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create a seven-minute presentation that demonstrates the results of your Business Report assignment’s background and recommendations. You should focus on the impact the event had on the company and present your key recommendations that will leverage or mitigate the impact of the event.

Strategic Use of YouTube During a National Public Health Crisis: The CDC’s
Response to the 2009 H1N1 Flu Epidemic
Business Report – MCS 2000
Sienna Faria, Hannah Felicetti, Haoyue Liu, Youssef Shaaban, Alexi Markakis
Cover Letter:
Business Communication Consultants – Group 35
38 Guelph Line
Guelph, ON R4J 2E1
November 7, 2021
Corporate Business Communications Team
Centers for Disease Control and Prevention (CDC)
1340 Jefferson St East
Dear Corporate Business Communications Team of CDC,
With our combined experience in the marketing studies of business communications,
we believe we can portray a keen sense of highly knowledgeable consultants who can fill the
required position of your business. We can display our strong understanding and ability to work
as a team to analyze and strategize the best of our ability towards any position at CDC.
We believe we can exceed all expectations in filling in the required role for CDC. We are
five very experienced professionals who are studying at the University of Guelph and have a lot
of experience as consultants. With our courage and demanding work, we can help make CDC a
better company, using our experience over the years of our schooling. We have noticed you
have strongly valued the importance of the 2009 H1N1 epidemic. The use of social media
accounts to publish daily information to the public helps our community understand the
importance of this event. With constant efforts to reduce the spread of this flu, it is important
to portray the effects of this virus by continuing to put time and effort into resolving this
situation.
The idea of publishing YouTube videos to the public to raise awareness and update the
community on the current situation of this epidemic is especially important to provide a clear
understanding to children, regarding the importance of washing your hands daily. Actions have
been taken to explain the importance of protecting oneself to the virus, and we are aware of
this.
We are very fascinated with the work that has been done by you and hope to hear back
from you as soon as possible. Our goal is to show our contribution to CDC and hope that you
find this message safe. We would appreciate it if you could find time to call (416)-490-3365 to
schedule an interview to discuss further actions needed.
Sincerely,
Alexi Markakis, Haoyue Liu, Hannah Felicetti, Sienna Faria, and Youssef Shaaban
Introduction
Purpose:
The purpose of this report is to deliver the importance of the CDC’s response to the 2009
H1N1 Epidemic and to provide future recommendations and suggestions. This report will cover
the significance of social media platforms while navigating through a health crisis. The
implementation of the internet video platform is an effective tool and information source.
Background and Significance:
A strain of influenza was recently found in a patient which rapidly spread throughout the
United States. The Centers for Disease Control and Prevention (CDC) had been preparing for an
upcoming epidemic virus, although they were hit with the unpredictable online communication
environment. The CDC had limited experience with these emerging platforms, and they needed
to deliver complex online videos to reach a large audience. Social media specialists at CDC
quickly created a communication strategy through YouTube, delivering accurate, timely, and
credible health updates in relation to the H1N1 virus. The goal was to “reduce transmission and
illness severity, and provide information to help health care providers, public health officials and
the public to address the challenges posed by the new virus” (CDC, p.13)
Methods:
YouTube was searched during the H1N1 Epidemic, using the keywords swine flu, H1N1,
and influenza for videos uploaded in the past 3 months containing relevant information about the
disease. Based on over 3 million views on the videos, it is evident that individuals used YouTube
as a key information source.
The 2009 H1N1 Campaign
Analysis
The Centers for Disease Control’s use of the YouTube platform was strategic, and the
organization reached many people. Notably, one of the videos that the organization posted
garnered over two million views on the platform (Walton, Seitz, & Ragsdale, 2012). Besides, the
CDC’s YouTube productions were consistent and strategic while staying true to the
organization’s mission statements of being right, credible, and first to inform the public on the
status of health in the country.
The organization’s use of integrated communication approaches helped to increase the
level of awareness about the pandemic. Notably, the leaders of CDC decided to keep using
traditional message tools such as brochures, flyers, public service announcements, and
information hotlines to supplement their social media campaigns. The integrated approach also
allowed the Centers for Disease Control to use its communication channels across multiple
channels. For instance, the organization created links to websites and YouTube which are then
posted to other sites such as Facebook and on the fliers.
Nevertheless, the organization realized that increasing the value of the production did not
necessarily increase the number of viewers that it garnered. Instead, the viewership reduced after
the organization began using cartoon graphics and motion graphics. The viewership likely
reduced since people wanted straightforward information about the pandemic instead of the
graphically focused productions that the organizations had begun conducting.
