Taming the Clearance Beast: A Practical Approach to Streamlining Scientific Clearance to Communicate Risk in Real-Time

Background:  The Outbreak Response and Prevention Branch (ORPB) at the U.S. Centers for Disease Control and Prevention (CDC) works to ensure rapid and coordinated detection of and response to multistate foodborne outbreaks of Salmonella, Escherichia coli, and Listeria infections. Each year, ORPB investigates over 220 multistate clusters of these infections. One of CDC’s primary tools to stop a foodborne outbreak involves communicating risk to the public and explaining what consumers can do to protect themselves. Since 2006, CDC has posted announcements for over 100 multistate foodborne outbreak investigations.

Program background:  Timeliness is one of the most important factors to consider when developing risk communication messages for foodborne outbreaks. If there is ongoing risk, a timely and actionable message may prevent additional illnesses. Rapid risk communication is especially important when an outbreak is causing severe illness or affects a high-risk population. The message needs to be accurate, and at CDC, part of the process to ensure message accuracy is called “scientific clearance,” requiring sequential review and approval of documents by multiple experts. Clearance can be an obstacle to timeliness, so ORPB developed a method that ensures foodborne outbreak messages are thoroughly reviewed in the shortest amount of time possible.

Evaluation Methods and Results:  ORPB uses several practical approaches to ensure clearance is completed smoothly and quickly. A template for the outbreak web announcements is used that includes standard sections of information and language (e.g., outbreak highlights, advice to consumers, and symptoms of the infection). Also, rather than CDC’s electronic clearance system which can cause delays if designated reviewers are out of the office, ORPB uses email to facilitate rapid review of outbreak-related communications. A primary and secondary reviewer are identified at each level of clearance in the event someone is unavailable when expedient review is needed. Reviewers receive advance notification that the document is forthcoming, including when to expect the draft for review. Clearance is done hierarchically and sequentially; one reviewer at a time reviews, returning the draft with comments to a clearance coordinator who then sends the draft to the next reviewer in the sequence. Once completed, the clearance coordinator shares the cleared document with partners to encourage message consistency. Using a clearance process with which all reviewers are familiar allows ORPB to clear foodborne outbreak announcements in as short as several hours.

Conclusions: Scientific clearance of communication materials can be a significant barrier to timely message dissemination. During an ongoing foodborne outbreak, risk messages that include advice for people to protect themselves need to be shared in a timely manner to prevent additional illnesses. These messages also help ensure contaminated food is removed from the market.

Implications for research and/or practice:  Communicators and programs that need to develop and clear risk messages rapidly would benefit from the adoption of an expedited and simplified clearance process that is simpler than the process normally reserved for clearance of other communication materials, such as promotional items or scientific manuscripts. Programs should consider a similar process that includes a message template if applicable, a single clearance coordinator, and a sequential, hierarchical clearance chain.