Articles categorized as:  Pandemic/Infectious Diseases index

Dr. Peter M. Sandman
Pandemic Flu and
Other Infectious Diseases Index

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 October 2014, 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.

Then came two false alarms in quick succession: H7N9 (a different bird flu) and MERS. And now, as I write this, an unprecedentedly huge Ebola epidemic in West Africa has sent sparks flying to Nigeria, Senegal, the U.S., and Spain. Those sparks look like they have been extinguished or are in process of being extinguished, but experts are justly worried not just about the ongoing catastrophe in West Africa, but also about what might happen if Ebola sparks ignite in cities that fail to extinguish them, giving us an Ebola pandemic that could spread from Mumbai to Mexico City, Cairo to Karachi.

One way or another, a lot of experts think infectious diseases are likely to be a big issue – and a big risk communication challenge – in the coming decades. Some of them I’ve yet to write about, including dengue, malaria, and chikungunya.

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 section is on Ebola. As I write this in October 2014, some experts think Ebola may become “The Big One” that bird flu, swine flu, SARS, and MERS all didn’t become. We’ll see. Meanwhile, I have put Ebola near the top because it’s current.

The third 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 subsection 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 fourth 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

Especially Important to Read

  • The CDC Tells More of the Truth than Usual about Flu Vaccine Effectiveness

    Website column

    Posted: February 1, 2013

    Though far better than nothing, the influenza vaccine is surprisingly ineffective, working only 50–70% of the time in healthy young adults and significantly less than that in the people who need it most, the sick and the elderly. For years the CDC and other public health agencies have hyped flu vaccine effectiveness. And for years Jody Lanard and I have criticized the hype, fearful that it could ultimately undermine the credibility of flu vaccination, vaccination generally, the CDC, and public health itself. So we were surprised and delighted at the tenor of the CDC’s January 11, 2013 flu press briefing, which showcased a preliminary CDC finding that the 2012–2013 flu vaccine was only about 62% effective. It remains to be seen whether the CDC’s unprecedented candor is a one-off or the start of a new era. Either way, this column annotates the press briefing, finding much to praise and, inevitably, some things to criticize as well.

  • Three-part video interview conducted October 27, 2010

    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.)

    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.)

    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.)

    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.

  • The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives

    Website column by Peter M. Sandman and Jody Lanard

    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.

  • Why did the CDC misrepresent its swine flu mortality data – innumeracy, dishonesty, or what?

    Guestbook entry and response(s)

    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.

  • U.S. Pandemic Vaccine Supply and Distribution: Addressing the Outrage

    Website column by Peter M. Sandman and Jody Lanard

    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.

  • The meme that this pandemic is “like the seasonal flu”

    Guestbook entry and response

    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).

  • Swine Flu for Grownups

    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.

  • Containment as Signal: Swine Flu Risk Miscommunication

    Website column by Peter M. Sandman and Jody Lanard

    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.

  • Swine flu worst case scenarios: warn people now or wait till things start getting nasty?

    Guestbook entry and response

    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.”

  • Is swine flu moving slowly? Did the authorities overreact? What should the key messages be now?

    Guestbook entry and response

    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.

  • 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!

    Website column

    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 link is to a PDF:link is to a PDF file 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.

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

    Website column by Peter M. Sandman and Jody Lanard

    Posted: March 15, 2007

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

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

    Website column by Peter M. Sandman and Jody Lanard

    Posted: May 29, 2006

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

  • The Flu Pandemic Preparedness Snowball

    Website column

    Posted: October 10, 2005

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

  • Bird Flu: Communicating the Risk link is to a PDF

    by Peter M. Sandman and Jody Lanard

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

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

    (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.

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

    Website column by Peter M. Sandman and Jody Lanard

    Posted: July 6, 2005

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

  • Pandemic Influenza Risk Communication: The Teachable Moment

    Website column by Peter M. Sandman and Jody Lanard

    Posted: December 4, 2004

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

  • Worst Case Scenarios

    Website column

    Posted: August 28, 2004

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

Ebola

Subsections

Articles

  • COMMENTARY: When the Next Shoe Drops – Ebola Crisis Communication Lessons from October

    by Peter M. Sandman and Jody Lanard

    Posted on the website of the Center for Infectious Disease Research and Policy, December 9, 2014

    For more than a month the University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP) and its director, Mike Osterholm, urged me to write a CIDRAP commentary on crisis communication lessons from the U.S. bout with Ebola in October 2014. I hesitated – partly because it wasn’t much of a crisis, partly because it was over and I was tired of writing about it, and partly because I doubted CIDRAP’s principal audience of public health professionals wanted to hear my complaints about how they handled it (especially their uncivil response to the quarantine controversy). But in early December I decided to go ahead, jointly with my wife and colleague Jody Lanard. The resulting article focuses on four main crisis communication errors: over-reassurance; over-confidence and even absolutism instead of acknowledging uncertainties about Ebola science; misdiagnosing the public as panicking; and ridiculing the public’s Ebola fears instead of accepting and guiding them.

  • Ebola in the U.S. (So Far): The Public Health Establishment and the Quarantine Debate

    Website column

    Posted: November 15, 2014

    This column is a slightly edited version of an email I sent on November 12, 2014 to the editor of Emergency Management magazine, in response to a November 10 email asking to interview me about Ebola risk communication in the U.S. It includes some brief points about risk communication errors with regard to the first U.S. case in Dallas, describing these as “the ordinary first half of this crisis communication story.” But the bulk of the column is devoted to the quarantine debate that arose after returning volunteer Craig Spencer was diagnosed in New York City. It focuses on my belief that the U.S. public health establishment was dishonest and uncivil in the way it misappropriated “the science” on behalf of the anti-quarantine position in the debate, and ridiculed the pro-quarantine position as unscientific and even idiotic.

  • Why It’s OK To Worry About Ebola, And What’s Truly Scary

    by Nancy Shute

    Posted on the NPR website, October 30, 2014

    Nancy Shute of NPR emailed me on October 28 to arrange an interview about Ebola, not for radio but for the NPR website. We agreed to focus on both what I thought about Americans’ Ebola fears and what I thought was worth fearing. Our October 29 phone conversation lasted about an hour and wasn’t taped. I tried to connect the two topics by emphasizing that when people are learning about a new risk they often emphasize the aspects that are most immediate, nearby, and personal, rather than the aspects that will ultimately be most important. I said the job was to use the teachable moment by helping people transition to the most worrisome aspects – which for Ebola, in my judgment, is the possibility of more epidemics throughout the developing world. I criticized officials, experts, and the media for trying to squelch people’s Ebola fears instead of trying to guide them, thus sacrificing the teachable moment. Nancy did a good job of condensing that and more into the short article she posted on the 30th.