While the messaging by the Centers for Disease Control was consistent, it did not cover
all the minority races in the country. The organization may have translated much of the
information from English to Spanish, but it failed to deliver customized information to the black
community. Analysts argue that the failure to include the black community in the delivery of the
messages led to disproportionate hospitalizations of the African-Americans suffering from H1N1
influenza (Quinn, Kumar, Freimuth, Musa, Casteneda-Angarita, & Kidwell, 2011). Notably, the
messages did not consider the economic disparities between African-Americans and White
Americans. For instance, social distancing was a critical step to avoid contracting the disease.
However, African-Americans are more likely to live in a metro area that is crowded than their
fellow white counterparts. Therefore, the messaging they should have received should have
reflected their living situation.
Topics Learned in the Case Study
One of the topics learned from the case study is the role of technology in organizational
communication. The advent of technology has improved communication in business. The
revolution of the internet has enabled organizations such as CDC to reach more people without
increasing their operational costs. The advancement in technology has made it possible to
integrate multiple communication channels and ensure consistent messaging with the intended
audience.
The second topic learned from the case study in crisis communication. In a profit-making
organization, crisis communication occurs when the company must manage public relations after
an incident occurs which may damage the reputation of the company. On the other hand, crisis
communication in the public sector occurs when a government organization has reassured
citizens that it is in control of the situation. CDC had to engage in crisis communication to
educate the public on the emergent pandemic and the measures that they were to take to avoid
contracting the disease. One of the key concepts in crisis communication is knowledge
dissemination. The Centers for Disease Control was worried about the false information that may
emerge due to the failure of the public to understand the pandemic. Therefore, the organization
had to disseminate information fast and consistently. The second concept is ownership. The
videos that the Centers for Disease Control published on YouTube contained details of the
speakers on the lower quarter of the video frame. The strategy enabled the public to gain trust
with the organization and continue consuming the messages.
The other topic learned is the evolution of technology in the dissemination of information
to the public. Indeed, social media platforms such as Facebook, Twitter, and YouTube attracted
millions of followers upon their formation. The fete has challenged the government and private
organizations to change their communication strategies to take advantage of the new methods of
communication to interact with the intended audiences.
Business Communication Concepts
Communication in business transcends the transmission of the message and the message
itself to include the mutual exchange of information that both parties, the sender, and the
receiver, understand. Communication is crucial for the basic functions of management to take
place including organizing, staffing, controlling, directing, and planning. As organizations
become larger and more complex than before, effective communication can help the business
achieve its goals with minimum costs. The company can avoid conflicts between the
management and the employees and improve the process of decision-making.
Concepts
One of the concepts of organizational communication is intercultural communication.
The world is becoming more diverse as people migrate from one area to another. Consequently,
organizations have become more diverse as they employ people from different races. Therefore,
business leaders must recognize the cultural sensitivities of the different people they hire to work
at their companies. Notably, the lack of a coherent method to help the diverse races to work in
the same company can result in conflicts and possibly negative publicity. Cultural sensitivity was
key during the H1N1 YouTube campaign by the CDC since the organization had to disseminate
information to as many people as possible without altering the intended message.
The other concept in business communication is formal and informal communication.
Informal communication in an organization travel through chats or grapevines. Informal
communication exists in all organizations and is an extension of formal communication
especially when the employees feel that they are not receiving adequate information from their
superiors. While the organization can allow for informal communication, the managers must set
limits since people easily believe the unofficial news from the company which could end up
distorting the intended messages (Chaturvedi, 2011). Formal communication in an organization
flows through the formal lines of communication such as from the supervisors to the subordinate
staff. Formal communication also flows through the functional relationships which include the
various departments in the company. As the premier organization in charge of health in the
country, the CDC had to maintain majorly formal communication channels to ensure that it
coordinated well with other government organizations.
The other concept is technology in business communication. Technology has enabled
organizations to globalize their operations in multiple markets. Besides, it has enabled businesses
to reduce the costs of operations and improve their decision-making processes. Technologyenabled CDC to reach out to more people than it had previously done. Today’s organizations can
utilize information communication technology to reach out to wider markets and increase their
sales.
Recommendations
The CDC should have included ethnicity when reporting on H1N1 deaths and
hospitalizations. The failure to integrate race into the data meant that the organization was blind
to the disproportionate exposure and susceptibility that the African-American community was
facing. If the organization had included race in the data, they would have realized their weakest
links in protecting the public and reformed their communication strategies to include racial
minorities. The targeted communication would have encouraged the minority races to perceive
their vulnerabilities and taken timely action to protect themselves.
