2009 Flu Summit: Risk Communication & Closing Statements

[Howard Koh] We have absolutely a top notch panel to end the day, and so
I'll turn this over to Dr. Besser and Dr. Reynolds.
[Barbara Reynolds] Thank you, Dr. Koh.
I want to talk about crisis and emergency risk communication
in terms of a framework, in which we're using, and to
explore crisis and emergency risk communication through the H1N1
case study basically.
And so Dr. Besser graciously agreed to let us take a look
at some of his work during the last couple of months, and then
dissect it or deconstruct it, whichever way we're going
to go about it.
But I wanted to say before I begin that we're going to talk here
pretty quickly about some overarching principles,
and then open it up for questions.
So we are going to leave about 15 minutes of the time that we have
before 3:29 to answer questions.
So please, as you have them, you know, be ready to just
jump up, and we'll answer as many of them as we can.
I want to make the point that when we're talking about crisis and
emergency risk communication, we are talking about risk
communication in an atmosphere of great uncertainty; that's
what makes it a crisis.
And it can be pretty daunting for people to work through what needs
to be said and how it needs to be said within that context
of uncertainty, but it can be done.
I do want to state unequivocally that there were challenges.
There's no question about it, in CDC and other organizations
around the country, we had challenges, and some of those
include "What are we going to name this virus?"
You know, we had a switch in names, right?
We had some questions about travel restrictions.
We had questions about school closings and, of course,
is this a pandemic or isn't it?
So I'm not here saying that there's any magic way to go
about communicating in a crisis, but there are things you can do
to communicate and ways to approach that communication
to maintain your credibility despite the uncertainty,
and despite the challenges that come with the kind of crisis
that we were dealing with.
I'd like to, before we go on, to actually just show -- if that's
okay, Dr. Besser -- a few of your clips.
I have some clips from press conferences that he held from
CDC, and then also some of the national coverage that you may
be familiar with.
So if we could just show those clips really quickly.
[begin clip]
[Dr. Besser] -- talk about the cases and specific actions, I want
to recognize some initial guiding concepts.
First I want to recognize that people are concerned
about this situation.
We hear from the public and from others about their concern,
and we are worried as well.
Our concern has grown since yesterday in light of what
we've learned since then.
I want to acknowledge the importance of uncertainty.
At the early stages of an outbreak, there's much
uncertainty, and probably more than everyone would like.
Our guidelines and advice are likely to be interim and fluid,
subject to change as we learn more.
We're moving quickly to learn as much as possible and work with
many local, state and international partners to do so.
I always like to make the point that control of an outbreak of
infectious disease is a shared responsibility.
There are things that individuals need to do, there are things that
communities need to do, there are things that the government
needs to do.
Frequent hand washing, if you don't have access to soap and
water, use an alcohol gel; covering your cough or your
sneeze, that's very important; and if you're sick, if you have
a fever and you're sick, and your children are sick, don't go to
work and don't go to school.
[end clip]
[begin clip]
[Female Speaker] Dr. Richard Besser is the Acting Director for the
Center for Disease Control and Prevention.
Dr. Besser, thanks for being with us.
[Richard Besser] Thank you very much for having me.
[Female Speaker] We know that health officials so far have stopped short of
calling this a pandemic, but what's your level of concern
that this flu epidemic could turn into just that?
[Richard Besser] We are very worried about the situation taking place
in Mexico and the potential for development into a pandemic.
We are working very closely with the World Health Organization,
and we'll be participating in their expert meeting, to look
at the evidence to date and determine whether a change
in the pandemic status is warranted.
[end clip]
[begin clip]
[Female Speaker] Let me ask you about the CDC's response to the swine flu
outbreak in this country.
There's a private company called Veratech that monitors health
crises like swine flu, and apparently they had contacted
the CDC with a warning on April 6, and again on April 16, but the
public didn't find out about it until April 24.
Why the delay in getting that information to the people?
[Richard Besser] You know, I'm starting to hear these reports and, with any
outbreak response, one of the things we do as it goes forward
and into the future is look to see: was there anything
we knew or anything anyone knew that would have allowed us or
could have allowed us to detect this sooner?
And we use that information to improve our systems so that in
the future our detection efforts are much faster.
[end clip]
[begin clip]
[Male Speaker] "We should brace ourselves for the possibility of more deaths
as a result of swine flu or H1N1."
Do you still feel that way?
[Richard Besser] Well, let me put encouraging -- in context.
Every year with seasonal flu we see 36,000 deaths, so influenza
is a very serious infection.