  • Ebola: Failures of Imagination

    Website column by Jody Lanard and Peter M. Sandman

    Posted: October 24, 2014

    Almost since we started worrying about the Ebola epidemic in West Africa, my wife and colleague Jody Lanard and I have been worrying about the prospect of its spreading to developing countries around the world – countries less able than the U.S. and Spain to extinguish Ebola “sparks.” This column fleshes out that worry a bit. It also addresses some reasons why our leaders might be reluctant to raise the possibility of an Ebola pandemic in the developing world, much less to discuss its likely impacts on the developed world. But mostly the column is about how difficult it is for anybody (officials, experts, reporters, us) to stay focused on something that horrible … and how important it is to try harder to sound the alarm.

  • How Rational Are Our Fears of Ebola?
    (Note: Link goes off-site to a page with a link to this 4-min. audio.)

    Edited interview with Jody Lanard by Jeremy Hobson of WBUR’s “Here & Now,” October 15, 2014

    Aired on PBS, October 16, 2014

    “Here & Now” telephoned my wife and colleague Jody Lanard on October 14, asking her to come into a New York City studio to tape an interview about whether Americans are overreacting to a domestic Ebola “crisis” that has so far resulted in just one death. She did the interview the next day. Jody stressed that it’s rational to pay attention to a risk you’re newly aware of, even if that attention is temporarily excessive, and that people will get past their temporary adjustment reaction more quickly if officials don’t label it irrational or panic. We have already decided how worried to be about flu, car crashes, and other familiar risks, she said. “We're not going to decide … that this is the week we should pay more attention to driving safety. This is the week we are going to learn about Ebola.”

  • Official Ebola Risk Communication: “Don’t Scare the Children” Note: Link launches an on-site audio file (52MB, 38 min.)

    Interview with Peter M. Sandman by Betsy McKay of the Wall Street Journal, October 13, 2014

    On October 13, 2014, at her request, I did a telephone interview with Betsy McKay of the Wall Street Journal on the way U.S. officials at the CDC were communicating about Ebola in Dallas. I focused at the start on my opinion that officials weren’t emphasizing Ebola uncertainties sufficiently; I relied especially on two examples of what I consider over-confident over-reassurance: whether Ebola sufferers always have a sudden onset of symptoms, and whether they’re never able to transmit the disease before those symptoms arrive. Later in the interview I turned to other Ebola risk communication issues. Among them: (a) The CDC’s rush to blame the nurse and the hospital system for a “breach of protocol” when she caught the disease from her patient, rather than suggesting that maybe the equipment or protocol might themselves be to blame; (b) My view that the widespread public fear about Ebola was not panic but simply a temporary adjustment reaction, and that the CDC should say so; and (c) My desire to see the CDC urge people to worry more about the possibility that the West African epidemic could spread through the developing world, instead of urging people simply to stop worrying about Ebola. Betsy didn’t end up writing any stories that made use of this interview, though maybe it was useful background for her. With her permission, I recorded my answers without her questions. I have cut some desultory conversation from the beginning and end of the audio file, but otherwise this is the whole interview. Remember, it took place on October 13: before the second nurse got sick, before the CDC decided it should recommend more protective PPE, etc.

  • Ebola Blame and Ebola Apology

    by Peter M. Sandman and Jody Lanard

    Two unsolicited emails to Lisa Schnirring of CIDRAP News, October 12 and October 13, 2014

    After a Dallas nurse who had helped care for America’s first Ebola patient became America’s second Ebola patient (not counting the ones who have been airlifted in pods from West Africa to special high-tech facilities), the CDC held an October 12 press briefing at which CDC head Tom Frieden repeatedly attributed the case to a “breach of protocol.” Together with my wife and colleague Jody Lanard, I sent an unsolicited email to Lisa Schnirring of CIDRAP News criticizing what he had said. Frieden was widely criticized by others as well for blaming the victim, the hospital, and the healthcare profession – and for not even mentioning the possibility of equipment failure. So on October 13 he briefly apologized, saying he hadn’t meant to blame anybody. I didn’t think the apology went far enough, and sent Lisa another email (without Jody) to that effect. Lisa didn’t use either email in her October 12 and October 13 articles, but here they are.

  • Health officials struggle to control the media narrative about Ebola

    by Elise Viebeck

    Published in The Hill, October 12, 2014

    Three Priorities for Ebola Messaging

    by Peter M. Sandman

    Email in response to a query from Elise Viebeck, October 10, 2014

    Reporter Elise Viebeck of The Hill emailed me on October 10, asking for input to an article she was writing on “how the CDC is struggling to control the media narrative on Ebola,” especially what she called “the balancing act they face between maintaining public calm and pressing for a greater response to the epidemic.” I replied that same day with an email outlining “three themes for CDC’s Ebola messaging that I think are not coming across well enough yet”: that Americans are resilient; that there is a huge amount we don’t know yet about Ebola; and that the biggest threat is the possibility of seeing similar epidemics in other parts of the developing world. Elise’s story made some use of the first two themes.

  • How to talk to the public about Ebola: Five tips from risk communication experts

    by Kai Kupferschmidt

    Posted on ScienceInsider, October 9, 2014

    What Needs to Change in Ebola Risk Communication: Pivoting away from Dallas

    by Peter M. Sandman and Jody Lanard

    Email response to query from Kai Kupferschmidt, October 5, 2014

    Kai Kupferschmidt emailed me on October 5 asking to interview me about Ebola risk communication, especially with regard to uncertainty and future scenarios. I got his okay to respond via a joint email with my wife and colleague Jody Lanard. Our email outlined what it would take for U.S. Ebola coverage to pivot away from one case in Dallas to thousands in West Africa and the threat of a global Ebola pandemic. We also described four competing responses to the West Africa epidemic: vaccine development, “spark suppression” (trying to confine the epidemic to West Africa), patient isolation and contact tracing, and treatment. We emphasized our view that, post-Dallas, spark suppression would be the big story. We concluded the email with five recommendations for improving Ebola risk communication and a short list of relevant risk communication principles. Kai’s post quoted the five recommendations verbatim, and summarized much of the rest – along with some additional content documenting what he called the “media frenzy” in the U.S. Our complete email is on this site.