The second recommendation is that CDC should have stuck to providing straightforward
information instead of focusing on the motion and cartoon graphics. Nevertheless, organizations
should not be too rigid to change their information. As the pandemic progressed, the need to
change the type of information that CDC disseminated changed. For instance, the organization
had to focus on encouraging people to get vaccinated by end of August of 2009. Such flexibility
is essential if an organization’s communication strategies are to remain relevant.
An analysis of the communication strategies that CDC used towards healthcare providers
showed that the organization overwhelmed such healthcare providers with excessive
information. During the vaccination campaign, healthcare providers were unable to keep up with
the multiple formulations of the vaccine, changing priority groups and ever-changing
information on the availability of the vaccines. Data from the CDC shows that many of the
Health Alert Notices they sent did not reach most of the physicians (Altevogt, Nadig, & Stroud,
2011). The CDC should have devolved the messaging of health care providers to the local
governments. The local governments were best placed to inform the local physicians on the
availability of the vaccines and formulations of the different doses.
The CDC should seek to improve efficiency in its communications strategy. It can
increase efficiency by creating a specialized team that will oversee the campaign ensuring
consistent messaging, data analytics, and coordinating media planning. The team should include
epidemiologists, immunologists, virologists, and other technical experts, as well as health
educators, media officers, health services experts, trained communicators, and state and local
health officials.
Conclusion
This report aims to discuss and provide analysis followed by recommendations in the
context of the actions taken by the CDC. Detailed explanations of the attentive solutions can be
located under recommendations, that being, the necessary implications needed to reach
audiences from all races and countries. In addition, the need to improve the effectiveness of
specific information platforms as well as the use of cartoon graphics and how it affects the
serious meaning behind messages. In the efforts to keep individuals safe and healthy during
vulnerable situations such as the H1N1 epidemic, the CDC must reflect on precautions taken
during such events to be more effective in the future. The CDC is advised to take the information
given into account as it provides effective solutions to the issues that arose during the epidemic.
Bibliography
Altevogt, B. M., Nadig, L., & Stroud, C. (Eds.). (2011). The 2009 H1N1 influenza vaccination
campaign: summary of a workshop series. National Academies Press.
Chaturvedi, P. D. (2011). Business communication: Concepts, cases, and applications. Pearson
Education India.
Quinn, S. C., Kumar, S., Freimuth, V. S., Musa, D., Casteneda-Angarita, N., & Kidwell, K.
(2011). Racial disparities in exposure, susceptibility, and access to health care in the US
H1N1 influenza pandemic. American journal of public health, 101(2), 285-293.
Walton, L. R., Seitz, H. H., & Ragsdale, K. (2012). Strategic use of YouTube during a national
public health crisis: the CDC’s response to the 2009 H1N1 flu epidemic. Case studies in
strategic communication, 1(3), 25-37.
Volume 1
2012
www.csscjournal.org
ISSN 2167-1974
Strategic Use of YouTube
During a National Public Health Crisis:
The CDC’s Response to the 2009 H1N1 Flu Epidemic
Laura Richardson Walton
Mississippi State University
Holli H. Seitz
University of Pennsylvania
Kathleen Ragsdale
Mississippi State University
Abstract
The emergence of the 2009 H1N1 influenza epidemic produced a number of unique
communication challenges for the Centers for Disease Control and Prevention (CDC).
Part of the CDC’s response to these challenges included the strategic use of video
posted to YouTube to address the public’s need for information in a timely and
accessible way. This case study includes an examination of the context in which this
communication response took place, an overview of the research and strategy
development that informed the strategic communication, and an evaluation of the
response.
Keywords: health communication; social media; public relations; strategic communication;
emergency and risk management
Introduction
In mid-April 2009, a new strain of influenza (later termed the 2009 H1N1
flu) was identified in a 10-year-old California patient. The unique strain of
influenza virus initially emerged in Mexico and began to spread rapidly
throughout the United States (U.S.). By the end of April, the Centers for
Disease Control and Prevention (CDC) was certain a national public health
To cite this article
Walton, L. R., Seitz, H. H., & Ragsdale, K. (2012). Strategic use of YouTube during a national public health crisis:
The CDC’s response to the 2009 H1N1 flu epidemic. Case Studies in Strategic Communication, 1, 25-37. Available
online: http://cssc.uscannenberg.org/wp-content/uploads/2013/10/v1art3.pdf
Walton, Seitz & Ragsdale
Use of YouTube During Public Health Crisis
emergency existed.1 As the H1N1 epidemic emerged, the CDC activated the
Emergency Operation Center and the Joint Information Center, which is
the hub of CDC strategic communication during national health
emergencies. Years of strategic planning and emergency exercises in
preparation for a global influenza pandemic were paying off, but there
was one element of this epidemic that the CDC could not have been
predicted: the dynamic online communication environment in which this
major public health event would take place.