What we're seeing though, as this spreads around the country,
is that the rates of hospitalization are
not different, so far, than we've seen with seasonal flu
and that's encouraging.
The bottom line, though, is that people need to stay the course
in terms of hand washing, covering their coughs,
and staying home if they're sick.
[end clip]
[Dr. Reynolds] Those are just a few of the questions that Dr. Besser
faced early on in the evolution of H1N1.
Before we go on and talk about that, because I'm sure you have
something you'd like to share with us, I just want to say that for
good communication to work in a crisis situation for any office
or organization, there has to be a trusting collaboration between
your communication professionals and the leadership.
And that becomes very important in situations like that, both sides
have to be able to work together to come up with the right messages
and right tone.
And, of course, it's better if a little of that training occurs
before the crisis presents itself.
I think that's a message we've been hearing all day long.
I also want to make the point that Dr. Besser is up here,
but Dr. Besser was not the only person speaking for CDC,
and that the framework we're talking about works as each
leader steps up to the microphone to talk about this issue.
We had wonderful physicians and subject matter experts speaking
on all kinds of issues within this, and were able to
successfully talk about it because we were all working
from a common framework, a position of what we think
communication should mean.
And we have six principles that we work with in that arena, and three
of them are focused on responsibilities for
the organization and the way we approach our communication,
and the other three are focused on the needs of the people in
the crisis, who are experiencing the crisis.
So emotionally, what do they need; to keep themselves safe,
what do they need?
And if we approach our communication keeping
them in mind, as well as keeping in mind our responsibilities to
them from our organization, wie'll go a long way.
We talked about some of the questions we saw, some of
the questions you had there, Dr. Besser.
We can anticipate those questions.
Some of them are, without question, going to be
"Are my family and I safe?"
"What have you found here that may affect me?"
"What can I do to protect myself?"
"Who caused this?"
And, "Can you fix it?"
These are questions we know will come.
But, Dr. Besser, those aren't the only questions that come up.
What are some of the others that you saw re-occurring?
[Richard Besser] With this situation, because it was a situation of uncertainty,
especially early on, lots of questions about the unknown.
"Why was the situation in Mexico different?"
That was a question I got in every briefing, and so trying
to turn that and put that in context of what we were trying
to do to answer that question -- what studies were underway,
what were we doing -- took the fear of uncertainty to a feeling
that it was under control, because work was going
on to try and address that.
Early on, from day one, a question of, "When
will there be a vaccine?"
And so turning that into an opportunity to teach about
how are vaccines produced, what are the steps that are underway,
what are the decisions need to be made?
We're still along that continuum now, and so we still need to
communicate about those messages.
And this morning we heard about that, that there's steps underway
to make a vaccine, but will -- as Dr. Fauci was saying, there's
studies that need to be done to make sure it's safe and effective,
and then there are decisions that have to be made around who will
get the vaccine.
So with each of these questions, it doesn't matter how much you
know, is truly known, you can turn it into something that provides
effective, useful public health information.
[Barbara Reynolds] Exactly, we know what the questions will be.
We don't know exactly the form and time in which these questions will
come up, but we can anticipate some of these questions.
That doesn't mean we necessarily have the answers at the point
that the question comes up, so what do we do?
Well, one of the things that we know is -- that may be actually
counterintuitive -- but it's okay to tell someone that you don't
have the answer to that question.
In fact, it's actually even better if you bring up the
question, anticipating the needs of the public in the situation,
because it increases your credibility.
Some of those other questions that I know that you were getting more
question in terms of who was in charge of one aspect or another
of the crisis.
What could we expect?
I think that was important, because at the point when
there's so much uncertainty, people are wanting to reduce
that uncertainty and anxiety that comes from that by being told
what's next, and sometimes we can't predict it,
and sometimes we can.
And then the question that came up that we saw in the clips here was,
"Did you have forewarning?"
"What did you know and when did you know it?"
[Richard Besser] That was an issue early on -- and here "early on" was the
first few days.
It was all, "What can you tell us to keep people safe?"
But beyond that, when people -- when reporters reached a level
of comfort, then it was more of the, "Couldn't you have picked
this up sooner" kind of things, questioning the kind of things
that were going on.
So that's a natural transition, and it doesn't mean that you're
doing anything wrong in terms of the response, it's just another
role of the media.
[Barbara Reynolds] Exactly, in fact we talk about, in the crisis communication
life cycle, different phases of the crisis, and at the point
that you start to get the questions "Did you have
forewarning," those kinds of, you know, "What did you know,
when did you know it?"
