[A long article, but well worth the read. I'll include a few excerpts, click on title for the whole article]
Posted: April 29, 2009
by Peter M. Sandman
And whatever the situation is like by the time you read this, that won’t be the end of the story either. A mutated virus (more virulent or more transmissible or resistant to antivirals) could come roaring back a few months later.
As a risk communication professional, I have been watching the U.S. government walk a tightrope between over-reassurance and over-alarm about a swine flu outbreak that could easily turn out devastating, minor (except in Mexico), or anywhere in between.
I will focus my comments here on the U.S. government, because I have been watching it most closely. Most governments in places with fewer cases, or none so far, have been much more reassuring in their public communications than the U.S. government has been. The U.S. hasn’t faced the temptation to issue false reassurances that the authorities will keep the pandemic from “our” shores – a temptation to which dozens of governments have succumbed. I doubt any government is doing better swine flu risk communication than the U.S. government. So let’s talk about what the U.S. government is doing, especially what I believe it is doing wrong.
If you want to know more about how the rest of the world’s governments – and some U.S. state governments – have been mishandling the crisis, check out a posting on the Flu Wiki Forum with the wonderful title “Ministers in Wonderland / Beyond Indefensible Over-reassurance.” “Path Forward” (the poster) is the nom de flu of my wife and colleague Jody Lanard, currently working with WHO in Asia.
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The CDC’s biggest failure: not doing nearly enough to help people visualize what a really bad pandemic might be like – while helping them also to hold in mind that it’s only one of many possibilities – so they can feel the knot in their stomachs that everyone on the inside is feeling, get past this adjustment reaction, gird up their loins, and start preparing.
It is especially important to get this message to business and community leaders, who have prep work to do ASAP in case things get worse.
But individuals also have prep work to do – logistical as well as emotional prep work. All that preparing will stand us in good stead even if The Big One isn’t right around the corner yet … and it’ll be essential if it is!
For the ordinary citizen, the U.S. government has so far recommended only hygiene, not preparedness. It has told people to stay home if they’re sick, cover their coughs, and wash their hands a lot. It hasn’t told people to stock up on food, water, prescription medicines, and other key supplies. Two years ago HHS Secretary Mike Leavitt was crisscrossing the country with that advice. These past few days Acting CDC Director Richard Besser kept evading questions from journalists about whether it’s still good advice.
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Fear of fear and “panic panic.”
There is a virtual terror of frightening people excessively (as if that were easy). Although crisis management experts have known for decades that panic is rare, officials routinely go into “panic panic” – either predicting that the public will panic if told alarming things or misdiagnosing orderly efforts to prepare as panic. A Google News search this morning for “swine flu panic” netted over 8,000 hits. Some of them were urging people not to panic (unnecessary and condescending advice); a few were pointing out that people weren’t in fact panicking, not even in Mexico City. But the vast majority were interpreting precaution-taking as evidence of panic. No wonder, then, that officials are reluctant to urge precaution-taking! For more on this phenomenon, see Fear of Fear: The Role of Fear in Preparedness … and Why It Terrifies Officials, which I wrote with Jody Lanard in 2003.
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Reputational worries.
Underlying the fear of frightening people is the fear of being accused of frightening people, especially in the current economic environment. This is a realistic fear, I have to concede. Every novel risk brings out a cadre of commentators, poised to accuse officials of “fear-mongering” for issuing excessively dire warnings about a phenomenon that has hardly killed anybody yet … as if the proper time for preparedness were after the disaster has struck.
Already the same officials that I am criticizing for under-warning the public are being accused by others of over-warning the public. And of course if the virus recedes and this pandemic never materializes, these critics will consider themselves vindicated … as if the fact that your house didn’t burn down this year proved the foolishness of last year’s decision to buy fire insurance. It is dangerous nonsense to imagine that warnings are justified only if they are followed quickly enough by disasters. People who don’t take precautions often escape injury. That makes them lucky, not wise.
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Projection.
Underlying both of the above, I believe, are the sources’ own fears of what a pandemic might be like. They try to suppress the knot in their own stomachs, and it emerges as a psychological projection: “The public is panicking!” What they don’t understand is that the knot is part of a useful “adjustment reaction.” They need to guide themselves through it, and they need to guide the public into it and then through it.
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The other psychological effect of precaution-taking may matter less to the CDC right now, but it matters just as much to the country’s prognosis if a pandemic happens. Some people – a lot of people, in fact – are not yet very worried about a possible swine flu pandemic. It was a big story yesterday, but not THE big story; Arlen Specter’s defection to the Democrats was bigger. (And plenty of people ignored both.) Many drug stores have run out of surgical masks and Tamiflu, but they didn’t have much of a supply to start with; as far as I know, supermarkets haven’t run out of anything. The government may be worried about the risk of pandemic anxiety, but I am more worried about the risk of pandemic apathy.
When officials urge people to take precautions, that doesn’t necessarily pierce the apathy – but it helps. Each time officials repeat the advice, more people take it. Some of them take it skeptically, but take it nonetheless.
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