Until 2003 my risk communication work only occasionally 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 crisis 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. In the next couple of years, I 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.
When Jody and I wrote our first pandemic flu column in December 2004, many experts thought a bird flu (H5N1) pandemic might well be impending and might well be catastrophically severe. Between 2005 and 2007 I added a lot of bird flu risk communication writing to this website … and to keep it all organized I added this “Pandemic Flu and Other Infectious Diseases Index.”
As of mid-2010, bird flu still hasn’t gone pandemic. It still could. But in the meantime, we got the swine flu (H1N1) pandemic of 2009–2010, which aroused a lot of justifiable concern and then turned out anticlimactically mild.
Even apart from influenza pandemics, a lot of experts think infectious diseases are likely to be a big issue – and a big risk communication challenge – in the coming decades. We have brand new emerging diseases like SARS and Ebola, re-emerging diseases like antibiotic-resistant tuberculosis, and tropical diseases like dengue and malaria that are starting to spread to temperate countries (perhaps thanks to global warming).
There’s another reason for a separate index. Pandemics and other infectious disease outbreaks don’t squeeze easily into my categories of crisis communication, precaution advocacy, and outrage management.
- Beforehand, the main task is precaution advocacy: trying to arouse concern and motivate preparedness even though there’s nothing bad on the immediate horizon.
- When a serious disease outbreak looks potentially imminent, wise risk communicators segue into pre-crisis communication, an amalgam of precaution advocacy and crisis communication. The trick is to get people ready for something that might be really bad, while simultaneously reminding them that it might also be no big deal.
- In the middle of a serious disease outbreak, the job is mostly crisis communication: helping people bear the outbreak and guiding them through it. But there’s also a lot of precaution advocacy aimed at the segment of the public that isn’t upset enough yet. And there’s a lot of outrage management, aimed at those who are excessively upset, upset about the “wrong” things, or appropriately upset about certain aspects of outbreak response (delayed or misleading information; overpromised and under-delivered protective measures; etc.).
- Afterwards, outrage management is the key. If the outbreak was severe, the outrage focuses on why officials didn’t prepare better and warn us more. If the outbreak was mild, the outrage focuses on why officials wasted money over-preparing, hyped the risk, and provoked unnecessary worry. Precaution advocacy regarding the next outbreak should also accompany the public post-mortem on the last one, though it often doesn’t.
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.
The first section of this index is entitled “Especially Important to Read.” These aren’t necessarily introductory articles. (I don’t write enough introductory articles.) They’re the ones I consider most important. All of them are also included under narrower subject headings in the sections that follow.
The second and longest section is devoted to “The Swine Flu Pandemic of 2009–2010” – a wonderful case study of every stage in pandemic communication, all applied to a pandemic so mild it was almost a practice exercise. There’s a subsection on “Major Articles.” Then come the “Swine Flu Pandemic Communication Updates” I added to this website periodically throughout the pandemic – almost daily at the start, every few months by the end. The last two subsections are “Other Articles” and “Guestbook Entries.“
(For the handful of readers who may want to immerse themselves in the swine flu risk communication case study, I have added a section with links to everything on the website in chronological order, starting with my first two-paragraph alert on April 24, 2009. Everything else is in reverse chronological order as usual.)
The third section is on “Influenza Pandemics other than Swine Flu” – which at least so far is mostly about the bird flu pandemic that has yet to materialize. Like the swine flu section, this section has subsections on “Major Articles,” “Other Articles,” and “Guestbook Entries.” There is also a subsection – placed second – containing my “Columns from CIDRAP Business Source Weekly Briefing,” a pandemic preparedness newsletter published in 2006–2007 by the Center for Infectious Disease Research & Policy at the University of Minnesota. Most of these columns are based – sometimes very closely based – on my longer bird flu risk communication writing for this website.
The final section is a catchall, with writing on “SARS, ‘Ordinary’ Flu, and Other Infectious Diseases.” It has two subsections, one with “Articles” and the other with “Guestbook Entries.”
Topical Sections in Infectious Diseases
The Swine Flu Pandemic of 2009–2010
Swine Flu Pandemic Communication Updates
Everything in Chronological Order
Influenza Pandemics other than Swine Flu
Columns from CIDRAP Business Source Weekly Briefing
Especially Important to Read
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Vaccination Safety Skepticism: Public Health’s Self-Inflicted Wound
Posted: January 30, 2011
When I was asked to do an interview for a documentary on vaccines and vaccine safety, I agreed on condition that I be allowed to post the entire interview online. I focused my comments on public skepticism about vaccine safety – and especially on what vaccination proponents do that exacerbates the skepticism and what they can do to ameliorate it. The interviewer’s questions have been edited out, but the rest is here, uncut, in three parts.
- Part 1 (37 min.)
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Part One discusses: the kinds of vaccination audiences – apathetic versus hostile; suppressing the other side’s 5% of the truth; being empathic and being accountable; and other risk communication aspects of vaccination safety skepticism.
- Part 2 (29 min.)
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Part Two discusses: vaccination/autism controversies; who’s in charge of vaccine safety research; what’s left out of flu vaccination messaging; and other risk communication aspects of vaccination safety skepticism.
- Part 3 (36 min.)
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Part Three discusses: lying about polio; different messaging for different audiences; why “good guys” mislead more; and other risk communication aspects of vaccination safety skepticism.
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The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives
Posted: June 29, 2010
In June 2010, one year after the World Health Organization declared swine flu a full-fledged pandemic, WHO’s credibility nosedived as even mainstream sources began to take seriously the absurd allegation that WHO had invented a “fake pandemic” in order to enrich the pharmaceutical industry. This column assesses at great length the three main reasons why this allegation made the move from fringe to mainstream: (a) WHO’s failure to acknowledge the ongoing mildness and current low incidence of the pandemic; (b) WHO’s failure to acknowledge that it changed some flu pandemic definitions and descriptions just as H1N1 was emerging; and (c) WHO’s failure to acknowledge until recently the legitimacy of concerns about transparency and conflict of interest. In a nutshell, the credibility of the World Health Organization crashed and burned because WHO mishandled some essential aspects of pandemic risk communication.
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Why did the CDC misrepresent its swine flu mortality data – innumeracy, dishonesty, or what?
Posted: February 2, 2010
Communication Professor Rob Ulmer wrote to me after reading my Swine Flu Pandemic Communication Updates for December 2 and December 15, in which I accused the CDC of misrepresenting its own data about swine flu severity, both overall and for specific age groups. Dr. Ulmer attributed the misrepresentation to innumeracy rather than dishonesty. This long Guestbook entry presents my evidence that the misrepresentation was intentional; my observations and speculations about why “good guys” so often feel entitled to mislead in a good cause; some previously unpublished CDC data about age-specific swine flu population mortality rates; and Dr. Ulmer’s continued conviction that innumeracy rather than dishonesty is probably the culprit.
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U.S. Pandemic Vaccine Supply and Distribution: Addressing the Outrage
Posted: November 18, 2009
As in most other developed countries, the fall rollout of the U.S. pandemic vaccination program has been hampered by a shortage of vaccine. The result is outrage – outrage that there isn’t as much vaccine as people wanted and expected, and outrage that the distribution process feels so chaotic, frustrating, and in some cases unfair. The shortage itself is nobody’s fault; the vaccine virus turned out to be difficult to grow. But officials are very much at fault for having overpromised, frequently predicting that there would be ample vaccine by mid-October. Even before the pandemic began, in fact, the meme was established that it would require only three to six months after the emergence of a pandemic influenza strain to manufacture sufficient vaccine. Managing public (and health care provider) outrage about vaccine supply and vaccine distribution has thus become an important pandemic risk communication task, a necessary distraction from the paramount task of convincing people to get vaccinated. This column describes how officials are handling the outrage so far, and proposes some improvements.
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The meme that this pandemic is “like the seasonal flu”
Posted: October 23, 2009
Like many public health officials around the world (and in the U.S.), officials in Italy often say the ongoing pandemic is “like the seasonal flu.” An Italian science journalist wrote to ask if I share her objections to making the pandemic sound “normal” in this way. I do – and this Guestbook response, written jointly with my wife and colleague Jody Lanard, explains why. Equating the two is technically inaccurate. For example, the pandemic virus is less dangerous than the seasonal flu to seniors, but more dangerous than the seasonal flu to younger people. And the pandemic virus is more likely than the seasonal flu viruses to mutate suddenly into a more virulent strain. Ignoring differences like these is a way of normalizing the pandemic, presumably in order to avoid frightening the public. Like over-reassurance generally, it does harm if it works (because people don’t protect themselves enough) and harm if it doesn’t work (because people learn to mistrust public health officials).
