Dr. Peter Sandman
Pandemic Flu and
Other Infectious Diseases Index

Until a few years ago my risk communication work only rarely dealt with infectious disease outbreaks. Even when I got involved in the U.S. government’s response to the anthrax attacks and the possible threat of a smallpox attack, I saw myself as working on terrorism communication, not infectious disease communication.

Then came SARS. Working jointly with my wife, physician Jody Lanard, I started helping the World Health Organization think through its communication efforts on SARS. Pretty soon Jody and I were writing about how various countries, especially Singapore and Canada, had handled their SARS outbreaks. By the time avian influenza caught my attention in January 2004, infectious disease outbreaks were one of my things. Since then I’ve had a chance to advise clients or write columns on a polio inoculation program, a hemorrhagic fever outbreak, a flu vaccine shortage, and the effort to “recall” a laboratory test kit that contained a potentially pandemic strain of influenza.

The compelling worldwide interest in bird flu and the prospect of a flu pandemic prompted me to add an index of content on this website relevant to pandemic flu and other infectious diseases. There’s another reason for a separate index. Pandemic flu risk communication doesn’t fit well in my categories of crisis communication, precaution advocacy, and outrage management — for now, at least, it is pre-crisis risk communication, hovering somewhere between crisis communication and precaution advocacy.

One section of this index lists columns I originally wrote for Business Source Weekly Briefing, a pandemic preparedness newsletter published for a while by the Center for Infectious Disease Research and Policy at the University of Minnesota. The Weekly Briefing later morphed into the Osterholm Briefing written by CIDRAP’s Michael Osterholm, so I’m not producing the columns anymore. Most of them are based – sometimes very closely based – on my longer writing for this website.

For the most part I haven’t included bioterrorism articles in this index – my writing on the anthrax attacks, for example, can be found in the crisis communication index but not here. But I made some exceptions; I included my column on the risk of H2N2 terrorism here because it’s flu, and I included my columns on the U.S. smallpox vaccination program because it’s vaccination.

Topical Sections in Infectious Diseases

Pandemic Flu: Essential Reading

• What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five

  Website column by Peter M. Sandman and Jody Lanard

  Posted: March 15, 2007

  If and when a serious pandemic arrives, messaging will shift from precaution advocacy (high-hazard, low-outrage) to crisis communication (high-hazard, high-outrage). There will be a transition period between the two, when the pandemic looks imminent and outrage is rising fast. This very long column – split into four parts – identifies 25 “standby messages” for that transition period. It elaborates both the messages and their risk communication rationales. Jody Lanard and I wrote the column with two goals in mind: to help officials prepare their communications for the early days of a pandemic, and to help them decide to be more candid (and thus more alarming) in their pre-pandemic communications now in order to make those early days less of a shock.

• Bird Flu, Pandemic Flu, and Poultry Markets: Playing Ostrich or Talking Turkey?

  Website column by Peter M. Sandman and Jody Lanard

  Posted: May 29, 2006

  When the next influenza pandemic finally arrives, it will be carried by people, not birds. In the meantime, the public is understandably confused about the distinction between the “bird flu” that threatens poultry flocks and the poultry industry (and an occasional unlucky person) right now and the “bird flu” that may someday mutate to facilitate human-to-human transmission and threaten us all. In this column, Jody Lanard and I try to disentangle bird flu from pandemic flu. And then we address the most common risk communication errors committed by government and industry in virtually every country beset by bird flu, when they set out to convince consumers not to worry and not to stop eating poultry.

• The Flu Pandemic Preparedness Snowball

  Website column

  Posted: October 10, 2005

  I published this column in late 2005, when the U.S. public’s interest in pandemic preparedness was as high as it’s been so far. This was the teachable moment, I wrote. It wouldn’t last, so preparedness advocates needed to make the most of it. The column discusses nine recommendations to improve pandemic preparedness advocacy. Among the highlights: Focus less on the pharmaceutical fix; focus more on worst case scenarios, non-medical preparedness, and non-governmental preparedness; stop implying that a pandemic is imminent. Much of this advice is relevant even in periods of diminished attention, and most of it will still be on-target the next time pandemic preparedness is hot.

• Bird Flu: Communicating the Risk

  By Peter M. Sandman and Jody Lanard

  Published in Perspectives in Health (Pan American Health Organization), vol. 10, no. 2, 2005, pp. 2–9

  PAHO asked us to combine a primer on risk communication with a primer on avian influenza. The resulting article talks about the challenge of alerting the public to bird flu risks, then offers ten risk communication principles, each illustrated with bird flu examples. The PDF file also includes the cover, an editor’s note entitled “Communication: risky business,” and the contents page. (Note the confusion of “bird flu” with pandemic flu in this 2005 article – and this blurb, also written in 2005.)