At the time of the 2009 H1N1 outbreak, Twitter was emerging as a key
online medium for exchanging brief news and information, while
Facebook had more than 200 million users (Zuckerberg, 2009). Earlier
that same year, YouTube had 100 million viewers and an estimated 76.8
percent of U.S. Internet users were online video users (comScore, Inc.,
2009). According to 2011 data, the average YouTube user is female and
between the ages of 25 and 54 years old (Ignite Social Media, 2012),
making the online video-sharing platform an ideal tactic for targeting
caregivers of both small children and the elderly – the two populations
most at risk for complications from the H1N1 virus. The increasing
importance of social media during disasters and emergencies was
confirmed by the American Red Cross in its 2010 study, indicating 82
percent of participants (N=1,058) utilize social media weekly with nearly
half of respondents (48%) participating daily (American Red Cross, 2010).
Interestingly, only 1 in 6 participants reported using social media to
obtain information about a disaster or emergency, but nearly half of
participants utilizing social media daily indicated they would share
disaster or emergency information via social media channels (American
Red Cross, 2010).
Due to the rapid expansion in popularity of these online communication
channels, social media specialists at CDC were brought into the 2009
H1N1 response to create a communication strategy for social media
Initial reports linked the H1N1 virus to a swine origin influenza virus because the
combination of genes closely resembled those of the North American and Eurasian
swine-lineage H1N1 influenza viruses. From December 2005 to January 2009, 11 of the
12 cases of human infection reported either direct exposure or close proximity to pigs.
The April 2009 cases in the U.S., however, did not involve exposure to pigs, thus the new
virus was being spread via human to human contact and not human-to-swine. When the
CDC confirmed there was no link between the spread of the H1N1 virus and pigs, an
effort was made to identify the virus as “2009 H1N1” (CDC, 2010b, p. 1-2).
1
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Use of YouTube During Public Health Crisis
channels that would complement traditional media strategies. Although
the social media plan would eventually involve a heavy presence on
Facebook and Twitter, YouTube was used early in the CDC’s response to
provide timely, accurate, and credible health messages via social media.
Indeed, one of the first 2009 H1N1 videos released by the CDC garnered
2.1 million views on YouTube.
Background
As a federal agency within the U.S. Department of Health and Human
Services, the CDC employs more than 15,000 staff and is the agency
primarily responsible for public health (CDC, 2010a). The response to the
2009 H1N1 outbreak was likely influenced by agency dynamics in the
years and months leading up to the outbreak. Prior to the event, the CDC’s
emergency communication function had been tested as the agency
responded to an outbreak of Severe Acute Respiratory Syndrome (SARS)
in 2003, public health issues related to Hurricane Katrina in 2005, and
containment of highly drug-resistant tuberculosis in 2007. During the
2009 H1N1 event, the CDC was headed by an interim director, Richard
Besser, M.D., whose considerable expertise in managing national
emergencies had been honed during his years as the Director of the
Coordinating Office for Terrorism Preparedness and Emergency Response
(COTPER).2
Within the U.S., the first wave of H1N1 began in April 2009, peaked during
May and June of that year, and began to decline in early August. At that
point in the epidemic, 477 deaths had been linked to H1N1, including 36
children under the age of 18. The second wave of H1N1 peaked in October
2009, during which 49 states reported H1N1 cases in one week alone.
October also marked the launch of the national H1N1 vaccination
campaign, which was designed to encourage stakeholders to take all
The 2009 H1N1 outbreak was a complex event that required a coordinated response
from multiple countries, the World Health Organization, the Pan American Health
Organization, and the global public health community (Brownstein, Freifeld, & Madoff,
2009). While this case study focuses specifically on the response of the Centers for
Disease Control and Prevention in the U.S. in an attempt to provide a vivid example of
how an organization can use social media to meet strategic communication goals, it is
important to note that this case was situated within a global response effort. The use of
YouTube allowed CDC to meet its domestic communication goals, and these videos were
publicly, and thus globally, available for those with open access to the internet.
