Skip to main content Accessibility help
Hostname: page-component-684899dbb8-5dd2w Total loading time: 0.453 Render date: 2022-05-28T06:54:26.888Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true }

The Public Sphere in Emerging Infectious Disease Communication: Recipient or Active and Vocal Partner?

Published online by Cambridge University Press:  17 July 2015

Anat Gesser-Edelsburg*
School of Public Health, University of Haifa, Haifa, Israel
Yaffa Shir-Raz
Department of Communication, University of Haifa, Haifa, Israel
Nathan Walter
Department of Communication, University of Haifa, Haifa, Israel
Emilio Mordini
Responsible Technology SAS, Paris, France
Dimitris Dimitriou
Zadig Communication, Information and Education in Science, Rome, Italy
James J. James
Society for Disaster Medicine and Public Health, Rockville, MD
Manfred S. Green
School of Public Health, University of Haifa, Haifa, Israel
Correspondence and reprint requests to Anat Gesser-Edelsburg, PhD, Senior Lecturer and Head of Health Promotion Department, School of Public Health, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa 3498838, Israel (e-mail:



Recent years have seen advances in theories and models of risk and crisis communication, with a focus on emerging epidemic infection. Nevertheless, information flow remains unilateral in many countries and does not take into account the public’s polyvocality and the fact that its opinions and knowledge often “compete” with those of health authorities. This article addresses the challenges organizations face in communicating with the public sphere.


Our theoretical approach is conceptualized through a framework that focuses on the public sphere and that builds upon existing guidelines and studies in the context of health and pandemics. We examine how health organizations cope with the public’s transformation from recipients to an active and vocal entity, ie, how and to what extent health organizations address the public’s anxiety and concerns arising in the social media during outbreaks.


Although international organizations have aspired to relate to the public as a partner, this article identifies notable gaps.


Organizations must involve the public throughout the crisis and conduct dialogues free of prejudices, paternalism, and preconceptions. Thereby, they can impart precise and updated information reflecting uncertainty and considering cultural differences to build trust and facilitate cooperation with the public sphere. (Disaster Med Public Health Preparedness. 2015;9:447–458)

Original Research
Copyright © Society for Disaster Medicine and Public Health, Inc. 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