  (A Spanish language edition is also available. There is also an online version (same text, but easier to read than a PDF file) posted on the PAHO website. The entire issue is also there.

• Superb Flu Pandemic Risk Communication: A Role Model from Australia

  Website column by Peter M. Sandman and Jody Lanard

  Posted: July 6, 2005

  On May 2, 2005, Australian Health Minister Tony Abbott gave a speech on pandemic preparedness. It wasn’t especially earthshaking; in fact, it attracted fairly little media attention. But Jody Lanard and I thought it was terrific – candid, alarming, tentative, all the things most official pandemic presentations were not (and are not). So we sat down to annotate the speech in terms of 25 crisis communication recommendations we had published previously. If you just read the speech, you’ll discover that good risk communication can sound just as ordinary as bad risk communication. If you read the column’s annotations, you’ll discover how extraordinary this particular speech really was.

• Pandemic Influenza Risk Communication: The Teachable Moment

  Website column by Peter M. Sandman and Jody Lanard

  Posted: December 4, 2004

  This is the first column Jody Lanard and I wrote about pandemic preparedness. We wrote it when many experts believed a devastating H5N1 flu pandemic might be just around the corner – and so we thought so too. (We still think the risk is serious, but there’s much less sense of imminence as I write this blurb in mid-2008.) The thrust of this long column is how to sound the alarm. After a primer on why H5N1 is “not your garden variety flu,” the column proposes a list of pre-crisis pandemic talking points. Then it assesses how well experts and officials were addressing those points as of late 2004. The experts, we wrote, were doing their best to arouse the public. But governments and international agencies were undermining the sense of urgency with grossly over-optimistic claims about pharmaceutical solutions.

• Worst Case Scenarios

  Website column

  Posted: August 28, 2004

  Most of this long column is addressed to risk communicators whose goal is to keep their audience unconcerned. So naturally they’d rather not talk about awful but unlikely worst case scenarios. The column details their reluctance even to mention worst case scenarios, and their tendency when they finally get around to discussing them to do so over-reassuringly. It explains why this is unwise – why people (especially outraged people) tend to overreact to worst case scenarios when the available information is scanty or over-reassuring. Then the column lists 25 guidelines for explaining worst case scenarios properly. Finally, a post-script addresses the opposite problem. Suppose you’re not trying to reassure people about worst case scenarios; you’re trying to warn them. How can you do that more effectively?

Pandemic Flu Preparedness Columns from
CIDRAP Business Source Weekly Briefing

• Read “FAFfing About” if you need some motivation

  July 2007

  Whenever my commitment to pandemic preparedness starts to flag, I read something wrongheaded by an opponent of preparedness. Here’s my take on an example from a major medical journal.

• The bird flu / pandemic flu confusion

  (not yet published by CIDRAP)

  We have told people to worry about a “bird flu pandemic.” No wonder they think the danger comes from birds.

• Whose pandemic fatigue?

  June 2007

  Far from being fatigued by pandemic warnings, the public is just beginning to hear the message. As planners, we’re the ones at risk of pandemic fatigue, as we slog our way forward.

• Why talk now: The case for communicating with employees before the pandemic arrives

  June 2007

  Your company is preparing for a pandemic, but your employees aren’t. Can that possibly make sense?

• Corporate pandemic precaution advocacy: The time is now

  May 2007

  Business continuity planners say they’re talking to their employees and other stakeholders about pandemic preparedness. Is it really happening?

• What kind of risk communication does pandemic preparedness require?

  May 2007

  When the virus hits the fan, it’ll be crisis communication. But what it is now depends on your opinions and your audience.

• Start thinking in phases – risk communication phases

  April 2007

  You have a few crucial moments for talking about pandemic preparedness. Use them well.

• Riding the many pandemic seesaws

  April 2007

  Because most people feel ambivalent about possible future pandemics, communicating effectively with them requires skillful balance on a wide range of communication “seesaws.”

• Seesaw your way through ambivalence

  March 2007

  Most people think about possible future pandemics – when they think about them at all – with a good deal of ambivalence. To communicate with ambivalent people, you need to understand the “risk communication seesaw.”

• Talking about a flu pandemic worst case scenario

  March 2007

  The pandemic worst case is: (a) Truly horrific, (b) Truly unlikely, (c) Truly worth planning for, (d) All of the above. The right answer: (d) All of the above.

