Posted: April 28, 2009
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Article SummaryThe Washington Post asked me to write a 200-word piece on how I thought the U.S. government was doing on swine flu risk communication. My first draft was 600+ words. Then I revised to around 200, and sent the editor both. He used the short one. I’m posting the long one here. Both emphasize my sense that the government has been preparing for the worst while hoping for the best – but hasn’t yet urged the public to do the same thing.

The Government is Preparing for the Worst While Hoping for the Best – Now It Needs to Tell the Public to Do the Same Thing!

The published version is also online.

As a risk communication professional, I have been watching the World Health Organization and the U.S. government walk a tightrope between over-reassurance and over-alarm about a swine flu outbreak that could easily turn out devastating, trivial (in the U.S.), or anywhere in between.

The CDC in particular is doing a superb job of explaining the current situation and how uncertain it is. Anyone who’s paying attention gets it that we just don’t know if this thing is going to fizzle, hang in abeyance for months, disappear and then reappear, spread but stay mild, replicate the 1918 catastrophe, or what. The reiteration of uncertainty and the insistence on what that means – e.g. advice may change; local strategies may differ; inconsistencies may be common – has been almost unprecedentedly good.

The CDC’s biggest failure: Not doing nearly enough to help people visualize what a really bad pandemic might be like – while helping them also to hold in mind that it’s only one of many possibilities – so they can feel the knot in their stomachs that everyone on the inside is feeling, get past the adjustment reaction, gird up their loins, and start preparing. It is especially important to get this message to business and community leaders, who have prep work to do ASAP in case things get worse. But individuals also have prep work to do – logistical as well as emotional prep work. All that preparing will stand us in good stead even if this isn’t The Big One this time … and it’ll be essential if it is!

For the ordinary citizen, the U.S. government has so far recommended only hygiene, not preparedness. It has told people to stay home if they’re sick, cover their coughs, and wash their hands a lot. It hasn’t told people to stock up on food, water, prescription medicines, and other key supplies. Two years ago HHS Secretary Leavitt was crisscrossing the country with that advice. This weekend and today Acting Secretary Napolitano and Acting CDC Director Besser kept evading questions from journalists about whether it’s still good advice.

In order to avoid frightening the public, the U.S. government has avoided clueing in the public that we should all be preparing for a possible pandemic – not just the feds.

Tonight the WHO finally ratcheted up from Pandemic Phase 3 to 4. I hope the U.S. public will see that as a signal to start preparing. I hope the U.S. government will see it as a signal to start sending different signals.

Why are officials so leery of describing the worst case vividly and urging people to prepare for that possibility? Here’s why:

  • Fear of fear and “panic panic” – a virtual terror of frightening people excessively (as if that were easy).
  • Reputational worries – underlying the fear of frightening people is a fear of being accused of frightening people, especially in the current economic environment.
  • Projection – underlying both of the above are the sources’ own fears of what a pandemic might be like. They try to suppress the knot in their own stomachs, and it emerges as a projection: “The public is panicking!” What they don’t understand is that the knot is a useful “adjustment reaction.” They need to guide themselves through it, and they need to guide the public into it and then through it.

Here’s the secret of preparedness that fearful government leaders tend to forget: It’s a calming experience to prepare. People who have been working hard not to worry about the pandemic that might be looming will feel more in control after they have taken some concrete steps to get themselves and their family ready. I hope they read tonight’s WHO decision as advice to do that tomorrow.

Copyright © 2009 by Peter M. Sandman

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