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Distributed by Project Syndicate, July 27, 2009
Project Syndicate is a nonprofit organization that distributes op-ed commentaries on currently hot topics to newspapers around the world, free of charge. They asked me to do one on how public health officials ought to be communicating with the public about the ongoing H1N1 pandemic. The resulting piece briefly discusses nine mistakes officials should stop making: don’t feign confidence; don’t over-reassure; don’t worry about panic; don’t obsess over accusations of fear-mongering; don’t fight the adjustment reaction; don’t oversell what the government is doing; don’t oversell what the public can do; don’t ask the impossible; and don’t neglect the teachable moment.
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Containment as Signal: Swine Flu Risk Miscommunication
Posted: June 29, 2009
The swine flu pandemic started in North America, and by the time the virus was identified it was already widely seeded in the U.S. So the experts judged that it was too late to try to “contain” its U.S. spread; from Day One, the U.S. was focused mostly on coping with the disease, not stopping or even slowing it. Outside North America, on the other hand, an initial containment strategy made public health sense. But containment isn’t just a public health strategy. It is also a risk communication signal of enormous importance. Containment sends a signal that the pandemic can be contained and that it must be contained – that it is stoppable and severe. Instead of countering these misleading signals, the governments of many countries have issued misleading messages to match. This is doing significant damage to the world’s preparedness to cope with the unstoppable (and soon to be pervasive) but so far mild pandemic that is just beginning.
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Swine flu worst case scenarios: warn people now or wait till things start getting nasty?
Posted: May 30, 2009
This description was written when it was unclear whether swine flu was going to turn more severe or stay mild. It stayed mild, but I’ve left the blurb unchanged. Dan Rutz, a communication professional at the U.S. Centers for Disease Control and Prevention, wrote to challenge my view that the CDC (and other authorities) should do more to help people imagine what a severe pandemic might be like, and to motivate people to prepare for the possibility that one might be coming. He argued that warning about worst case scenarios right now, when swine flu has turned out mild so far, is both unkind and futile. Worse, it is likely to squander credibility that will be needed if a severe pandemic does start to look imminent. I responded, and Dan annotated my response. The result is a dialogue that makes both viewpoints clear. Dan also proposed a compromise: Include worst case scenarios as one of the uncertainties mentioned, but without undue emphasis. And “give people permission to stockpile food, etc., but don’t push it on everyone; that way, we’re respecting those who choose to be cautious, but not antagonizing those who decide to wait it out a bit longer.”
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Is swine flu moving slowly? Did the authorities overreact? What should the key messages be now?
Posted: May 10, 2009
A reader expressed doubts about my judgment that swine flu is spreading slowly so far, and accused me of prematurely deciding the authorities had overreacted to the outbreak. My response stresses that I agree with the reader – fervently – that swine flu may yet turn into the virulent, snowballing pandemic we all fear, and that the authorities didn’t overreact at all. If anything, I think they have underplayed the threat, and especially the need to prepare. But I argue nonetheless that so far this swine flu epidemic is mild and it is spreading slowly – facts that many people mistakenly see as evidence that the authorities overreacted. That makes it much harder to persuade people to prepare in case things get worse. Warnings about how bad swine flu could get, I conclude, won’t be credible unless they’re accompanied by acknowledgments that, so far, it’s not as bad as we initially feared … and still fear.
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Posted: April 29, 2009
This was my first substantial piece of writing about swine flu. I have resisted the temptation to update the description that follows. When I started criticizing the government for talking about swine flu as if there were nothing for the public to do but watch and practice good hygiene, we were at WHO Pandemic Phase 3. When I started this column (this morning) we were at Phase 4. When I finished the column (this evening), it was already Phase 5. The focus of this column is why the U.S. government is reluctant to urge the public to prepare now for a possibly imminent pandemic, and why I think the government should overcome its reluctance and do it! If you’re skeptical about advising people to imagine The Big One, get used to that knot in their stomachs, and then get started on preparedness, read this column. If you’re not skeptical and want to know what I think the important messages for right now are, skip this column and instead read “What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five..”
On May 21, 2009, Nature published a major abridgment and minor updating of this column under the title “Pandemics: good hygiene is not enough.” An Adobe Acrobat file (707-kB pdf) of the complete article
is available. (Note: The Nature links require payment. Free access to a copy is available.) French translations of my column and the Nature article, originally posted on the website Zone Grippe Aviaire (which has disappeared) are also available on this site.
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What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five
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 that looks like it might be severe, 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.
A French translation of the 25 messages, originally posted on the website Zone Grippe Aviaire (which has disappeared), is now available on this site.
French translations available
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Bird Flu, Pandemic Flu, and Poultry Markets: Playing Ostrich or Talking Turkey?
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.
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The Flu Pandemic Preparedness Snowball
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.
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Bird Flu: Communicating the Risk
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.)
(There is an online version (same text, but easier to read than a PDF file) posted on the PAHO website. The entire issue is also there.
Spanish translation available
Traducción en Español: La gripe aviar: cómo comunicar el riesgo
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Superb Flu Pandemic Risk Communication: A Role Model from Australia
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.
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Pandemic Influenza Risk Communication: The Teachable Moment
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.
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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 postscript 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?
The Swine Flu Pandemic of 2009–2010
Subsections
Major Articles
(The Swine Flu Pandemic of 2009–2010)
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The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives
Posted: June 29, 2010
In June 2010, one year after the World Health Organization declared swine flu a full-fledged pandemic, WHO’s credibility nosedived as even mainstream sources began to take seriously the absurd allegation that WHO had invented a “fake pandemic” in order to enrich the pharmaceutical industry. This column assesses at great length the three main reasons why this allegation made the move from fringe to mainstream: (a) WHO’s failure to acknowledge the ongoing mildness and current low incidence of the pandemic; (b) WHO’s failure to acknowledge that it changed some flu pandemic definitions and descriptions just as H1N1 was emerging; and (c) WHO’s failure to acknowledge until recently the legitimacy of concerns about transparency and conflict of interest. In a nutshell, the credibility of the World Health Organization crashed and burned because WHO mishandled some essential aspects of pandemic risk communication.
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Swine Flu Pandemic Communication Challenges and Lessons Learned
Posted: May 5, 2010
Responses to emailed questions from Lisa Schnirring of CIDRAP News
On April 21, 2010, Lisa Schnirring of CIDRAP News (part of the Center for Infectious Disease Research & Policy at the University of Minnesota) wrote me that she was working on an article on communications challenges and lessons learned from the swine flu pandemic – one of a series of CIDRAP News retrospectives to mark the first anniversary of the emergence of the new H1N1 virus. Would my wife and colleague Jody Lanard and I like to be interviewed? I replied that if she would email us some questions, we would answer in writing. No article ever materialized, but here are Lisa’s questions and our answers.
European hearing airs WHO pandemic response, critics’ charges
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), January 26, 2010
Charges that the World Health Organization (WHO) exaggerated the risk of the H1N1 pandemic in collusion with drug companies came to a head in a January 26 hearing of the Council of Europe’s Committee on Social, Health and Family Affairs. Lisa Schnirring covered the story for CIDRAP News. While she was working on her article, I sent her an email offering some comments. My wife and colleague Jody Lanard did so as well (at Lisa’s request), and Lisa wound up quoting us both – Jody mostly on the normal antipathy between WHO and Big Pharma and thus the irony of the conflict-of-interest charge; and me mostly on WHO’s failure to concede two valid charges among the invalid ones: that WHO hadn’t sufficiently acknowledged the pandemic’s mildness and that WHO had dropped severity from its characterization of flu pandemics at the last minute.
After Lisa’s article was published, Jody and I decided to expand my email to document more thoroughly the two valid charges, the risk communication case for acknowledging them, and WHO’s failure to do so. The resulting critique (“It’s Not a Fake Pandemic – but WHO’s Defense Lacks Candor”) is a lot tougher on WHO than the CIDRAP News article.
