Evidence Based Communications Research Articles

Protecting mass-gathering events in a pandemic with testing tracks and transparent information: an experimental study with festival guests

Objective. To enable future open-air festivals during a pandemic, model festivals tested restricted access and behavioural rules to prevent SARS-CoV-2 transmissions. However, the uptake of health-protective measures depends on informed acceptance, meaning people are more likely to follow measures if they understand their effectiveness and related disease risks. Design and main outcome measures. With a series of online surveys, we studied risk perceptions of 6,500 festival guests and the association of perceived effectiveness of protective behaviours with reported compliance. In a scenario-based online experiment (N = 1,958) among festival guests, we tested the effect of informing transparently about the risk-reducing potential of protective measures at festivals on the intention to attend hypothetical events. Results. We found that guests tended to overestimate infection risks while still perceiving them as low. Self-reported mask wearing and distancing at and around the festivals could not be associated with the understanding of the measures’ effectiveness. However, in addition to protective measures themselves, providing transparent information about their absolute risk-reducing effect increased intentions to attend festivals that employ varying protective measures. Conclusion. Our findings suggest that the acceptance of protected festivals can be influenced by transparent information about the effectiveness of protective measures. This calls for further research on evidence-based public health communications to improve their impact.

Implementing mandatory COVID-19 vaccination for Australian aged care workers.

Implementing mandatory COVID-19 vaccination for Australian aged care workers.

The effects of communicating scientific uncertainty on trust and decision making in a public health context

AbstractLarge-scale societal issues such as public health crises highlight the need to communicate scientific information, which is often uncertain, accurately to the public and policy makers. The challenge is to communicate the inherent scientific uncertainty — especially about the underlying quality of the evidence — whilst supporting informed decision making. Little is known about the effects that such scientific uncertainty has on people’s judgments of the information. In three experimental studies (totalN=6,489), we investigate the influence of scientific uncertainty about the quality of the evidence on people’s perceived trustworthiness of the information and decision making. We compare the provision of high, low, and ambiguous quality-of-evidence indicators against providing no such cues. Results show an asymmetric relationship: people react more strongly to cues of low quality of evidence than they do to high quality of evidence compared to no cue. While responses to a cue of high quality of evidence are not significantly different from no cue; a cue of low or uncertain quality of evidence is accompanied by lower perceived trustworthiness and lower use of the information in decision making. Cues of uncertain quality of evidence have a similar effect to those of low quality. These effects do not change with the addition of a reason for the indicated quality level. Our findings shed light on the effects of the communication of scientific uncertainty on judgment and decision making, and provide insights for evidence-based communications and informed decision making for policy makers and the public.

Health TrueInfo: A multilingual Android app and social media approach in tackling COVID-19 vaccine misinformation and hesitancy in Bolivia, India, and Canada

COVID-19 vaccine misinformation has been fueling vaccine hesitancy, which has been one of the main factors in slowing down the vaccination rate (Loomba et al., 2021). An increase in vaccine hesitancy, especially among the vulnerable communities, will exacerbate the already overwhelming economic and health burden of COVID-19. The purpose of Health TrueInfo is to use knowledge translation strategies to implement evidence-based health communications via social media in order to tackle COVID-19 vaccine misinformation and hesitancy among vulnerable populations in Bolivia, India, and Canada. The Health TrueInfo initiative is in collaboration with health experts and community members, asking them to create audiovisuals that convey powerful and culturally relevant messages to their communities. Such content combats local misinformation and encourages vaccine uptake. The audiovisual content is then uploaded to our multilingual Android app and social media platforms on Twitter, Facebook, Instagram, and LinkedIn.The concept of using social media to tackle misinformation was informed from systematic reviews, highlighting its potential by health organizations to combat prevalent misinformation as social media is widely used to share and seek health information (Chou et al., 2018; Suarez-Lledo & Alvarez-Galvez, 2021). Community engagement and searching grey literature were important methodologies to understand different local contexts of misinformation. For instance, to better comprehend how misinformation plays a role in increasing vaccine hesitancy among the Indigenous Quechua peoples in Bolivia, we collaborated with a Quechua social media influencer, who helped us create a skit inspired by the current local misinformation. Likewise, we have asked other stakeholders in healthcare like local teenagers, frontline doctors, and health experts to help create content addressing their respective communities. The knowledge translation strategies utilized here were to contextualize information, appeal to potential vaccine-hesitant groups, and use community engagement strategies like involving influencers to help us reach specific demographic groups and overcome linguistic and cultural barriers (Bella et al., 2021). One way to quantitatively estimate the impact of the project is through social media analytics. When contributors or influencers helped create audiovisuals and share with their followers, some of our content have reached over 1000 impressions and 200 views within targeted demographics. This initial success may imply how Health TrueInfo models the idea of health experts, social media influencers, and members of their own communities working together to reduce vaccine misinformation and hesitancy via creating multimodal social media contents, which in turn might help increase health and digital literacy, and battle social isolation. As health misinformation is a relatively new research field and vaccine hesitancy literature for countries like Bolivia and for the Indigenous communities in general are limited, Health TrueInfo can inspire participatory action research in countries and communities that are under-represented in the peer-reviewed literature to better understand different context-specific factors contributing to vaccine misinformation and hesitancy.

