programs from their own frame of reference. The messages make sense
to them, they understand the information and the risk, and they are
already compelled to take action. “Typically, though, the people who are
designing the programs are not the ones you are trying to reach. They are
not the ones that are at risk. They are not the best barometer of what
works and what does not work,” said Kreps. “We need to be going out
and focusing on who are the people you want to reach and what are their
issues.”
It is important, then, he added, to understand how diverse audiences
have responded to these programs. “One of the things that I want to talk
to you about is segmenting your messages to specific at-risk populations,
because the idea of one-size-fits-all does not work well with risk
communication,” said Kreps. “You need to figure out who you want to
communicate with, who the people are, who are most misinformed, who
is at greatest risk, where they get their information, what do they need to
know, what is going to work for them in their lives, in their communities,
within their families, and what they can and cannot do. Once you know
these things, then you can be very strategic about the ways that you
communicate.”
Kreps stressed the importance of setting measurable goals and
outcomes and having funds to evaluate the effectiveness of a messaging
campaign. With regard to infectious diseases, which are always going to
be around, he urged that evaluation should become a standard operating
procedure that includes generating baseline data on what people knew
and what they were doing before a program launches. Without such data,
it is difficult to know if a program has met its goals. He noted, too, that
many powerful social and behavioral theories explain how different types
of messages influence people, how people perceive different types of
messages, and how they interpret the information in those messages.
These theories can provide practical insights into what type of messages
and information make people want to take action and to recognize,
respect, and believe different sources of information.

Three Stages of Evaluation Research

After recounting some of the many reasons he has heard public health
communicators cite for why they do not do research and evaluation, such
as resource and time constraints, Kreps dismissed them all by pointing out
that having good data is like turning on a light. “When you are dealing
with a crisis, you want to see where you are going and why you are going
there,” he said. “Good data allow you to adjust, refine, and improve over
time.” He also cautioned that creating a good message is hard and rarely
accomplished on the first try, which again argues for the importance of
ongoing evaluation. Data can also shine a light on whether the outcomes
that a program achieves were worth the investment.
Formative evaluation of health communication is critical, said Kreps, as
it can assess the need for a communication program. Formative
evaluation can identify and segment key audiences so that tailored
messages will reach the most homogeneous groups, and it includes
extensive audience analysis research to understand the backgrounds,
interests, communication orientations, literacy levels, and expectations of
those audience segments. Formative evaluation can also identify the best
channels to reach audiences and the most effective message strategies to
influence those audiences.
Process evaluation, conducted during a communication campaign, tests
program implementation in key settings to see how well the program is
accepted and used. It also tracks initial user responses to programs to see
how audience members interpret messages. “You need to evaluate how
people are responding to your messages,” said Kreps. “Do they
understand them? Are they paying attention to them? Are the messages
influencing them? Are people doing what you want them to do or are they
doing something else?” Process data, he explained, enable tracking
messages, assessing their effectiveness, and refining those messages.
Kreps said he is a big believer in feedback, and he stressed the
importance of building a process of getting feedback into every
communication program. “We need to get people to tell us what their
experiences are, what they want, what they like and do not like, and then
use those data to refine our messages over time,” said Kreps. “We need
to track responses to refine programs and figure out what works so that
we can implement and sustain those good parts of the programs.”
Summative evaluation is the last piece of the research process, and it
takes advantage of the data generated during the formative and process
evaluations, explained Kreps. Summative evaluation assesses patterns of
program use and overall user satisfaction with the program. It evaluates
message exposure and retention and tracks changes in key outcome
variables, such as learning, health behaviors, service use, and health
status. Summative evaluation aims to identify the best program strategies,
features, and approaches, including building support for sustaining
successful programs. Summative evaluation may also benefit from
including an economic analysis of a program’s costs and benefits.
When asked to speak to some of the challenges of incorporating
research into the risk communication cycle and making it an integral part
of planning in decision making, Kreps said the biggest issue is that people
do not realize the complexity of the research process and therefore do not
figure out ahead of time how to collect the data needed for research and
evaluation. One solution he and Fischhoff both recommend is for public
health agencies to have at least one person on staff who is good at
collecting social science data and who understands how to use them. “It
has not really been a priority in the past, but I think that there is an
opportunity to recruit students who are now developing expertise in this
area,” said Kreps. There are many experts in academia, Fagerlin added,
who would love to collaborate with public health agencies to develop
ongoing data collection and analysis procedures.
Kreps noted there is a tremendous amount of archival data available
from previous research and demographic studies about different
populations that every researcher should access ahead of time. Doing so,
he said, would allow a project to move more quickly. He also suggested
that risk communication programs should be gathering more information
from in-depth interviews with key informants from different communities,
both to understand the needs of those communities and to build close
relationships with them ahead of time. “I think if we can build those kinds
of ongoing flowing data sources, we can be a lot smarter about the ways
that we respond, and also be a lot more adaptive than we have been in
the past,” said Kreps.

