Swine Flu: Uncertainty Creates Challenges for Risk Communicators
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Swine Flu: Uncertainty Creates Challenges for Risk Communicators

Remember SARS, the Y2K bug, Avian flu? Reporters do, as do many members of the public. And the fact that none of those scares came close to fulfilling the promise of the apocalyptic headlines that accompanied them is making life exceedingly difficult for risk communicators.

Paul Holmes

Remember SARS, the Y2K bug, Avian flu? Reporters do, as do many members of the public. And the fact that none of those scares came close to fulfilling the promise of the apocalyptic headlines that accompanied them is making life exceedingly difficult for risk communicators charged with advising the public on how to react to the recent outbreak of swine flu.


The first reports about the new swine flu virus appeared on April 23, after the Centers for Disease Control confirmed the first cases in the United States. The Mexican government quickly confirmed that it had been monitoring the flu, which was apparently responsible for more than 20 fatalities in that country. On April 25, the World Health Organization declared a public health emergency and a day later the U.S. Department of Health & Human Services followed suit. Since then, cases have been reported in several U.S. states, in the U.K. and continental Europe, in Asia and Australasia. By the end of last week the WHO had raised its level of alert to a five (on a scale of six) and warned health authorities around the world to prepare for an “imminent” pandemic.


The reaction to the epidemic has been characterized by confusion and conflicting advice. In the United States, President Barack Obama announced that the flu was not a cause for alarm. But Vice President Joe Biden appeared on NBC's Today show and said he would advise against riding the subway or taking commercial flights and implied that schools should be closed because “If you're out in the middle of a field and someone sneezes that's one thing. If you're in a closed aircraft or a closed container or closed car or closed classroom it's a different thing.”


The European Union, meanwhile, first advised travelers to put off any non-essential travel to Mexico or the U.S., then resisted a French plan to ban all flights from the continent to Europe, and then advised its citizens not to panic.


In the U.K., a senior health official warned that a flu pandemic could strike three-quarters of a million Britons and could cost $3 trillion dollars. In response, columnists like Simon Jenkins of The Guardian saw over-reaction everywhere: “Risk aversion has trounced risk judgment,” Jenkins claimed. “An obligation on public officials not to scare people or lead them to needless expense is overridden by the yearning for a higher budget or more profit... The World Health Organization, always eager to push itself into the spotlight, loves to talk of the world being ‘ready’ for a flu pandemic, apparently on the grounds that none has occurred for some time. There is no obvious justification for this scaremongering.”


And in perhaps the most extreme over-reaction to date, the Chinese government detained a family of Mexicans, who were taking to a hospital and told they would not be allowed to leave, and has refused admittance to anyone arriving on a Mexican passport.


Says Peter Sandman, founder the Environmental Communication Research Program at Rutgers University and an expert in risk management: “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.”


There have been devastating outbreaks of flu in the past. The Spanish flu pandemic of 1918 to 1919—the most virulent strain of flu in recent history—killed about 50 million people. The most recent pandemic was the Hong Kong flu that killed about 1 million people in 1968 and 1969.

But there have also been instances of panic and wild over-reaction. In 1976, health officials warned that a new strain of swine flu could kill one million Americans. In reality, the death toll was precisely one person—although a hastily-developed vaccine led to an increased risk of paralysis and death for the 45 million people who were immunized against the flu.


The U.S. CDC is doing a superb job of explaining the current situation and how uncertain it is,” says Sandman, writing at his website. “Anyone who’s paying attention gets it that we just don’t know if this thing is going to fizzle, hang in abeyance for months, disappear and then reappear, spread but stay mild, replicate or exceed the 1918 catastrophe, or what.


“The reiteration of uncertainty and the insistence on what that means—advice may change; local strategies may differ; inconsistencies may be common—has been almost unprecedentedly good.”

In particular, he says the CDC has done three things superbly: it has told the public exactly what it knows so far and—far less common—it has conducted “responsible speculation: about likely and possible future scenarios and it has been willing to make predictions in areas where the probabilities are clear—such as letting people know that some U.S. deaths are likely—and it has insisted on uncertainty in areas where the probabilities are not clear, such as the eventual extent and severity of the outbreak.


That point is echoed by Ben Goldacre, who writes the Bad Science column for The Guardian in the U.K. and is well-known for debunking scientific nonsense. Interestingly, after the initial wave of stories focusing on worst-case scenarios, Goldacre was on the receiving end of numerous telephone calls from reporters and producers looking for quotes to support the theory that health experts and the media were over-reacting.


In a blog post last week, he wrote that “By Tuesday, pundit-seekers from the media were suddenly contacting me, a massive nobody, to say that swine flu is all nonsense and hype, like some kind of blind, automated naysaying device. “Will you come and talk about the media overhyping swine flu?” asked Case Notes on Radio 4. No. “We need someone to say it’s all been overhyped,” said BBC Wales….


In the time that I have been writing this piece—no embellishment—I’ve had calls off This Week at the BBC (”Is the coverage misleading?”), Al-Jazeera English (”We wanted to talk to someone on the other side, you know, challenging the fear factor”), the Richard Bacon Show on Five Live (”Is it another media scare like Sars and bird flu?”) and many more.” His conclusion: “Not only have the public lost all faith in the media; not only do so many people assume, now, that they are being misled; but more than that, the media themselves have lost all confidence in their own ability to give us the facts.”


