Date Published: October 31, 2018
Publisher: Public Library of Science
Author(s): Ayan Jha, Leesa Lin, Sarah Massin Short, Giorgia Argentini, Gaya Gamhewage, Elena Savoia, Aram Dobalian.
The World Health Organization (WHO) commissioned a systematic review of literature to facilitate evidence syntheses for the development of emergency risk communication (ERC) guidelines for its member states. The goal of this review was to integrate ERC best practices into governmental and non-governmental health systems for all emergencies of public health concern, by addressing three questions: (1) to identify best practices for the integration of ERC into national and international public health preparedness; (2) to identify mechanisms to establish effective intra-agency, inter-agency, and/or cross-jurisdictional information sharing; and (3) to identify methods to coordinate risk communication activities between responding agencies across organizations and levels of response. The review covered scientific and grey literature publications between January 2003 and February 2016, and searches were conducted in 17 English language electronic libraries besides Chinese, Portuguese and Spanish language databases. A mixed deductive-inductive process was used to synthesize findings across studies through identifying thematic areas. While 8,215 articles were initially retrieved, after a sequential screening process, the final evidence syntheses comprised of 21 articles for question (1) and 24 for questions (2) and (3) combined (due to overlap of themes). The confidence in findings was assessed by the Qualitative Evidence Syntheses (GRADE-CERQual) tool. PRISMA guidelines were followed to the extent possible given the limitations inherent to a review largely based on qualitative studies. The identified literature was very context-specific and referred to mechanisms, practices from the field, and recommendations that were derived from planning or response efforts implemented at the national or local levels in specific countries. Integration of ERC functions into public health emergency preparedness, planning and response activities was influenced by reforming components of the leadership structure when needed, modifying organizational factors, and nullifying restrictions (including amending laws/ regulations) that might have been an obstacle to the timely release of information. Exercises and trainings were recognized as effective strategies to identify the barriers and successes in this process of integration. Key elements to enhance information sharing and coordination across organizations included the creation of networks, task-forces and committees across disciplines, organizations and geographic areas. Engagement of local stakeholders was also important to guarantee the flow of information up and down the incident command system. On the whole, few empirical studies, especially from low- and middle-income countries, related to the WHO research questions, demonstrating the need for research in these areas. To facilitate an accurate identification of the gaps, the authors suggest integrating current findings with case studies across the WHO regions to better understand the specific evidence that is needed in practice across the multitude of ERC functions.
Emergency risk communications (ERC) consist of “the real-time exchange of information, advice and opinions” between decision-makers, experts and the general public.  Over the last decade, nations have increasingly faced challenges in acquiring, processing and communicating information to protect the physical, social and economic wellbeing of their citizens during emergency situations. This challenge is in part due to the lack of evidence on how to best communicate among responding agencies and with the public. 
The functioning of ERC is intricately linked to the varying political and cultural landscapes present across nations. Therefore, in some circumstances, centralized ERC systems may work better than localized ones, or vice versa. Researchers had noted that decentralized health systems (e.g. as in Indonesia) faced greater challenges in implementing preventive and outbreak response measures, and the level of efficiency depended heavily on local political commitment.  In contrast, there was a need for increased decision-making power at the level of provincial and local public health agencies in China to enable them to release critical ERC to the public, circumventing barriers in organizational hierarchy.  Hence, issues like political goodwill and leadership, as well as the structure of the national health system (degree of centralization) are to be considered as key factors in planning and policy-making for ERC.