You actually should take a big sigh of relief, because you
must be answering some of the toughest questions, that there
must be a reduction in uncertainty, because until
we can say emphatically "What do we need to do to keep us safe?"
that question won't go away.
But once it does and we start seeing some of these other
questions, we're actually at a different point in the management
of the crisis overall.
It's worthwhile to take those and not become defensive but actually
say "Aha, we're at a better point in this crisis than I thought we
might have been" the first time that you get it.
But I also want to take a moment to talk about some of the things
that we know repeatedly can happen in the communication
that I call them "success killers."
Good communication can help a good operational response,
but good communication can't save a bad response.
I just have to say that straight out.
[laughter]
But it is tough, when things are going right, and somehow the
communication is going wrong, and so therefore it doesn't feel like
it to anyone that it's going right.
And there are some mistakes that we can anticipate and
try to work against.
I'm not saying, again, that we can do it perfectly,
but we know these.
Five of the big ones -- anyone who does this for a living can
probably name more -- but five of the big ones are when we have
mixed messages from multiple experts.
And I'm not saying incorrect messages necessarily, but when
there's something that should be settled and we're not settling
it as professionals in the response to the crisis,
that can be very disconcerting to the public.
So it's not even necessarily -- a bad message, an incorrect
message, we can go out there strongly and correct it,
but when there's some power struggles and confusion and
people aren't getting the messages that they need at the time that
they need it, that can be a real problem.
It saps our credibility as a response.
And then information released late.
Now some of us may think, "Okay, how do we fix that
one and is it fixable at all?"
I just want to say that if we don't fix it, we're leaving
open the door for people to talk about this topic who may not have
the public's best interest at heart.
So it's really our responsibility to work through our bureaucracies
and manage the clearance of our messages in a way that we are
giving the public the information they critically need at the time
that they need it, and that is something that we can work on.
One of the other mistakes that often is made in a crisis
situation, especially early on, is paternalistic attitudes.
You know, I call it the old John Wayne, "Don't worry little lady,
we gotcha covered."
You know, it doesn't work.
People don't want to be made to feel like children.
Yes, they may be anxious, they may be fearful, but they also want to
be given the information they need to empower their decision making.
We have to invite the public into the process, and allow
them to understand: how did we come to this conclusion?
It's frustrating, I think, sometimes for subject matter
experts to be in a position where they're having to, in some way,
defend their decisions.
But by explaining to the public why we're making the decisions
we are -- why are we closing the schools?
We're helping them make a decision for themselves, and we all know
that a decision that an individual makes for themselves is the
strongest decision that will be made.
They'll stick to it.
If we're imposing decisions, it's much more difficult.
And then another thing that we need to do in our communication,
a mistake that can be made, is if we don't counter rumors and
misinformation quickly, in real time.
Now I've been saying this for a few years, but I am telling you,
in this age with social media, we are really taking on quite
a responsibility by saying that.
But it is something that we have to do, and we have to become
flexible with our channels of communication and be able to
fix problems where they occur when they occur.
[Richard Besser] On that point, in this outbreak, that is something that we took
very seriously, so that if there was something that was floating
around in the morning that we'd seen in the media, that folks
up in Washington had seen, we would make sure that we had
someone at noon on our press briefing, or reaching out to
another media source out there, correcting the information,
and that was very important.
So it didn't allow that information to circulate
very long without a correction.
[Barbara Reynolds] Good, and I'd like to also point out that Dr. Besser
made a decision very early on in this response to hold daily press
briefings -- for about three weeks we did, including over
the weekends -- and to not turn down interviews.
[Richard Besser] Yeah, I think it was the second day of the outbreak, we made
a strategic decision that we were going to use communication and
engagement with the media as a way of shaping perception around the
event, and that we were not going to turn down a single
media request for an interview.
And that meant ensuring that we had people at CDC who were
trained, who understood not just how to -- didn't just have media
training, and that's part of it, but also had risk
communication training.
If you go on YouTube and you search on "Joe Bresee,"
you will pull up a CDC medical epidemiologist with more than
a million hits; and there he is, explaining what H1N1 is.
And if you search for CDC, you'll see a wide range of people who
are there who were able to address issues on a daily basis.
I think the ability to shape the perception of the event was
extremely important in terms of our ability to do our other
work and responsd.
[Barbara Reynolds] Good, good.
