Thu, Jul 30, 2009 - Page 9 News List

Swine flu for grownups

Eventually, a severe pandemic will strike, whether it’s (A)H1N1 or not, and we should do what we can, now, to prepare

By Peter Sandman


No one knows how the swine flu A(H1N1) pandemic will evolve. Will it keep spreading, or will it fizzle? Will it retreat during the northern hemisphere’s summer and return in the fall? Will it stay mild or turn more severe? Flu experts just don’t know.

What is certain is that health officials risk mishandling how they explain this new and potentially alarming threat to the public. Although they know a lot about virology and public health, they often know next to nothing about how to talk (and listen) to people about risks.

So here’s a primer on the swine flu pandemic risk communication, framed in terms of what health officials shouldn’t do when they’re telling you about this new disease.

1. Don’t feign confidence. Nobody likes uncertainty; we all wish the experts knew exactly what will happen. But we cope better with candidly acknowledged uncertainty than with false confidence. When health officials tell us confidently that X is going to happen, and then Y happens instead, we lose trust in their leadership. Smart officials are planning for various swine flu pandemic scenarios, and expecting surprises that will force them to change their plans. They should tell us so.

2. Don’t over-reassure. So far, this pandemic is mild. But even a mild influenza virus kills a lot of people, especially those with other medical problems. And experts worry that the novel (A)H1N1 virus could mutate into a more severe strain. Yet officials endlessly insist that there is, as a Scottish health official put it, “absolutely no need for the public to be concerned.” This is false and it could backfire. Even before a situation deteriorates (if it does), people sense when they are being “calmed” rather than informed. Not trusting that officials will be candid about alarming information, we rely more on rumors. Not trusting official over-reassurances, we become even more alarmed.

3. Don’t worry about panic. Panic is rare in emergencies. Although people may feel panicky, they almost always behave well. But “panic panic” — leaders’ fear that they will be unable to stop their people from panicking — is both common and harmful. In the grip of “panic panic,” officials issue over-reassuring statements, suppress or delay alarming news, and speak contemptuously about how the public is “irrational,” “hysterical,” or “panicking.” Such disdainful communication further reduces trust.

4. Don’t obsess over accusations of fear-mongering. Nothing officials say is likely to cause panic, but they may be accused of causing panic no matter what they say. Even when officials over-reassure, they’re often accused of fear-mongering by critics who can’t bear any signs of public concern. That particular criticism is inevitable, and officials should shrug it off. Far more officials have lost their jobs for under-warning the public about risks that turned out to be serious than for over-warning about risks that didn’t.

5. Don’t fight the adjustment reaction. While panic is rare, it is natural for people to need some time to adjust to a new risk — and this swine flu pandemic is new to us all. We cannot skip what risk communicators call the “adjustment reaction” phase, during which we may become temporarily overanxious and hypervigilant, and may even take precautions that are technically unnecessary or premature. Adjustment reactions are brief, but useful — a cognitive, logistical, and emotional rehearsal for possible hard times ahead. Health officials should guide people through their adjustment reactions, not demand that they skip that step.

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