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What Information Drives Political Polarization? Comparing the Effects of In-group Praise, Out-group Derogation, and Evidence-based Communications on Polarization

This project differentiates between communication that praises one's political in-group ( in-group praise), attacks the opposition ( out-group derogation), or focuses on policy details ( evidence based), testing their effects on network and attitude polarization. We begin with an agent-based model, which shows that congenial evidence-based exchanges polarize the network and the inclusion of identity-driven communications leads to greater polarization. Once out-group derogation reaches a certain threshold, the network of agents splits into two groups, yet the polarizing effects of in-group praise are yet stronger and emerge more rapidly (i.e., a lower threshold of in-group praise is needed to polarize the network). Using an experimental design on a sample of American partisans, we offer a partial validation of the model. In-group praise and out-group derogation polarize attitudes more than balanced evidence-based news, but not more than congenial evidence-based news. Identity-driven news also has no effects on affective polarization. This multidisciplinary evidence shows that the nature of political content matters.

CRISIS AND DISRUPTION COMMUNICATIONS MANAGEMENT IN THE AIRPORTS SECTOR: THE EFFECTIVE USE OF SOCIAL MEDIA

Although the use of social media within the airport industry is not a new practice, there are still varying degrees of real and perceived concerns around how to best deliver positive rather than negative user engagement and experiences through social media platforms. This perceived risk becomes particularly apparent during times of significant airport operational disruption and crisis. Using an airport user questionnaire (in Portugal) and operational expert interviews (in the UK), this study aimed to determine the ways in which airport use of social media platforms should be integrated into overall airport crisis and disruption management strategies. This led to an evidence-based template communications flow model for airport operations managers and their communications teams to help ensure common and consistent messaging, positive user engagement/experiences, and reduced business fallout from significant disruption and crises. Future research should seek to test the usefulness of specific communications and social media guidance that airports use internally to determine if they are consistent with the different user preferences by crisis typology as detailed in this study.

Menekülés a komplexitástól

As a result of the recently occurred pandemic it has become apparent even for the common people that reality no longer can be seen through the lenses of simplification. Humankind has entered a new age characterized by complexity and lack of transparency. The border between nature and society has disappeared revealing that both of them are ruled by laws of complex systems. The relationships in complex systems are non-linear, categories are bond to language and understanding is a function of fuzzy logic. There is one chaordic world where changes cannot be predicted. Sudden small changes can lead to major transformations. The human mind has not been equipped by evolution to the challenges of complexity. Human beings living complexity are driven to escape from insecurity to security. Instead of reducing tension infodemics in social media induce anxiety and a sense of insecurity resulting inadequate response of the users. As a consequence of cognitive inadaptation users of social media tend to develop symptoms of depression, anxiety, paranoia, irrational credulity and resistance to accept evidence-based communications.

BCS Impact Report Winter 2020

Abstract BCS members spoke out clearly on the sale of ARM; harnessing this strong response is the latest example of our evidence-based communications strategy, writes James Woodward, Head of Policy and PR.

Internet and social media use among patients with colorectal diseases (ISMAEL): a nationwide survey.