All right, well I presented some of the problems, some of the
mistakes that we know are going to happen in a crisis response
in terms of communication, but I do want to share with you very
quickly -- and then we're going to go to questions right away,
so get those questions ready for us -- I want to share the six
principles of crisis and emergency risk communication that we use.
Again, the first three are directed back at the agency
or the office or organization.
What can we do in our communication to make
it better in the crisis?
And the first one is "Be First."
What that means is that we can't be Johnny-Come-Lately
to the crisis.
If we have an important role in that crisis, once it occurs,
we have to be out there very quickly giving people a sense
that we're aware of their situation, that we know
that there is a problem here and that we're responding to it.
The next one, though, is -- the second principle is "Be Right."
I have been teaching this for a while, so I'll anticipate this
question: "Okay, how do we be first and be right, because
we may not have the information that we need."
One of the things that we need to do is become comfortable
with the idea of giving information out in increments.
I am not suggesting that we never not be accurate; we have
to be accurate with the information we give out.
But what we have to do is be aware of what we do know with certainty
that we can share immediately, and share it.
And then when we get a new piece of information, share it.
I actually think that Twitter is my best friend, because it's now
giving people the idea that they can give our information
in small chunks.
It was hard for me to get across in the past, especially some of
us old, trained journalists who, you know, had the five
W's and H in us.
And we thought, well, you had to put together all of the answers
to all of the five Ws and H -- who, what, where, when, why,
how -- and then present it out.
No, answer the ones that you can answer, and let people know that
you understand that they want answers to other questions,
and you'll get back to them as quickly as you can.
So be comfortable with the idea of giving information
out in increments.
That really requires, again, a lot of trust between leadership and
your communication professionals to allow them that latitude
to do that.
The other is "Be Credible," and that just means basically treat
people the way you want to be treated: tell the truth,
and then expressing empathy.
What we're talking about there is taking a moment to tell people,
in words expressed to them, what you know that they're feeling
in that situation.
So you will say, "I understand how concerning this is."
You saw that in the clips.
We don't shy away from the emotional aspects of the crisis.
Promoting action means giving people things to do.
You can help people restore a sense of self-control,
and reduce anxiety and fear, by promoting action.
And the overarching one, the last one, is "Show Respect."
And what that means is that everything that we do,
we take into consideration how do people want to be treated
and treat them that way.
The honesty, the openness, the speed at which we communicate,
all of those go into respect.
And now I'd like to turn it over to Dr. Besser to talk about these
things specifically.
[Richard Besser] Yeah, I just want to make a few comments about the approach that
I tried to take during this event, and then we'll throw
it to questions.
The first is that it's really important we all take risk
communication very seriously, and that it's something we actively
do, it's not something we just do in response to requests.
We had a very active media strategy just like we had
a very active strategy around surveillance and epidemiology
in our laboratory.
It's a very important part of the response.
I think you can do everything right on the public health-science
side, but if people don't know it, don't know what you're doing,
it really sets you up for a perception that the situation
is not under control and is not being handled appropriately.
That requires the training -- media training and risk
communication training.
Think about your audience.
When I get up to do a press conference, I'm a pediatrician,
I frame my comments and my answers as if I was talking to the parents
of one of my patients.
So that's the level of communication I like to use.
It's talking to a lay audience, it's not using scientific jargon,
but it's also talking to a concerned audience and
an audience that can take in difficult information
and wants to know.
Tell what you know, tell what you don't know, and tell what you're
doing to get the answers.
Acknowledging what you don't know is really important, because you
will very quickly be asked the questions, and you don't know,
and you can say, "Well, that's one of the things that I said
I didn't know."
[laughter]
Acknowledging the fear and uncertainty is important and
something we all did in our briefings everyday.
And I would always say "I understand people
are concerned" or "I understand people are afraid, but we'd like
to turn that fear and that concern into planning and action."
And then immediately launch into things people can do.
And it's very empowering to the people you're dealing with.
Never tell people not to worry; really, really bad.
You can tell immediately in the body language, if you've ever
said that to somebody -- you know, when they do this, that you've
totally lost them.
So acknowledge the worry, but don't tell them not to.
Foreshadowing; foreshadowing is something that I like
to use a lot.
And it might be foreshadowing the questions we might get.
It's saying, "People might be very concerned about what's going on
in Mexico," or early on, foreshadowing that they
may find guidance that is inconsistent, which during
an event, we always know that happens.
But saying to people, "You know, during an event we're going to
be getting guidance up very quickly, it's going to be
interim guidance.
There may be times that you find guidance in two different places
that is inconsistent.
