The Time to Prepare for Avian Flu Epidemic is Now
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The Time to Prepare for Avian Flu Epidemic is Now

“Trying to arouse concern about anything is pushing a rock uphill,” says risk communications expert and consultant Peter Sandman. “But if you’re lucky, the rock gets to the top of the hill and starts rolling down the other side. As it gains mass as well as momentum, it converts to a snowball.”

Paul Holmes

“Trying to arouse concern about anything is pushing a rock uphill,” says risk communications expert and consultant Peter Sandman. “But if you’re lucky, the rock gets to the top of the hill and starts rolling down the other side. As it gains mass as well as momentum, it converts to a snowball.”

As far as avian flu is concerned, the rock reached the summit, by Sandman’s estimate, toward the end of 2005, when then-secretary general of the United National Kofi Annan appointed a new coordinator for pandemic preparedness and politicians of both parties in the United States began to focus on the country’s lack of preparedness. Around that time, the first global public relations firms—Edelman, Hill & Knowlton and (a little later) Ketchum—announced special practices focused on the flu.

But even as interest in avian flu preparation began to gather momentum, some were questioning why some companies were devoting so many resources to a problem that might never occur. Some wondered whether avian flu would turn out to be a 21st century version of the Y2K bug, a potential crisis that generated rivers of ink and considerable fees for consultants but ultimately turned out to be much ado about nothing.

Hill & Knowlton’s Tony Burgess-Web acknowledged that view in a blog posting last year. “All major health authorities have now come to the chilling conclusion that it is not a case of whether another flu pandemic will strike, but when, where and how badly,” he wrote at the time. “Most of us are still hoping for the best. Having being frightened by the Y2K scare into hiding under the table, we’re not going to be fooled again.

“Yet, while denial may be an acceptable option for individuals, it is not for brands, companies, governments or other public organizations.”

There is evidence that companies around the world have been taking avian flu seriously. In March of 2006, a survey by human resources consultancy Watson Wyatt Worldwide found that multinational companies are taking steps to plan for the possibility of an avian flu outbreak. More than half (52 percent) of companies operating in Asia-Pacific are considering putting programs in place in that region to deal with the avian flu, while 48 percent of companies operating in the United States are considering such plans, as are 47 percent in Europe, 44 percent in Latin America and 42 percent in Canada.

Not surprisingly, companies are much more likely to already have plans in place (32 percent) in Asia-Pacific, compared to 15 percent in the United States, 11 percent in Europe, 10 percent in Canada and 9 percent in Latin America.

But an online survey of 450 companies in 38 countries and 26 industries conducted by Mercer Human Resource Consulting found a striking gap between employers’ concern about the impact of a human pandemic and actual pandemic planning. The survey found that while almost all respondents (90 percent) expect a moderate to high impact to their organization, only 47 percent of firms have started a business continuity plan and just 17 percent have a pandemic preparedness budget.

The survey found Asian respondents, particularly Singapore companies—which endured the SARS crisis in 2003 and with direct exposure to avian flu—are furthest advanced in preparedness. About 25 percent of Asian survey respondents have budgeted for preparedness, compared to 12 percent of respondents in Europe and just 7 percent in the United States.

“It is worth noting that Y2K was a theoretical threat, and one that never happened,” says Mark Senak, a senior vice president with Fleishman-Hillard. “But H5N1 is a real virus that has managed to kill millions of birds world wide by either infection or culling. In addition, nearly 200 humans have contracted the virus and died around the world. The mortality rate is quite high. So the basis for a transfer of H5N1 from bird to human is not theoretical, it is possible.”

But one reason for skepticism about the immediacy of the threat is confusion over the way in which the term “bird flu” has been used by politicians and public health officials to describe two quite different issues, and the resulting conflation of two separate but interrelated crises: one real and urgent and the other more theoretical but terrifying in its potential consequences.

“The ‘right now’ problem—avian influenza in birds—afflicts millions of birds, plus a few hundred stunningly unlucky humans,” says Sandman. “It is the most deadly widespread poultry disease in recorded history, so it is an enormous problem for many governments, veterinarians, bird lovers and poultry farmers. But in terms of public health, it is a small problem.

“By contrast, the ‘some day’ problem—pandemic influenza in humans—may afflict millions of people, if and when it happens. It is a potentially huge public health catastrophe that is keeping experts awake at night around the world. Calling both of these problems ‘bird flu’ has been a monumental mistake. And instead of taking the blame for this communication error, officials blame the public—and the media—for getting it wrong.”

When the H5N1 strain of avian influenza first showed up in Hong Kong in 1997, it killed a lot of chickens and six people. It was the first flu strain known to jump directly from birds to humans and understandably concerned health authorities took the extreme step of ordering the slaughter of every chicken in Hong Kong. The virus then virtually disappeared for a few years, only to reappear—again in many birds and very few people—in Southeast Asia in 2003. In 2005 a mutated strain of the H5N1 virus was identified in Europe, and it has since appeared in the Middle East, Africa, and Canada.