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Posted: December 18, 2009
On December 2, 2009, and again on December 15, I criticized the U.S. Centers for Disease Control and Prevention in my “Swine Flu Pandemic Communication Update” for (in my view) intentionally misinterpreting its own data on the severity of the swine flu pandemic and on which age cohorts were most at risk. These criticisms aroused surprisingly little media interest. But a couple of reporters did call for interviews. Here are some excerpts from my side of one telephone interview. No story based on this interview ever materialized. The details are no longer of much interest, except as a pristine case study of successful CDC dishonesty.
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U.S. Pandemic Vaccine Supply and Distribution: Addressing the Outrage
Posted: November 18, 2009
As in most other developed countries, the fall rollout of the U.S. pandemic vaccination program has been hampered by a shortage of vaccine. The result is outrage – outrage that there isn’t as much vaccine as people wanted and expected, and outrage that the distribution process feels so chaotic, frustrating, and in some cases unfair. The shortage itself is nobody’s fault; the vaccine virus turned out to be difficult to grow. But officials are very much at fault for having overpromised, frequently predicting that there would be ample vaccine by mid-October. Even before the pandemic began, in fact, the meme was established that it would require only three to six months after the emergence of a pandemic influenza strain to manufacture sufficient vaccine. Managing public (and health care provider) outrage about vaccine supply and vaccine distribution has thus become an important pandemic risk communication task, a necessary distraction from the paramount task of convincing people to get vaccinated. This column describes how officials are handling the outrage so far, and proposes some improvements.
Sorting through panic and anxiety
Published in the Toronto Star, October 30, 2009
When a healthy 13-year-old soccer player in Toronto suddenly got swine flu and died, both major Toronto newspapers ran front-page stories urging people not to panic. Until then, public health authorities had been desperately trying to get people to take the pandemic seriously enough; now they reversed direction and started making reassuring statements. Instead of seizing the teachable moment, they succumbed to their own “fear of fear.” Judy Gerstel of the Toronto Star called me to ask about the mixed messages. The resulting story suffers a bit from ham-handed editing – but it is still on target.
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Flu Preparedness: An Even Tougher Sell than Usual
Posted: September 9, 2009
I wrote this short column in early June 2009 for The Synergist, a magazine for industrial hygienists, on some ways of communicating about flu – seasonal and pandemic – in the workplace. When I wrote it, most people had “recovered” from what they considered the spring “swine flu scare,” and they were in no mood to listen to any more influenza warnings. By the time the column was published in September 2009, some of the complacency had waned, and people were actually girding up (a bit) for another wave of mild-but-pervasive pandemic illness. So the column’s claim that flu preparedness is a tough sell needs to be modified somewhat. But its actual recommendations still stand.
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Distributed by Project Syndicate, July 27, 2009
Project Syndicate is a nonprofit organization that distributes op-ed commentaries on currently hot topics to newspapers around the world, free of charge. They asked me to do one on how public health officials ought to be communicating with the public about the ongoing H1N1 pandemic. The resulting piece briefly discusses nine mistakes officials should stop making: don’t feign confidence; don’t over-reassure; don’t worry about panic; don’t obsess over accusations of fear-mongering; don’t fight the adjustment reaction; don’t oversell what the government is doing; don’t oversell what the public can do; don’t ask the impossible; and don’t neglect the teachable moment.
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Containment as Signal: Swine Flu Risk Miscommunication
Posted: June 29, 2009
The swine flu pandemic started in North America, and by the time the virus was identified it was already widely seeded in the U.S. So the experts judged that it was too late to try to “contain” its U.S. spread; from Day One, the U.S. was focused mostly on coping with the disease, not stopping or even slowing it. Outside North America, on the other hand, an initial containment strategy made public health sense. But containment isn’t just a public health strategy. It is also a risk communication signal of enormous importance. Containment sends a signal that the pandemic can be contained and that it must be contained – that it is stoppable and severe. Instead of countering these misleading signals, the governments of many countries have issued misleading messages to match. This is doing significant damage to the world’s preparedness to cope with the unstoppable (and soon to be pervasive) but so far mild pandemic that is just beginning.
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Communication expert endorses WHO’s delay on pandemic declaration
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), June 12, 2009
On June 11, the World Health Organization finally let the other shoe drop, formally declaring H1N1 a pandemic. CIDRAP’s Robert Roos sent me an email asking for my comments. I responded that the delay itself had been pretty sensible – which turned into Bob’s lead angle. But I had mixed feelings about some of what Director-General Margaret Chan and Interim Assistant Director-General Keiji Fukuda said in making the announcement. What had motivated WHO to delay in the first place had been its twin concerns that the declaration might frighten people unduly (“Oh my God a pandemic!”) and that the declaration might reinforce people’s complacency (“This is a pandemic? What’s the big deal?”). Yet the announcement did relatively little to address either concern. My original exchange of emails with Bob Roos (“Reactions to the WHO’s Phase 6 Declaration”) is posted on this site.
Avoiding “warning fatigue” over swine flu
Posted on Emerging Health Threats Forum, May 8, 2009
Anita Makri of Emerging Health Threats Forum asked some of the most thoughtful questions I have been asked anywhere about the risk communication implications of the fact that swine flu has been mild so far, about what governments might have done differently in the way they warned people, about what they ought to be saying now, and about how to handle any future warnings that might be needed. She compiled my answers with answers from the CDC’s Barbara Reynolds into an excellent article on swine flu warning fatigue. This sentence from the article captures the problem best: “‘We need to persuade people who became alarmed (wisely) and then became less alarmed (also wisely) that they have nothing to feel foolish about and nothing to feel angry about … but good reason to remain vigilant,’ says Sandman.”
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Broadcast on KUNC radio, May 5, 2009
Grace Hood made a mistake at the start of this four-minute interview when she said I told her some people are panicking about swine flu. And I overstated things pretty badly myself when I said that at the start of the outbreak the experts were “on the phone in the middle of the night” worrying that swine flu might be “the granddaddy of all pandemics.” Despite both errors, this is a pretty solid interview on two key points I keep stressing: (a) that a good pandemic warning needs to be simultaneously scary and tentative; and (b) that the U.S. government didn’t do much to urge people to prepare when it looked like a severe pandemic might be imminent, so it’s hard to imagine it’ll do more now that the sense of imminence has gone.
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What’s in a name: H1N1 versus swine flu
Posted: May 3, 2009
One inevitable effect of the swine flu crisis that began in late April 2009 was public concern about eating pork products. In an effort to reassure people, international authorities decided that “swine flu” would henceforth be known instead as “A/H1N1.” An international financial manager wrote to the website Guestbook in support of the switch. Jody and I disagreed, arguing (a) that the new virus is in fact a swine flu, and it’s a mistake to pretend otherwise; (b) that there is already a seasonal A/H1N1, and it’s a mistake to give two circulating viruses the same name; and (c) that risk communication offers some better ways than linguistic cover-up to cope with the stigmatization of pork. Our answer grew too long for the Guestbook, so here it is. (We had to revise the half-written answer when Canada discovered human-to-pig transmission of the new virus. Other developments may strengthen our argument, as that one did – or, perhaps, weaken it.)
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Posted: April 29, 2009
This was my first substantial piece of writing about swine flu. I have resisted the temptation to update the description that follows. When I started criticizing the government for talking about swine flu as if there were nothing for the public to do but watch and practice good hygiene, we were at WHO Pandemic Phase 3. When I started this column (this morning) we were at Phase 4. When I finished the column (this evening), it was already Phase 5. The focus of this column is why the U.S. government is reluctant to urge the public to prepare now for a possibly imminent pandemic, and why I think the government should overcome its reluctance and do it! If you’re skeptical about advising people to imagine The Big One, get used to that knot in their stomachs, and then get started on preparedness, read this column. If you’re not skeptical and want to know what I think the important messages for right now are, skip this column and instead read “What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five..”
On May 21, 2009, Nature published a major abridgment and minor updating of this column under the title “Pandemics: good hygiene is not enough.” An Adobe Acrobat file (707-kB pdf) of the complete article
is available. (Note: The Nature links require payment. Free access to a copy is available.) French translations of my column and the Nature article, originally posted on the website Zone Grippe Aviaire (which has disappeared) are also available on this site.
Swine Flu Pandemic Communication Updates
(The Swine Flu Pandemic of 2009–2010)
On April 24, 2009, when a swine flu pandemic looked imminent and potentially very serious, I posted a two-paragraph alert on my website home page. This was the first of several dozen “Swine Flu Pandemic Communication Updates” I posted on the site. They soon got much, much longer and moved off the home page. They were no longer “alerts,” really, but rather essays on how the swine flu pandemic was evolving, how it was being communicated, and how I thought it should be communicated.
Other Articles
(The Swine Flu Pandemic of 2009–2010)
Why Seniors Really Should Fear Swine Flu
Blogged on the Newsweek website, January 8, 2010
I continue to be surprised that the mainstream media have paid so little attention to the CDC’s evidence that children are actually less at risk of catching a deadly case of swine flu than adults and seniors – and so little attention to the CDC’s decision not to change its vaccination messaging in response to that evidence. Even after I posted a Swine Flu Pandemic Communication Update on the subject, I was unable to arouse much of a reaction. This excellent blog post by Newsweek’s science editor is an exception … or perhaps a watershed. Starting from my update, Sharon Begley nailed the evidence that seniors are being dangerously misled into thinking they’re too old to worry about swine flu.
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Broadcast on NPR’s “Morning Edition,” November 6, 2009
The CDC website has detailed advice for parents with a child home sick with swine flu. But it’s not necessarily very practical or user-friendly advice. Deborah Franklin’s story on NPR’s “Morning Edition” features some of the ways the CDC’s recommendations might be a tad unrealistic. She used me to say the obvious: that there’s nothing wrong with telling parents how to achieve maximum infection control at home, but it would help to offer a Plan B for parents who can’t or won’t do it all. The link includes both the audio clip and a print version of the story from NPR’s website. Available on this site: An email I sent the reporter before the interview with some thoughts on public health professionals’ reluctance to help people prioritize among their recommended precautions.
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Broadcast on NPR’s “All Things Considered,” November 2, 2009
Richard Knox interviewed me for nearly an hour on how I think the Centers for Disease Control and Prevention should speak to people who aren’t just worried about the safety of the swine flu vaccine, but are also mistrustful of government and not inclined simply to take the CDC’s word that the vaccine is safe. I talked a lot about the sorts of accountability mechanisms smart corporations use, and how the CDC could use similar approaches if it weren’t so deeply offended by people’s mistrust. The resulting story in “All Things Considered” used only a little of the interview, of course. The link includes both the audio clip and a print version of the story from NPR’s website.
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Uncertainty over H1N1 warranted, experts say
Published in the Toronto Star, October 9, 2009
I’ve pretty much stopped posting news stories that quote me about pandemic risk communication, since neither the stories nor the quotes say much that’s new. But this Toronto Star “Analysis” story by Judy Gerstel swims against the tide. Like many other stories, this one covers official uncertainty about many aspects of the swine flu pandemic. It focuses particularly on an unpublished Canadian study that seems to show the seasonal flu vaccine might increase vulnerability to the pandemic virus, which has led to significant changes in some provinces’ vaccination policies despite contrary (also unpublished) studies. But instead of criticizing the uncertainty as official “double messages” leading to public “confusion,” Judy praises it as “transparency, responsiveness, agility and acknowledgement of uncertainty.” I was pleased to be part of the story. (I’m also in a less interesting Judy Gerstel swine flu story published the same day, “Swine flu squeezing out the seasonal bug,” which despite its headline actually focuses on what to call the pandemic virus.)
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Fundamentals of risk communication: How to talk to patients and the public about pandemic H1N1
Presented to the European Respiratory Society international conference, Vienna, Austria, September 14, 2009
The European Respiratory Society invited me give a 20-minute presentation on pandemic communication at its annual conference, as part of a panel on various aspects of pandemic H1N1. I pleaded for an extra hour right afterwards to go into more detail for those who wanted it. Some 20,000 respiratory disease doctors attended the conference; roughly 2,000 of them were at the panel; about 200 followed me to a smaller room for my extra hour (which I did jointly with my wife and colleague Jody Lanard, an M.D.). Only the panel presentation is posted on the ERS website. It’s mostly an introduction to the basics of risk communication (hazard versus outrage; precaution advocacy versus outrage management versus crisis communication), with some quick comments on the implications for pandemic communication. The meat was in the hour that followed, which unfortunately wasn’t recorded.
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British public slow to respond to pandemic
Posted on Emerging Health Threats Forum, July 16, 2009
A survey of pandemic attitudes in the U.K found people not very concerned and not very inclined to take precautions. Holly Else of the Emerging Health Threats Forum sent me an email asking what I thought of these results. I replied that they were unsurprising, since it often takes a generation to inculcate a new precaution in a society, especially with regard to a risk that isn’t obviously serious (yet). On the date this news story was being prepared, the U.K. had just experienced two pandemic deaths in previously healthy people (one of them a child), and the level of public anxiety was apparently higher than it was in early May, when the survey had been conducted – so I commented on that too, noting that a temporary adjustment reaction does not constitute panic. My original response (“It Isn’t Easy to Arouse Pandemic Concern. What Do We Need People to Know?”) is posted on this site. It also identified what I considered the three key things the U.K. public needed to know about the pandemic; that was a little beside the point and didn’t make it into the story.
WHO suspends reporting of H1N1 case counts
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), July 16, 2009
On July 16, the World Health Organization advised countries to stop routinely testing suspected pandemic flu cases to confirm the diagnosis. WHO’s main reason was to conserve laboratory resources better used for other purposes, once widespread community transmission has already been established. But there is also a risk communication angle to the story. The tally of confirmed cases is a much smaller number than the actual number of people who have had the disease. As I explained to Lisa Schnirring of CIDRAP News, overuse of the confirmed case count has given many people the misimpression that the pandemic is much less pervasive than it actually is, and has made sources who tried to explain its actual pervasiveness sound like fear-mongers. The emphasis on confirmed cases has also made the disease look more deadly than it actually is (so far), since the unconfirmed cases are missing from the denominator of the “case fatality rate” fraction.
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Critics say “mild” a misleading term for H1N1
Distributed by Canadian Press, June 28, 2009
Canadian Press reporter Helen Branswell (the dean of the pandemic press corps) sent me an email asking my opinion on all the official statements that pandemic H1N1 is “mild” and that it attacks mostly people with “underlying health conditions.” I wrote back that both claims are accurate but misleading. When applied to a flu pandemic, “mild” doesn’t mean what we think it does, and an awful lot of people have “underlying health conditions.” And anyway, why were officials trying so hard to reassure the public, when the real problem was public complacency? Helen used only a little of my email in her article. My original email to Helen (Is Swine Flu “Mild”? Are We Safe If We Have No “Underlying Conditions”?) is posted on this site.
We’re Living in a Pandemic: Now What Do We Do?
Blogged in Nancy Shute’s “On Parenting” blog, U.S. News & World Report, June 11, 2009
After WHO declared H1N1 a pandemic, Nancy Shute asked me what the declaration meant for how worried parents should be. I answered that it shouldn’t have any effect at all; the reasons to worry were just as compelling before the declaration as after, and the reasons to worry were mostly about what might happen, not what had happened so far. When the story appeared on Nancy’s “On Parenting” blog, it left the impression I thought there was little or no reason to worry, period. So I sent her a longer, more alarmist comment, entitled “Swine flu is more serious than many people think.”
WHO under pressure from member states to rewrite pandemic requirement
Distributed by Canadian Press, May 22, 2009
For weeks, a number of governments have been urging the World Health Organization to redefine “pandemic” so it wouldn’t have to declare H1N1 a pandemic. Their main worry: that a pandemic declaration would panic their publics, leading to demands for border closings and other such ineffective and economically damaging infection control measures. On May 22, WHO announced that it would reconsider its pandemic definition. I thought the rationale for doing so was mistaken. But I saw some merit in the decision itself, for exactly the opposite reason: that a pandemic declaration while H1N1 remained mild would “teach” people that pandemics are no big deal. This CP story by Helen Branswell quotes me briefly to that effect. My original email to the reporter (“On WHO Changing the Definition of ‘Pandemic’”) is on this site.
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Pandemics: good hygiene is not enough
Published in Nature, May 21, 2009, pp. 322–323
This is a pretty drastic abridgment and a very minimal updating of my April 29, 2009 column, “The Swine Flu Crisis: The Government Is Preparing for the Worst While Hoping for the Best – It Needs to Tell the Public to Do the Same Thing!“ But a Nature commentary can be a lot more influential than a website column, so I was happy to seize the opportunity. The focus, of course, is the same: that the authorities (for example the CDC in the U.S.) are being candid about swine flu but are not urging people to prepare, and not giving people a visceral sense of what a serious swine flu pandemic might be like. Why? Partly because they’re (mistakenly) afraid of frightening the public, and partly because they’re (correctly) afraid of being accused of frightening the public. I argue that they should get over both fears and use the teachable moment … a position I feel even more fervently on May 21 than I did on April 29.