Let us know about it so we can get that fixed right away."
But letting people know that ahead of time, because then when they
find it, it's like "Oh, we found one of those things that we heard
we would be finding."
Foreshadowing that different things would take place in
different places.
Dr. Layton [phonetic sp] earlier was talking about the difficulty
in that New York was doing some things that were different
from CDC guidance.
Well, in my briefings I was saying, "You may see different
things taking place in different parts of the country.
That's a good thing.
We can learn from that and that can help us frame our guidance."
Rather than people looking that and saying, "People are doing
things differently.
Why isn't there better guidance?"
Well, that's how you learn, and that's how you develop a guidance.
Be honest, and that's critically important.
An audience can read you right away if you're not being honest,
if you're trying to sell them something.
And then lastly, be yourself.
We each bring to leadership and to communication our
own personalities, and you have to go with that,
and go with who you are.
There are certain people who cannot do media and should
not do media, and do not force people to do media who really
have no interest, no comfort and no facility at doing it,
even if their position is such that they should be doing that.
Because -- it is something that you can get better at, it is
something that you can train to do, but some people -- you know,
I can't do gymnastics, and so don't ask me to do that.
And I can't play basketball, but I like to do media, and so find
people who like to do that and make sure they get the training.
So should we open up for questions?
Yeah, we've got about ten minutes for questions.
Please come to the microphones.
[Barbara Reynolds] While we're waiting for someone to come to the microphone,
I just want to say that it is important to find someone who
can be made comfortable in talking to the media, but you also have to
be careful of the people who may like it too much, and
that moderation has to take place.
[laughter]
[Richard Besser] Thanks, Barbara.
[Barbara Reynolds] Sure.
[Male Speaker] Hi, and Rich, you did, of course, a wonderful job.
We've told you that and we're all very grateful at the state level.
One of the things that worked so well was getting your talking
points early in the morning, before you went out with them,
so we could get them out to all the states so that the same
message was delivered across the country.
And then, at the same time, in our call everyday, we were able to get
back to say, "Here's how this message is playing in Peoria,"
or here and there, and I think that helped you change your
message for the following day.
So that was wonderful, and I hope we can continue our relationship
like that, and if anything, get it out quicker rather than slower.
The one thing I wanted to ask about is there's somewhat of
a paradox here, I think.
I agree completely with you that the job that was done
in communication was one of the reasons the public was so happy
with what happened, and that Harvard study showing that
88 percent of the public was happy with the communications they got,
and yet this is the second year in a row that the CDC's Office
for Marketing and Communications is seeing a cut.
What's going wrong?
How is it that we get, probably the administration and the
Congress, to recognize the importance that this is funded
appropriately as opposed to cutting it for a second
year in a row?
[Richard Besser] You know, I'm encouraged that with the supplemental funding
that's coming down for flu in the fall that we'll be able to meet
some of the needs in the marketing center.
There were some really innovative approaches that they took --
use of new media in particular -- with the tweeting and the use
of YouTube and podcasts.
It was very effective.
Often, you know, some of these systems, these preparedness
systems, it's really easy to let them slip, because until there's
a big crisis, it's not really clear -- they don't show their
value in the way that things that are used everyday show that value.
One thing I wanted to comment about your initial -- your
remarks about sharing talking points.
It's really important that people are talking off the same page or
at least understand what other people are saying.
Within CDC, we shared our talking points, and so
there was consistency.
I think there's real value in repetition as well.
If you're the person that's saying it over and over again,
it feels a little awkward, a little funny, but providing
the same information in terms of "Here's where we are today with
our cases, here's where we are with these key issues,
and here's what people can do to protect their health,"
was very useful.
Repetition is important for people to really take that message and
turn it into a behavior change.
So the fact that people were hearing similar things at the
federal level as they were hearing at the state and local was,
I think, effective.
[Dr. Reynolds] Okay, we'll wait for other questions, but we have
just a minute.
I'd like to also say that resources for communication
can't be underestimated -- I mean, it really is important to us --
and that there were a lot of resources helping CDC do what
we did during that time, including the work of Dr. Marsha Vandeford
in the joint information center, so we really appreciate that.
[Richard Besser] Thanks very much, we're going to wrap up and turn it back
over to Dr. Koh.
[applause]
[Howard Koh] Okay, thank you so much Dr. Besser and Dr. Reynolds.
We really owe you a debt of gratitude for that wonderful
presentation and for your leadership through a critical
time in our nation's history.
So what an incredible summit, and we've had really an
extraordinary day.