“The H5N1 strain is both incredibly contagious and incredibly deadly to domestic poultry,” says Sandman. “It is also incredibly deadly to humans—but not very contagious. Catching the H5N1 virus from a bird that has it is really, really difficult; millions of sick and dead birds have given the disease to just over 200 people so far. Catching the H5N1 virus from a person who has it is even more difficult.”

So the current problem is a disease that spreads rapidly among some species of birds and only with great difficulty to humans, posing a huge threat to the poultry industry and a tiny risk to public health.

But flu viruses are not very stable, so authorities worry that the H5N1 flu virus might mutate in a way that makes it possible for the strain to spread easily from birds to humans or that it might mutate into a new human influenza virus, which could spread easily from one human to another. If that happened, the result would almost certainly be a worldwide flu epidemic: a pandemic.

“It is only a matter of time before an avian flu virus, most likely H5N1, acquires the ability to be transmitted from human to human, sparking the outbreak of a human pandemic influenza,” says Lee Jong-Wook, director general of the World Health Organization. “We don’t know when this will happen. But we do know that it will happen.”

Once human-to-human transmission becomes possible, the virus is expected to spread rapidly. The WHO has warned that there will be only a 20 to 30 day window between the first case of human-to-human transmission and a pandemic. According to the CDC, a “medium-level” pandemic in the United States, in the absence of vaccination or drugs, could cause more than 200,000 deaths, almost three-quarters of a million hospitalizations, more than 40 million outpatient visits, and have an economic impact of as much as $166.5 billion. And, unlike the seasonal flu, which tends to be of greatest risk to the elderly, the very young and people with pre-existing medical conditions, everyone would be at risk from avian flu.

Says Sandman, “One worst case, almost beyond imagination, would be a flu virus as contagious and deadly among humans as H5N1 already is among poultry. That would be an unprecedented public health catastrophe, far worse than the famous Spanish Flu pandemic of 1918. Also possible, and far less scary: a new and fully human influenza virus that launches a pandemic much less deadly than 1918s, more like the nearly forgotten pandemics of 1957 and 1968.”

The name most officials and reporters use for this still-hypothetical problem is “bird flu,” the same term they use for the current strain that affects birds almost exclusively.

The implications for business are significant. According to a report by Mercer Management Consulting, a pandemic could lead to employee absence rates ranging between 20 percent and 60 percent. “Employees will be unable to work for many reasons,” the firm says. “Some absences will be caused by employees’ ill health. Other absences will reflect employees’ fear of becoming ill. Many workers will find they must take care of their families, while others will be unable to get to their jobs, as carpools and public transit systems become unreliable.”

Certainly, the argument for a proactive approach to preparedness looks even stronger today, after events in the United Kingdom over the past couple of weeks, after an outbreak of the H5N1 virus led to the gassing of 160,000 turkeys in Suffolk. The response of the company at the epicenter of that crisis, poultry giant Bernard Matthews, and of the government agencies responsible for consumer safety, suggests that even those on the front lines have a great deal of work to do to be ready for a larger, more serious outbreak.

By the end of the week, authorities in the U.K. were hinting that the company could be prosecuted after it became clear that Bernard Matthews had imported turkey meat from a slaughterhouse 30 miles from the source of an outbreak of avian flu in Hungary. British consumers, meanwhile, were surprised to find that Bernard Matthews’ turkey, which boasts of a 50-year heritage and proud Norfolk traditions on its labeling, had in fact been imported for Hungary. It was allowed to carry a British hallmark on its packaging because it had been processed in Britain.

As for the government, there are questions about why the Food Standards Agency, responsible for consumer protection, had not been informed about a possible contamination of meat for human consumption, even though the Department for the Environment, Food and Rural Affairs has known about the risk for almost a week.

The impact is already being felt. YouGov’s BrandIndex, which monitors consumer attitudes to 1,100 brands every day, revealed that Bernard Matthews is now the second most unpopular brand in Britain (behind only McDonald’s). Supermarket chain Sainsbury’s reported a 10 percent slump in poultry sales and rival Tesco reported a similar decline.

“Business, on the whole, cannot probably be characterized as prepared,” says Senak. “The travel industries and food preparation industries are among those who have been most proactive. Hospitals are not as prepared as others: one problem has been the investment of time and resources into planning for a theoretical circumstance as opposed to real problems that are presenting themselves on a daily basis. Is it worth it to put money towards planning for something that may never happen?”

Given the potential consequences of a pandemic among humans, most health experts believe the answer is yes.