• A severe pandemic is not overdue – it’s not when but if

  February 2007

  We have no grounds for confidence that a severe pandemic is imminent. Our communications shouldn’t imply otherwise.

• “Might help a lot, might help a little, might not help at all – and worth trying!”

  February 2007

  There are no perfect pandemic precautions. We need to say so – and push hard for imperfect precautions.

• The four faces of bird flu

  January 2007

  Bird flu is four problems, not one. Keeping them straight is a prerequisite to sensible risk communication – and sensible preparedness.

• Get your slice of the ‘fearfulness’ pie

  January 2007

  Fear is like a pie (or money): There’s usually not enough to go around. If you want people to take precautions, you have to compete for your share.

• Scaring people is scary

  December 2006

  We are all likeliest to take precautions when we’re frightened. But “fear of fear” is widespread – and a major barrier to pandemic communication.

• How’s Your Business Discontinuity Program?

  November 2006

  More and more companies are starting to integrate pandemic preparedness into their business continuity programs. That’s good news – and helping to facilitate it is one of the reasons this newsletter was launched.

Pandemic Flu: Other Important Articles

• Video and Audiotapes on Pandemic Precaution Advocacy

  Presented to the Texas Department of State Health Services, August 20, 2007

  On August 20, 2007, I gave a five-hour pandemic communication seminar to the Texas Department of State Health Services. The focus was on how to persuade an apathetic public to take pandemic preparedness seriously – that is, on precaution advocacy. There is no transcript available. But the seminar was webstreamed to health department offices throughout the state, and the webstream videos are available online in both audio and video formats. The picture quality is pretty bad (and there’s not much to see anyway), but the audio is okay. And I think these tapes are useful if you’re trying to arouse public concern about pandemics … or anything else.

  There are three tapes. Part One has three segments of roughly 30 minutes apiece: “Pandemic 101: The Four Faces of Bird Flu”; “Risk Communication 101: Hazard, Outrage, and the Four Kinds of Risk Communication”; and “Assessing the Public’s Mood: Apathetic? Burnt Out? Skeptical? Yet to Hear?” Part Two is a 75-minute segment entitled “Selling Pandemic Preparedness” – my effort to list core strategies of pandemic precaution advocacy. Part Three is mostly an hour-long practitioner panel on “What’s Working and What’s Not,” with my interpolated comments. There is periodic audience discussion on all three tapes.

  Systems requirements to access the videos are: (a) Windows Media Player 10 or better; and (b) Internet Explorer 6.0 or better. Access to the tapes is not user-friendly. It took me several tries. Here are some instructions.

• When warnings become a scare

  By Gregory M. Lamb

  Published in The Christian Science Monitor, July 07, 2005

  This short news story deals with the controversy over how much to try to alarm the public about a possible flu pandemic. Predictably, I anchor the go-ahead-and-scare-them side of the debate.

• Psychological Barriers Getting in the Way of Pandemic Preparations: Experts

  By Helen Branswell

  Distributed by Canadian Press, November 20, 2004

  Helen Branswell initially wrote to me for my comments on the psychology of flu pandemic preparedness.

  My complete response is on this site.

• Avian Flu Exercise: What Are They Doing?

  Handout by Peter M. Sandman, Ph.D. and Jody Lanard, M.D.

  In “Crisis Communication: Guidelines for Action – Planning What to Say When Terrorists, Epidemics, or Other Emergencies Strike,” a CD-ROM/DVD produced by The American Industrial Hygiene Association, May 2004

  This exercise provides quotations from early avian flu/pandemic flu communications and asks the reader to decide what crisis communication principles each quotation either illustrates or violates. It was prepared to accompany a crisis communication CD-ROM/DVD produced by the American Industrial Hygiene Association.

Pandemic Flu: Additional Reading

• Study: Media can distort public’s views on infectious diseases

  By Lisa Schnirring

  Posted on the website of CIDRAP News (Center for Infectious Disease Research and Policy, University of Minnesota), November 5, 2008

  CIDRAP’s Lisa Schnirring asked me to comment on a new research paper showing that students take infectious diseases that have been much-covered in the media more seriously than diseases that have had less media attention. The paper’s authors interpreted this as evidence that media coverage distorts people’s perceptions of infectious diseases. I thought it was likelier that some characteristics of some infectious diseases – such as the potential to launch a pandemic! – rightly make them a bigger concern for both the media and the public than diseases without those characteristics. I sent Lisa a fairly blistering critique of the paper. She toned it down in what she published.

• Businesses urged to avoid pandemic planning pitfalls

  By Lisa Schnirring

  Posted on the website of CIDRAP News (Center for Infectious Disease Research and Policy, University of Minnesota), October 9, 2008

  CIDRAP’s Michael Osterholm asked me to join him in hosting an October 9 webinar entitled “Avoiding the Big 7 Pandemic-Planning Mistakes: How Set-to-Survive Companies Sidestep These Missteps.” I focused on two of the mistakes/missteps – fearing to frighten stakeholders and failing to involve employees – and commented on the other five. I also contributed my depressing judgment that pandemic planners need to plan to be islands of preparedness. My agreement with CIDRAP provides that I may post the webinar itself (either a transcript or a video) after 90 days. Meanwhile, here is Lisa Schnirring’s summary from the CIDRAP website.

• Physician survey shows mixed views on pandemic risk

  By Lisa Schnirring

  Posted on the website of CIDRAP News (Center for Infectious Disease Research and Policy, University of Minnesota), June 6, 2007

  This is a news report about a survey of European physicians, focusing on their estimates of the probability of a flu pandemic “in the next few years.” Slightly more than half thought it wasn’t very likely. The survey results were interpreted by the authors as indicating that the respondents weren’t as concerned as they ought to be. That might be true for all I know – but it’s not necessarily complacent to think a pandemic is inevitable sooner or later, while doubting that it’s imminent. In fact, I told the reporter, it’s a huge mistake to ground the case for pandemic preparedness in the hunch that it’s coming soon, rather than in the well-founded conviction that it’s coming. I expanded on this point in an email to the reporter.

• Understanding the Risk: What Frightens Rarely Kills

  From the edited transcript of a conference on pandemic media coverage, published in Nieman Reports, vol. 61, no. 1, Spring 2007

  For three days starting 30 November 2006, Harvard University’s Nieman Foundation for Journalism ran a conference on how the news media cover (and should cover) the risk of an influenza pandemic. I spoke twice, a stand-alone presentation on “Risk Perception, Risk Communication, and Risk Reporting: The Role of Each in Pandemic Preparedness” and a panel presentation on “Fear of Fear and Panic Panic: Is It Okay to Scare People about Pandemics?” The two were abridged and combined into one article when Nieman Reports published an edited transcript in Spring 2007. As compiled by the Nieman Foundation, the published article focuses on two topics – the four kinds of risk communication as applied to pandemic risk and the importance of fear in pandemic preparedness. The entire edited conference transcript is also available online. For the (nearly) unedited transcripts of the two presentations, see below.

• Risk Perception, Risk Communication, and Risk Reporting: The Role of Each in Pandemic Preparedness

  Originally presented at a conference on “Avian Flu, a Pandemic & the Role of Journalists,” Nieman Foundation for Journalism, Harvard University, Cambridge MA, December 1, 2006

  An abridged version ( above) of this presentation was published in the Spring 2007 issue of Nieman Reports (see the previous entry). The Nieman Foundation for Journalism also made the original transcript available to me. I edited it very lightly so it makes sense – but it's still very much a transcript, not a polished article.

• Understanding Human Responses [to pandemic risk]: Communication Focus

  With Howard Koh, Glen Nowak, and Dick Thompson

  Panel discussion at a conference on “Avian Flu, a Pandemic & the Role of Journalists,” Nieman Foundation for Journalism, Harvard University, Cambridge MA, December 2, 2006

  I was joined in this panel discussion by three experienced risk communication practitioners, Howard Koh, Glen Nowak, and Dick Thompson. My contribution was entitled “Fear of Fear and Panic Panic: Is It Okay to Scare People about Pandemics?” An abridged version of my presentation and a tiny bit of the Q&A were published in the Spring 2007 issue of Nieman Reports (look two entries up). The Nieman Foundation for Journalism also made the original panel discussion transcript available to me, very slightly edited by them. I edited my parts a bit more thoroughly, though it’s still very much a transcript, not a polished article. I left other people’s presentations and comments alone – so blame any garbles on the transcription process, not the speakers. The conversation ranged widely over the various challenges of pandemic communication.

• Internet rumours of bird flu case in Rimouski, Que., are ‘totally untrue’

  By Helen Branswell

  Distributed by Canadian Press, November 29, 2006

  Helen Branswell’s story focuses on the pros and cons of alarmist rumors, especially those found on the website of Henry Niman, a favorite site for people obsessed with pandemic risk. Helen didn’t use what I thought was the best line I gave her, so here it is: “Before the Internet the problem was getting information. Now the problem is vetting information.”

• Recent H5N1 Outbreaks: The Evolving Challenge of Defining and Communicating Pandemic Risk

  Transcript of a June 22, 2006 teleconference sponsored by Bio Economic Research Associates

  As part of its pandemic preparedness consulting business, Bio Economic Research Associates (“bio-era”) conducts periodic teleconferences for clients and prospective clients. Its June 2006 session featured an illustrated presentation by Jim Newcomb of bio-era, with a detailed update on bird flu developments and pandemic risks. But bio-era managed to squeeze in three other speakers – United Nations pandemic coordinator David Nabarro, the Wildlife Conservation Society’s Billy Karesh, and me. My piece runs from page 23 to page 27. It focuses on the different “kinds” of bird flu/pandemic flu problems, but also includes my answers to questions about how companies should talk about these problems – how restaurants should talk to their customers about bird flu and how manufacturers should talk to their employees about pandemics.

• Skeptics warn bird flu fears are overblown

  By Rebecca Cook Dube

  Posted on MSNBC.com, April 20, 2006

  Subtitled “Chicken Little alert? Hysteria could sap money from worse health threats,” this article was part of an MSNBC package on pandemic flu. Reporter Rebecca Cook Dube warned me when she interviewed me that she was covering “the other side” — the people who claim the risk is overblown. My job was to represent the other side of the other side — to explain why a virus that has so far killed only a handful of people could nonetheless deserve to be taken seriously. I get awfully tired of this particular non sequitur; it’s as if somebody thought hurricane preparations were self-evidently pointless until the hurricane hit land and started claiming victims ... or self-evidently pointless so long as it remained debatable whether the hurricane would ever hit land at all. I tried to explain that people buy fire insurance not because they think it’s inevitable that their house will catch fire, and not because the fire is already raging, but because they think a fire is possible and could be devastating. Some of what I said about low-probability high-magnitude risks made it into the end of the story.

• Talking risk: avian flu advice from a risk communicator  

  By Carole Sugarman

  Published in Food Chemical News, March 27, 2006, p. 29. Copyright © 2006 by Agra Informa, Inc. Posted with permission. For more information, go to www.foodchemicalnews.com.

  Carole Sugarman of Food Chemical News interviewed me in March about how the poultry industry should talk about bird flu, as distinct from pandemic flu, and what I think industry spokespeople are doing wrong. I didn’t know the interview was actually published until a colleague sent me a copy in late April. Here it is. It’s a little incoherent. (I’d like to blame that on Carole’s note-taking, but it’s probably my burbling.) But the main points are clear enough, I think.

• Bird flu’s potential toll warrants alerts

  By Jeffrey P. Koplan

  Published in the Atlanta Journal-Constitution, March 17, 2006

  This 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.

• The Bird Flu: How Much Fear Is Healthy?

  By Christine Gorman

  Posted on TIME.com, March 15, 2006

  Christine Gorman of Time has covered H5N1 since it appeared in Hong Kong in 1997. I figured our 15-minute telephone interview might turn into a paragraph in a roundup on the week’s bird flu news. Instead, she devoted this article to my views on the importance of warning people, of accepting that fear (not panic — that was her word) is the price of preparedness, of non-medical preparedness, of using survivors as volunteers, etc. It’s a short article that doesn’t say anything I haven’t said before. But it’s nice to see it on the Time website.

• Fear can play role in pandemic readiness, speaker says

  By Robert Roos

  Published on the website of the Center for Infectious Disease Research & Policy (CIDRAP), University of Minnesota, February 17, 2006

  This article summarizes a speech I gave at CIDRAP’s groundbreaking Minneapolis conference, “Business Planning for Pandemic Influenza: A National Summit.” It focuses on two of the main points I made: that if you want to persuade people to take precautions you need to be willing to frighten them; and that frightening people shouldn’t mean claiming that a severe 1918-like pandemic is inevitable. (The probability is extremely high of a pandemic of unknown magnitude, I said; the probability is unknown of a pandemic of extremely high magnitude.)