2
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Use of YouTube During Public Health Crisis
necessary steps to protect themselves from this highly contagious and
potentially deadly strain of influenza. The risk communication efforts
continued into January 2010 and culminated with President Obama
declaring January 10-16, 2010, to be “National Influenza Vaccination
Week,” a designation that drew considerable attention to the continued
necessity of precautionary measures against H1N1 (CDC, 2010c).
The CDC’s Formative Research
At the time of the 2009 H1N1 outbreak, CDC had been preparing for the
possibility of an epidemic influenza event for several years. This
preparation included the development of a series of manuals for crisis and
emergency risk communication, with one specifically designed to address
an epidemic influenza event (Reynolds, 2007). In addition, CDC had
recently completed a planned emergency hurricane response exercise,
during which―for the first time―social media had been incorporated as
part of the CDC’s official emergency response structure.
While the CDC’s H1N1 response plan was clear, the social media structure
was less well-developed. The constantly evolving nature of social media
technologies provides both considerable opportunities and considerable
planning challenges for public health practitioners. During the early stages
of the expansion of social media, the CDC recognized that posting public
health-related videos on YouTube would makes it possible for the Center
to disseminate complex health messages—such as how to properly wash
one’s hands to prevent the spread of infectious diseases—that cannot be
conveyed easily through print media. Although the CDC had established a
YouTube channel to broadcast health-related videos prior to
implementing its H1N1 response plan, the Center had not yet established
a presence on Facebook and had limited experience with Twitter. Because
the CDC recognized that H1N1-related public health messages were
necessarily going to be extremely complex, the Center’s communication
specialists decided to deliver online video health messages via YouTube as
a complement to traditional media strategies in order to expand the
dissemination of H1N1 prevention/treatment messages to as broad an
audience as possible.
In addition to developing new social media channels, the CDC also had to
quickly develop H1N1 flu messages that were appropriate for the
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Use of YouTube During Public Health Crisis
channels. Prior to the H1N1 epidemic, CDC had invested time and
resources into the development of general epidemic flu messages and
seasonal flu messages for use in social media. With the onset of the H1N1
epidemic, the CDC was able to adapt these pre-existing messages for use in
the H1N1 social media campaign. For example, the CDC regularly conducts
focus groups with target audiences to test seasonal influenza messages
(which typically target vaccination), and was able to draw on those
findings when crafting H1N1 messages. In addition to the ongoing
research on seasonal flu messages, the CDC also conducted a thorough
evaluation of epidemic flu messages in 2005. This research included focus
groups with general audiences and healthcare providers in four regions of
the U.S. (Janssen, Tardif, Landry, & Warner, 2006). This research
contributed to the development of key messages for the public about
epidemic flu—messages that could be adapted for social media during the
H1N1 flu outbreak.
Strategy
The primary goal of the CDC during the 2009 H1N1 event was to “reduce
transmission and illness severity, and provide information to help health
care providers, public health officials and the public address the
challenges posed by the new virus” (CDC, 2010c, p. 13). The response
team’s primary strategy—rooted in emergency risk communication
principles—was to develop a communication strategy that would provide
accurate and timely information to the public regarding the H1N1
outbreak. Throughout the epidemic, the CDC sought to clearly
communicate its goals and intended actions for responding to the
situation. Communication strategists sought to harness the power of social
media channels to complement traditional media strategies and thus allow
the CDC maximum reach and impact with its “consistent, clear” message
(CDC, 2010c, p. 13). The CDC based its messages around three core values:
Be first, be right and be credible (CDC, 2010d). Message strategies
included information regarding H1N1 preventative measures, symptoms,
and treatment options.
The CDC relied on a strategic mix of traditional communication tools as
well as the introduction of emergent technologies in its response to the
H1N1 event. Traditional communication methods included maintaining a
24-hour national contact center (CDC-INFO), media relations, and health
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Use of YouTube During Public Health Crisis
alert networks email, providing a variety of factsheets, flyers and
brochures available for free download, and establishing a dedicated
website for the H1N1 epidemic. The CDC also translated key materials and
web pages into multiple languages, including a Spanish version of its 2009
H1N1 website. Newer methods included podcasts, the use of social
networking sites (e.g., Facebook, Twitter), and the focus of this case study,
YouTube (CDC, 2010d). It is especially significant to note that this
integrated communication approach allowed the CDC to use its
communication tools across multiple platforms. Links to videos and other
informational resources could be posted on the Facebook pages as well as
the CDC’s various Twitter accounts, enabling the CDC to reach a diverse
audience across multiple social media sites.