Social media are used daily by both healthcare workers and patients. Online platforms have the potential to provide patients with useful information, increase their engagement and potentially revolutionize the patient-physician relationship. This survey aimed to evaluate the impact of the Internet and social media (I&SM) on patients affected by colorectal and proctological diseases to define a pathway to develop an evidence-based communications strategy. A 31-item anonymous electronic questionnaire was designed. It consisted of different sections concerning demographics and education, reason for the visit, knowledge of the diseases, frequency of I&SM use and patients' opinions about physicians' websites. Over a 5-month period, 37 centres and 105 surgeons took part in the survey, and a total of 5800 patients enrolled. Approximately half of them reported using the Internet daily, and 74.6% of the study population used it at least once per week. There was a correlation (P<0.001) between those who used the Internet for work and those who had knowledge of both symptoms and the likely diagnosis before consultation. Patients who used the Internet daily were more likely to request a consultation within 6months of symptom onset (P<0.0001). Patients with anorectal diseases were more likely to know about their disease and symptoms before the visit (P<0.001). Colorectal patients use I&SM to look for health-related information mainly after their medical visit. Surgeons and hospital networks should plan a tailored strategy to increase patient engagement, delivering appropriate information on social media.

Improving Screening Uptake among Breast Cancer Survivors and Their First-Degree Relatives at Elevated Risk to Breast Cancer: Results and Implications of a Randomized Study in the State of Georgia.

Women diagnosed with breast cancer at a relatively early age (≤45 years) or with bilateral disease at any age are at elevated risk for additional breast cancer, as are their female first-degree relatives (FDRs). We report on a randomized trial to increase adherence to mammography screening guidelines among survivors and FDRs. From the Georgia Cancer Registry, breast cancer survivors diagnosed during 2000–2009 at six Georgia cancer centers underwent phone interviews about their breast cancer screening behaviors and their FDRs. Nonadherent survivors and FDRs meeting all inclusion criteria were randomized to high-intensity (evidence-based brochure, phone counseling, mailed reminders, and communications with primary care providers) or low-intensity interventions (brochure only). Three and 12-month follow-up questionnaires were completed. Data analyses used standard statistical approaches. Among 1055 survivors and 287 FDRs who were located, contacted, and agreed to participate, 59.5% and 62.7%, respectively, reported breast cancer screening in the past 12 months and were thus ineligible. For survivors enrolled at baseline (N = 95), the proportion reporting adherence to guideline screening by 12 months post-enrollment was similar in the high and low-intensity arms (66.7% vs. 79.2%, p = 0.31). Among FDRs enrolled at baseline (N = 83), screening was significantly higher in the high-intensity arm at 12 months (60.9% vs. 32.4%, p = 0.03). Overall, about 72% of study-eligible survivors (all of whom were screening nonadherent at baseline) reported screening within 12 months of study enrollment. For enrolled FDRs receiving the high-intensity intervention, over 60% reported guideline screening by 12 months. A major conclusion is that using high-quality central cancer registries to identify high-risk breast cancer survivors and then working closely with these survivors to identify their FDRs represents a feasible and effective strategy to promote guideline cancer screening.

Dietary Protein and Amino Acids in Vegetarian Diets-A Review.

While animal products are rich in protein, the adequacy of dietary protein intake from vegetarian/vegan diets has long been controversial. In this review, we examine the protein and amino acid intakes from vegetarian diets followed by adults in western countries and gather information in terms of adequacy for protein and amino acids requirements, using indirect and direct data to estimate nutritional status. We point out that protein-rich foods, such as traditional legumes, nuts and seeds, are sufficient to achieve full protein adequacy in adults consuming vegetarian/vegan diets, while the question of any amino acid deficiency has been substantially overstated. Our review addresses the adequacy in changes to protein patterns in people newly transitioning to vegetarian diets. We also specifically address this in older adults, where the issues linked to the protein adequacy of vegetarian diets are more complex. This contrasts with the situation in children where there are no specific concerns regarding protein adequacy because of their very high energy requirements compared to those of protein. Given the growing shifts in recommendations from nutrition health professionals for people to transition to more plant-based, whole-food diets, additional scientific evidence-based communications confirming the protein adequacy of vegetarian and vegan diets is warranted.