• The Dilemma of Personal Tamiflu Stockpiling

  Website column by Peter M. Sandman and Jody Lanard

  Posted: January 10, 2006

  When Jody Lanard and I wrote this long column, there was a shortage of Tamiflu. Officials and physicians argued that the available supply should be saved for current use against the seasonal flu and government stockpiles against a possible pandemic – but should not be stockpiled by individuals. We wrote the column to expose the many illogical, inconsistent, and inaccurate arguments being used against personal Tamiflu stockpiling, but we conceded that the competition with other uses was a valid issue. Now the Tamiflu supply exceeds the demand; “excess” manufacturing capacity has been mothballed. The competition argument is dead in the water. Officials and physicians still oppose personal Tamiflu stockpiling, but the only arguments they have left are the specious ones analyzed in this column.

• Worst Case Scenarios, Bird Flu, and Risk Perception – Interview with Peter Sandman (Part 2)

  Published in safety AT WORK, January 2006, pp. 4–10

  In November 2005 I did a two-hour interview in Melbourne with Kevin Jones, editor of Safety at Work, a monthly electronic magazine published out of Australia but distributed worldwide. We covered an extremely wide range of topics – from whether the mining industry is serious about safety (and why it so often sounds like it isn’t) to how to talk about worst case scenarios like a severe influenza pandemic to why I put everything I can on my website and don’t trademark anything. I imagined that Kevin would edit out the boring parts and organize the nuggets. But instead he used the whole two hours verbatim.

• Staving Off Panic in a Flu Pandemic

  By Jon Hamilton

  Broadcast on “Morning Edition,” NPR (National Public Radio), January 10, 2006

  This is the second “Morning Edition” story by NPR’s Jon Hamilton that draws on his two-hour December 2005 interview with me and my wife and colleague Jody Lanard. This one uses other sources as well, and focuses on what governments should do to avoid fostering panic in (or before) a pandemic. Hamilton makes good use of our concept of “panic panic” — official fear that the public may be panicking when there is no evidence that it is doing so.

• Sifting Through Official Speak on Bird Flu

  By Jon Hamilton

  Broadcast on “Morning Edition,” NPR (National Public Radio), December 28, 2005

  NPR’s Jon Hamilton came to New Jersey with a dozen audio clips of top U.S. officials talking about bird flu, and spent two hours going over the clips with me and my wife and colleague Jody Lanard. He put a little of what he got into an eight-minute story on what they’re doing right and what’s not so right in bird flu and pandemic risk communication. Jody and I think Hamilton did an excellent job of getting to some of the big issues: the need to find a balance between excessive fear and insufficient fear, the importance of getting the public involved rather than pretending the government will do it all, etc. The link gets you to a written summary of Hamilton’s story, and to a link to the audio.

• Talking to the Public about a Pandemic: Some Applications of the WHO Outbreak Communication Guidelines

  By Jody Lanard

  Published in the Yale Journal of Biology and Medicine, vol. 78, December 2005, pp. 369–376

  This article was adapted from a presentation my wife and colleague Jody Lanard gave at an October 21, 2005 symposium on “Ethical Aspects of Avian Influenza Pandemic Preparedness” at Yale University. It focuses chiefly on official opposition to Tamiflu stockpiling, official enthusiasm for vaccines and antivirals, and official reluctance to involve the public in pandemic planning.

• Are you a sitting duck for bird flu?

  By Anita Manning

  Published in USA Today [posted online at USATODAY.com December 6, 2005]

  This story on the flu pandemic precautions people are taking is more respectful than journalists usually are of the people on one end of the bell curve — those who are preparing strenuously for the worst case scenario, stockpiling medications, food, and even weapons. The story quotes me on the wisdom of taking at least some precautions, of not being on the opposite end of the bell curve – and then getting on with life. It also quotes me on the value of thinking through what a serious pandemic might be like, so as to be psychologically prepared as well.

• The Fear Factor: Preparing the public for a major disaster like pandemic flu without inciting panic is tricky. But the truth goes a long way.

  By Nancy Shute

  Published in U.S. News and World Report, November 21, 2005; online November 13, 2005

  This is an excellent summary of the dilemma authorities face when trying to alert the public to the risk of pandemic flu — a risk that could be severe or mild, imminent or far into the future. Despite its title, the article does point out that the risk of inciting panic isn’t a major problem, although the (unjustified) fear of inciting panic is. It offers justified praise to the U.S. government and the World Health Organization for their increasing willingness to sound the alarm.

• Risk Communication Before and During Epidemics

  Presentation at “Bulls, Bears, and Birds: Preparing the Financial Industry for a Pandemic,” a September 23, 2005 New York City conference sponsored by the Center for Biosecurity of UPMC, Deutsche Bank, and Contingency Planning Exchange, Inc.

  Despite the title, this brief speech focused mostly on pre-pandemic communication, and especially on the need to overcome official “fear of fear” and scare people into pandemic preparedness. (Please note that the article is located on the source page.)