1. Ray, SJ. Strategic Communication in Crisis Management: Lessons from the Airline Industry. Westport, CT: Quorum Books; 1999.Google Scholar
2. Fink, S. Crises Management: Planning for the Inevitable. New York, NY: American Management Association; 1986.Google Scholar
3. Turner, BM. The organizational and inter-organizational development of disasters. Admin Sci Quart. 1976;21(3):378-397.CrossRefGoogle Scholar
4. Courtney, J, Cole, G, Reynolds, B. How the CDC is meeting the training demands of emergency risk communication. J Health Commun. 2003;8(sup1):128-129.CrossRefGoogle ScholarPubMed
5. Pechta, LE, Brandenburg, DC, Seeger, MW. Understanding the dynamics of emergency communication: propositions for a four-channel model. Journal of Homeland Security and Emergency Management. 2010;7(1):1-18.CrossRefGoogle Scholar
6. Gesser-Edelsburg, A, Valter, N, Shir-Raz, Y, et al. New Framework Model for Outbreak Communication. Twelfth International Conference on Communication, Medicine & Ethics (COMET 2014); 2014; Lugano, Switzerland.Google Scholar
7. Bogue, R. Deleuze and Guattari. London: Routledge; 1989.Google Scholar
8. Nerlich, B. Change in Language: Whitney, Bréal and Wegener. London: Routledge; 1990.Google Scholar
9. Wallis, P, Nerlich, B. Disease metaphors in new epidemics: the UK media framing of the 2003 SARS epidemic. Soc Sci Med. 2005;60(11):2629-2639.CrossRefGoogle ScholarPubMed
10. McNab, C. What social media offers to health professionals and citizens. Bull World Health Organ. 2009;87(8):566-566.CrossRefGoogle ScholarPubMed
11. Hall, S. Encoding/decoding. In: Durham MG, Kellner DM, eds. Media and Studies: KeyWorks. Oxford: Blackwell; 2001:166-176.Google Scholar
12. Katz, E, Lazarsfeld, P. Personal Influence: The Part Played by People in the Flow of Mass Communications. New Brunswick, NJ: Transaction Publishers; 2006.Google Scholar
13. Nisbet, MC, Kotcher, JE. A Two-Step Flow of Influence? Opinion-Leader Campaigns on Climate Change. Sci Commun. 2009;30(3):328-354.CrossRefGoogle Scholar
14. Habermas, J. The Structural Transformation of the Public Sphere: An Inquiry into a Category of Bourgeois Society. Cambridge: Polity Press; 1989.Google Scholar
15. Habermas, J. The Divided West. Malden, MA: Polity Press; 2004.Google Scholar
16. Jankowski, NW, van Selm, M. The promise and the practice of public debate in cyberspace. In: Hacker KL, van Dijk J, eds. Digital Democracy: Issues of Theory and Practice. London: Sage Publications Ltd; 2000:149-165.CrossRefGoogle Scholar
17. Van de Donk, W, Loader, BD, Nixon, PG, Rucht, D. Cyberprotest: New Media, Citizens and Social Movements. London: Routledge; 2004.Google Scholar
18. van Os, R, Jankowski, NW, Vergeer, M. Political communication about Europe on the internet during the 2004 European parliament election campaign in nine EU member states. European Societies. 2007;9(5):755-775.CrossRefGoogle Scholar
19. Silverstone, R. What’s New about New Media? Introduction. New Media & Society. 1999;1(1):10-12.CrossRefGoogle Scholar
20. Fenton, N. New Media, Old News: Journalism and Democracy in the Digital Age. London: SAGE Publications Ltd; 2010.CrossRefGoogle Scholar
21. Cline, RJ, Haynes, KM. Consumer health information seeking on the Internet: the state of the art. Health Educ Res. 2001;16(6):671-692.CrossRefGoogle ScholarPubMed
22. Tustin, N. The role of patient satisfaction in online health information seeking. J Health Commun. 2010;15(1):3-17.CrossRefGoogle ScholarPubMed
23. Masters, K, Ng’ambi, D, Todd, G. “I Found it on the Internet”: Preparing for the e-patient in Oman. Sultan Qaboos Univ Med J. 2010;10(2):169-179.Google ScholarPubMed
24. Polgreen, PM, Chen, Y, Pennock, DM, et al. Using internet searches for influenza surveillance. Clin Infect Dis. 2008;47(11):1443-1448.CrossRefGoogle ScholarPubMed
