Imminent Pandemic Standby Messages
This very long section will discuss the 25 messages we have come up with for deploying when a pandemic looks imminent. Before we start going through them one-by-one, here’s a list of all 25.
Imminent Pandemic Standby Message #1
This is obviously your news peg. Notice that it’s not enough to say that a pandemic is about to start. You have to tell people that this is an important and upsetting development, and you have to tell them why.
We have participated in many pandemic tabletop exercises. “Officials” in these exercises hardly ever warn the public early on that they are heading into a scary situation. Messaging accompanying the announcement of WHO Phase 4 and even Phase 5 has mostly ranged from purely factual (“here’s what we know and here’s what you should do”) to overtly reassuring (“we’re ready to manage this situation”).
There are three major downsides when officials fail to warn people about hard times to come:
- The public suspects that the officials are hiding how worried they really are (which is often true), and wonders what else they are hiding.
- Those who are frightened despite official reassurances are left alone with their fears instead of being guided through them.
- Those who are persuaded by the official reassurances and remain unafraid miss the opportunity to adjust to the new situation. Instead of going through an early adjustment reaction, an “emotional rehearsal” that will help them absorb later bad news, they postpone their period of adjustment until the situation is dire.
All of these downsides reduce officials’ ability to help the public cope with the crisis when it arrives.
That’s how it usually plays out in tabletop exercises. When the exercise is debriefed, participants often note that, in hindsight, they wish their earlier messages had been more candidly alarming.
Imminent Pandemic Standby Message #2
This wouldn’t be a terribly important message, except that so many people have “learned,” mistakenly and only half-consciously, that pandemics are spread by birds. This misimpression can be corrected only if it is explicitly acknowledged and rebutted. (It will help if officials take the blame rather than blaming the audience. “We gave you a misimpression by talking for years about bird flu pandemics,” for instance.)
The reason to correct this misimpression isn’t chiefly to protect poultry markets – though that, too, is worth doing. It’s more fundamental than that. A lot of people think they know what to do about bird flu: Stay away from birds. This false knowledge will be a powerful initial barrier to the public’s acceptance of more useful pandemic precautions.
It is conceivable that the H5N1 virus will mutate in a way that facilitates efficient bird-to-human transmission as well as human-to-human transmission. If that happens, and if the virus makes its appearance in local bird populations, then both birds and humans will be dangerous. It’s also conceivable that bird-to-human transmission will become efficient while human-to-human transmission remains difficult. That would be a “panzoonotic,” not a pandemic, but it would certainly be an unprecedented public health threat … from birds. Most experts consider these scenarios very unlikely, because they have never happened before as far as we know. But if they happen, obviously, “it’s no longer about the birds” won’t be the message.
Imminent Pandemic Standby Message #3
In tabletop exercises, official sources tend to neglect or downplay this crucial message. But without it, lots of people, and some journalists, will think they’re hearing another iteration of the same old warnings. At stake is an important principle of crisis communication: When officials change their interpretation of what’s happening, they need to say so explicitly. You don’t just stop saying X and start saying Y; you explain why you have moved from X to Y.
By this time WHO will have raised the pandemic phase – a readymade explanation for why you are sounding a louder alarm than your previous warnings. Of course you will also need to explain why WHO did what it did, and why you consider the change so important.
Imminent Pandemic Standby Message #4
It isn’t conventional to acknowledge uncertainty and expert disagreement when talking to the public. No matter how much internal debate precedes a decision, official sources usually choose to speak with confidence and to “speak with one voice” when announcing that decision. The concern, of course, is that any sign of indecisiveness or dissention might undermine not just this particular decision but also the public’s overall confidence in your ability to lead.
Despite this concern, most crisis communication experts agree that acknowledging uncertainty does more good than harm. They’re not so sure about acknowledging internal disagreement; “speak with one voice” often shows up on lists of crisis communication best practices, and our judgment that it is wiser to let the opinion diversity show is a minority position. (See Peter’s earlier columns on “Acknowledging Uncertainty” and “‘Speak with One Voice’ – Why I Disagree”)
On an issue this big, you really have no choice. If you try to suppress the doubts and disagreements, the word will get out anyway. And the story won’t be just that you’re not sure and even some of your own people disagree; the story will be that you tried to hide your uncertainty and internal dissent from the public. The resulting controversy will distract people from your precautionary messages, and will appropriately cast doubt on your candor.