Execution
As the number of H1N1 cases rapidly grew, the CDC sought to respond to
the public’s need for information via a variety of mass communication
formats. Although traditional public relations tools were an integral part
of its strategy, the use of YouTube videos provided the CDC a relatively
quick and highly accessible means to deliver information to the public (see
Figure 1). As the outbreak quickly became a global issue, the use of
YouTube videos also allowed for wide geographic distribution.
In its effort to quickly provide relevant and essential information
regarding the spread and treatment of H1N1 flu, the CDC relied on simple
and straight-forward production for its YouTube videos. Most of its early
productions were shot from one angle with variations between close-up
and extreme close-up views. As the viewing numbers for the videos
reflect, this “no frills” production approach was an effective means of
asynchronously presenting the necessary information. Millions of people
were seeking accurate and reliable information about the H1N1 epidemic
and the CDC placed the information on YouTube where the public would
have 24-hour access. Names and titles of CDC officials were frequently
used in the lower-third of the YouTube videos to identify key speakers and
their official roles in addressing the H1N1 epidemic. This was an effective
nonverbal communication strategy used to reinforce the CDC’s credibility
and trustworthiness in the situation.
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Use of YouTube During Public Health Crisis
Figure 1. Timeline of YouTube videos posted by the CDC. Click video cells to view original YouTube videos.
Walton, Seitz & Ragsdale
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Use of YouTube During Public Health Crisis
As the crisis progressed, the YouTube videos began to include slightly
more variation in theme and content, with B-Roll footage under voiceovers being utilized as a regular production feature. In latter stages,
cartoon characters were featured in the CDC’s productions with the
launch of “The Happy Hand-washing Song” and high-quality motion
graphics were featured in the 60-second “I never get the flu” YouTube
production. These videos were a diversion from the CDC’s straightforward approach to presenting relevant information to the public and,
interestingly, only captured about 12,000 views combined. Due to the
gravity of the situation and the likelihood that users were seeking
straightforward facts about the H1N1 epidemic, it is likely these more
“flashy” and graphically-focused pieces were not as effective in
dissemination of the information sought. Alternately, the timing of these
videos may have contributed to their low popularity, as the initial wave of
H1N1 had passed.
Although the production quality and theme variation of the CDC’s
YouTube videos increased during the public health crisis, the videos
consistently sought to create a general sense of concern and urgency
regarding protection and treatment of H1N1. Nearly all the videos covered
the basics of protecting oneself from the virus: 1) Covering nose/mouth
when coughing or sneezing; 2) Washing hands often; and 3) Avoiding
contact with sick persons and staying home if diagnosed with H1N1.
Several videos focused solely on providing this information to viewers.
Information about H1N1 symptoms and when
to
seek
treatment―including warning signs and steps to receive H1N1 care―were
clearly stated and reinforced throughout the majority of the YouTube
videos.
Evaluation
The World Health Organization (WHO) International Health Regulations
(IHR) Emergency Committee officially declared the H1N1 influenza
pandemic over on August 10, 2010 (CDC, 2010c). In the wake of the
epidemic, the CDC sought to evaluate its efforts with a variety of measures,
including web analytics, social media tracking, observation, and feedback
from stakeholders. In a June 2010 “Summary Highlights” report, the CDC
described its response to the H1N1 epidemic within the U.S. as a “complex,
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Use of YouTube During Public Health Crisis
multi-faceted and long-term” reaction to a national health crisis (CDC,
2010b, p. 1).
This communication effort resulted in tremendous reach. The CDC
estimates its risk communication campaign resulted in 403 million
impressions from article placement in print and internet news media
outlets alone (CDC, 2010b).3 While the CDC does not report the estimated
reach through other traditional media outlets, such as radio ads, television
public service announcements, and printed materials, estimates of
additional reach through nontraditional media are substantial. One report
cited the CDC-INFO contact center had handled 212, 368 inquiries about
the virus—141,774 general public phone calls, 47,311 general public
emails, 23,268 clinician phone calls and 13 letters (CDC, 2010d). The
CDC’s Facebook fan page grew by more than 55,000 individuals and one
report cited more than 1.2 million followers of the CDC emergency profile
on Twitter and nearly 34,000 followers of its @CDC_eHealth Twitter
account (CDC, 2010d). In just the first three weeks of the response, the
CDC website grew from one page to more than 200 with estimates of page
views reaching 221 million (CDC, 2010d). Although one report mentions
Facebook and Twitter analytics and website page views, it makes no
mention of the fact that the 24 YouTube videos that compiled the CDC’s
“2009 H1N1 playlist” reached well over 3 million views (CDC, 2010b).
Analysis and Discussion
This case study provides information essential to understanding the CDC’s
response to the H1N1 epidemic. The CDC is considered a leader in the
recent movement to combine the best practices of risk communication
and crisis communication, and this case study provides significant support
for its efforts to articulate that the response to global threats to the public
must be “strategic, broad based, responsive and highly contingent”
(Reynolds & Seeger, 2005, p. 49). Reynolds and Seeger (2005) argue the
crisis and emergency risk communication (CERC) model is a “blended
Media monitoring at CDC takes many forms, including traditional clipping services,
automated programs (Janssen, Haag, & Pierre, 2010), and systems that involve manual
searching and coding by trained staff members. During an emergency activation, media
monitoring activities are concentrated in the Joint Information Center and result in
periodic summary reports that are used to provide situation updates to leadership,
inform communication strategy, and track communication efforts (see Prue, Lackey,
Swenarski, & Gantt, 2003, for an example).
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form of communication” that “emphasizes the developmental features of
crisis and the various communication needs and exigencies of audiences at
various points in the ongoing development of an event” (p. 49). The CERC
model posits that crises generally have five distinct stages: 1) Precrisis, 2)
Initial event, 3) Maintenance, 4) Resolution, and 5) Evaluation.4
While the CDC continued to rely on traditional and more conventional
communication tactics such as media relations, web sites, and printed
materials, this study illustrates the necessity of making vital public health
messages accessible to the general public on YouTube. At more than 3
million views, the number of views for the CDC-produced H1N1 videos
broadcast on YouTube indicates that a significant number of individuals
were interested in information relevant to the 2009 H1N1 epidemic.
Additionally, it emphasizes the importance of public health entities being
willing to adapt to the changing nature of information dissemination in the
face of innovative technologies and new media.
The CDC remains a highly credible source for public health information,
and has recognized and responded to the need to expand its strategic
communication boundaries to include new media by launching accounts
in a variety of social media domains and developing best practices for the
use of social media for public health communication (see the CDC Social
Media Toolkit for Health Communicators). Their guidelines for the use of
YouTube suggest that health communicators develop content appropriate
for target audiences, keep videos short, and maximize production
quality—all qualities found in the videos produced for the response to
2009 H1N1 flu. In the case presented here, the CDC was able to use a
relatively new technology, YouTube, to deliver a consistent public health
message to a widely varied mass audience during a national health crisis.
4
Within the five stages of the CERC model, communication strategies for the organization
vary based on the characteristics of the given crisis. Generally, they are as follows: 1)
Precrisis: risk messages, warnings, and preparations; 2) Initial event: uncertainty reduction,
self-efficacy, reassurance; 3) Maintenance: ongoing uncertainty reduction, self-efficacy,
reassurance; 4) Resolution: updates regarding resolution, discussions about cause and new
risks/understanding of risk; and 5) Evaluation: discussion of adequacy of response, consensus
about lessons and new understandings of risks (Reynolds & Seeger, 2005, p. 52-53).
Case Studies in Strategic Communication, 1 | 2012
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Walton, Seitz & Ragsdale
Use of YouTube During Public Health Crisis
Discussion Questions and Activities
1. Although YouTube is an extremely popular social media site, it often
features material that is poorly sourced or may lack credibility (e.g.,
may not be considered “official” or trustworthy by the viewer). What
risks was the CDC taking by using YouTube as a communication
channel during a national public health crisis? Do you think the
benefits of using YouTube outweighed the risks in this situation? Why
or why not?
2. The use of YouTube during a national health crisis gives rise to many
questions about the changing nature of strategic communication,
specifically during health-related crises. Is the lessening dependence
on traditional news media as a mass communication vehicle a positive
or a negative shift? Explain your position.
3. Small group exercise: Given what you know about the CDC’s use of
YouTube during the H1N1 epidemic, how would you build on it to
create a comprehensive social media strategy for responding to this
national public health crisis? Decide which social media tools or
channels you would select and what kinds of messages you would use
in each channel.
4. In addition to its YouTube campaign, the CDC relied on other popular
social media platforms, such as Facebook and Twitter, to distribute its
health-focused message. How has the proliferation of social media
changed the way we seek and use health-related information? What
impact has this had on health professions and the practice of health
communication?
References
American Red Cross. (2010). Social Media in Disasters and Emergencies. Retrieved
from http://www.redcross.org/www-files/Documents/pdf/other/
SocialMediaSlideDeck.pdf
Brownstein, J. S., Freifeld, C. C., & Madoff, L. C. (2009). Influenza A (H1N1) Virus,
2009—Online monitoring. The New England Journal of Medicine, 360, 2156.
Centers for Disease Control and Prevention (2010a). CDC Fact Sheet. Retrieved from
http://www.cdc.gov/about/resources/facts.htm
Case Studies in Strategic Communication, 1 | 2012
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Walton, Seitz & Ragsdale
Use of YouTube During Public Health Crisis
Centers for Disease Control and Prevention (2010b). The 2009 H1N1 pandemic:
Summary highlights, April 2009-April 2010. Retrieved from
http://www.cdc.gov/h1n1flu/cdcresponse.htm
Centers for Disease Control and Prevention (2010c). 2009 H1N1 Flu. Retrieved from
http://www.cdc.gov/h1n1flu/
Centers for Disease Control and Prevention (2010d). 2009 H1N1: Overview of a
Pandemic. Retrieved from http://www.cdc.gov/h1n1flu/yearinreview/yir8.htm
comScore, Inc. (2009). YouTube surpasses 100 million U.S. viewers for the first time:
Americans’ time spent viewing jumps 15 percent versus previous month.
Retrieved from http://www.comscore.com/Press_Events/Press_Releases/
2009/3/YouTube_Surpasses_100_Million_US_Viewers
Ignite Social Media, Inc. (2012). 2011 Social Network Analysis Report – Geographic –
Demographic and Traffic Data Revealed. Retrieved from
http://www.ignitesocialmedia.com/social-media-stats/
2011-social-network-analysis-report/
Janssen, A., Haag, E. S., & Pierre, J. (2010, April). Rapid and longitudinal analysis of
H1N1 News and Social Media. Paper presented at the 44th National
Immunization Conference, Atlanta, GA. Abstract retrieved from
http://cdc.confex.com/cdc/nic2010/webprogram/Paper22799.html
Janssen, A. P., Tardif, R. R., Landry, S. R., & Warner, J. E. (2006). “Why tell me now?”
The public and healthcare providers weigh in on pandemic influenza. Journal of
Public Health Management and Practice, 12, 388-394.
Prue, C. E., Lackey, C., Swenarski, L., & Gantt, J. M. (2003). Communication
monitoring: Shaping CDC’s emergency risk communication efforts. Journal of
Health Communication, 8, 35–49.
Reynolds, B. (2007). Crisis and Emergency Risk Communication: Pandemic Influenza.
Washington, DC: Government Printing Office.
Reynolds, B. J. (2010). Building trust through social media. CDC’s experience during
the H1N1 influenza response. Marketing Health Services, 30, 18-21.
Reynolds, B., & Seeger, M. W. (2005). Crisis and emergency risk communication as an
integrative model. Journal of Health Communication, 10, p. 43-55.
Zuckerberg, M. (2009, April 8). 200 million strong [Weblog post]. Retrieved from
http://blog.facebook.com/blog.php?post=72353897130
LAURA RICHARDSON WALTON, Ph.D., APR, is an assistant professor in the
Department of Communication at Mississippi State University. She is also a
Research Fellow and Coordinator of the Media Collaboration Laboratory in the
Social Science Research Center. Email: lwalton[at]comm.msstate.edu.
HOLLI H. SEITZ, MPH, is a doctoral student studying health communication in
the Annenberg School for Communication at the University of Pennsylvania.
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Walton, Seitz & Ragsdale
Use of YouTube During Public Health Crisis
KATHLEEN RAGSDALE, Ph.D., is an assistant research professor at the
Mississippi State University Social Science Research Center. She is an
applied medical anthropologist who is currently conducting mixed
method research on how new media/electronic technologies can be harnessed to
address health disparities among minority and vulnerable populations, with a
particular focus on high risk behavior prevention among rural and at-risk youth.
The preparation of this manuscript was supported by the Social Science Research
Center (SSRC) at Mississippi State University and the Annenberg School for
Communication at the University of Pennsylvania. The authors gratefully
acknowledge the contribution of research assistants Cameron White and Sydney
Hall in the SSRC’s Media Collaboration Laboratory.
Editorial history
Received January 23, 2012
Revised April 9, 2012
Accepted April 18, 2012
Published May 13, 2012
Handled by editor; no conflicts of interest
Case Studies in Strategic Communication, 1 | 2012
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