  In addition to the speech transcript (which I edited a little for clarity and grammar), a video of the speech itself is also available.

• Most Canadians have taken note of the threat of a flu pandemic

  By Helen Branswell

  Distributed by Canadian Press, March 30, 2005

  Helen Branswell initially wrote to me for my comments on a survey of Canadian awareness of avian influenza, which showed higher awareness than I’d expected but also more skepticism. My complete response is on this site.

SARS, “Ordinary” Flu, and
Other Infectious Diseases

• A Blind Spot for Bad Guys

  Website Column by Peter M. Sandman and Jody Lanard

  Posted: June 16, 2005

  This column argues that western society has a blind spot for bad guys – that our vision of an actionable emergency is an accident, not an attack. It discusses several examples, from the resistance to evidence that the 1984 Bhopal “accident” was probably sabotage to the opposition of the U.S. public health profession to the possibility that smallpox might constitute a weapon of mass destruction that could justify a vaccination program. The best example – detailed in the column – happened in April 2005, when it was learned that an infectious disease testing company had mistakenly sent samples of a potentially pandemic strain of influenza to labs all over the world. So a fax went out to all the labs telling them so, and asking them to destroy the sample – thus converting a small accident risk into a much larger terrorism risk. The facts were public at the time, but a society with a blind spot for bad guys simply ignored their implications.

• Flu Vaccine Shortage: Segmenting the Audience

  Website Column by Peter M. Sandman and Jody Lanard

  Posted: October 22, 2004

  Because of manufacturing problems, the U.S. had less vaccine for the 2004–05 flu season than it expected to need. The shortfall actually increased the demand, as people who don’t usually get vaccinated decided that this year they would. Jody Lanard and I were critical of what officials were telling the American public about the situation. We were especially critical of the failure to segment the audience – both according to the medical importance of vaccinating each segment and according to whether members of that segment bother to get vaccinated in a normal year. Since audience segmentation is a basic principle of risk communication (and all communication), we decided to show how it’s done by developing different flu vaccination messages for each segment. This column is the result.

• Sars Communication: What Singapore Is Doing Right

  By Jody Lanard and Peter M. Sandman

  The Straits Times (Singapore), May 6, 2003; also in The Toronto Star (Canada), May 9, 2003, under the headline “Canadian Response to SARS Scorned as Whiny”

  After a rocky start, the world’s premier performer in SARS risk communication turned out to be the authoritarian city-state of Singapore! In this brief op-ed in Singapore’s biggest newspaper, my wife and colleague Dr. Jody Lanard and I tell the surprising story. A link to the longer, unpublished version of the article is provided.

  On September 21, 2004, Jody told another version of this story as one of the keynote presentations at a World Health Organization conference on “outbreak communications.” The conference was scheduled in Singapore in part because of the superlative job Singapore had done communicating with its population about SARS – an accomplishment WHO wanted to help other countries emulate in other outbreaks. Entitled “WHO Expert Consultation on Outbreak Communications – Singapore's SARS Outbreak Communications,” the speech text was on the website of the Singapore Ministry of Health for a while, but now is available only on this site.

• SARS Exercise: What Are They Doing?

  Handout by Peter M. Sandman, Ph.D. and Jody Lanard, M.D., May 2004

  In “Crisis Communication: Guidelines for Action – Planning What to Say When Terrorists, Epidemics, or Other Emergencies Strike,” a CD-ROM/DVD produced by The American Industrial Hygiene Association, May 2004

  This exercise provides quotations from SARS communications and asks the reader to decide what crisis communication principles each quotation either illustrates or violates. It was prepared to accompany a crisis communication CD-ROM/DVD produced by the American Industrial Hygiene Association.

• Practicing for The Big One: Pennsylvania’s Hepatitis A Outbreak and Risk Communication

  Website column by Peter M. Sandman and Jody Lanard

  Posted: December 4, 2003

  In late 2003, an outbreak of hepatitis A in Western Pennsylvania provided a neat case study of pretty good risk communication (not perfect, but not bad) about a pretty serious problem (not huge, but not tiny). In this column, Jody Lanard and I use Pennsylvania’s hepatitis outbreak to illustrate four basic dilemmas in crisis communication – dilemmas that are sure to come up in bigger emergencies: preoccupation with panic; trust and secrecy; over-reassurance; and anticipatory guidance.

• Risk Communication Recommendations for Infectious Disease Outbreaks

  By Peter M. Sandman Ph.D. and Jody Lanard M.D.