Influenza is notoriously unpredictable, and every pandemic is different. Most messages about the next flu pandemic need to include acknowledgments of uncertainty and expert disagreement. The crucial Communication Phase 4 message that the next pandemic now looks imminent is no exception.
But won’t the public seize on all that uncertainty as an excuse not to take precautions? Those who are in denial may do exactly that – like a determined smoker who reasons that “if they’re not absolutely sure that cigarettes give you cancer, I guess I can keep smoking.” But most people become more worried, not less, when they learn how much uncertainty and expert disagreement there is. This increase in worry will certainly be appropriate at the possible start of a pandemic of unknown severity.
Here are three key points to keep in mind:
- If the approaching pandemic really does fizzle, your reputation will suffer less if you were upfront about that possibility from the start. And your reputation is important to your ability to lead during the next crisis.
- If you get caught suppressing uncertainty and dissent (and if you do it you will probably get caught), that will undermine your credibility, your ability to lead, and your precautionary recommendations – even if you turn out right about the approaching pandemic.
- You are not going to get through a pandemic without making some “bad” decisions that you’ll later have to reverse based on new information. Best to establish from the outset that we’re all muddling our way together through a thicket of uncertainties.
None of this means you should let your acknowledgment of uncertainty overshadow your warning that a pandemic looks imminent. You need to find a middle ground between overconfidence and over-tentativeness. Either can undermine your effort to help people prepare.
But the more common mistake by far is overconfidence.
Imminent Pandemic Standby Message #5
Note that this acknowledgment of uncertainty is very different from the one in #3. In the scenario we’re working on now, Communication Phase 4, most experts think a pandemic is probably imminent, but they’re not absolutely sure. By contrast, they really haven’t a clue yet what the case fatality rate is going to be. (The attack rate is also unknown, but that has varied less in past pandemics.)
Uncertainty, in short, isn’t a dichotomy. Some things are almost certain; some are completely unknown. The communication goal is to reproduce in the audience’s minds the same level of uncertainty the experts are currently experiencing.
Imminent Pandemic Standby Message #6
Severity is going to be the key question during Communication Phase 4. The fact that we will know a lot more in a few weeks won’t keep officials and citizens from demanding that the experts provide informed guesses in the meantime. Our messaging must empathically acknowledge how badly everyone wants the answer. And we must provide whatever fragments of the answer we have.
Telling people how deadly a pandemic might be when it hasn’t yet claimed its first few dozen victims is, of course, speculation. Some experts will refuse to speculate. Instead, they will insist on a wait-and-see approach. But the public will be desperate for early indications and expert judgments based on those indications. So will officials. No one can make intelligent decisions about how to prepare without a tentative, preliminary prediction of the pandemic’s severity.
The more extreme sources on both ends of the spectrum tend to be more willing to speculate. Reasoning from the 60%+ (bird-to-human) pre-pandemic case fatality rate, some will predict Armageddon. Reasoning from the historical record of the two most recent pandemics, others will predict a blip on the charts noticeable only to public health professionals and stressed-out hospital managements. Many experts closer to the middle of the distribution will find it uncomfortable – but essential – to join in the speculation. (See our column on “It Is Never Too Soon to Speculate.”)
As you speculate, remember the two key rules of responsible speculation. First, be emphatically clear that you’re speculating, that you don’t actually know the answer. And second, focus your speculation on two scenarios – the outcome you think is likeliest, and the worst outcome you think is credible. “What do you expect” and “what do you fear” are the anchors of responsible speculation. Along the way, be sure to mention the other scenarios too – the anticlimactically mild one (your fondest hope) and the incredibly horrific one (your darkest fear).
Imminent Pandemic Standby Message #7
In the fortunate West, we have little recent experience helping societies prepare for widespread catastrophes. It may help to look back at the war speeches of Winston Churchill and even Abraham Lincoln. And we can look for role models from less fortunate countries.
The language of emotional determination doesn’t come naturally to most experts and officials. Why “resort” to this kind of language? Because people don’t only need help deciding what to do; they also need help deciding how to feel.
The run-up to a potentially severe pandemic will be a very fearful time. Authorities will need to legitimize the fear, not leave people alone with it. Along with providing factual information, they will need to show that they share the fear and are determined to bear it and take appropriate action. They will need to be emotional role models, not just sources of technical information and advice – and certainly not sources of over-reassurance. (See our earlier column on “Fear of Fear.”)
Imminent Pandemic Standby Message #8
One crucial phrase here is “put aside many other priorities.” People will judge the seriousness of the situation largely by what their leaders decide to cancel or postpone to make room for final pre-pandemic efforts to prepare. Several years ago we urged the World Health Organization to dramatize the seriousness of its pandemic concern by publicly postponing a few other health campaigns to make room for pandemic preparedness efforts. That didn’t happen. The suggestion stands a better chance in Communication Phase 4, when a pandemic looks imminent.
The other crucial phrase in this message is “choose between two ways of possibly turning out wrong.” We have written often that pandemics happen from time to time, but over the course of known history a severe pandemic has to be considered a low-probability high-magnitude risk. (See particularly Peter’s August 2004 column on “Worst Case Scenarios.”)
When we get to Communication Phase 4, the probability of a pandemic will be very high, but the probability that it will turn out severe will be impossible to estimate. Under such circumstances it is neither honest nor effective to urge people to prepare by telling them that the coming pandemic is sure to be severe, or even that it is sure to come. The case for preparedness should be grounded in the unbearable cost of facing a severe pandemic unprepared, versus the far more acceptable cost of preparing unnecessarily. The public should be helped to face this preparedness dilemma squarely and resolve it wisely – not to imagine that there is no such dilemma.
Imminent Pandemic Standby Message #9
This may be a hard message to deliver credibly. People have learned to expect, and demand, endless help from all levels of government. The response to HHS Secretary Michael Leavitt’s “you’re on your own” messaging in 2006 was mixed. Some listeners appreciated his candor; others resented what felt to them like passing the buck. And those were comparatively well-informed audiences, considering the matter abstractly with no pandemic in sight. A broader audience facing an imminent pandemic is more likely to resent the buck-passing than to appreciate the candor.
Nonetheless, a severe pandemic (if that’s what we get) will be the ultimate decentralizer. Leaders must not shrink from this message. One strategy that may help a little is called counter-projection: acknowledging the audience’s likely negative feelings. “I know a lot of people will accuse me of passing the buck. A government’s most fundamental job is to protect its citizens, and here I am telling you we can’t, you’ll have to do it yourself….”
The decentralization message will be easier to hear when it comes from those who are trying to fill the breach. We hope every neighborhood group, every fraternal order, every Parent-Teacher Organization, every church and mosque and synagogue, every block association, every local company and local union and local grange, will be ready with its “here’s how we think we can help” messaging.
Imminent Pandemic Standby Message #10
The conventional wisdom is that there’s no place in mass communication for this kind of structural message: “There are three of these and two of those and two of those other.” We concede that short sound bites can’t be that organized; reporters gnash their teeth when sources like us (like Peter, really) start an answer with “There are three answers to that question….”
But when people’s thinking ability is stressed by strong emotion, they need more organizational help, not less. Many doctors find it useful to organize their instructions to patients: “There are five things I want you to do. Write them down, please!” While a TV news interview doesn’t lend itself to clear structural signposting, other media do. Your website is one example; a pamphlet or brochure is another. And if your TV news interview turns into hours of pandemic explanation, with lots of repetition of key message points, a couple of PowerPoint slides wouldn’t be amiss.
Imminent Pandemic Standby Message #11
All too often in an emergency, people are told what to do without being told why. When they don’t comprehend the rationale behind the instructions, they are less likely to comply. They are also less able to adjust and innovate, to come up with alternative ways of meeting the same objectives. And they are less able to understand that when the situation changes, the instructions may change to match.
In a pandemic, many people will need to manage their own pandemic preparedness, deciding whether to obey or ignore official recommendations. And official recommendations are likely to change as we learn what works and what doesn’t in this particular pandemic. It will therefore be important to give people reasons, not just instructions.
Imminent Pandemic Standby Message #12
How Safe Is Safe Enough: Sharing the Dilemma.”) Authorities usually face difficult dilemmas privately, make a decision, and then pretend publicly that it was a no-brainer. But there are many advantages to sharing the dilemma instead. It moderates the debate; it makes those who prefer another option feel respected; it makes it easier to change course if you turn out wrong.This is a good example of the crisis communication strategy of dilemma-sharing. (See Peter’s April 2006 column on “
When a decision hasn’t been made yet, it is sensible to share the dilemma before deciding. Maybe somebody will think of a good reason to decide one way instead of the other, or suggest a new choice that’s better than either. But even when the decision is a done deal, dilemma-sharing is feasible and useful. “This was a tough call. There were these good reasons to close the schools, and these good reasons to keep them open. We finally decided to [close them] [keep them open]. Here’s why….”
Copyright © 2007 by Peter M. Sandman and Jody Lanard