25. Ginsberg, J, Mohebbi, MH, Patel, RS, et al. Detecting influenza epidemics using search engine query data. Nature. 2009;457(7232):1012-1014.CrossRefGoogle ScholarPubMed
26. Lampos, V, Cristianini, N. Tracking the flu pandemic by monitoring the social web. Paper presented at: IAPR 2nd Workshop on Cognitive Information Processing (CIP 2010); June 14-16, 2010; Tuscany, Italy.Google Scholar
27. Larson, HJ, Smith, DM, Paterson, P, et al. Measuring vaccine confidence: analysis of data obtained by a media surveillance system used to analyse public concerns about vaccines. Lancet Infect Dis. 2013;13(7):606-613.CrossRefGoogle ScholarPubMed
28. Bults, M, Beaujean, DJ, Richardus, JH, et al. Pandemic influenza A (H1N1) vaccination in The Netherlands: parental reasoning underlying child vaccination choices. Vaccine. 2011;29(37):6226-6235.CrossRefGoogle ScholarPubMed
29. Chew, C, Eysenbach, G. Pandemics in the age of Twitter: content analysis of Tweets during the 2009 H1N1 outbreak. PLoS One. 2010;5(11):e14118.CrossRefGoogle ScholarPubMed
30. Gordon, J. The mobile phone and the public sphere: mobile phone usage in three critical situations. Convergence: The International Journal of Research into New Media Technologies. 2007;13(3):307-319.CrossRefGoogle Scholar
31. Zhang, P, Gao, D. Collective sensemaking in social media: the case of the H7N9 flu pandemic in china. Presented at: iConference ’14; March 3-7, 2014; Berlin, Germany.Google Scholar
32. Vultee, F, Vultee, DM. What we tweet about when we tweet about disasters: the nature of microblog comments during emergencies. Int J Mass Emerg Disasters. 2011;29(3):221-242.Google Scholar
33. Petrie, KJ, Faasse, K.. Monitoring public anxiety about flu. Published June 11, 2009; Accessed July 12, 2014.Google Scholar
34. Davies, M. Swine Flu as social media epidemic; CDC tweets calmly online. Published May 1, 2009; Accessed July 12, 2014.Google Scholar
35. Tausczik, Y, Faasse, K, Pennebaker, JW, et al. Public anxiety and information seeking following the H1N1 outbreak: blogs, newspaper articles, and Wikipedia visits. Health Commun. 2012;27(2):179-185.CrossRefGoogle ScholarPubMed
36. Signorini, A, Segre, AM, Polgreen, PM. The use of Twitter to track levels of disease activity and public concern in the U.S. during the influenza A H1N1 pandemic. PLoS One. 2011;6(5):e19467.CrossRefGoogle Scholar
37. Centers for Disease Control and Prevention. National, state, and urban area vaccination coverage among children aged 19–35 months – United States, 2004. MMWR Morb Mortal Wkly Rep. 2005;54(29):717-721.Google Scholar
38. Centers for Disease Control and Prevention. National, state, and local area vaccination coverage among children aged 19–35 months – United States, 2008. MMWR Morb Mortal Wkly Rep. 2009;58(33):921-926.Google ScholarPubMed
39. WHO, World Bank. State of the Worlds Vaccines and Immunization , 3rd ed. Geneva: World Health Organization; 2009.Google ScholarPubMed
40. Jacobson, RM. Vaccination refusal and parental education: lessons learnt and future challenges. Pediatric Health. 2010;4(3):239-242.CrossRefGoogle Scholar
41. Velan, B, Boyko, V, Lerner-Geva, L, et al. Individualism, acceptance and differentiation as attitude traits in the public’s response to vaccination. Hum Vaccin Immunother. 2012;8(9):1272-1282.CrossRefGoogle ScholarPubMed
42. Davies, P, Chapman, S, Leask, J. Antivaccination activists on the World Wide Web. Arch Dis Child. 2002;87(1):22-25.CrossRefGoogle ScholarPubMed
43. Lehmann, BA, Ruiter, RA, Kok, G. A qualitative study of the coverage of influenza vaccination on Dutch news sites and social media websites. BMC Public Health. 2013;13:547.CrossRefGoogle ScholarPubMed
44. Betsch, C, Renkewitz, F, Betsch, T, et al. The influence of vaccine-critical websites on perceiving vaccination risks. J Health Psychol. 2010;15(3):446-455.CrossRefGoogle ScholarPubMed
