Posted: May 10, 2009
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Article SummaryThis article from an Israeli newspaper is more balanced than most media stories about “swine flu hype.” Reporter Assaf Uni interviewed my wife and colleague Jody Lanard, who pointed out that preparing isn’t panicking, and that it’s better to warn people about a risk that doesn’t materialize than to leave them unaware of one that does.

Crying wolf about pigs

Haaretz, May 9, 2009 / Iyyar 15, 5769

BERLIN—On Monday afternoon, when it looked as though the media uproar surrounding the “swine flu” was subsiding as fast as it had been ignited, the World Health Organization’s director general, Dr. Margaret Chan, convened a press event, of sorts: She gave a Web conference from the situation room of the WHO’s Geneva headquarters, transmitted live around the world.

Chan sat in a dimly lit room, surrounded by people, and read slowly from a written text. She looked as if she were broadcasting from a dark bunker, as the End of Days was approaching, if not during the actual eruption of Armageddon. Her remarks focused on what she and others see as the complacency that has arisen since the H1N1 virus – which first erupted in Mexico and then spread elsewhere – was discovered to be less threatening than initially feared.

A Hong Kong-born doctor, Chan served in a variety of positions in her country’s health system during the outbreaks of avian flu and severe acute respiratory syndrome (SARS) in recent years. In her speech, she recalled flu pandemics in the distant past that claimed the lives of tens of millions of people. Only toward the end, did she emphasize that it is anything but certain whether the present virus will assume similar proportions.

“We do not know how long we have until we move to phase 6, which indicates we are in a pandemic. We are not there yet,” she said, referring to the highest level of emergency for pandemics. The numerical scale was instituted by WHO in 2005, shortly after the establishment of the sophisticated situation room from which Chan broadcasted her address.

The experience of past pandemics shows that the initial situation can change in manifold ways – with many, many surprises. Chan said that throughout history, influenza pandemics have circled the globe in two, sometimes three, waves: During the last century, for instance, the deadly 1918 pandemic began with a mild wave and returned in a more deadly form. WHO’s director general also referred to the pandemic of 1957, which began with a mild phase that was followed, in several countries, by a second wave with more fatalities. She stressed that the pandemic of 1968 remained, in most countries, comparatively mild in both its first and second waves. At present, Chan added, there was no indication that the current situation was similar to that of 1918. But she did stress that the situation can change. The critics of the media hysteria – who see the outbreak of swine flu as an opportunity for politicians to keep the public in a state of fear, for health organizations to prove they are important, and for the media to increase their ratings – believe Chan’s speech marked yet another stage in a two-week “scare campaign”: So far, apparently only 26 people have died from the illness (out of the 1,893 cases confirmed by the WHO). While other pandemics have claimed many more lives (in the past four months, some 1,900 people in northern Nigeria have succumbed to a meningitis epidemic), the world’s attention is focused on a virus that has a mortality rate similar to that of more familiar flu viruses.

Established by the United Nations over 60 years ago, WHO employs thousands of people all over the world today; its annual budget of about $2 billion is secured from contributions by UN members. The organization can take credit for the eradication of smallpox, the war against tobacco products (a 2005 decree forbids the organization from hiring smokers), and the promotion of treatment of AIDS patients in Africa. It is also considered a bastion of bureaucracy that spends most of its budget on its employees and has failed in the war against malaria and polio in Africa.

In recent years, especially since the 2003 SARS epidemic in Asia, WHO has been warning every few months that the outbreak of a lethal global flu pandemic is only a matter of time: In the last five years, the organization’s heads have repeated that such a pandemic is expected to strike “already in the course of the 21st century.” Although most fears have been focused on a mutation of the avian flu virus (H5N1), which renders it contagious through human-to-human transmission, the organization in recent weeks found itself fighting a flu that apparently originated in pigs, and it is working with governments, the media and the public all over the world, which are thirsty for information. WHO is definitely prepared to provide it.