  Presented to the World Health Organization SARS Scientific Research Advisory Committee, Geneva Switzerland, October 20, 2003

  In October 2003, the WHO included social scientists (including me) on its SARS-fighting team for the first time. This invited paper has a list of 24 risk communication principles relevant to a possible second SARS outbreak or to any infectious disease outbreak; it also lists SARS-related risk communication research needs and has a short bibliography.

• Crisis Communications to the Public: A Missing Link

  Chapter 5C.6 of Learning from SARS — Renewal of Public Health in Canada: A Report of the National Advisory Committee on SARS and Public Health (the “Naylor Report”), October 2003

  One small section of the official Canadian government report on the lessons of SARS addresses public communication – and leans predominantly on the “scathing” assessment of Sandman and Lanard.

• What next? Insanity?

  By Judy Gerstel

  Published in The Toronto Star, May 30, 2003

  This is an almost shockingly lighthearted piece on Toronto’s SARS epidemic. It starts out with a weird focus on the question of whether SARS is God’s punishment, but winds up making some fairly solid points.

• Sars Communication: What Singapore Is Doing Right

  By Jody Lanard and Peter M. Sandman

  The Straits Times (Singapore), May 6, 2003; also in The Toronto Star (Canada), May 9, 2003, under the headline “Canadian Response to SARS Scorned as Whiny”

  After a rocky start, the world’s premier performer in SARS risk communication turned out to be the authoritarian city-state of Singapore! In this brief op-ed in Singapore’s biggest newspaper, my wife and colleague Dr. Jody Lanard and I tell the surprising story. A link to the longer, unpublished version of the article is provided.

  On September 21, 2004, Jody told another version of this story as one of the keynote presentations at a World Health Organization conference on “outbreak communications.” The conference was scheduled in Singapore in part because of the superlative job Singapore had done communicating with its population about SARS – an accomplishment WHO wanted to help other countries emulate in other outbreaks. Entitled “WHO Expert Consultation on Outbreak Communications – Singapore's SARS Outbreak Communications,” the speech text was on the website of the Singapore Ministry of Health for a while, but now is available only on this site.

• “Fear Is Spreading Faster than SARS” — And So It Should!

  Website column by Peter M. Sandman and Jody Lanard

  Posted: April 28, 2003

  Until it turned out less contagious than initially thought, SARS looked to many experts like it might very well be the devastating pandemic they had spent decades fearfully awaiting. When Jody Lanard and I wrote this column in April 2003, that was still an open question. The public’s SARS fears were entirely justifiable – yet many governments, experts, and even journalists were working overtime to dampen those fears. The column describes this “soft cover-up” of SARS over-optimism, tries to explain why so many officials were seduced by it, and offers both good examples of guiding the public’s fear and bad examples of trying to allay that fear. The column concludes with a list of 18 specific risk communication recommendations for talking about SARS.

• SARS: How Singapore outmanaged the others

  By Alan Fung

  Published in Asia Times, Hong Kong, April 9, 2003

  I thought Singapore handled SARS risk communication a lot better than China, Hong Kong, or Canada. But I never expected to be explaining why in a Hong Kong newspaper.

• Candour, not PR, will calm virus fears

  By Andy Ho

  Published in The Straits Times, Singapore, March 27, 2003

  Early 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.

• Smallpox Vaccination: Some Risk Communication Linchpins   and
  Public Health Outrage and Smallpox Vaccination: An Afterthought

  Website columns

  Posted: December 30, 2002 and January 12, 2003

  In December 2002, I was asked to help plan and run a meeting on risk communication recommendations for the U.S. program to vaccinate healthcare workers and emergency responders against smallpox. The first column is an edited version of my introductory remarks. It addresses some familiar “risk communication linchpins” – paying attention to outrage, doing anticipatory guidance, expressing wishes and feelings, tolerating uncertainty, sharing dilemmas, riding the seesaw, etc. – all customized for the controversies I thought likeliest to emerge over smallpox vaccination. What I learned from the meeting was that most of the public health professionals implementing the smallpox vaccination program were themselves outraged that it even existed. So I wrote an “afterthought” on the sources of that outrage, and the need to deal with it lest it undermine the program … which, in my judgment, it later did.

• Vaccination Camp

  By Jody Lanard, M.D.

  Published in The Trenton Times, July 12, 2002

  I think this is my wife and colleague Jody Lanard’s first risk communication publication, a newspaper op-ed urging that people who want to be vaccinated against smallpox get sent to “vaccination camp.”

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