45. Kata, A. Anti-vaccine activists, Web 2.0, and the postmodern paradigm: an overview of tactics and tropes used online by the anti-vaccination movement. Vaccine. 2012;30(25):3778-3789.CrossRefGoogle ScholarPubMed
46. Thackeray, R, Neiger, BL, Burton, SH, et al. Analysis of the purpose of state health departments’ tweets: information sharing, engagement, and action. J Med Internet Res. 2013;15(11):e255.CrossRefGoogle ScholarPubMed
47. WHO. WHO Outbreak Communication Guidelines. 2005. Accessed 22 July, 2014.Google Scholar
48. Härtl, G. Novel coronavirus: the challenge of communicating about a virus which one knows little about. East Mediterr Health J. 2013;19(supp.1):S26-S30.Google Scholar
49. Jones, B. Mixed uptake of social media among public health specialists. Bull World Health Organ. 2011;89:784-785.Google ScholarPubMed
50. Merchant, RM, Elmer, S, Lurie, N. Integrating social media into emergency-preparedness efforts. N Engl J Med. 2011;365(4):289-291.CrossRefGoogle ScholarPubMed
51. Thackeray, R, Neiger, BL, Smith, AK, et al. Adoption and use of social media among public health departments. BMC Public Health. 2012;12(1):242.CrossRefGoogle ScholarPubMed
52. CDC. Social Media Guidelines and Best Practices. Last updated May 16, 2012. Accessed June 23, 2014.Google Scholar
53. Walton, LR, Seitz, HH, Ragsdale, K. 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. 2012;1:25-37.Google Scholar
54. Danforth, EJ, Doying, A, Merceron, G, et al. Applying social science and public health methods to community-based pandemic planning. J Bus Contin Emer Plan. 2010;4(4):375-390.Google ScholarPubMed
55. Neiger, BL, Thackeray, R, Burton, SH, et al. Use of Twitter among local health departments: an analysis of information sharing, engagement, and action. J Med Internet Res. 2013;15(8):e177.CrossRefGoogle ScholarPubMed
56. WHO. Pandemic Influenza Risk Management WHO Interim Guidance. 2013. Accessed April 16, 2015.Google Scholar
57. CDC. 2009 H1N1: Overview of a Pandemic. 2010. Accessed April 16, 2015.Google Scholar
58. Falls, J, Deckers, E. No Bullshit Social Media: The All Business, No Hype Guide To Social Media Marketing, Pearson Education; 2011.Google Scholar
59. Slovic, P. The Perception of Risk. London: Earthscan; 2000.Google ScholarPubMed
60. Furgal, C, Powell, S, Myers, H. Digesting the message about contaminants and country foods in the Canadian north: a review and recommendations for future research and action. ARCTIC. 2010;58(2):103-114.CrossRefGoogle Scholar
61. Krimsky, S, Plough, A. Environmental Hazards: Communicating Risks as a Social Process. Dover, MA: Auburn House Publishing Company; 1988.Google Scholar
62. Lindell, MK, Perry, RW. Communicating Environmental Risk in Multiethnic Communities. Thousand Oaks, CA: Sage; 2004.Google Scholar
63. Gesser-Edelsburg, A, Mordini, E, James, JJ, et al. Risk communication recommendations and implementation during emerging infectious diseases: a case study of the 2009 H1N1 influenza pandemic. Disaster Med Public Health Prep. 2014;8(02):158-169.CrossRefGoogle Scholar
64. WHO. International Health Regulations (2005). 2nd ed. 2008:24. Accessed October 20, 2012.Google Scholar
65. WHO. World Health Organization Outbreak Communication Planning Guide. 2008. Accessed October 20, 2012.Google Scholar
66. Reynolds, B. Crisis and emergency risk communication: pandemic influenza. Atlanta, GA: Centers for Disease Control and Prevention; 2007. Accessed June 9, 2010.Google Scholar
67. Lam, PP, McGeer, A. Communication Strategies for the 2009 Influenza A (H1N1) Pandemic. 2011. Accessed August 20, 2013.Google Scholar
68. Brennan, B, Hall, W. Putting Planning Into Practice: The Communications Response to H1N1. A Global Communications Conference sponsored by the Pan American Health Organization and the United States Department of Health and Human Services. Pan American Health Organization, US Department of Health and Human Services; 2009.Google Scholar