‘Warning fatigue’

Jody Lanard, a physician and a risk communication consultant, has in recent years helped WHO develop its media response to an outbreak of a new type of flu virus. In a telephone interview from Malaysia, where she is working on one of the organization’s other projects, she gives high marks to WHO for its media response this time around. She claims it is better to incur the minimal damage resulting from an erroneous warning about a pandemic that fails to materialize, than to cope with the human loss that would incur if no warnings are issued or preparations are made.

Lanard feels that when you work for a health organization, it’s much better to issue warnings about events that will not happen, than to be reassuring. The worst that could happen, she says, is that you’ll be laughed at in the end. But if you make the mistake of not issuing a warning, you will not only be fired – people are liable to die as a result of that oversight.

Lanard so maintains that there will be a lethal flu pandemic some time in the future – which is why the public can never be too frightened. Any information transmitted to the public about dealing with a flu pandemic will be useful, she notes, as long as it doesn’t lead to panic – and what we’re witnessing right now is very far from that. Panic involves people’s irrational behavior and a failure to react in a way that would be beneficial, whereas at present, she says, people are buying masks and maybe washing their hands more carefully: both logical actions. They aren’t panicking; they are mindful of a situation that is liable to be very dangerous.

There have been several controversial reactions to the disease. Egypt’s government exploited the epidemic to slaughter the country’s entire population of pigs, which were for the most part raised by the Coptic Christian minority, a target of ongoing discrimination. The Russian government, perhaps in an attempt to improve the dire economic situation, announced a ban on the import of pork from the United States and from European countries where the virus is discovered. In China, dozens of Mexican tourists were quarantined in a hotel until they were flown back to their country.

Prof. Arnon Shimshoni, the former director of the Israel Agricultural Ministry Veterinary Services and an expert in the ProMED service (an acronym for the Program for Monitoring Emerging Diseases, which was the first to report on the SARS outbreak in China), also believes that WHO has no choice, but to take the threat of a flu pandemic seriously.

Shimshoni: “As opposed to the criticism being leveled in the media, I believe the organization has acted responsibly. To react with indifference to the threat of a pandemic at such an early stage of the outbreak of H1N1 would be irresponsible. We have to wait and see whether the virus returns this fall in a more violent form, as happened with the ‘Spanish flu’ in 1918.

“WHO had a contingency plan available for responding to a flu pandemic caused by an entirely new virus to which the world population has not been exposed in the past. Flu pandemics occur every few decades, like earthquakes that return to certain regions. WHO was already on alert; considering the partial statistics that initially arrived from Mexico, in light of the fact that they didn’t know how long the new virus had been circulating in the area and had no clue about its mortality rate, and in light of past experience showing that a pandemic is liable to begin with a wave of relatively light morbidity, I don’t think that their reaction was exaggerated.

“Of course,” Shimshoni adds, “the organization must also consider the ‘boy-who-cried-wolf scenario’: If WHO announces the outbreak of a suspected ‘flu pandemic’ too frequently, people are liable to become indifferent.”

Lanard disagrees: The phenomenon known as “warning fatigue” is actually not very common, she declares. Studies on warnings about hurricanes, including advising people to evacuate their homes, have actually demonstrated that as long as citizens see their leaders as evincing primary concern for public health, they usually forgive them for a mistaken warning, and adhere to subsequent ones. Lanard is in favor of “crying wolf” – as long as there’s a chance that there are wolves around. In the case of the flu, the danger is so great, she says, that we have to take any warning sign seriously.

That very same approach is also guiding Chan, who took up her post about two years ago, after being elected by a majority of WHO’s 193 members. In the only interview she granted to the media this week, to The Financial Times, she replied to her critics: “I’m not predicting the pandemic will blow up, but if I miss it and we don’t prepare, I fail. I’d rather over-prepare than not prepare.”

Copyright © 2009 by Haaretz

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