  • Ebola Outbreak As Black Swan: How To Think Clearly About An Unpredictable Hazard

    by F.D. Flam

    Posted on the Forbes website, October 7, 2014

    Science writer Faye Flam interviewed me for almost an hour on October 6, ranging widely from the basics of risk communication to the specifics of Ebola news coverage. Then she harvested the interview for a short Forbes website post that framed Ebola in terms of my signature hazard-versus-outrage distinction. Two other points she took from the interview that aren’t stressed enough in most Ebola stories: (1) that risk is a future-oriented concept, so what matters isn’t the current U.S. prevalence of Ebola but its possible future impact on our lives; and (2) that all the uncertainties of Ebola mean reporters should be focusing on both likeliest scenarios and worst case scenarios (the ones that aren’t vanishingly unlikely), and on the high probability of surprises to come. There was a lot more in the interview; if Faye gets me the audio I will post it.

  • Health Care Risk Expert: There Are Little If Any Signs of Ebola Panic in the U.S.

    by Ellis E. Conklin

    Published in Seattle Weekly, October 7, 2014

    Ellis Conklin called me on October 7 with a very specific story in mind: Why are Americans getting all panicky and hysterical about new diseases like Ebola and EV-D68? I gave him only ten minutes or so, running through my usual litany: People aren’t panicky or hysterical, they’re only worriedly interested; looking up a disease on Google isn’t panicking; reporters who write that “the public” is panicking invariably tell me they don’t personally know anyone who is panicking; it’s both natural and useful to have a brief “adjustment reaction” to a new risk; etc. Ellis took it all in, and wrote what I consider an excellent story.

  • Media goes overtime on Ebola coverage, but not necessarily overboard

    by Paul Farhi

    Published in the Washington Post, October 6, 2014

    Three Ebola News Stories: Dallas, West Africa, and What-If

    by Peter M. Sandman

    Email reponse to query from Paul Farhi of the Washington Post, October 6, 2014

    Paul Farhi emailed me on October 6 asking what I thought of Ebola media coverage. He was especially interested in whether I agreed that there was too much attention to one U.S. Ebola sufferer, especially compared to other U.S. health risks. I replied that same day, outlining three different Ebola stories: the domestic Ebola story in Dallas, the epidemic Ebola story in West Africa, and the what-if Ebola story in the rest of the world. I explained why I thought all three deserved coverage, but especially the third, which was badly under-covered. Paul’s article stuck to the emphasis in his email, contrasting Ebola in the U.S. with other diseases that are currently afflicting far more Americans, especially a previously rare enterovirus with the unexciting label “D68.” He used me only at the end of his piece, briefly, as the expert who disagreed with everyone else and thought Ebola wasn’t being over-covered. Even then he focused on the small part of my reply that had noted how scary Ebola is, deemphasizing my main point that Ebola poses genuinely important risks. But at least my view – “not necessarily overboard” – got into his article’s headline. My complete email to Paul is on this site.

  • Ebola Risk Communication: Talking about Ebola in Dallas, West Africa, and the World

    by Peter M. Sandman and Jody Lanard

    Posted: October 6, 2014

    In early October, I started getting media inquiries about Ebola risk communication. Three such inquiries led me to write emails (two of them jointly with my wife and colleague Jody Lanard) that collectively summarized most of our thinking about how U.S. sources and the U.S. media were handling Ebola – the first U.S. case in Dallas, the disastrous epidemic in West Africa, and the global pandemic risk. Included in this column are: (a) Our October 3 response to Sharon Begley of Reuters; (b) Our much shorter October 5 response to Kai Kupferschmidt of Science; and (c) My short October 6 response to Paul Farhi of the Washington Post. The articles that Sharon, Kai, and Paul wrote are referenced and linked at the very end of this column, or will be once they’re published. (Note that I had some follow-up communications with Kai, by phone and email, that he relied on in his article but are not included in the column.)

  • An Ebola Empathy Exercise (pure speculation, based on hypothetical what-ifs)

    by Peter M. Sandman and Jody Lanard

    Posted: October 3, 2014

    Throughout August and September, my wife and colleague Jody Lanard and I obsessed over Ebola. We wrote part or all of several Ebola risk communication columns, only to have our thinking overtaken by events. This short column, completed in one day, focuses on a very narrow question: What might have happened at Texas Health Dallas Presbyterian Hospital on September 25–26, 2014, when Thomas Eric Duncan came to the emergency room with fever and abdominal pain, said he was visiting from Liberia (the heart of West Africa’s Ebola hot zone), and was nonetheless sent home? Two days later, days in which he might have infected other people, Duncan was brought back to Texas Health Dallas by ambulance. That time Ebola was suspected, and later confirmed, making Duncan the first Ebola patient to be diagnosed outside Africa. Commentary has been understandably hostile to both Duncan and the hospital staff for what may turn out to have been a tragic miscommunication. Jody and I felt that anger too. We have tried to temper it with this Ebola empathy exercise, a purely speculative effort to look at a ghastly mistake without assuming reckless irresponsibility on either side. As more facts come out, our speculations may well be proven entirely false. Even so, the need for people to respond empathically to Ebola will not go away. Empathy is needed for the horrific conditions West Africans are enduring; for the threat to the rest of us; for the ways people at overwhelming risk may resort to denial, while people whose risk is much smaller may temporarily overreact; even for the officials who yield to the temptation to oversimplify or over-reassure. The column isn’t about all that, though. It’s just an attempt to imagine empathically what might have happened in that Dallas emergency room.

Guestbook Entries

The Swine Flu Pandemic of 2009–2010

Subsections

Major Articles
(The Swine Flu Pandemic of 2009–2010)

  • The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives

    Website column by Peter M. Sandman and Jody Lanard

    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.

  • Swine Flu Pandemic Communication Challenges and Lessons Learned

    by Peter M. Sandman and Jody Lanard

    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

    by Lisa Schnirring

    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.

  • The CDC’s Pandemic Data versus the CDC’s Pandemic Communications: Outtakes from a Media Interview
    (Note: This link goes to a page on-site with links to a number of MP3 audio files.)

    by Peter M. Sandman

    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.