Building the Infrastructure for Data Collection

When Damien Chalaud, executive director of the World Federation of
Science Journalists, questioned how to collect data in countries that have
little or no infrastructure, Kreps agreed that working in the absence of
resources and infrastructure is a challenge, which is why he believes it is
important to build a network of people in the community who can serve
as an ongoing source of data. The growth of social media and the digital
environment worldwide can also be a source of data given that people
can post and provide information about their experiences and provide the
Another random document with
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Tervehdä minulta näitä
Humala-päitä!

J. F. Granlund

[Ensikerran painettu 1837.]

WIIPPERÄN ULLALLE

Mukailtu C. M. BellmanIN teoksesta "Fader Berg i hornet stöter" etc.

Torvi. –– Pamppu soittaa torvellansa,

Tyttö kaunis riemussansa
Tanssailla löyhyttää.
Torvi. –– Katsos kuinka Pamppu tässä
Kyöstin kanssa juo ja mässää,
Päätänsä löylyttää.
Hurroo! Kas, Ulla tanssaa
Loistavissa vaatteissansa;
Walkosia kinttujansa
Katsokaas! :,:
Ne välkkyivät jo taas.

Torvi. –– Torven ääni raikuvainen,

Laulu kaunis kaikuvainen
Kestissä hauskuuttaa.
Torvi. –– Katsos, tuossa Ulla kukka,
Puna-kenkä, valko-sukka,
Noin menee sipsuttaa.
Hurroo! Kas hamettansa
 Liehumassa lennossansa,
Katsos kuinka Pamppu kanssa
Kurkistaa, :,:
Ja vahtaa nurkista.

Torvi. –– Soita torvee peijakasta

Aikalailla akkunasta,
Nyt tulee vähittäin
Torvi. –– Kreivijä ja paroneita,
Trakuunoita, husareita,
Taas juomaan tänne näin.
Hurroo! Kas Ullan iloo,
Katsos tupsu-päitten tuloo,
Nytpä vasta hauska elo
Aljetaan! :,:
Hei! Pamppu, soita vaan!

Torvi. –– Torvi soi, ja pauhinalla

Juovuksissa pöydän alla
Kilvassa kontataan.
Torvi. –– Ulla kukka koriana,
Joka päivä morsiana,
Huhtoopi mennä vaan.
Hurroo! Hän laulullansa,
Hauskuuttaapi vieraitansa.
Pyörä-päänä niiden kanssa
Ryömimään, :,:
Ja maata tänne jään!

J .F. Granlund

[Ensikerran painettu v. 1837.]

KROUWILAN ÄMMÄLLE

Mukailtu C. M. Bellmanin teoksesta: "Kära mor, slå nu hand på

kjolen."

Wijooli – – Ämmä, hoi!

Hyppää keviänä,
Hame leviänä,
Nyt vijooli soi.
Wijooli – – Katsokaas
Äijäseni tätä
Kyösti raukan hätää,
Kieli katkes taa.
Soita, tensta, juo ja pauhaa,
Ett'ei peijakaskan rauhaa
Wijooli – – Saisi soitoltas.

Wijooli – – Ämmä, so'!

Tuokaa viinaa tänne,
Tuokaa tyttöjänne,
Kiiruusti nyt jo!
Wijooli – – Ett'ei vaan
Pelin-soittajamme
 Pääsis joukostamme
Pojes karkaamaan.
Hei! Kas, kuinka pöydän alla,
Juovuksissa konttaamalla,
Wijooli – – Jaloin tapellaan.

J. F. Granlund

[Ensikerran painettu v. 1837.]

JUOPPO JÖRSISTÄ WALITUS-LAULU

Mukailtu C. M. BellmanIN teoksesta "Hjertat mig klämmer" etc.

Nyt surussani
Wijooliani
Sormilla soitan näin: pling plang.
Pöydät ja pannut,
Pullot ja kannut
Rikki ja nuriin päin. Kling klang.
Krouvin ovi auki seljällänsä,
Hengetönnä Jörsi kyljellänsä
Laattialla pullo vieressänsä,
Klingeli plingeli klingeli plang.

Woi sentään tätä

Tuskaa ja hätää,
Mistäs nyt ryypyn saan? pling plang.
Seinässä riippuu
Torvi ja piippu;
Wiinaa ei löydy vaan. Kling klang.
Pillit, sarvet, vijoolit ja räikät
Orvoiksi ne seinään roikkuun jäivät.
Kun nyt loppui Jörsi raukan päivät.
Klingeli plingeli klingeli plang.

Kolkutan vielä:
Onkohan siellä
Yhtään henkee? — Hei! — Pling plang.
Ei ketään ole,
Ei ketään tule;
Myrkkykös kaikki vei! Kling klang.
Pois on olut juossut tynnyristä,
Wiinat, sahdit maahan lekkeristä;
Kas, se vasta sydäntäni pistää.
Klingeli plingeli klingeli plang.

Nyt kiusallakin
Päähäni lakin
Lasken ja lähden pois. Pling plang.
Wiinaa en maista,
En edes haista,
En, vaikka kuka tois! Kling klang.
Kuollo kulta on jo ystäväni,
Jörsi vainaata on ikäväni;
Perässänsä lähden mielelläni.
Klingeli plingeli klingeli plang.

