From: Crawford Kilian
To: Adel bin Mohammed Faqih, Minister of Labour and Health, Kingdom of Saudi Arabia
Subject: An effective health-communication strategy about MERS
I congratulate Your Excellency on the new tasks assigned to you. As you are doubtless aware, the outbreak of Middle East Respiratory Syndrome has caused concern and alarm across the Kingdom and around the world. Having followed the progress of MERS since 2012, I believe I have some grasp of the seriousness of the problem. And I am not alone in believing that part of the problem, both political and epidemiological, stems from an ineffective strategy in releasing information on MERS.
Because such information has been so inadequate, Saudi social media are full of rumours; the Ministry of Health suffers from a lack of trust in its statements; and even other health agencies, national and international, are worried about the refusal to share critical information.
Last year, months after the inadequacy of the MERS reports had become apparent, I posted a memo here addressed to your predecessor. I respectfully re-submit my suggestions, with some further thoughts:
An aggressive, open communication policy is now urgently called for. Rather than indulge in a litany of past problems, I would like to recommend some steps your ministry could take right now to ease concerns around the world while also ensuring solid support from Saudi professionals and public.
1. Frame a detailed, standard format for reporting each case.
At a minimum, this should include:
• the age, gender, and occupation of the patient;
• mention of specific underlying medical conditions, if any;
• place and date of onset;
• a description of treatment and place of treatment;
• the specific relationship, if any, to previous cases;
• tests administered and results of those tests;
• if possible, a statement by a Ministry spokesperson putting this case in the context of recent events.
Each case should be announced when the suspicion of MERS arises, and mentioned again when test results are known and when the patient recovers or dies. On occasion, a more detailed account may help to explain what is being learned about the disease, or why a particular case has developed in an unusual way.
The Ministry of Health, in its reply to my original note, commented on the need for privacy, a view I fully share. But the format I suggest above should adequately protect patient and family privacy, while providing two additional benefits: experts will have more information on which to base their search for the sources of infection, and the public will believe what the MOH says.
2. Give the struggle against MERS a human face and official voice.
In China, Dr. Zhong Nanshan has ably served as an authority against SARS, H5N1, H1N1, and now H7N9. When his new is bad, his blunt statements do not disturb; they reassure the Chinese public that he is being honest with them. When he has good news, it is therefore trusted.
In the Kingdom, Dr. Ziad Memish has already assumed this role to a certain extent. He has great credibility with his colleagues around the world, and his scientific papers on MERS are read attentively. His posts to ProMED-mail have been welcomed. He can do more—both to advise his foreign colleagues through more scientific publications, and to interpret the science of MERS for the Saudi and international public.
3. Improve the information content of your MERS site, in both Arabic and English.
The Arabic site appears to be updated promptly, but reports of new cases fail to indicate most of the details listed in my first point above. All too often, the first we learn about a new case is the report of the victim's death.
Surprisingly, we rarely hear of MERS cases recovering and leaving hospital. The Chinese, especially in the early months of the H7N9 outbreak, made a point of reporting the happy departure of patients to the applause of their doctors and nurses. Doctors Without Borders, in its reports from Guinea, are doing the same thing with recovered Ebola patients. Every victory counts.
The English site shares the same problems, aggravated by a persistent slowness in updating. Surely the MOH must have bilingual staff who can post English-language reports simultaneously with the Arabic reports.
The MOH is frequently quoted in the Saudi media as warning people to trust only its own announcements, not the rumours in the social media. Such rumours will vanish will people believe they are getting the full, unvarnished truth from your Ministry, which the social media will pick up and transmit because you will be trusted.
As an example of how you could improve your online information, please consult the website of CIDRAP at the University of Minnesota. It combines both breaking news and permanent features, including an excellent MERS-CoV Resource List—with links to the MOH MERS-CoV page. With a more technical approach oriented to health professionals, ECDC's website is still accessible to non-specialist readers.
I realize that these suggestions are both simple and difficult to implement. They require a clear policy, effectively implemented by trained communications experts with solid political backing from you and your government. But public health, like justice, must not only be done; it must be seen to be done.
It would also be wise to treat MERS not only as a threat but as an opportunity: In combatting the disease, the Kingdom's health resources face a challenge they must rise to; when they do, it will be a proud day for all Saudis. They will enjoy the applause and respect of the Arab world, the international Muslim community and indeed the whole world, for the Saudi government's courage, honesty, and dedication.
Rest assured that people around the world sincerely want the Kingdom of Saudi Arabia to overcome this mysterious disease, and to point the way for the rest of us. Since you, Your Excellency, are the new leader of the effort against MERS, you can tell us how that effort is going. We wish you every success.