Cholera control and prevention: Role of evidence-based advocacy and communications

Evidence-based communications and policy outreach are critical elements in building awareness about a disease, build public momentum and decision making and resource mobilization. In India, communications and advocacy played an important role in managing diseases like HIV/AIDS, pneumonia, tuberculosis, etc. and addressing barriers to adoption of new health interventions. These learnings from the past, can help India manage cholera more effectively through a strong advocacy and communications strategy involving multiple stakeholders and partners, with a focus on engaging decision makers. The article discusses strategic communications and advocacy programs for cholera that can be instrumental in paving the way for cholera vaccine use to combat this public health problem and its social and economic impact.

Cancer Council New South Wales: Policy and Advocacy Report Community Insights to Inform the Policy Positioning of Tobacco Retailing Reform in NSW, Australia

Background and context: In the lead-up to the next state election, Cancer Council New South Wales (CCNSW) will run the “Saving Life 2019” advocacy campaign focused on changing NSW Government policy in cancer control. In developing a policy agenda, three priority areas were identified that required further research to better understand public perceptions, inform messaging and engagement strategies. Reform of current tobacco retailing was identified as one of these priorities. Aim: Understand how key audiences view current tobacco retailing laws and widespread tobacco availability in NSW; Find new opportunities to progress our policy objectives by identifying additional key audiences in the general population; Build the evidence base for a salient and convincing messaging guide for the advocacy campaign strategy and CCNSW's broader policy engagement and influencing work. Strategy/Tactics: The campaign will seek to demonstrate community support for reform of current tobacco retailing laws in NSW to the community, the media and political candidates to achieve policy commitments. CCNSW existing campaign strategy includes tactics across grassroots mobilization, targeted political engagement and securing earned media. The development of strategic research to underpin this campaign, including development of an evidence-based communications strategy, was critical in optimizing communications and public engagement. Program/Policy process: CCNSW commissioned an independent external agency to conduct the research. The research used a mixed methodology that included a facilitated online focus group of up to 20 people, followed by polling of the general public. Focus groups were conducted over two days, with participants recruited from a wide geographical spread and constituted a mixture of general population, parents, hospitality workers and small business owners. Outcomes: A research and communications report containing an overview of the research, key findings, as well as communications considerations based on the research was used to inform our overall campaign strategy, including policy messaging and communications planning. What was learned: Findings noted that while cancer of all types is seen as a serious public health issue, cancer specifically resulting from smoking and tobacco use is not top-of-mind. It revealed the link between ease of access to tobacco products and increased usage is clearly understood, and there was support for further restricting where tobacco can be sold. The concept of a “retailer fee” to pay for the cost of antismoking initiatives received limited support, mostly driven by concern for smaller retailers. The most popular arguments were those which reinforced existing community beliefs, rather than challenging them.

Community Insights to Inform the Policy Positioning of Junk Food Marketing Reform in NSW, Australia

Background and context: In the lead up to the next state election, Cancer Council New South Wales (CCNSW) will run the “Saving Life 2019” advocacy campaign focused on changing NSW Government policy in cancer control. In developing a policy agenda, three priority areas were identified that required further research to better understand public perceptions, inform messaging and engagement strategies. Reform of current junk food marketing on government owned assets (including public transport) was identified as one of these priorities to reduce childhood obesity. Aim: •Understand how key audiences view overweight and obesity as a public health issue and specifically junk food marketing to children •Find new opportunities to progress CCNSW policy objectives by identifying additional key audiences in the general population; •Build the evidence base for a salient and convincing messaging guide for the advocacy campaign strategy and CCNSW's broader policy engagement and influencing work. Strategy/Tactics: The campaign will seek to demonstrate community support for restricting junk food marketing on government owned assets in NSW to the community, the media and political candidates to achieve policy commitments. CCNSW existing campaign strategy includes tactics across grassroots mobilization, targeted political engagement and securing earned media. The development of strategic research to underpin this campaign, including development of an evidence-based communications strategy, was critical in optimizing communications and public engagement. Program/Policy process: CCNSW commissioned an independent external agency to conduct the research. The research used a mixed methodology that included two facilitated online focus groups of up to 20 people each, followed by polling of the general public. Focus groups were conducted over two days, with participants recruited from a wide geographical spread and constituted a mixture of general population and parents who are the main meal preparer in households. Outcomes: A research and communications report containing an overview of the research, key findings, as well as communications considerations based on the research was used to inform our overall campaign strategy, including policy messaging and communications planning. What was learned: Findings noted that unprompted, overweight and obesity is considered an important public health issue. The specific issue of childhood obesity is seen to be a personal family issue and the responsibility of parents. The provision of junk food by parents to children was seen as a driver of childhood obesity, but the role of junk food marketing and its regulation was not top-of-mind. When prompted, the idea of banning junk food advertising on public transport was an action that could be taken by government to tackle childhood obesity, with children perceived as being vulnerable and requiring protection.