J .F. Granlund

[Ensikerran painettu v. 1837.]

YLÖLLISYYS

Mukailtu C. M. Bellman teoksesta: "Supa klockan öfver tolf" etc.

Juovuksissa kaiken yön

Riihotonna reuhon,
Tuolit, pullot rikki lyön,
Kirkaten ja teuhon
Enkä muusta huolikkaan
Kun ma aika ryypyt saan,
Ryypyt saan, :,:
Ryypyt saan, :,:
Kuolemaani asti
Yhtä runsahasti.

Waikka takki ylläni

Roikaleina roikkuu,
Wiinaa sentään kylläni
Juon niin että loikkuu.
Kaiket päivät vähittäin
Pullostani ryypin näin,
Ryypin näin, :,:
Ryypin näin, :,:
Että puna noista
Poskistani loistaa.

Taata vainaan', jos hän vaan

Pääsis haudastansa,
Ryypyn juoksis ottamaan
Mielellänsä kanssa.
Sitte mulle sanois taas:
Weikkoseni otetaas,
Otetaas, :,:
Otetaas, :,:
Lähtö-ryypyt tästä
Mailman elämästä!

Joska rikkaaks' tulisin

Riemukseni kerran,
Loistavana kulkisin
Yli monen herran;
Oitis uuden takinkin,
Housut, kengät ostaisin,
Ostaisin, :,:
Ostaisin, :,:
Myöskin kellon kanssa
Kulta-viljoissansa.

Mutta suutani en saa

Kuivillansa pitää,
Sitävasten pullosta
Lahduttelen sitä:
Weikkoseni! otetaas
 Riemuksemme ryyppy taas!
Ryyppy taas! :,:
Ryyppy taas! :,:
Sitte nukkukaamme
Pullot huulillamme.

J .F. Granlund

[Ensikerran painettu v. 1837.]

[Tässä ei yllytetä ylöllisyyteen, vaan osotellaan ylöllisesti

nautinneen käytöstä.]
SOMA SOTKUSESTA

Mukailtu C. M. Bellman teoksesta "Käraste Bröder, Systrar och

vänner" etc.

Ystävä-kullat, Siukut ja Weikot!

Sotkunen, vaikk’ on sormensa heikot –
Wirttääpi viuluansa
Ja kieliä kynsin lyö.
Silmä on poisa, nokka on poikki;
Sylkeepi Wiulun tappihin loikki;
Katsoopi kannuansa,
Nyt ankara alkaa työ:
Wiulu – – – Suu on kuin kiulu;
Wiulu – – – Winkuupi Wiulu;
Wiulu – – – – – –
Ääniä ratkoo, katkoo ja syö.
Hei! Weli-kullat, varvastakaa;
Reuhkana olla raivoilla saa.
Kah! kun Kaisa kukka,
Siisti sini-sukka
Kengin sievin sipsuttaa.
 Kah! kasvojansa liehtoopi Lassi;
Hampaissa kärsä, housuissa massi;
Sinne ja tänne tuiskii;
Juo viinan kuin laho-puu.
Keltanen kesä-voikko on takki;
Korvilla lammas-nahkanen lakki;
Luimussa-korvin luiskii;
On naama kuin täysi kuu.
Wiulu – – – Siirolla silmin,
Wiulu – – – Kallella korvin;
Wiulu – – – – – –
Hyppää kuin härkä, märkän' on suu.
Siukkuni! sievä on erittäin
Hyppiä, hupa, kohmelo-päin
Ynnä kaiken yötä.
Maija tulee myötä,
Selkä suoraan – juuri näin.

Kah! kuka tuoll' on kauhtana yllä?

Niin tuoko halli-saapas? Se kyllä;
Tuo joka niinkuin hylje
Nyt tanssata työttii – tuo!
Saakeli soi! Kah sammetti-ranne;
Ympäri päätä punanen vanne.
Juo, Sotkunen, ja sylje;
Hyi! Konnakos kaljaa juo?
Wiulu – – – Pulloss’ on juomaa
Wiulu – – – Pannusta tuomaa;
Wiulu – – – – – – – –
Wetääkös nahka, rahkanen suo! –
Siukut! nyt rinkiin remahtakaa;
 Laukata, nauraa, langeta saa.
Silmät siki-umpeen,
Korvat kovaan lumpeen;
Pelimanni oksentaa.

Huh! tyttö-hurjat, hentoo ne mennä!

Nostata helmaas Liisa ja lennä;
Wie – Pelimanni tahtoo –
Pihkaa ja viinaa tilkka vie.
Sotkunen kuule! tunnetkos tuota
Nyt joka astuu akkunan luota?
Eukkohan tuolla kahtoo
Karsas-silmä. Sekö lie,
Wiulu – – – Pyylevä pankka;
Wiulu – – – Astuu kuin ankka;
Wiulu – – – – – – – –
On siinä muori nuori kuin tie.
Tyttöjä tääll’ on vaikkapa nais;
Oltta ja viinaa oivalta sais;
Täällä olet sinä,
Täällä olen minä,
Täält’ ei poiskaan haluttais.

Kemell
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