  • U.S. Pandemic Vaccine Supply and Distribution: Addressing the Outrage

    Website column by Peter M. Sandman and Jody Lanard

    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

    by Judy Gerstel

    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.

  • Flu Preparedness: An Even Tougher Sell than Usual

    Website column

    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.

  • Swine Flu for Grownups

    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.

  • Containment as Signal: Swine Flu Risk Miscommunication

    Website column by Peter M. Sandman and Jody Lanard

    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.

  • Communication expert endorses WHO’s delay on pandemic declaration

    by Robert Roos

    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

    by Anita Makri

    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.”

  • Communicating the Message of Swine Flu: An Expert’s Opinion
    (Note: This link goes to a webpage off-site with the link to this MP3 audio file.)

    by Grace Hood

    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.

  • What’s in a name: H1N1 versus swine flu

    Expanded Guestbook response by Peter M. Sandman and Jody Lanard

    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.)

  • 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!

    Website column

    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 link is to a PDF:link is to a PDF file 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.

June 29, 2010The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives
January 17, 2010 Pandemic Interruptus: It Ain’t Over Till It’s Over
December 15, 2009What the CDC Is Saying about Swine Flu Severity
December 15, 2009Update on the December 2 Update
December 2, 2009It’s Official (sort of): The Swine Flu Pandemic Is Mild So Far
November 18, 2009U.S. Pandemic Vaccine Supply and Distribution: Addressing the Outrage
September 26, 2009Overselling Seasonal Flu Vaccination in a Pandemic Season
August 21, 2009Talking about Pandemic H1N1 Vaccination
July 21, 2009The Three-Legged Stool of Pandemic Messaging
July 7, 2009 Why Pandemic Complacency Isn’t Okay
June 17, 2009 Would you like another wakeup call?
June 4, 2009 Swine Flu Pandemic Prospects: Nobody Knows
May 23, 2009 Swine Flu Pandemic Prospects: Nobody Knows
May 16, 2009 Swine Flu Pandemic Prospects: Nobody Knows
May 6, 2009 Swine Flu Pandemic Prospects: Nobody Knows
April 29, 2009 Swine Flu Pandemic Scare Gets Serious
April 28, 2009 Swine Flu Pandemic Scare Gets Serious
April 26, 2009 Swine Flu Pandemic Scare Gets Serious
April 24, 2009 Swine Flu Pandemic Scare Gets Serious

Other Articles
(The Swine Flu Pandemic of 2009–2010)

  • H1N1 cases in India sparking media hype

    by Lisa Schnirring

    Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), April 9, 2012

    India’s Response to Swine Flu – Still Weird

    by Peter M. Sandman

    Email to Lisa Schnirring, April 9, 2012

    When CIDRAP News decided to do a story about recent hype in India’s media coverage of swine flu, I pointed out that it wasn’t just recent and it wasn’t just the media. So reporter Lisa Schnirring asked if I wanted to comment on the record. This is the response I sent her. She used most of it in her story, along with a lot of other good material on Indian pandemic H1N1 hype.

  • Why Seniors Really Should Fear Swine Flu

    by Sharon Begley

    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.

  • Flu Precautions: Making Sense of CDC Advice
    (Note: This link goes to an article off-site with a link to this MP3 audio file.)

    by Deborah Franklin

    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.

  • Marketing Flu Vaccine: A Tough Sell for Many
    (Note: This link goes to an article off-site with a link to this MP3 audio file.)

    by Richard Knox

    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.

  • Uncertainty over H1N1 warranted, experts say

    by Judy Gerstel

    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.)

  • 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.

  • British public slow to respond to pandemic

    by Holly Else

    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

    by Lisa Schnirring

    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.

  • Critics say “mild” a misleading term for H1N1

    by Helen Branswell

    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?

    by Nancy Shute

    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

    by Helen Branswell

    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.

  • 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 link is to a PDF:link is to a PDF file 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.

  • The WHO That Cried Flu?

    by Jess Hill

    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.)

    by Claudia Hammond

    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?

    by Clare Forrester

    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.

  • Flu overhyped? Some say officials ‘cried swine’

    by Lindsey Tanner and Mike Stobbe

    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.

  • Crying wolf about pigs

    by Assaf Uni

    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.

  • Between a virus and a hard place

    Editorial in Nature, May 7, 2009

    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.

  • H1N1 outbreak revealed seasonal flu lingered in Minn.
    (Note: This link goes to an article off-site with a link to this MP3 audio file.)

    by Lorna Benson

    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.

  • What happens if swine flu goes away?

    by Maggie Fox

    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.”

  • Fear Is Fungible

    by “Artichoke”

    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.

  • 5 Ways to Manage the Family’s Swine Flu

    by Nancy Shute

    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.

  • Swine Flu Questions and Answers
    (Note: This link is to a 9.7-MB, 10:20-min. MP3 audio file on this site.)

    by Lisa Mullins (interview with Peter M. Sandman and Christine Gorman)

    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.

  • Behavioral research can help curb the spread of swine flu – but is anyone listening?

    by Michael Price

    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.

  • Swine Flu Precautions: Figuring Out Which Ones Make Sense
    (Note: This link is to a 4.3-MB, 6:06-min MP3 audio file on this site.)

    by Stephen Evans (interview with Peter M. Sandman)

    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.

  • Experts worry mild disease outside of Mexico hampers bid to get people to prepare

    by Helen Branswell

    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.

  • Is America Prepared for a Pandemic?

    by Jeffrey Levi, Peter M. Sandman, and Thomas B. Inglesby

    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.

  • WHO raises pandemic alert to phase 4

    by Robert Roos

    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.

  • WHO declares public health emergency as US swine flu cases rise

    by Lisa Schnirring

    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.

