Posted: March 26, 2003
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Article SummaryEarly in Singapore’s SARS epidemic, the country’s dominant English-language newspaper published this article on how two American risk communicators thought it should manage the crisis.

Candour, not PR, will calm virus fears

The Straits Times, Singapore, March 27, 2003

IN THE ongoing pneumonia outbreak, the authorities must communicate with the public better.

United States-based Dr Peter Sandman, a risk communication specialist and adjunct professor in public health at Rutgers University in the US, tells The Straits Times that better communication requires the authorities to, counter-intuitively, avoid over-reassurance and acknowledge uncertainty, be human, and err slightly on the alarmist side of things.

Some authorities are getting it right, some of the time. For example, Health Minister Lim Hng Kiang prepared the public by sharing his dilemmas in advance of potentially having to make high-cost decisions.

He said in Parliament on March 18: “It will require another 10 to 14 days, two more incubation cycles, before we can declare all clear – if all things go well. The infection is brought in by humans and so, unless we encourage Singaporeans not to travel and be infected overseas, we have no effective means to stop the chain reaction.”

On March 24, with 12 out of 65 cases seriously ill, Mr Lim took the unprecedented move of invoking the Infectious Diseases Act to quarantine 740 individuals at home. By then, the public was adequately buffered, having been briefed by Mr Lim twice over three days. People do much better with bad news when they see it coming.

A week earlier, the authorities had not acknowledged their uncertainty sufficiently. Without knowing the cause of severe acute respiratory syndrome (Sars), they over-reassured the public by pronouncing it contained here.

On March 18, medical services director Tan Chorh Chuan said: “We have taken all the measures that should be taken to contain this. Singapore is safe.”

There was no need to avoid crowded places or to don a face mask, he averred, saying that the infection occurred only after close contact with a sick person.

A vigilant public disagreed – face masks flew off the shelves.

ST reader Maria Loh said pointedly in a letter to the paper that she was confused by Professor Tan’s advice. The three who brought the bug home from Hongkong, she said, were just shopping and eating there. So, perhaps people could catch the disease just going about their daily business, she suggested.

At that point, the authorities were probably still operating in their public relations (PR) mode, as distinct from a stakeholder relations mode.

Dr Sandman, who advised the US government during the anthrax crisis last year, explains: PR is about distilling your key message into a 10-second soundbite for an apathetic but credulous audience. By contrast, stakeholder relations is about an attentive but sceptical audience which wants the experts to acknowledge problems and share control of the situation.

Dr Sandman’s co-worker, Dr Jody Lanard, a psychiatrist by training, says that, too often, professionals thinking in PR terms assume that appearing to be confident will inspire trust.

In a health crisis situation, however, over-confident experts leave people alone with their fears, she says.

Almost always in their bid to look professional, authorities come across as robotic and uncompassionate. But anxious people cannot be led by officials who appear calmly unconcerned.

Said Dr Lanard: “If I’m in fear, I can’t model myself after an apparently fearless leader. We need leaders who help us bear our worries by visibly feeling and bearing those worries themselves. They don’t have to fake their humanity, just hide it less.”

On March 14, World Health Organisation (WHO) spokesman Dick Thompson said: “With relatively few Sars deaths, one might think we are overreacting but when you don’t know the cause, when it strikes hospital staff, and moves at jet speed… until we can get a grip on it, I don’t see how it will slow down… It’s highly contagious. It’s bad.”

Analysing that, Dr Lanard says: “Acknowledging that the public might be wondering why so much attention was being paid to those small numbers is correct. The “one might think” makes people feel understood. Otherwise, people may feel stupid as they do not understand how the disease is spreading.”

The candour here raises people’s concern to an appropriate level in a new situation without overshooting.

The authorities must avoid emotionless jargon, like that used in all too many ministry replies to newspaper letters. Be clear, simple and human.

Upon news that a coronavirus may be causing Sars, which raised the spectre of a global influenza epidemic, director of WHO’s communicable disease programme David Heymann said on March 24: “The disease may have begun occurring spontaneously and be starting to spread more widely. That’s alarming if it happens.”

This was jargon-free and just alarmist enough to prepare the public for the worst. In a situation where public outrage may become very high, overestimating risk preserves credibility.

Dr Sandman reasons that if you later admit that it’s worse than you thought, you lose much of your credibility. An unbelieving public can stymie preventive measures you want to implement. By contrast, you’ll still retain some credibility if you have to say later on that it’s not as bad as you first thought.

In this crisis, it is with compassionate candour, Dr Sandman recommends, that the authorities will engender what serves everyone’s best interests: a calm, accurate concern among the public.

Andy Ho is a senior writer with The Straits Times.

Copyright © 2004 by The Straits Times

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