Again I want to thank everybody here ,for making such an effort
to come and contribute to such an important kickoff for this
upcoming season.
We are very, very grateful to the planning committee for
this very critical day.
If I can just acknowledge two people who have really worked
especially hard and I think deserve a special round of
applause, our wonderful Chief of Staff Laura Petrou,
and the Deputy Chief of Staff Sam Mitchell.
Laura and Sam, can you just stand up and get a round
of applause here.
[applause]
Thank you, and it's a wonderful testament to the dedication of
our new Secretary of Health and Human Services that Secretary
Sebelius wanted to come back at the end of the day and share
some final thoughts with all of us.
We often have Secretaries begin the day, but not often come back
at the end to conclude as well.
So please join me in welcoming back to the
podium Secretary Kathleen Sebelius.
[applause]
[Kathleen Sebelius] Well, hello again.
I certainly hope that today has been productive for you.
I know it's been productive for us at the Department of Health and
Human Services, and at the Department of Homeland Security,
and my colleague at the Department of Education.
We always learn a lot when we talk to one another, and hopefully that
and the panel members have been helpful to all of you.
I want to begin by thanking the panelists who spent their time
and expertise with us today.
I think the insight is always enormously valuable, and the
discussions with one another I think can help you as you
continue your preparedness efforts.
As we've said all day, this summit really isn't about panicking
people or stoking fears, but it's about remaining vigilant, ensuring
we have the tools and resources we need to be prepared to
protect the public.
And most importantly, we hope the summit will motivate your
governments and the American people to continue to prepare
for the outbreak of the H1N1 flu.
We hope that you'll return home and host meetings just like this
one, so that local governments and community leaders, private
business organizations, can be prepared if an
outbreak gets more serious.
I would urge you to work with mayors and county officials.
Please reach out, if you have -- live in Indian country, to tribal
leaders and faith-based organizations.
And too often we do leave out the private sector, an important
element in planning for contingencies to come.
On the health provider side, we face an unprecedented need
for traditional medicine and public health to work together
and to collaborate together.
We've got resources, I know, in the hospital and provider
community that they're eager to share with the public health
community, but this is the time to begin those conversations.
And we need all levels of government to work
closely together.
We hope that you'll update your pandemic preparedness plans.
One of the things that I think that's important that you might
do is to do an in-depth assessment of what happened this spring with
school closures and the information.
Who was missing from the puzzle?
What have you heard from parents and teachers?
What did your public health officials say?
Do your own checklist on how well that outbreak happened
in late April/May, before school got out.
I think that's a great place to start with your own preparedness
plans, to identify gaps and identify missing persons
from the conversation.
We hope you're ready to execute your plans, including now a new
addition, getting shots in the arms of the folks who may be
prioritized for vaccination.
So hopefully, with your help to ensure the health care community
and the business community that we are prepared to act.
We would really appreciate help with driving people
to the site flu.gov.
I think anything you can do to remind individuals throughout
the country that starting now, they need to start to monitor
the site, to be better informed, to follow the production of
vaccine, to watch what's happening with the outbreak.
The last thing we want is millions of parents to be surprised if a
notice comes home saying, "We'd like you to think about
signing a consent form for your child's vaccine," and they've
never heard about it.
Starting now, I think getting that information out using
school openings and school fair times, the times parents are
beginning to gather, before a vaccine will become available,
to have discussions to talk about this is an important step forward.
So again, we know this isn't easy, but we also know that state and
local officials, tribal governments will take
on an incredible burden.
But we're committed at the federal level and throughout
the administration to assisting with this.
The resources provided by the federal government will help
alleviate some of the strain on tough state and local budgets,
and we'll do everything in our power to help you get ready
for the H1N1 flu.
We absolutely can't afford to be unprepared, and we can't protect
the American public and improve public health
if we don't work together.
But most importantly, we know this can be a successful effort.
I think if we look at the history, the public health history, we know
that vaccination programs are one of the great public health stories
from the 20th Century.
Public health has improved dramatically because of the
many steps taken by government to stop the spread of illness
and disease.
So now, as we tackle the H1N1 flu virus, we have to learn from our
past successes and take new steps to protect public health that will
ensure we're prepared to combat this and other
viruses in the years ahead.
So again, thank you for coming.
We look forward to working with you in the weeks and months ahead
to put these lessons learned into practice.
We want to acknowledge that we appreciate you being in the
room today, but this is the first of many conversations as we share
information with you and head together for a successful
combating this virus in the fall.
Thank you so much.
[applause]