An Adobe Acrobat file (707-kB pdf) of the complete article
is also available. (Note: The Nature links require payment. Free access to a copy is available.) A French translation of this article, originally posted on the website Zone Grippe Aviaire (which has disappeared) is now available on this site.French translation available
En Français: Pandémie: une bonne hygiène ne suffit pas (Nature)
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Posted on newmatilda.com, May 12, 2009
I’m not sure what to say about this Australian website posting. Its tone is awfully flip. And author Jess Hill got some details wrong. (For example, she writes about my “‘Watch out! Stop Worrying’ approach” – which is actually two antithetical approaches.) Still, she really does seem to understand the dilemma WHO faces as it tries to warn people about a situation that looks quite mild at the moment. And she has condensed a lot of my website writing on pandemics into two risk communication strategies she thinks WHO is using with regard to swine flu: “Get Your Slice of the ‘Fearfulness Pie’” and “Use ‘Teachable Moments’ to Establish ‘The New Normal.’” Once I got past the tone, I found this short article a very thoughtful assessment.
By the way, Hill quotes me as saying that I have worked on over 500 crises. It’s an accurate quotation, but it’s not so. I have worked on over 500 controversies that felt like crises to my clients, because their reputations or their profitability was threatened – but far fewer actual crises that seriously threatened public health. Swine flu is one of the latter.
Health Check
(Note: This link is to an 8.1-MB, 8:40-min. MP3 audio file on this site.)Broadcast on BBC World Service, May 10–12, 2009
“Health Check” is a weekly program on BBC radio. This audio clip deals with people’s emotional reactions to swine flu. It starts with a report from Mexico City, followed with an interview with me. I point out that officials suffer from “panic panic,” excessively worried that the public will panic, but that in most crisis situations (this one included) apathy is a much bigger problem than panic. I also talk about the role of denial, and emphasize that what officials need to do is to legitimize people’s fears – not tell them they shouldn’t be afraid.
H1N1 flu – are we preparing for the worst or hoping for a break?
Published in the Jamaica Observer, May 9, 2009
Jamaica Observer columnist Clare Forrester is the former Media and Communication Advisor of the Office of Caribbean Program Coordination of the Pan American Health Organization, where she worked with my wife and colleague Jody Lanard. This is a thoughtful and level-headed column arguing that the swine flu threat is still serious, that officials need to be candid rather than over-reassuring, and that the real danger isn’t panic but apathy – and loss of trust if officials over-reassure and then things get bad. She interviewed Jody and looked at my website to get some additional quotes, but she had it right to start with.
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Flu overhyped? Some say officials ‘cried swine’
Distributed by the Associated Press, May 7, 2009
Unlike many stories on the widespread conviction that the swine flu risk was overblown by officials and the media, this AP story pays attention to why that conviction is mistaken. It quotes me – my website, actually – on how skeptical people are likely to be if things start looking bad again and officials try to renew their warnings.
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Published in Haaretz, May 7, 2009
This article from an Israeli newspaper is more balanced than most media stories about “swine flu hype.” Reporter Assaf Uni interviewed my wife and colleague Jody Lanard, who pointed out that preparing isn’t panicking, and that it’s better to warn people about a risk that doesn’t materialize than to leave them unaware of one that does.
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Between a virus and a hard place
This editorial in the May 7 issue of Nature argues that “complacency, not overreaction,” is the greatest swine flu danger – and uses me to make the point that WHO and the CDC have actually done an excellent job of acknowledging how uncertain the experts are about the future course of this new virus.
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Broadcast and posted on Minnesota Public Radio, May 6, 2009
This overview of recent swine flu developments discusses people’s sense that initial warnings were overblown, and includes my concern that authorities will hesitate to risk still more credibility by doing what they should do: warn people that swine flu may still pose a serious threat and that they should use the current calm to get better prepared. This site has both a transcript and an audio file.
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What happens if swine flu goes away?
Distributed by Reuters, May 4, 2009
This “Analysis” piece by Reuters Health and Science Editor Maggie Fox quotes me on my hope that “the government is more worried about the public being caught with its pants down than the government being called fear-mongers.”
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Blogged on May 3, 2009
This blog entry is only casually about swine flu; mostly it’s a summary of some of my old writing on hazard versus outrage, panic, and “panic panic,” as applied to everything from swine flu to education.
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5 Ways to Manage the Family’s Swine Flu
Blogged on the U.S. News & World Report website, May 1, 2009
Nancy Shute called to ask me about three things: whether parents should worry about their children in connection with swine flu, what they should do about it, and how they should talk to their kids about the situation. She really wanted to interview my wife and colleague Jody Lanard, but Jody’s in Asia and Nancy figured maybe a three-time father might be able to gin up some child-sensitive risk communication answers too. I tried. She captured what I said very well, I think, except that I didn’t say you should “sympathize” with a child’s legitimate swine flu worries; I said you should share them – not the same thing at all.
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Broadcast on PRI’s “The World” (National Public Radio), April 30, 2009
Long-time health journalist Christine Gorman and I chatted with host Lisa Mullins for about 20 minutes. PRI used about half of it. I spent a lot of my time riding my hobbyhorse that the government needs to do more to urge people to prepare in case a serious pandemic is around the corner. But Lisa got us talking about other things as well, notably why it doesn’t make a lot of sense to close the Mexican border when lots of people on this side of the border are already carrying the flu virus, while lots of trucks on the other side are carrying goods we need.
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Behavioral research can help curb the spread of swine flu – but is anyone listening?
Posted on the American Psychological Association website, April 30, 2009
Michael Price discussed what behavioral science has to offer swine flu risk communication with me and Carnegie Mellon University expert Baruch Fischhoff, then wrote this feature on some of our swine flu communication recommendations.
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Broadcast on BBC World Service “Business Daily,” April 29, 2009
This is only marginally about risk communication. The “Business Daily” reporter’s working hypothesis was that swine flu precautions – individual and societal – are excessive given how few people have died compared to the fatalities from many other risks (worker accidents, for example, not to mention the seasonal flu). I tried to explain that what’s scary about swine flu isn’t what has already happened; it’s what might (or might not) happen. It’s hard to choose precautions when the risk in question could end up catastrophic or trivial or anywhere in the middle. Going further and further beyond my field of expertise, I ended up explaining why I think dispersing antivirals nearer to population centers probably makes sense and closing airports probably doesn’t. The editors pretty much left my risk communication points on the cutting room floor (the psychological benefits of taking precautions, for example), and ran with my off-the-cuff amateur opinions about infection management. Not their fault, of course; I was the one answering the damn questions.
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Experts worry mild disease outside of Mexico hampers bid to get people to prepare
Distributed by Canadian Press, April 29, 2009
For days I have been haranguing Helen Branswell of Canadian Press (and everyone else I can buttonhole) about the need for officials to be simultaneously scary and tentative in what they tell the public about the swine flu pandemic that might (or might not) be impending. She eventually decided to do the story, pegged to the potentially misleading mildness of the non-Mexican cases so far. When she called to interview me, I also stressed the importance of urging people to undertake their own preparedness efforts, not just to watch the government prepare and practice good hygiene. And I criticized the government’s excessive fear of frightening the public. She managed to squeeze all three points into the story.
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Is America Prepared for a Pandemic?
Published in the Washington Post, April 28, 2009
The 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 (“The Government is Preparing for the Worst While Hoping for the Best – Now It Needs to Tell the Public to Do the Same Thing!”) here too. 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.
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WHO raises pandemic alert to phase 4
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), April 27, 2009
In the face of a very scary swine flu outbreak spreading from Mexico, the World Health Organization on April 27, 2009 did two things to its index of six pandemic phases: It implemented some changes in phase definitions (long in the works) that – among other effects – made the criteria for Phase 4 more demanding; and in spite of that it finally ratcheted up to Phase 4. Bob Roos of CIDRAP News sent me an email asking for comment on the likely impact of the latter change. His published article used some of what I said about my hope that the shift would signal organizations to trigger their pandemic plans and individuals to launch their own preparations. My original email (“Impacts of the WHO Ratchet from Pandemic Phase 3 to Phase 4”) is also on this site.
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WHO declares public health emergency as US swine flu cases rise
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), April 25, 2009
CIDRAP’s Lisa Schnirring quotes me here arguing that it’s important to help people envision how bad things might (or might not) get.
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More US swine flu cases, Mexico illnesses raise pandemic questions
Posted: Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), April 23, 2009
In this article near the start of the swine flu outbreak, CIDRAP’s Lisa Schnirring quotes me criticizing the CDC for missing the teachable moment to promote pandemic preparedness – a theme that I developed in detail in my April 29 column, The Swine Flu Crisis: The Government Is Preparing for the Worst While Hoping for the Best – It Needs to Tell the Public to Do the Same Thing!
Guestbook Entries
(The Swine Flu Pandemic of 2009–2010)
2011
Warning people about swine flu … again (April 2011)
2010
WHO: Hyping the pandemic or helping the world prepare? (June 2010)
Was it wrong to warn people even though the swine flu pandemic was turning out mild? (May 2010)
Making health care workers get vaccinated against the flu (March 2010)
Making pandemic communications (and all crisis communications) provisional (February 2010)
How should WHO have integrated severity into its pandemic communications? (January 2010)
2009
What should we tell people about vaccination if the pandemic wave is ebbing? (November 2009)
The meme that this pandemic is “like the seasonal flu” (October 2009)
Mandatory vaccination for health care workers (October 2009)
The importance of telling people about pandemic flu precautions (August 2009)
Pandemic prioritizing: Vulnerable people versus essential people (July 2009)
Swine flu worst case scenarios: warn people now or wait till things start getting nasty? (May 2009)En Français: Pires scénarios de grippe porcine: avertir les gens maintenant ou attendre que les choses commencent à mal tourner?
WHO’s “Outbreak Communication Guidelines” – and calling a pandemic a pandemic (May 2009)
Selling pandemic prep to family and friends (May 2009)En Français: Vendre l’état de préparation à une pandémie, à la famille et aux amis
Visualizing a mild pandemic: The risk comparison to 36,000 U.S. annual flu deaths (May 2009)En Français: Visualiser une pandémie légère: la comparaison de risques avec 36,000 décès annuels aux États-Unis, causés par la grippe [saisonnière]
What’s in a name: H1N1 versus swine flu (May 2009)
Trying to get Tamiflu in case of a swine flu pandemic (April 2009)
Everything in Chronological Order
(The Swine Flu Pandemic of 2009–2010)
More US swine flu cases, Mexico illnesses raise pandemic questions
Swine Flu Pandemic Scare Gets Serious
WHO declares public health emergency as US swine flu cases rise
Swine Flu Pandemic Scare Gets Serious
WHO raises pandemic alert to phase 4
Swine Flu Pandemic Scare Gets Serious
Impacts of the WHO Ratchet from Pandemic Phase 3 to Phase 4
Is America Prepared for a Pandemic? Is America Prepared for a Pandemic?
Trying to get Tamiflu in case of a swine flu pandemic
Experts worry mild disease outside of Mexico hampers bid to get people to prepare
Swine Flu Pandemic Scare Gets Serious
Behavioral research can help curb the spread of swine flu – but is anyone listening?
5 Ways to Manage the Family’s Swine Flu
What’s in a name: H1N1 versus swine flu
What’s in a name: H1N1 versus swine flu
What happens if swine flu goes away?
Communicating the Message of Swine Flu: An Expert’s Opinion
Swine Flu Pandemic Prospects: Nobody Knows
H1N1 outbreak revealed seasonal flu lingered in Minn.
Between a virus and a hard place
Flu overhyped? Some say officials ‘cried swine’
Avoiding “warning fatigue” over swine flu
H1N1 flu – are we preparing for the worst or hoping for a break?
Is swine flu moving slowly? Did the authorities overreact? What should the key messages be now?
Visualizing a mild pandemic: The risk comparison to 36,000 U.S. annual flu deaths
Swine Flu Pandemic Prospects: Nobody Knows
Selling pandemic prep to family and friends
Pandemics: good hygiene is not enough
WHO under pressure from member states to rewrite pandemic requirement
On WHO Changing the Definition of “Pandemic”
Swine Flu Pandemic Prospects: Nobody Knows
WHO’s “Outbreak Communication Guidelines” – and calling a pandemic a pandemic
Swine flu worst case scenarios: warn people now or wait till things start getting nasty?
Swine Flu Pandemic Prospects: Nobody Knows
Reactions to the WHO’s Phase 6 Declaration
We’re Living in a Pandemic: Now What Do We Do?
Swine flu is more serious than many people think
Communication expert endorses WHO’s delay on pandemic declaration
Would you like another wakeup call?
Critics say “mild” a misleading term for H1N1
Is Swine Flu “Mild”? Are We Safe If We Have No “Underlying Conditions”?
Containment as Signal: Swine Flu Risk Miscommunication
Pandemic prioritizing: Vulnerable people versus essential people
Why Pandemic Complacency Isn’t Okay
WHO suspends reporting of H1N1 case counts
British public slow to respond to pandemic
It Isn’t Easy to Arouse Pandemic Concern. What Do We Need People to Know?
The Three-Legged Stool of Pandemic Messaging
The importance of telling people about pandemic flu precautions
Talking about Pandemic H1N1 Vaccination
Flu Preparedness: An Even Tougher Sell than Usual
Overselling Seasonal Flu Vaccination in a Pandemic Season
Swine flu squeezing out the seasonal bug
Uncertainty over H1N1 warranted, experts say
Mandatory vaccination for health care workers
The meme that this pandemic is “like the seasonal flu”
Sorting through panic and anxiety
Marketing Flu Vaccine: A Tough Sell for Many
Prioritizing among Precautions: The Best Is the Enemy of the Good
Flu Precautions: Making Sense of CDC Advice
U.S. Pandemic Vaccine Supply and Distribution: Addressing the Outrage
U.S. Pandemic Vaccine Supply and Distribution: Addressing the Outrage
What should we tell people about vaccination if the pandemic wave is ebbing?
It’s Official (sort of): The Swine Flu Pandemic Is Mild So Far
Update on the December 2 Update
What the CDC Is Saying about Swine Flu Severity
The CDC’s Pandemic Data versus the CDC’s Pandemic Communications: Outtakes from a Media Interview
Why Seniors Really Should Fear Swine Flu
Pandemic Interruptus: It Ain’t Over Till It’s Over
European hearing airs WHO pandemic response, critics’ charges
It’s Not a Fake Pandemic – but WHO’s Defense Lacks Candor
How should WHO have integrated severity into its pandemic communications?
Why did the CDC misrepresent its swine flu mortality data – innumeracy, dishonesty, or what?
Making pandemic communications (and all crisis communications) provisional
Making health care workers get vaccinated against the flu
When a government decides swine flu is mild: Talking about crisis management policy changes
Swine Flu Pandemic Communication Challenges and Lessons Learned
Was it wrong to warn people even though the swine flu pandemic was turning out mild?
Further debate on whether the CDC misled people about age-specific death rates of pandemic H1N1
WHO: Hyping the pandemic or helping the world prepare?
The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives
The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives
Warning people about swine flu … again
Why U.K. nurses resisted swine flu vaccination – and why health care workers resist flu vaccination
Influenza Pandemics other than Swine Flu
Subsections
Major Articles
(Influenza Pandemics other than Swine Flu)
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What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five
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 that looks like it might be severe, 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.
A French translation of the 25 messages, originally posted on the website Zone Grippe Aviaire (which has disappeared), is now available on this site.
French translations available
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Bird Flu, Pandemic Flu, and Poultry Markets: Playing Ostrich or Talking Turkey?
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.
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The Dilemma of Personal Tamiflu Stockpiling
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.
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The Flu Pandemic Preparedness Snowball
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.
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Bird Flu: Communicating the Risk
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.)
(There is an online version (same text, but easier to read than a PDF file) posted on the PAHO website. The entire issue is also there.
Spanish translation available
Traducción en Español: La gripe aviar: cómo comunicar el riesgo
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Published in The Christian Science Monitor, July 7, 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.
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Superb Flu Pandemic Risk Communication: A Role Model from Australia
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.
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Pandemic Influenza Risk Communication: The Teachable Moment
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.
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Psychological Barriers Getting in the Way of Pandemic Preparations: Experts
Posted: 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.
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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 postscript 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?