  • More US swine flu cases, Mexico illnesses raise pandemic questions

    by Lisa Schnirring

    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)

Everything in Chronological Order
(The Swine Flu Pandemic of 2009–2010)

Influenza Pandemics other than Swine Flu

Subsections

Major Articles
(Influenza Pandemics other than Swine Flu)

  • H7N9 Risk Communication: Candor but No Push to Prepare

    Website column

    Posted: May 16, 2013

    This is a sequel to my April 8, 2013 column, “H7N9: A Tale of Two CDCs.” My focus then was on the ways the U.S. CDC was over-reassuring the public about the possibility of an H7N9 pandemic – even avoiding the word “pandemic” as much as possible. As this follow-up column documents, the CDC has become much more candid about the pandemic risk posed by this newly discovered influenza virus; other officials and experts around the world are being similarly candid. The column then discusses two remaining concerns about H7N9 risk communication: the failure to be candid about the likelihood that we'll face the pandemic, if it comes, without vaccine; and – more important still – the failure to make any attempt to involve the public in pandemic preparedness. The column also documents that public interest in H7N9 has already declined from its (modest) peak in early April.

  • H7N9: A Tale of Two CDCs

    Website column

    Posted: April 8, 2013

    As I write this on April 8, 2013, I have no idea – nor does anyone else – whether H7N9 will launch a devastating pandemic, or become endemic and minor, or disappear without a trace, or what. What we all know so far is that a strain of flu never before seen in humans has made a sudden appearance in eastern China, where it has infected 24 people and killed seven of them so far. This column reports on the first week of H7N9 messaging of two national health agencies: The Center for Disease Control and Prevention in China and the Centers for Disease Control and Prevention in the United States. China CDC was surprisingly candid in its prompt release of information and its avoidance of the temptation to over-reassure the very anxious Chinese public. The U.S. CDC, faced with a much less anxious (and perhaps even skeptical) U.S. public, chose to go along with the mood of mild, casual interest. It didn’t withhold any information that I am aware of, but it certainly didn’t seize the opportunity to warn people to prepare for a possible pandemic. Its first H7N9 press briefing sounded much less concerned than I believe its experts actually are.

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

    Website column by Peter M. Sandman and Jody Lanard

    Posted: March 15, 2007

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

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

    Website column by Peter M. Sandman and Jody Lanard

    Posted: May 29, 2006

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

  • The Dilemma of Personal Tamiflu Stockpiling

    Website column by Peter M. Sandman and Jody Lanard

    Posted: January 10, 2006

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

  • The Flu Pandemic Preparedness Snowball

    Website column

    Posted: October 10, 2005

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

  • Bird Flu: Communicating the Risk link is to a PDF

    by Peter M. Sandman and Jody Lanard

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

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

    (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.

  • When warnings become a scare

    by Gregory M. Lamb

    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.

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

    Website column by Peter M. Sandman and Jody Lanard

    Posted: July 6, 2005

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

  • Pandemic Influenza Risk Communication: The Teachable Moment

    Website column by Peter M. Sandman and Jody Lanard

    Posted: December 4, 2004

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

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

    by Helen Branswell

    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.

  • Worst Case Scenarios

    Website column

    Posted: August 28, 2004

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

  • Avian Flu Exercise: What Are They Doing? link is to a PDF

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

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

Columns from CIDRAP Business Source Weekly Briefing
(Influenza Pandemics other than Swine Flu)

CIDRAP logo

Other Articles
(Influenza Pandemics other than Swine Flu)

  • Tamiflu report comes under fire

    by Declan Butler

    Posted on the Nature website, April 22, 2014; published in the print edition of Nature, vol. 508, pp. 439–440 (April 24, 2014).

  • Overstated Attack Hiding Behind Scientific Assessment: An April 2014 Cochrane Review Trashes the Usefulness of Influenza Antiviral Drugs

    by Peter M. Sandman and Jody Lanard

    Email to Declan Butler, April 15, 2014

    In early April 2014, BMJ (British Medical Journal) published two articles reporting a research review by the Cochrane Collaboration, arguing that antiviral drugs are of minimal use against influenza. When reporter Declan Butler of Nature emailed me and my wife and colleague Jody Lanard asking for comment on how the Cochrane Review was communicated, we quickly sent back a response summarizing two key criticisms of the Cochrane researchers: that they ignored the downsides of the Cochrane methodology, which considers only randomized controlled trials; and that they massaged and cherry-picked their own results to make them look worse for antivirals. Declan’s article addressed many aspects of this complicated story, and he had room for only a little of what we had sent him. Meanwhile, we had written a more comprehensive assessment, which we are posting on this website as an introduction to what we originally sent Declan.

  • H7N9 cases grow by 7, along with China poultry industry outcry

    by Lisa Schnirring

    Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), February 6, 2014

    Forgoing Trust, China’s Poultry Industry Lobbies for an H7N9 Cover-Up

    by Jody Lanard and Peter M. Sandman

    Email to Lisa Schnirring, February 6, 2014

    Lisa Schnirring of CIDRAP News (part of the Center for Infectious Disease Research & Policy at the University of Minnesota) has been writing frequent articles about H7N9 since that novel bird flu virus reappeared in China in late 2013. Among the developments she decided to cover in her February 6, 2014 article was a new lobbying effort by China’s poultry industry to suppress some information about new H7N9 cases, especially information it feared would exacerbate Chinese consumers’ growing avoidance of poultry. When I asked if her article could use a risk communication perspective, Lisa said yes. So my wife and colleague Jody Lanard and I sent her an email, emphasizing that cover-ups never reassure the public. To the contrary, people become much more concerned about a risk when they discover that potentially alarming information is being covered up. Lisa’s article included several quotes from our email elaborating on this point.

  • With Chinese New Year H7N9 cases soar, but experts struggle to assess the risk

    by Helen Branswell

    Distributed by The Canadian Press, January 31, 2014

    It’s Hard to Warn People about What H7N9 Might Do Someday without Sounding Over-Alarming about What It’s Doing So Far

    by Peter M. Sandman and Jody Lanard

    Email to Helen Branswell, January 30, 2014

    Helen Branswell of The Canadian Press is almost universally considered the “dean” of flu reporters. So of course she has paid close attention to H7N9, a novel bird flu virus that emerged in China about a year ago. H7N9 is harmless to poultry but often deadly to humans on those rare occasions when it passes from one to the other. On January 30, 2014, Helen sent an email jointly to me and my wife and colleague Jody Lanard, asking us to comment on “the challenge it [H7N9] poses in terms of risks communications.” Our answer focused on the difficulty of warning people about what might happen while reassuring people about what has happened so far. Helen used a few quotes from our answer in her story, along with others from flu experts (as opposed to risk communication experts) she had interviewed.

