Posted: March 18, 2006
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Article SummaryThis op-ed by the former director of the U.S. Centers for Disease Control and Prevention argues that alerting people to the pandemic threat requires good risk communication. As his gold standard for good risk communication he cites principles I tried to urge on CDC during the anthrax attacks of 2001 (when he was its head) – pretty much the same principles covered in the crisis communication CD-ROM/DVD Jody Lanard and I produced a few years later. (The CD-ROM/DVD handouts are available on this site.) I had a couple of reactions to the op-ed that I sent to Jeff, and have posted excerpts from my email and his response at

Bird flu’s potential toll warrants alerts

Atlanta Journal-Constitution March 17, 2006

Hardly a day goes by without a newspaper or TV report warning about pandemic influenza – new cases, dead birds, a government plan, insufficient resources. Is the threat real? Is the issue being hyped by government or the media? Is this scare-mongering of the weapons of mass destruction, smallpox, Code Red, explosives-in-every-sneaker sort? No. The threat of pandemic flu is real and the warnings are warranted.

As has been described often and in detail, the threat of pandemic flu involves a new virus (the H5N1 strain) with a totally unprotected human population. It’s a virus that spreads easily among birds, has spread quickly across countries and continents, kills often when it infects people, and mutates constantly, permitting it to develop new characteristics. When such a mutation permits the virus to spread efficiently from person to person, we will have the basis for a pandemic as has occurred with other new influenza strains regularly and periodically for hundreds of years.

Understanding this threat and the nature and likelihood of its occurrence are important for government leaders, health professionals and the news media, but also for the public at large. No one knows when a pandemic will begin, but we would be unwise to ignore the warning signs and shun preparation and planning for it.

Explaining the biologic and epidemiologic facts as we know them is relatively straightforward. Conveying the “risk,” the likelihood of the events and severity, and the appropriate attitude to bring to this problem, is much more complex. We already have plenty to worry about, and we are all reluctant to add a heaping spoonful of health threat to our already overflowing plates of existing health, financial, familial, political and social concerns.

So how might such risks best be communicated? How might government officials, the scientific community and the news media do this most effectively?

There has been a lot written on risk communication. Some of what I offer comes from my association with a professional risk communicator, Peter Sandman. We are in the stage of what Sandman refers to as “precautionary advocacy” but might be better expressed as “watch out!” – alerting people to serious hazards when they lack interest.

Many of the principles of risk communication are being followed: don’t over-reassure, acknowledge uncertainty and tell people what to expect. Others either are inappropriate at this stage (“don’t downplay the public’s emotions”) or are hard to make practical (“offer people things to do” – the duct tape and extra batteries plan).

Admittedly, at this stage we don’t have a good set of steps to recommend beyond the obvious and familiar: Get your routine, annual flu immunization. But some of Sandman's principles are valid and desirable throughout the period of threat: Let people choose their own actions; be explicit about changes in opinion, prediction or policy; and aim for total candor and transparency.

In a public health crisis, communicating the risks and the remedies to the public is a governmental responsibility, but one that is shared by the news media – the Fourth Estate. We are in a period of potential risk for pandemic flu and these institutions are doing their job and largely doing it well.

When pandemic influenza becomes reality, be it tomorrow or in 10 years, such communication will be even more vital and complicated. But we will have been badly served and sorely vexed if the warnings of what may be coming were not conveyed as the information was available.

Copyright © 2006 by the Atlanta Journal-Constitution

I had a couple of reactions to this op-ed that I emailed to Jeff. I have posted excerpts from my email and his response on this site.

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