In such an environment, a grown-up approach to risk communications is almost impossible.

Says Goldacre: “All people have done is raise the possibility of things really kicking off, and they are right to do so, but we don’t have brilliantly accurate information. Someone has said that up to 40 percent of the world could be infected. Is that scaremongering? Well it’s high, and I’m sure it’s a bit of a guess, but maybe up to 40 percent could be. Annoying, isn’t it, not to know?”
Sandman believes that the most responsible approach to risk communications in such circumstances involves as much transparency as possible.


“There is a virtual terror of frightening people excessively,” he says. “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…. The paradox of ‘panic panic’ is that it backfires so routinely. Officials who imagine that the public is panicking or may soon panic often feel impelled to make over-reassuring statements, to suppress alarming information, and to belittle those who are frightened as ‘irrational’ or ‘hysterical.’”


Underlying the fear of frightening people is the fear of being accused of frightening people—as in the Simon Jenkins column cited above—especially in the current economic environment.

Says Sandman: “The only consolation I can offer officials is this one: Over the years, many more bureaucrats and politicians have lost their jobs for failing to take a disaster seriously enough than for being excessively alarmist about a possible disaster that never materialized. Yes, there will be critical comments about ‘overreaction’ if swine flu goes away; but think about the Congressional investigations into preparedness failures that will follow a full-scale swine flu pandemic.”


If Sandman has a criticism, it is that the CDC and others are “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, 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.”


Some public relations firms are offering similar advice. At employee communications specialist Gagen McDonald, for example, “Many of our clients have told us they are wrestling with how to proactively communicate with stakeholders as well as prepare for a potential situation in which further spread may require organizations to take large-scale action…. While the Swine Flu, now being referred to as the H1N1 Flu, has not yet significantly disrupted the operations of most organizations, the World Health Organization’s decision to raise the global alert level to level 5 increases the potential of operational disruption in the near-term. We believe it will also raise the level of concern among employees.


“In situations such as this, it is important to understand that your employees share the same concerns and fears as the general population. As a corporate communicator, you are in a unique position to provide timely, actionable and reliable information that can alleviate concerns to an extent by ensuring your employees understand your environment, the company’s response and any steps they can take to protect themselves.”


The firm recommends that a crisis management system should be put into action to monitor the situation, internally and externally, with three objectives.

·         Keeping Calm: “The best way to do this is to provide your stakeholders with understandable and reliable information that reinforces the main message you’ll hear from public officials, ‘do not panic.’”

·         Building Your Defenses: “There are simple and effective steps proven to reduce the risk of catching and spreading the H1N1 Flu. Reinforcing these behaviors among your employees serves as your best preventative defense and increases the likelihood of early diagnosis.”

·         Understanding Your Resources: “In case the current level becomes significantly more severe, it’s important to ensure that there is clarity around relevant issues such as your company’s travel, sick leave and alternative work arrangement policies, and that there is agreement on responsibilities.”


“If the situation escalates to a point where you need to alter your day-to-day operations, companies should be prepared to implement business continuity plans and execute an overarching communications strategy,” the firm says. The priorities:

·         Protect Your People: “Provide consistent (internal versus external), integrated (your message versus public health official statements) and actionable (what can your employees do) information about the impact of the outbreak. This is critical to helping people protect themselves and maintain business operations to the fullest extent possible.”

·         Maintain Your Business: “Your customers and employees need to understand how you intend to alter your operations to serve your customers if required. Your communications plan also should involve other business partners, including suppliers, to ensure they are in a position to continue to serve your needs.”

·         Meet Your Communication Responsibility: “Communicate in a responsible way—this includes considering the timeliness, accuracy and means of delivering your messages. Ensure you are communicating in a timely fashion by monitoring media updates of the external situation as well as your own intra-company developments and responding accordingly. Make an effort to re-enforce credible and responsible sources such as public health agencies; this will help reduce the potential that rumors will gain legitimacy. And ensure your communications are available to employees who may be working from alternative locations or are putting in extra hours implementing continuity plans. Make sure the information is delivered in a clear and concise manner that is easily accessible and conveys the proper sense of urgency.”


New Jersey-based public relations firm MWW Group is also reminding organizations how quickly internal communications can create external issues. Says the firm’s chief executive, Michael Kempner: “Companies experiencing a confirmed case will be directed to identify and notify other employees, customers, with whom there was likely contact. In the case of a suspected infection or a rumor, some organizations may even lean towards preemptive notification in an effort to stay ahead of the issue.


“It will be extremely difficult to keep such notifications quiet, particularly with an issue of this scale and potential impact. Internal memos quickly become public and social media platforms virtually guarantee exposure within minutes. And for organizations whose employees who interact with the public on a regular basis such as retailers, restaurants, universities, and hospitals, communicating through the media may be a necessary part of the response plan.


“In all cases it is critically important that the communications process be handled correctly and the message be right. Downplay the incident and you appear uncaring. Overplay the incident and you start a panic. Both can have a devastating impact on an organization's reputation and business prospects. If you are not already thinking about ‘what's next’ you should be.”

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