69. Fischhoff, B. Scientifically sound pandemic risk communication (House Science Committee Briefing, Gaps in the National Flu Preparedness Plan: Social Science Planning and Response, December). In: New KD, ed. McGraw Hill Handbook of Terrorism and Counter-terrorism. New York: McGraw Hill; 2005.Google Scholar
70. Driedger, SM, Cooper, E, Jardine, C, et al. Communicating risk to aboriginal peoples: first nations and Metis responses to H1N1 risk messages. PLoS One. 2013;8(8):e71106.CrossRefGoogle ScholarPubMed
71. Gray, L, MacDonald, C, Mackie, B, et al. Community responses to communication campaigns for influenza A (H1N1): a focus group study. BMC Public Health. 2012;12(1).CrossRefGoogle ScholarPubMed
72. Massey, PD, Miller, A, Saggers, S, et al. Australian Aboriginal and Torres Strait Islander communities and the development of pandemic influenza containment strategies: community voices and community control. Health Policy. 2011;103(2-3):184-190.CrossRefGoogle ScholarPubMed
73. Massey, PD, Pearce, G, Taylor, KA, et al. Reducing the risk of pandemic influenza in Aboriginal communities. Rural Remote Health. 2009;9(3):1290.Google ScholarPubMed
74. Rudge, S, Massey, PD. Responding to pandemic (H1N1) 2009 influenza in Aboriginal communities in NSW through collaboration between NSW Health and the Aboriginal community-controlled health sector. N S W Public Health Bull. 2010;21(1-2):26-29.CrossRefGoogle Scholar
75. Ministry of Health, Republic of Botswana. Ebola Virus Alert. 2014. Accessed September 11, 2014.Google Scholar
76. WHO. Ebola virus disease in Guinea, Disease Outbreak News. Published March 23, 2014. Accessed April 16, 2015.Google Scholar
77. Cassoobhoy, A. CDC: Ebola Questions and Answers. Published August 8, 2014. Accessed April 16, 2015.Google Scholar
78. Achenbach, J, Dennis, B, Hogan, C. American Doctor Infected with Ebola Returns to U.S. The Washington Post. Published August 2, 2014. Accessed April 16, 2015.Google Scholar
79. Sandman, P. Hazard versus outrage in the public perception of risk. In: Covello VT, McCallum DB, Pavlove MT, eds. Effective Risk Communication: The Role and Responsibility of Government and Nongovernment Organizations. New York: Plenum Press; 1989:45-49.CrossRefGoogle Scholar
80. Fischhoff, B. A diagnostic for risk communication failers. In: Leiss W, Powell D, eds. Mad Cows and Mothers Milk: The Perils of Poor Risk Communication . 2 ed. Montreal & Kingston: McGill-Queen’s University Press; 2004:26-40.Google Scholar
81. Rosen, NO, Knäuper, B. A little uncertainty goes a long way: state and trait differences in uncertainty interact to increase information seeking but also increase worry. Health Commun. 2009;24(3):228-238.CrossRefGoogle Scholar
82. Transcript of WHO Virtual Press Conference of 6 August 2009 with Dr Marie-Paule Kieny, Director of the Initiative for Vaccine Research at WHO Headquarters and Gregory Hartl, Spokesperson for H1N1 [press release]. World Health Organization. 2009. Accessed April 16, 2015.Google Scholar
83. Transcript of virtual press conference with Gregory Hartl, Spokesperson for H1N1, and Dr Marie-Paule Kieny, WHO Director of the Initiative for Vaccine Research, World Health Organization [press release]. 30 October 2009 (updated 2 November 2009). World Health Organization. Accessed April 16, 2015.Google Scholar
84. Doshi, P. Influenza: marketing vaccine by marketing disease. BMJ. 2013;346:f3037.CrossRefGoogle ScholarPubMed
85. Lau, JT, Kim, JH, Tsui, HY, et al. Anticipated and current preventive behaviors in response to an anticipated human-to-human H5N1 epidemic in the Hong Kong Chinese general population. BMC Infect Dis. 2007;7:18.CrossRefGoogle Scholar