Cancer Council New South Wales Policy and Advocacy Report: Community Insights to Inform the Policy Positioning of Smoke-Free Legislation Reform in NSW, Australia

Background and context: In the lead-up to the next state election, Cancer Council New South Wales (CCNSW) will run the “Saving Life 2019” advocacy campaign focused on changing NSW Government policy in cancer control. In developing a policy agenda, three priority areas were identified that required further research to better understand public perceptions, inform messaging and engagement strategies. Reform of current smoke-free laws was identified as one of these priorities. Aim: Understand how key audiences view current smoke-free laws and issues of exposure to second-hand smoke in NSW licensed venues; Find new opportunities to progress policy objectives by identifying additional key audiences in the general population; Build the evidence base for a salient and convincing messaging guide for the advocacy campaign strategy and our broader policy engagement and influencing work. Strategy/Tactics: The campaign will seek to demonstrate community support for the reform of current smoke-free laws in NSW to the community, the media and political candidates to achieve policy commitments. CCNSW existing campaign strategy includes tactics across grassroots mobilization, targeted political engagement and securing earned media. The development of strategic research to underpin this campaign, including development of an evidence-based communications strategy, was critical in optimizing our communications and public engagement. Program/Policy process: Cancer Council NSW worked with an external agency to conduct the research. The research used a mixed methodology that included a facilitated online focus group of up to 20 people, followed by polling of the general public. Focus groups were conducted over two days, with participants recruited from a wide geographical spread. Targeted sampling to ensure participants visit a pub or club at least once per fortnight was also incorporated. Outcomes: A research and communications report containing an overview of the research, key findings, as well as communications considerations based on the research was used to inform our overall campaign strategy, including policy messaging and communications planning. What was learned: Preliminary findings noted that while smoking and related health issues is a key concern for participants, it is of greatest concern among those who are smokers, have previously smoked, or are close to someone who does. They revealed a high level of awareness of the meaning.

Thymosin α1-Based Immunomodulatory Therapy for Sepsis: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials

Background: Preclinical studies suggest that thymosin α1 has immunoregulatory and anti-inflammatory properties in various septic models. However, whether these effects will transform into improved outcomes in humans with sepsis remains unclear. We performed a meta-analysis to define the role of thymosin α1-based immunomodulatory therapy in sepsis.Methods: We searched Medline and Embase to identify randomized controlled trials that assessed the effect of thymosin α1-based immunomodulatory therapy compared with standard care for adults with sepsis. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) using a random-effects model. The primary outcome was 28-day mortality.Results: Nine articles with 10 trials involving 1425 patients were included. Compared with standard care, thymosin α1-based immunomodulatory therapy was associated with a significant 31% relative risk reduction of 28-day mortality (RR 0.69, 95% CI 0.60-0.80, P<0.001), with no statistical heterogeneity (I2=0%). The benefit was confirmed by trial sequential analysis and was consistent across all subgroup analyses. For secondary outcomes, thymosin α1-based immunomodulatory therapy was associated with shorter length of intensive care unit (ICU) stay and duration of mechanical ventilation, increased T lymphocyte subsets (CD3+, CD4+, and CD4+/CD8+), and decreased inflammatory mediators (tumor necrosis factor-α, interleukin-1β, and interleukin-6).Conclusions: Thymosin α1-based immunomodulatory therapy decreases 28-day mortality in patients with sepsis. The benefit might be attributed to its immunomodulatory and anti-inflammatory effects. However, caution should be used to translate these findings to clinical practice, because current evidence is potentially subject to bias. Hence, high-quality and adequately powered trials are still warranted. Citation: Wan-Jie Gu, Xiao-Ping Gu, Zheng-Liang Ma. Thymosin α1-based immunomodulatory therapy for sepsis: a meta-analysis with trial sequential analysis of randomized controlled trials. J Anesth Perioper Med 2017; x: x-x. doi:10.24015/JAPM.2017.0017This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Vagal Nerve Stimulation: A Potentially Useful Adjuvant to Treatment of Sepsis

Aim of review: The hyper-inflammatory response is the classical pathogenesis of course. It has been shown that efferent nerve stimulation can regulate inflammatory response through a combination of acetylcholine and special α7 nicotinic acetylcholine receptor expressed on macrophages, which is defined as the cholinergic anti-inflammatory pathway (CAP). Furthermore, therapeutic methods related to CAP have been studied on lots of pathologic conditions, such as sepsis, ischemia/reperfusion injury, pancreatitis and hemorrhagic shock, etc. The aim of this review is to provide the evidence that VNS may be an effective adjuvant treatment bringing benefits for prognosis of by controlling excessive inflammatory response.Methods: We searched literatures published in the Pubmed with keywords inflammation, sepsis and vagal nerve stimulation (VNS) from January, 1986 to November, 2016, analyzed them and then assessed the evidence as to whether VNS may be an effective adjuvant for treatment of sepsis. In this review, the evidence regarding the role of hyper-inflammatory response in the pathogenesis of and inflammatory regulation of CAP will first be described. Then, the possible beneficial effects of VNS on inflammatory response of by modulating CAP will be provided.Recent findings: Sepsis is complex interactions between infecting microorganism and host's immune, inflammatory, and coagulation systems. The beneficial effects provided by CAP activation have been demonstrated on lots of pathologic conditions related to inflammation. Furthermore, VNS has been shown to promote the gastrointestinal motility and provide protection of intestinal barrier, reducing organ injury. In addition, VNS has been effectively used for treatment of some diseases in clinical practice.Summary: There is limited number of effective therapies available for septic patients. Because the CAP plays an important role in the regulation of inflammatory response, we consider that with the standard intensive care therapy, VNS may be an effective adjuvant treatment bringing benefits for prognosis of by controlling excessive inflammatory response. If efficiency of this new intervention is proved by clinical experiments, it may represent an exciting opportunity to develop novel therapeutics recovering unregulated inflammatory response in septic patients. Citation: Gui-Zhen Yang, Fu-Shan Xue, Chao Sun, Xu Liao, Jian-Hua Liu. Vagal nerve stimulation: a potential useful adjuvant to treatment of sepsis. J Anesth Perioper Med 2017; x: x-x. doi: 10.24015/JAPM.2017.0012This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Fifteen years post-SARS: Key milestones in Canada's public health emergency response.

This year marks the 15th anniversary of Severe Acute Respiratory Syndrome (SARS) in Canada and the 100th anniversary of the 1918 Spanish influenza pandemic. These, and other recent public health events, provide an opportunity for us to review and reflect on the evolution of Canada's public health emergency response over the past 15 years-from SARS, to the 2009 H1N1 pandemic influenza, to Ebola virus and Zika virus disease. Key lessons have been learned and milestones achieved that have shaped and sharpened our response approach and structures. While SARS was a wake-up-call to strengthen infection prevention and control capacity in health care settings and led to the formation of the Public Health Agency of Canada, it also strengthened our Federal/Provincial/Territorial (FPT) senior-level governance and led to agreements for pan-Canadian mutual aid and infectious disease information sharing. As well, our collective public health laboratory capacity has been strengthened through ongoing response and sharing of advanced diagnostics and research. As we move forward, it will be important to explore the design of scalable or modular emergency response strategies and structures that are socio-culturally appropriate and employ evidence-based strategic risk communications that continue to be critical, especially given the volume and spread of misinformation. With the current global reality, we must recognize that public health threats that go unchecked anywhere in the world have the potential to very rapidly become a public health threat in Canada. We need to build, maintain and share our best public health practices globally, for we neglect these at our peril.