  • More Spin than Science: Risk Communication about the H5N1 Bioengineering Research Controversy (speech notes)

    link is to an audio MP3 fileMore Spin than Science: Risk Communication about the H5N1 Bioengineering Research Controversy (audio file)
    (Note: This link launches an MP3 audio file from this site.)

    by Peter M. Sandman

    Presented via telephone at a conference on “Freedom in Biological Research: How to Consider Accidental or Intentional Risks for Populations,” Fondation Mérieux and Institut National de la Santé et de la Recherche Médicale, Veyrier-du-lac, France, February 8, 2013

    The controversy over whether scientists should be allowed to bioengineer potentially pandemic bird flu viruses had pretty much died down by the time I was asked to speak at a February 2013 conference on the issue in France. Since I had criticized the controversy’s consistently miserable risk communication, I was delighted that at least one post mortem conference wanted a risk communication perspective. But I had prior commitments and couldn’t go. When the organizers invited me to present by telephone instead, I jumped at the chance. My speech notes are more extensive than I had time for in the actual presentation. On the other hand, the MP3 recording of the actual presentation includes about 25 minutes of Q&A. My presentation was mostly borrowed from my previous articles and Guestbook entries on the controversy, all of which are listed and linked at the end of the notes.

  • H5N1 Researchers Ready as Moratorium Nears Endlink is to a PDF file

    by David Malakoff

    Published in Science, January 4, 2013, pp. 16–17.

    The Moratorium on H5N1 Bioengineering Research: What Was It For? What Did It Accomplish?

    by Peter M. Sandman

    Email to David Malakoff, December 26, 2012

    H5N1 (“bird flu”) is an especially deadly strain of influenza that could pose a huge human health risk if it ever acquired the ability to spread easily in humans – which so far it has not done. But in early 2012 a controversy arose over research aimed at bioengineering a new kind of H5N1 that would be more readily transmissible in mammals. The debate focused on the potential value of the research (for example, it might help scientists better understand how to stop H5N1 from becoming transmissible) versus its potential risks (an accident or an intentional release might launch an H5N1 pandemic). While the debate raged, a voluntary moratorium on similar research was instituted, while scientists, policymakers, and interested citizens tried to thrash out how this sort of research should be regulated. By the end of 2012, new rules had been proposed and the moratorium was pretty obviously about to end. That’s when David Malakoff of Science contacted me for comment on what I thought the moratorium had accomplished. His January 4, 2013 story used only one quotation from the email I sent him in response. Both David’s story and my email to him are on this site.

    A German translation of my email to David, somewhat edited, was posted January 19, 2013 on the website of Frankfurter Allgemeine Zeitung and published in that newspaper’s January 20, 2013 print issue.

  • Science versus Spin: How Ron Fouchier and Other Scientists Miscommunicated about the Bioengineered Bird Flu Controversy

    by Peter M. Sandman

    Re-edited excerpt from a May 17, 2012 Guestbook entry

    Posted: June 7, 2012

    In 2011, two papers were submitted to major journals detailing how scientists created mutations of H5N1 avian influenza (“bird flu”) that could transmit through the air between mammals. In the controversy that followed over whether the papers should be published, scientists on both sides frequently used evidence as ammunition, one-sidedly briefing their cases instead of objectively assessing the science. Ron Fouchier, the senior author of one of the two papers, was particularly guilty of this scientific sin – making very different claims about his research early on when he was trying to arouse interest than later when he was trying to allay concern instead. This article – excerpted and adapted from a May 17, 2012 Guestbook entry – tracks Fouchier’s public miscommunications about his H5N1 bioengineering study.

  • Misoversimplification: The Communicative Accuracy Standard Distinguishes Simplifying from Misleading

    Website column

    Posted: June 5, 2012

    The need to simplify technical content is not an acceptable excuse for “simplifying out” information that is essential to credibility – especially information that seems to contradict your message, and that will therefore undermine your credibility if you leave it out and your audience learns it elsewhere. The obligation to include that sort of information is called the communicative accuracy standard; the failure to include it might appropriately be called “misoversimplification.” The column distinguishes three levels of misoversimplification, depending partly on how controversial the issue is and partly on whether you’re on the warning (precaution advocacy) or reassuring (outrage management) side. The three levels are illustrated with infectious disease examples: whooping cough, bird flu, and polio.

  • Talking to the Public about H5N1 Biotech Research (original longer version)

    Submitted to Genetic Engineering & Biotechnology News, March 18, 2012

    Talking to the Public about H5N1 Biotech Research    (accepted shorter version)

    Published in Genetic Engineering & Biotechnology News, April 15, 2012

    The H5N1 (“bird flu”) virus is incredibly deadly to humans, but almost never transmits from human to human – at least until late 2011, when two teams of scientists bioengineered H5N1 to make it transmissible in mammals. Now a battle rages over whether the two papers detailing this work should be published, and whether the work itself should continue – and whether the concerns of the general public should be considered in making these decisions. When I was quoted in Nature urging proponents to dialogue with critics rather than merely trying to “educate” them, Genetic Engineering & Biotechnology News asked me to write a brief opinion piece expanding on my view. Both the short version accepted for publication and a somewhat longer version (with a little more background on the controversy) I submitted at the same time are posted on this site.

  • WHO H5N1 study group extends moratorium, calls for full publication

    by Lisa Schnirring

    Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), February 17, 2012

    The H5N1 Debate Needs Respectful Dialogue, Not “Education” or One-Sided Advocacy

    by Peter M. Sandman

    Email to Lisa Schnirring, February 17, 2012

    When laboratory researchers succeeded in creating a potentially pandemic strain of bird flu, a U.S. government agency recommended editing out methodological details before the two papers were published. Others suggested the research should never have been done and should not be pursued. The result was a pitched battle over what limits, if any, should be put on research and publication. The World Health Organization responded in part with a two-day meeting of public health officials and flu experts. At the end of the meeting the group announced some recommendations of its own. Lisa Schnirring of CIDRAP News asked for my comments, so I sent her an email – parts of which she used in her story on the WHO meeting.

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

    by Lisa Schnirring

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

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

  • Businesses urged to avoid pandemic planning pitfalls

    by Lisa Schnirring

    Posted on the website of CIDRAP News (Center for Infectious Disease Research & 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.

  • Physician survey shows mixed views on pandemic risk

    by Lisa Schnirring

    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.

  • Understanding the Risk: What Frightens Rarely Kills link is to a PDF

    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.