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Avian Flu Exercise: What Are They Doing?
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.
Columns from CIDRAP Business Source Weekly Briefing
(Influenza Pandemics other than Swine Flu)
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Read “FAFfing About” if you need some motivation
Published by CIDRAP: July 17, 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
(Never published by CIDRAP)
We have told people to worry about a “bird flu pandemic.” No wonder they think the danger comes from birds.
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Published by CIDRAP: June 14, 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
Published by CIDRAP: June 7, 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
Published by CIDRAP: May 17, 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?
Published by CIDRAP: May 3, 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
Published by CIDRAP: April 19, 2007
You have a few crucial moments for talking about pandemic preparedness. Use them well.
Riding the many pandemic seesaws
Published by CIDRAP: April 5, 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
Published by CIDRAP: March 22, 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
Published by CIDRAP: March 8, 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
Published by CIDRAP: February 22, 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!”
Published by CIDRAP: February 7, 2007
There are no perfect pandemic precautions. We need to say so – and push hard for imperfect precautions.
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Published by CIDRAP: January 24, 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
Published by CIDRAP: January 10, 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.
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Published by CIDRAP: December 20, 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?
Published by CIDRAP: November 29, 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. But….
Other Articles
(Influenza Pandemics other than Swine Flu)
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Study: Media can distort public’s views on infectious diseases
Posted on the website of CIDRAP News (Center for Infectious Disease Research & 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
Posted on the website of CIDRAP News (Center for Infectious Disease Research & 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.
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Physician survey shows mixed views on pandemic risk
Posted on the website of CIDRAP News (Center for Infectious Disease Research & 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.
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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. For the (nearly) unedited transcripts of the two presentations, see below.
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Risk Perception, Risk Communication, and Risk Reporting: The Role of Each in Pandemic Preparedness
Posted: 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
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.
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Internet rumours of bird flu case in Rimouski, Que., are ‘totally untrue’
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.”
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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.
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Skeptics warn bird flu fears are overblown
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.
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Talking risk: avian flu advice from a risk communicator
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.
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Bird flu’s potential toll warrants alerts
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.
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The Bird Flu: How Much Fear Is Healthy?
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.
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Fear can play role in pandemic readiness, speaker says
Posted 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.)
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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.
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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.
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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.
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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.
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Are you a sitting duck for bird flu?
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.
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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.
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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 available. -
Most Canadians have taken note of the threat of a flu pandemic
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.
Guestbook Entries
(Influenza Pandemics other than Swine Flu)
2012
Bird flu risk perception: bioterrorist attack, lab accident, natural pandemic (January 2012)
2008
The dangers of excessive warnings … and of over-reassurance (July 2008)
Risk communication is a type; outbreak communication is a subtype (July 2008)
You can’t hector people into pandemic preparedness (February 2008)
2007
Panflu risk communication to foreign-born populations (August 2007)
Corporate Tamiflu stockpiling (April 2007)
Pandemic preparedness and the poor: Are we urging people to do more than they can? (January 2007)
2006
Talking about animal culls (December 2006)
Pandemic flu good communication example file (October 2006)
Pandemic flu misinformation “Hall of Shame” (October 2006)
Talking about “high-path” and “low-path” avian flu (September 2006)
How much should we trust what WHO says about pandemic phase? (September 2006)
“Mild” versus severe pandemics – public health versus emergency response (May 2006)
Preparing for a severe pandemic (May 2006)
Talking to wildlife rescuers about their bird flu risk (April 2006)
Coming out of the closet about pandemic preparedness (April 2006)
Measuring pandemic fear, panic, denial, and apathy (April 2006)
More on Tamiflu stockpiling ethics and psychology (March 2006)
Message points for a pandemic flu school flyer for parents (March 2006)
Surgical masks: Another pandemic risk communication controversy (February 2006)
Pandemic risk and the U.S. poultry industry (January 2006)
2005
Likelihood of a severe pandemic – the hunger for a number (December 2005)
The flu pandemic issue-attention cycle – where does skepticism fit? (December 2005)
Talking to a local government official about pandemic flu (November 2005)
Talking to healthcare workers about pandemic risks (November 2005)
Trusting in your government’s pandemic planning (November 2005)
Pandemic preparedness: the individual, the government, and the world of finance (November 2005)
Some flu pandemic adjustment reactions (October 2005)
Pandemic preparedness – what’s a doctor to do? (October 2005)
The ethics of Tamiflu (October 2005)
Myanmar takes note of bird flu (September 2005)
Giving children frightening bird flu information (August 2005)
Homeland Security's color coding as an excuse not to warn people about bird flu (July 2005)
People getting themselves ready for a flu pandemic (July 2005)
The math behind the U.S. Tamiflu supply (June 2005)
Magnitude of the communication problem during a flu pandemic (May 2005)
What can individuals do to prepare for a bird flu pandemic? (May 2005)
WHO’s new pandemic influenza phases (May 2005)
Communication plans for flu pandemics (March 2005)
People’s need for health emergency information (February 2005)
SARS, “Ordinary” Flu,
and Other Infectious Diseases
Subsections
Articles
(SARS, “Ordinary” Flu, and Other Infectious Diseases)
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Flu Vaccination of Healthcare Workers: Two Risk Communication Issues
Comments on draft recommendations
of the Healthcare Personnel Influenza Vaccination Subgroup, National Vaccine Program Office, U.S. Department of Health and Human Services, submitted January 14, 2012The public health establishment in the U.S. is pushing hard for mandatory flu vaccination of healthcare workers (HCWs), chiefly on the grounds that vaccinated HCWs are less likely to give patients the flu. A committee of the National Vaccine Program Office of the U.S. Department of Health and Human Services issued draft recommendations
that included mandatory vaccination if organizations fail to vaccinate at least 90% of HCWs voluntarily. Comments on the draft were solicited, so on January 14, 2012 my wife and colleague Jody Lanard and I submitted some. We focused on two risk communication issues: the dangers of overstating flu vaccination benefits, and the dangers of requiring reluctant HCWs to get vaccinated. Flu vaccine efficacy: Time to revise public messages?
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), November 4, 2011
Overselling Flu Vaccine Effectiveness Risks Undermining Public Health Credibility
Email to Robert Roos, October 27, 2011
On October 25, 2011, a team led by Michael Osterholm of the University of Minnesota published a meta-analysis of prior research on the effectiveness of the flu vaccine, showing it to be less effective than public health officials and experts have usually claimed. In the resulting media coverage, many in public health said the Osterholm paper wasn’t really surprising and denied that flu vaccine effectiveness has been routinely oversold. So Jody Lanard and I made a case that it was still being oversold, focusing particularly on two very recent updates on the CDC website, and emailed it to Robert Roos of CIDRAP News. Bob interviewed public health professionals about what we said and put together a November 4 story called “Flu vaccine efficacy: Time to revise public messages?” There’s no question mark in the title we’re giving our email: “Overselling Flu Vaccine Effectiveness Risks Undermining Public Health Credibility.”
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Broadcast on Minnesota Public Radio, October 25, 2011
In October 2011, Lancet Infectious Diseases published a new statistical analysis of the literature on flu vaccine effectiveness, showing that the vaccine is less effective than most patients, most doctors, and even many state and local health departments have believed. Lorna Benson of Minnesota Public Radio included some comments from me in her story on the new study. I emphasized that flu vaccine experts have known for some years that the vaccine doesn’t work as well as they wish, but have been reluctant to say so very publicly, fearing that candor about the vaccine’s low efficacy might dissuade some people from getting vaccinated or getting their kids vaccinated. (Lorna reported that some actual flu vaccine experts told her the same thing, but refused to be named.) I argued that the bigger risk was that people who discovered that flu vaccine effectiveness had been systematically hyped might start to worry – logically but I think mistakenly – that perhaps public health officials can’t be trusted on vaccine safety either. That may be why the CDC recently snuck in a downward revision of the assessment of flu vaccine efficacy on its own website, belatedly acknowledging the truth about the vaccine – but still not acknowledging the truth about its prior hype.
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Vaccine Risk Communication: Dishonesty Makes Things Worse
Posted October, 7, 2011
My 40-minute speech is basically a distillation of points I made at greater length in my three-part interview on “Vaccine Safety Skepticism: Public Health’s Self-Inflicted Wound.” But there are a few new points.
The presentation was part of a panel on “Research Integrity Issues with Vaccines and Public Trust,” chaired by Michael Yudell of Drexel University. The other panelists were Virginia Caine and Steve Ostroff. Our joint Q&A is only partly about vaccine risk communication, of course.
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Posted: May 7, 2011
This 14-minute audio clip identifies some risk communication strategies appropriate for four specific healthcare scenarios. Three of them – persuading healthcare workers to get their flu shots, to wash their hands often, and to use patient ceiling lifts – involve varying mixes of precaution advocacy and outrage management. The fourth – SARS – is a crisis communication scenario. The discussion of ceiling lifts gets into the “tranches” in thinking through employee safety communication. The discussion of SARS emphasizes the need to acknowledge uncertainty about an emerging crisis that might be horrific and might fizzle. This is one of four podcasts on “Risk Communication in Healthcare Settings,” aimed at healthcare managers, produced from a 50-minute telephone interview.
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Posted: May 7, 2011
This 14-minute audio clip focuses on two challenges that healthcare communicators face often: confidentiality and uncertainty. The discussion of confidentiality emphasizes the difference between confidentiality as an excuse and real confidentiality problems, and offers some guidelines for handling the latter. The discussion of uncertainty argues for matter-of-factly acknowledging not just uncertainty but also differences of opinion within your organization. The podcast closes with a brief wrap-up on three key characteristics of good risk communication: honesty, empathy, and strategy. This is one of four podcasts on “Risk Communication in Healthcare Settings,” aimed at healthcare managers, produced from a 50-minute telephone interview.
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Broadcast on Minnesota Public Radio, April 27, 2011
Talking about the Vaccination-Autism Connection … to Somali Parents of Autistic Children(Note: This link launches the MP3 audio file on this site.)Lorna Benson of Minnesota Public Radio asked if she could interview me about a long-brewing controversy between the Somali community in Minnesota and state health officials over the high rate of autism among Somali children in Minnesota and the resurgence of measles in the Somali community because many Somali parents suspect a connection and choose not to vaccinate their kids. The 35-minute radio interview took place on April 27. It focused on ways I though the Minnesota Department of Health might deal more empathically with Somali concerns – and, more generally, on my criticism of the public health establishment for sometimes sounding more deeply committed to defending the safety of the MMR vaccine than to vaccinating kids against measles or seeking an answer to the riddle of autism. Lorna's story ended up focusing mostly on a Minnesota “vaccination awareness forum” that had also taken place on April 27; toward the end of the story she linked some of my interview comments to some of what she had heard at the forum.
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Research Integrity Challenges ’s Self-Inflicted Wound
Posted: January 30, 2011
When I was asked to do an interview for a documentary on vaccines and vaccine safety, I agreed on condition that I be allowed to post the entire interview online. I focused my comments on public skepticism about vaccine safety – and especially on what vaccination proponents do that exacerbates the skepticism and what they can do to ameliorate it. The interviewer’s questions have been edited out, but the rest is here, uncut, in three parts.
- Part 1 (37 min.)
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Part One discusses: the kinds of vaccination audiences – apathetic versus hostile; suppressing the other side’s 5% of the truth; being empathic and being accountable; and other risk communication aspects of vaccination safety skepticism.
- Part 2 (29 min.)
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Part Two discusses: vaccination/autism controversies; who’s in charge of vaccine safety research; what’s left out of flu vaccination messaging; and other risk communication aspects of vaccination safety skepticism.
- Part 3 (36 min.)
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Part Three discusses: lying about polio; different messaging for different audiences; why “good guys” mislead more; and other risk communication aspects of vaccination safety skepticism.
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Trust the Public with More of the Truth: What I Learned in 40 Years of Risk Communication
Written speechAudio (they’re pretty different)
(Note: This link launches an MP3 audio file (62MB, 1 hr, 6 min.) from this site.)Link off-site to the video
(Note: This link goes to a page off-site where you may watch this video.)The National Public Health Information Coalition is an organization of federal, state, and local health department communicators. NPHIC asked me to give its 2009 “Berreth Lecture” at its annual conference in Miami Beach – and specified that the presentation should be about myself and my career, not the substance of risk communication. But as I walked the group through my 40 years in risk communication, a substantive theme emerged: that public health communicators are at least as untrustworthy as corporate communicators, that nobody has the courage to trust the public with those parts of the truth that conflict with the message, and that public health agencies need to learn how to cope better with mistrust and outrage. I illustrated my thesis with a lot of flu and other infectious diseases examples. I had written the speech out in advance – something I almost never do – but I departed from my text more than a little, so both versions are here.
A Polish translation was published in December 2010 in Bezpieczeństwo i Technika Pożarnicza (Safety & Fire Technique).
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Flu Preparedness: An Even Tougher Sell than Usual
Posted: September 9, 2009
I wrote this short column in early June 2009 for The Synergist, a magazine for industrial hygienists, on some ways of communicating about flu – seasonal and pandemic – in the workplace. When I wrote it, most people had “recovered” from what they considered the spring “swine flu scare,” and they were in no mood to listen to any more influenza warnings. By the time the column was published in September 2009, some of the complacency had waned, and people were actually girding up (a bit) for another wave of mild-but-pervasive pandemic illness. So the column’s claim that flu preparedness is a tough sell needs to be modified somewhat. But its actual recommendations still stand.
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Convincing Health Care Workers to Get a Flu Shot … Without the Hype
Posted: January 10, 2009
Convincing health care workers to get a flu shot might normally be seen as a straightforward problem in precaution advocacy, but this column focuses on an aspect of the problem that’s grounded in outrage management: flu protection hype. By means of three case studies, Jody Lanard and I document that hype – misleading, one-sided messaging on behalf of vaccination and other flu precautions – does in fact characterize much of what’s produced by flu prevention campaigners. We also argue, with much less evidence, that the hype leads health care workers to mistrust what the campaigners are telling them, and that the mistrust probably reduces their willingness to get vaccinated. The column ends with a list of less tendentious recommendations for convincing health care workers to get a flu shot.
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Published in Vaccine, vol. 24, 2006, pp. 3921–3928
This article assesses the controversy over whether the MMR vaccine might cause autism in terms of my list of outrage components, and offers some outrage-based recommendations for ways public health communicators could better address the controversy. Published in 2006, it is grounded in my 1993 book Responding to Community Outrage, and doesn’t reference any of my more recent writing on this website (on the vaccination/autism controversy or on outrage management generally). Nor, of course, does it reference recent developments in the controversy itself. A similar analysis of the mobile telephone controversy, written by Simon Chapman and published in 1997, is also on this website.
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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.
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Flu Vaccine Shortage: Segmenting the Audience
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.
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SARS Exercise: What Are They Doing?
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.
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Practicing for The Big One: Pennsylvania’s Hepatitis A Outbreak and Risk Communication
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.
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Risk Communication Recommendations for Infectious Disease Outbreaks
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.
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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.
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Fear Factory: Have the Media Overblown Canada’s Health Scares?
Published in Maclean’s, June 9, 2003
When a magazine article starts by asking whether the media have overblown a story – in this case, SARS – you can bet the answer is going to be yes. But the article does quote me (and some others) saying that SARS was serious and that if anything the media were over-reassuring – which paradoxically scared people all the more.
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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.
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Sars Communication: What Singapore Is Doing Right
Published in 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.
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“Fear Is Spreading Faster than SARS” – And So It Should!
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.
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SARS: How Singapore outmanaged the others
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.
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Candour, not PR, will calm virus fears
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.
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Smallpox Vaccination: Some Risk Communication Linchpins
Public Health Outrage and Smallpox Vaccination: An Afterthought
Posted: December 30, 2002 and January 19, 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.
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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.”
Guestbook Entries
(SARS, “Ordinary” Flu, and Other Infectious Diseases)
2011
Scaring people into getting their flu shot (September 2011)The risk communication in Contagion and Contagion as risk communication (September 2011)
Sarcasm isn’t an effective way to persuade parents to vaccinate their kids (August 2011)
2010
Mandatory flu vaccination for health care workers (again) (November 2010)
Making health care workers get vaccinated against the flu (March 2010)
2009
Mandatory vaccination for health care workers (October 2009)
2008
Risk communication is a type; outbreak communication is a subtype (July 2008)
Vaccination and autism: Responding to the Hannah Poling case (March 2008)
2007
Does taking the thimerosal out of vaccines reassure people or scare them? (October 2007)
2004
Flu vaccine risk communication (October 2004)
