Posted: March 18, 2006
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Article SummaryI had a couple of reactions to Jeff Koplan’s op-ed “Bird flu’s potential toll warrants alerts” ( Here are excerpts from my email to him and his response.

Email Exchange between
Peter M. Sandman and Jeffrey P. Koplan

about Koplan’s March 17, 2006
Atlanta Journal-Constitution Op-Ed
(See “Bird flu’s potential toll warrants alerts”)

From Peter Sandman to Jeffrey P. Koplan:

Thank you so much for the very gracious acknowledgment in your op-ed in tomorrow’s Atlanta Journal-Constitution. I liked the piece, and I very much appreciated the credibility that someone of your stature gives to these ideas.…

I do have two nitpicks.

First, I think you’re right that pandemic preparedness is still largely in the precautionary advocacy corner of the risk communication map – the high-hazard low-outrage corner. But not entirely. Obviously, bird flu (as opposed to pandemic flu) is already a crisis for the poultry industry, and for backyard farmers around the world. Talking to them is certainly crisis communication (just as talking to everyone will be crisis communication once the pandemic materializes, if it does). But even in the U.S., there is an ever-increasing cohort of people whose level of emotional arousal about pandemic preparedness is already high. When talking to what I sometimes think of as “the Flu Wiki crowd,” pandemic communication is already crisis communication (high-hazard high-outrage), not precautionary advocacy.

Of course the goal is to make it crisis communication for everyone – before the crisis itself is upon us. Pandemic preparedness requires that as many people as possible experience the crisis of a possible flu pandemic before they have to experience the pandemic. The boundary between precautionary advocacy and crisis communication – the moment when people first recognize the issue as a crisis – is what my wife and colleague Jody Lanard and I have termed the adjustment reaction. We want to guide people through their adjustment reactions now, so they will be ready to cope with the pandemic itself if and when it arrives.

Second, I wonder why you wrote that my advice not to downplay the public’s emotions is “inappropriate at this stage.” I would argue that it is crucial. Of course you’re absolutely right for the people who don’t yet have any emotions with regard to pandemic risk; whether or not communicators are contemptuous of people’s emotions isn’t an issue for them (yet). But there is already an army of reactants (Wendy Orent, Gary Butcher, Marc Siegel, Michael Fumento, etc.) who are busy asserting that the pandemic risk is small and that those who take it seriously are panicky, hysterical, irrational, dupes of media sensationalism, etc.

(“Reactance” is a term of art for the tendency to underestimate any new risk and ridicule those who are more concerned than the reactant individual deems appropriate.)

Expert sources who try to sound the alarm are vulnerable not just to attack from reactants but also to muzzling by employers and colleagues who are worried about the criticism of reactants. I know – and you must know better than I – that this is a significant factor at WHO, CDC, and elsewhere….

More importantly, people who are very upset are left alone with their fears by officials who are more comfortable dismissing or ridiculing or patronizing their feelings than acknowledging and validating them. Some have even called bird flu fears psychotic. Here are a couple of examples, provided by Jody (who has been monitoring the media for them):

  • Italy’s Health Minister Storace said in a February 2006 news release that people were undergoing a “bird flu psychosis.”
  • A March 3, 2006 news story in India carried the headline, “Loss due to Bird Flu psychosis put at Rs 3000 cr” [almost $700 million U.S.]. The story began: “The fear psychosis about the avian influenza or Bird Flu H5N1 virus has caused an economic loss to the tune of Rs 3000 crore to the Indian poultry industry and Rs 700 crore in Andhra Pradesh alone, National Egg Coordination Committee (NECC) Zonal Chairman R Varadaraju said here today.”
  • In Hungary, an October 21, 2005 column by Laszlo Hazafi in the business-oriented newspaper Vilaggazdasag said: “The psychosis that has emerged in Hungary seems to be a typically Hungarian specialty…. It is hard to believe, still it seems to be true that an entire business [poultry processing] might be ruined by the news of something which practically does not even exist yet.”

There is already a lot of very unfortunate downplaying of people’s emotions about avian influenza and pandemic influenza – and as emotions keep rising, the downplaying (and the damage it does) is bound to keep increasing….

From Jeffrey P. Koplan to Peter Sandman:

Many thanks for your kind and prompt note and the excellent comments. Of course, I agree with you on both points.

Re: the latter one, I am finding very little emotional reaction to the current warnings of pandemic – much closer to apathy or momentary interest before turning to the basketball scores or a menu. My use of “inappropriate” is probably not the best word choice. It would be better to say something like, “even though many people still haven’t understood the potential impact of a pandemic, those that have responded with considerable concern deserve to have their concerns addressed and validated.”

Unfortunately a better version based on your suggestion will have to be in my future presentations as the newspaper jumped and published the op-ed a day earlier than I thought. Please pardon its publication without the advantage of corrections based on your comments. I will incorporate both your comments in upcoming talks, etc.

I hope our paths cross before too long. Thank you again both for your help on this and even more so for enlightening me and being supportive and instructive over several years.

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