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

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

    With Howard Koh, Glen Nowak, and Dick Thompson

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

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

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

    by Helen Branswell

    Distributed by Canadian Press, November 29, 2006

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

  • Recent H5N1 Outbreaks: The Evolving Challenge of Defining and Communicating Pandemic Risk link is to a PDF

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

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

  • Skeptics warn bird flu fears are overblown

    by Rebecca Cook Dube

    Posted on MSNBC.com, April 20, 2006

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

  • Talking risk: avian flu advice from a risk communicator  link is to a PDF

    by Carole Sugarman

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

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

  • Bird flu’s potential toll warrants alerts

    by Jeffrey P. Koplan

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

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

  • The Bird Flu: How Much Fear Is Healthy?

    by Christine Gorman

    Posted on TIME.com, March 15, 2006

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

  • Fear can play role in pandemic readiness, speaker says

    by Robert Roos

    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.)

  • Worst Case Scenarios, Bird Flu, and Risk Perception – Interview with Peter Sandman (Part 2) link is to a PDF

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

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

  • Staving Off Panic in a Flu Pandemic
    (Note: This link goes to an article off-site with a link to this MP3 audio file.)

    by Jon Hamilton

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

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

  • Sifting Through Official Speak on Bird Flu
    (Note: This link goes to an article off-site with a link to this MP3 audio file.)

    by Jon Hamilton

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

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

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

    by Jody Lanard

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

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

  • Are you a sitting duck for bird flu?

    by Anita Manning

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

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

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

    by Nancy Shute

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

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

  • Risk Communication Before and During Epidemics

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

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

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

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

    by Helen Branswell

    Distributed by Canadian Press, March 30, 2005

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

Guestbook Entries
(Influenza Pandemics other than Swine Flu)

SARS, “Ordinary” Flu,
and Other Infectious Diseases

Subsections

Articles
(SARS, “Ordinary” Flu, and Other Infectious Diseases)

  • Tamiflu report comes under fire

    by Declan Butler

    Posted on the Nature website, April 22, 2014; published in the print edition of Nature, vol. 508, pp. 439–440 (April 24, 2014).

  • Overstated Attack Hiding Behind Scientific Assessment: An April 2014 Cochrane Review Trashes the Usefulness of Influenza Antiviral Drugs

    by Peter M. Sandman and Jody Lanard

    Email to Declan Butler, April 15, 2014

    In early April 2014, BMJ (British Medical Journal) published two articles reporting a research review by the Cochrane Collaboration, arguing that antiviral drugs are of minimal use against influenza. When reporter Declan Butler of Nature emailed me and my wife and colleague Jody Lanard asking for comment on how the Cochrane Review was communicated, we quickly sent back a response summarizing two key criticisms of the Cochrane researchers: that they ignored the downsides of the Cochrane methodology, which considers only randomized controlled trials; and that they massaged and cherry-picked their own results to make them look worse for antivirals. Declan’s article addressed many aspects of this complicated story, and he had room for only a little of what we had sent him. Meanwhile, we had written a more comprehensive assessment, which we are posting on this website as an introduction to what we originally sent Declan.

  • Is MERS an emergency? Language of IHR boxes WHO into a messaging dilemma

    by Helen Branswell

    Distributed by Canadian Press, July 16, 2013

  • MERS Isn’t an “Emergency” … Yet

    by Peter M. Sandman

    Email to Helen Branswell, July 16, 2013

    On July 15, 2013, Canadian Press medical reporter Helen Branswell asked for an interview about how the World Health Organization was setting itself up by convening an “Emergency Committee” to decide whether to recommend declaring the MERS coronavirus a “Public Health Emergency of International Concern” (PHEIC). With MERS infecting only small numbers of people, nearly all of them in Saudi Arabia, wouldn’t such a declaration invite claims that WHO was once again hyping an infectious disease risk? We scheduled an interview for the morning of the 16th. I sent Helen this email beforehand. In both the email and the interview, I stressed that the word “emergency” implies urgency. But a MERS pandemic isn’t imminent, I said; what WHO really needs to do is alert people that a MERS pandemic (someday) could be horrific. Despite the unfortunate nomenclature – including the awkward pronunciation of the “PHEIC” acronym as “fake” – WHO could do a lot more than it’s doing to clarify the distinction.

  • Postscript: The CDC Is Up to Its Old Tricks Again re Flu Vaccine Effectiveness

    Website column

    Posted: February 24 , 2013

    On February 1, 2013 I posted “The CDC Tells More of the Truth than Usual about Flu Vaccine Effectiveness,” praising the U.S. Centers for Disease Control and Prevention (CDC) for unusual candor about some disappointing flu vaccine effectiveness data. Sadly, the CDC’s new spirit of candor about flu vaccine effectiveness didn’t last. The research the agency was so candid about in January 2013 continued. By February, with a larger sample, it was possible to analyze effectiveness separately for different age groups – and the data for people 65 and older turned out very disappointing. The updated study showed only 9% vaccine effectiveness for seniors against H3N2 – that is, virtually no protection for the most vulnerable age group against the most dangerous flu strain now circulating in humans. To its credit, the CDC didn’t suppress this discouraging new evidence. It published it. But it did everything it could to spin it in a more positive direction.

  • The CDC Tells More of the Truth than Usual about Flu Vaccine Effectiveness

    Website column

    Posted: February 1, 2013

    Though far better than nothing, the influenza vaccine is surprisingly ineffective, working only 50–70% of the time in healthy young adults and significantly less than that in the people who need it most, the sick and the elderly. For years the CDC and other public health agencies have hyped flu vaccine effectiveness. And for years Jody Lanard and I have criticized the hype, fearful that it could ultimately undermine the credibility of flu vaccination, vaccination generally, the CDC, and public health itself. So we were surprised and delighted at the tenor of the CDC’s January 11, 2013 flu press briefing, which showcased a preliminary CDC finding that the 2012–2013 flu vaccine was only about 62% effective. It remains to be seen whether the CDC’s unprecedented candor is a one-off or the start of a new era. Either way, this column annotates the press briefing, finding much to praise and, inevitably, some things to criticize as well.