86. Lau, JT, Yeung, NC, Choi, KC, et al. Acceptability of A/H1N1 vaccination during pandemic phase of influenza A/H1N1 in Hong Kong: population based cross sectional survey. BMJ. 2009;339:b4164.CrossRefGoogle Scholar
87. Leung, GM, Ho, LM, Chan, SK, et al. Longitudinal assessment of community psychobehavioral responses during and after the 2003 outbreak of severe acute respiratory syndrome in Hong Kong. Clin Infect Dis. 2005;40(12):1713-1720.CrossRefGoogle ScholarPubMed
88. Rubin, GJ, Amlôt, R, Page, L, et al. Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: cross sectional telephone survey. BMJ. 2009;339:b2651.CrossRefGoogle ScholarPubMed
89. Groves, RM. Theories and methods of telephone surveys. Annu Rev Sociol. 1990;16(1):221-240.CrossRefGoogle Scholar
90. Brownstein, JS, Freifeld, CC, Madoff, LC. Digital disease detection- harnessing the Web for public health surveillance. N Engl J Med. 2009;360(21):2153-2155, 2157.CrossRefGoogle ScholarPubMed
91. Dukic, VM, Lopes, HF, Polson, N. Tracking flu epidemics using Google Flu Trends and particle learning. Social Science Research Netwo rk . Published online November 25, 2009, doi: 10.2139/ssrn.1513705.Google Scholar
92. Pervaiz, F, Pervaiz, M, Abdur Rehman, N, et al. FluBreaks: early epidemic detection from Google flu trends. J Med Internet Res. 2012;14(5):e125.CrossRefGoogle ScholarPubMed
93. Hartley, D, Nelson, N, Walters, R, et al. Landscape of international event-based biosurveillance. Emerg Health Threats J. 2010;3:e3.Google ScholarPubMed
94. Hartley, DM, Nelson, NP, Arthur, RR, et al. An overview of internet biosurveillance. Clin Microbiol Infect. 2013;19(11):1006-1013.CrossRefGoogle ScholarPubMed
95. Gesser-Edelsburg, A, Shir-Raz, Y, Green, MS. Why do parents who usually vaccinate their children hesitate or refuse? General good vs. individual risk. J Risk Res. Published online December 12, 2014 DOI: 10.1080/13669877.2014.983947.Google Scholar
96. Beierle, TC. The benefits and costs of disclosing information about risks: what do we know about right-to-know? Risk Anal. 2004;24(2):335-346.CrossRefGoogle ScholarPubMed
97. Leighton, M, Roht-Arriaza, N, Zarsky, L. Beyond good deeds: case studies and a new policy agenda for corporate accountability. 2002. Accessed Dec. 29 2013.Google Scholar
98. Palenchar, MJ, Heath, RL. Strategic risk communication: adding value to society. Public Relations Review. 2007;33(2):120-129.CrossRefGoogle Scholar
99. Johnson, BB, Slovic, P. Presenting uncertainty in health risk assessment: initial studies of its effects on risk perception and trust. Risk Anal. 1995;15(4):485-494.CrossRefGoogle ScholarPubMed
100. Maxim, L, Mansier, P, Grabar, N. Public reception of scientific uncertainty in the endocrine disrupter controversy: the case of male fertility. J Risk Res. 2012;16(6):677-695.CrossRefGoogle Scholar
101. Sandman, P, Lanard, J. Explaining and proclaiming uncertainty: Risk communication lessons from germany’s E. Coli outbreak. Published August 14, 2011. Accessed November 23, 2014.Google Scholar
102. Slovic, P, Finucane, ML, Peters, E, et al. Risk as analysis and risk as feelings: some thoughts about affect, reason, risk, and rationality. Risk Anal. 2004;24(2):311-322.CrossRefGoogle ScholarPubMed
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

The Public Sphere in Emerging Infectious Disease Communication: Recipient or Active and Vocal Partner?
Available formats

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

The Public Sphere in Emerging Infectious Disease Communication: Recipient or Active and Vocal Partner?
Available formats

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

The Public Sphere in Emerging Infectious Disease Communication: Recipient or Active and Vocal Partner?
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *