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
A disease outbreak that could happen 30 years from now isn't at the top of most people's list of worries. But now the deadly avian flu virus has leapt from Asia into Europe, and perhaps the Middle East. President Bush is talking about how the military could help quarantine victims of a flu pandemic. And new United Nations pandemic flu czar David Nabarro cautions that up to 150 million people could die. Influenza is, suddenly, a source of great fear.
That's good news to infectious disease experts in the United States and abroad, who since 1997 have warned that the newly emerged H5N1 strain of bird flu posed a serious threat of sparking a human pandemic, only to have those warnings largely ignored. But it's bad news, too. Their worry is that this spike in public concern will soon wane but the threat will not, leaving nations and families unprepared. Thus the dilemma: How do you tell people to prepare for a risk that may be horrendous, but maybe not? For the first time, figuring out what to tell people, and when, has become a major part of preparing for a disaster, be it a Category 5 hurricane, a bioterrorism attack, or a deadly new strain of flu.
Tricky. "We've really been walking a tightrope on pandemic communications," says Dick Thompson, spokesman for infectious disease with the World Health Organization in Geneva. "We've wanted to motivate countries into action, but we haven't wanted to sacrifice our credibility with scare tactics. We don't know the timing of the next pandemic, how severe it will be. We don't know what drugs will work. We don't have a vaccine. Yet we're telling them to prepare for a pandemic. It's tricky." It's even trickier because some WHO members are not known for their candor--China, which tried to suppress news of the 2003 SARS outbreak, comes to mind. But during last week's meeting in Geneva to map a pandemic strategy, WHO membership backed the new, blunt approach. "This is scary, and we don't know," says Thompson. "That's the message."
The U.S. Department of Health and Human Services, which just four years ago was insisting that a Florida man's anthrax infection couldn't possibly be due to terrorism, is also learning the virtues of uncertainty and trepidation. "If a pandemic hits our shores, it will affect almost every sector of our society, not just healthcare but transportation systems, workplaces, schools, public safety, and more," HHS chief Mike Leavitt said last month. "We are inadequately prepared."
Much of this new willingness to play it straight with the public is due to an evolution in the understanding of how people communicate important but upsetting information--and how easily that communication can go awry. In the past 40 years, the analysis of risk has grown into a science, increasingly relied on by businesses and government in deciding how to spend their billions of dollars more wisely or profitably, be it on new cancer treatments or hurricane-resistant buildings. But where risk assessment is mathematical and quantifiable, risk communication is subtle and often counterintuitive.