  • Report: Complacency, misperception stymie quest for better flu vaccines

    by Robert Roos and Lisa Schnirring

    Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), October 15, 2012

    A game-changing approach to investigating flu vaccines

    by Lisa Schnirring and Robert Roos

    Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), October 15, 2012

    We’d Be Likelier to Develop a Better Flu Vaccine If Public Health Officials Didn’t Keep Misleading Everyone about the Flu Vaccine We Have

    by Peter M. Sandman

    Email to Lisa Schnirring, October 14, 2012

    On October 15, 2012, a University of Minnesota research organization issued a report on “The Compelling Need for Game-Changing Influenza Vaccines,” link is to a PDF file arguing that the current flu vaccine is sorely inadequate, that a key barrier to developing a better vaccine is the widespread judgment that the current one is fine, and that the main reason the vaccine’s effectiveness is so consistently overestimated is that public health officials keep saying it is better than it is. I served on an Expert Advisory Group that helped with the research. A few days before the report was released, Lisa Schnirring of CIDRAP News emailed me three questions. Bits of my response were included in two October 15 articles that Lisa coauthored with Robert Roos. But neither article addressed a key point I made in my answers: that public health officials aren’t just accidently mistaken about flu vaccine effectiveness; in their zeal to encourage people to get vaccinated, they are sometimes intentionally dishonest. Both CIDRAP News articles and my email to Lisa are linked above.

  • Misoversimplification: The Communicative Accuracy Standard Distinguishes Simplifying from Misleading

    Website column

    Posted: June 5, 2012

    The need to simplify technical content is not an acceptable excuse for “simplifying out” information that is essential to credibility – especially information that seems to contradict your message, and that will therefore undermine your credibility if you leave it out and your audience learns it elsewhere. The obligation to include that sort of information is called the communicative accuracy standard; the failure to include it might appropriately be called “misoversimplification.” The column distinguishes three levels of misoversimplification, depending partly on how controversial the issue is and partly on whether you’re on the warning (precaution advocacy) or reassuring (outrage management) side. The three levels are illustrated with infectious disease examples: whooping cough, bird flu, and polio.

  • Flu Vaccination of Healthcare Workers: Two Risk Communication Issues

    by Peter M. Sandman and Jody Lanard

    Comments on draft recommendations link is to a PDF file of the Healthcare Personnel Influenza Vaccination Subgroup, National Vaccine Program Office, U.S. Department of Health and Human Services, submitted January 14, 2012

    The 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 link is to a PDF file 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?

    by Robert Roos

    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

    by Peter M. Sandman and Jody Lanard

    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.”

  • Flu vaccine not as effective as thought, new study says
    (Note: This link goes to a written news story, which includes a link to the MP3 audio file.)

    by Lorna Benson

    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.

  • Presented at a conference on “Research Integrity Challenges in Vaccine Development and Distribution for Public Health Emergencies,” sponsored by the Drexel University School of Public Health and the Center for Bioethics at the University of Pennsylvania, Philadelphia PA, September 12, 2011

    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.

  • Risk Communication Scenarios – Flu Shots, Hand-Washing, Ceiling Lifts, SARS
    (Note: This link launches an MP3 audio file from this site: 11.5MB, 14 min.)

    Taped for the British Columbia (Canada) Provincial Health Services Authority and Vancouver Coastal Health, February 15, 2011

    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.

  • Risk Communication Challenges – Confidentiality, Uncertainty, Wrap-Up
    (Note: This link launches an MP3 audio file from this site: 11.3MB, 14 min.)

    Taped for the British Columbia (Canada) Provincial Health Services Authority and Vancouver Coastal Health, February 15, 2011

    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.

  • by Lorna Benson

    Broadcast on Minnesota Public Radio, April 27, 2011

    link goes to a page where you will find the MP3Talking about the Vaccination-Autism Connection … to Somali Parents of Autistic Children(Note: This link launches the MP3 audio file on this site.)

    Interview with Peter M. Sandman by Lorna Benson, April 27, 2011

    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.

  • Three-part video interview conducted October 27, 2010

    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.)

    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.)

    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.)

    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.

  • The 2009 Berreth Lecture, presented to the National Public Health Information Coalition, Miami Beach FL, October 20, 2009

    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).

  • Flu Preparedness: An Even Tougher Sell than Usual

    Website column

    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.

  • Convincing Health Care Workers to Get a Flu Shot … Without the Hype

    Website column by Peter M. Sandman and Jody Lanard

    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.

  • The MMR vaccination and autism controversy in United Kingdom 1998–2005: Inevitable community outrage or a failure of risk communication?   

    by David C. Burgess, Margaret A. Burgess, and Julie Leask

    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: Strategies for Effective Risk Communication,link is to a PDF file 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.

  • A Blind Spot for Bad Guys

    Website Column by Peter M. Sandman and Jody Lanard

    Posted: June 16, 2005

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

  • Flu Vaccine Shortage: Segmenting the Audience

    Website Column by Peter M. Sandman and Jody Lanard

    Posted: October 22, 2004

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

  • SARS Exercise: What Are They Doing? link is to a PDF

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

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

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

    Website column by Jody Lanard and Peter M. Sandman

    Posted: December 4, 2003

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

  • Risk Communication Recommendations for Infectious Disease Outbreaks

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

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

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

  • Crisis Communications to the Public: A Missing Link

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

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

  • Fear Factory: Have the Media Overblown Canada’s Health Scares?

    by Jonathan Durbin

    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.

  • What next? Insanity?

    by Judy Gerstel

    Published in The Toronto Star, May 30, 2003

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

  • Sars Communication: What Singapore Is Doing Right

    by Jody Lanard and Peter M. Sandman

    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.

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

    Website column by Peter M. Sandman and Jody Lanard

    Posted: April 28, 2003

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

  • SARS: How Singapore outmanaged the others

    by Alan Fung

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

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

  • Candour, not PR, will calm virus fears

    by Andy Ho

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

    Early in Singapore’s SARS epidemic, the country’s dominant English-language newspaper published this article on how two American risk communicators thought it should manage the crisis.

  • Smallpox Vaccination: Some Risk Communication Linchpins

    Public Health Outrage and Smallpox Vaccination: An Afterthought

    Website columns

    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.

  • Vaccination Camp

    by Jody Lanard, M.D.

    Published in The Trenton Times, July 12, 2002

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

  • Guestbook Entries
    (SARS, “Ordinary” Flu, and Other Infectious Diseases)

    Copyright © 2014 by Peter M. Sandman

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