“A major pandemic could have serious economic ramifications and disruptions to civil society,” says Jeffrey Levi, senior policy advisor at Trust for America’s Health, which has worked with Fleishman-Hillard on a forum discussing the implications of a pandemic. “There would be consequences not just for hospitals and healthcare providers, but for every sector, from the food supply chain to energy providers. This forum and efforts to prepare businesses and the private sector for a possible pandemic are essential for national and international readiness.”

And public relations experts agree.

“Avian flu has transcended media hyperbole,” says Tom Barriit, global director of the issues and crisis management network at Ketchum. “Corporations can’t afford to treat the threat as if Chicken Little again claimed the sky is falling…. A corporate response to avian flu requires full coordination between crisis response, risk management and business continuity, supported by strategic communications outreach to critical audiences.”

Some companies are clearly including avian flu plans in their broader crisis preparedness efforts.

“I believe that businesses are taking business continuity planning more seriously today versus preparing to respond to the avian flu specifically,” says John Morgan, regional managing director of Greater China operations for GolinHarris. “There’s certainly nothing wrong with that approach. What we’ve seen is that many clients begin to prepare for the avian flu, from both a business continuity and crisis communications perspective, but as we go along the strategy development we quickly realize that it’s more practical to prepare for the ‘general unthinkable’ than the ‘specific unthinkable.’

“Post 9-11, and particularly post-SARS in Asia, major business is fairly well prepared with more enhanced business continuity plans. We see that readiness from both an operational and communications perspective.”

The pharmaceutical industry, in particular, “must take a stance on a potential avian flu outbreak,” says Jill Mortensen, managing director for Weber Shandwick in Hong Kong. Roche has been on the frontline of the discussion because of the consensus that Tamiflu, its antiviral brand commonly used to treat flu symptoms, is the top candidate among possible treatments to fight avian flu. The company then faced considerable pressure from health advocates and international governments before finally agreeing to sub-license production of the drug to other manufacturers to help facilitate widespread supply.

“as Roche taking advantage of—or, even worse, fueling the public scare—to profit from public hysteria?” Mortensen asks. The company has been working with governments in the developed world to boost stocks of Tamiflu, while some developing countries have suggested that that they will allow generic versions of the drug if Roche cannot meet demand.

“This is where the dilemma lies for the industry,” says Mortensen. “The research and development driven multinational pharmaceutical companies invest millions in developing new, patented drugs and vaccines to help prevent and treat diseases. If they do not recover their costs, they will not be able to continue conducting medical research at the standard required by most governments to get new drugs approved. Governments cannot afford to do this research alone. At the same time, the media continues to attack the high prices of drugs without considering skyrocketing costs.

“From a PR perspective, this dilemma presents a great opportunity for the industry to tell the real story, but many companies shy away from this. The industry—and Roche is no exception—contributes a great deal to humanitarian causes…. It is now, more than ever, that the industry needs to pull its story together, to educate everyone in its path about what it takes to develop new medicines, and what it does to give back to communities…. To improve and preserve its reputation for the long term, now is the time for dialogue and cooperation.”

But beyond the pharmaceutical industry, focus on bird flu had been diminishing until these most recent headlines.

“A number of pharmaceutical companies have taken steps to prepare, because as an industry they understand the implications of infectious disease and the potential risk that exists to their employees and their businesses,” Barritt says. “There was greater focus among corporations a year ago, but as media attention subsided, some corporations moved on to other issues.  But whether it’s avian flu, or another infectious disease, experts agree that a pandemic is possible, and all businesses should consider the impact of such an event.

“Any business with employees that travel globally is at risk, as well as companies that interface with the public directly such as hospitality industries, the food industry, and the financial services and banking sectors.”

Other companies may find that a pandemic presents an opportunity. Stephanie Yu and Darren Burns of GolinHarris in Asia wrote last year that during the SARS (severe acute respiratory syndrome) epidemic in 2002, “SARS was a boon for e-commerce and courier companies as people around the region were ‘cooped up’ indoors.”

“International express companies also were quick to adapt. DHL increased delivery volumes during SARS as companies banned international business travel. Many samples and other documents were sent by express rather than presented at face-to-face meetings.

“If the Avian Flu breaks out, these same international express providers will fill a needed gap by providing special packages or avian flu protection products as a way to enhance their service to clients and protect people. An outbreak is also a great chance to remind the public of basic hygiene and nutrition. Sales of vitamin-packed kiwifruit and germ-killer Clorox grew during the SARS outbreak.

The consensus, then, is that every company should have a preparedness plan in place.

“It’s important that internal communications be set firmly in advance,” says Morgan. “Should the issue become a reality, what is the company doing, when and why? Many of those measures can be made now and don’t need to wait. It’s important that internal communications cascade down quickly through all levels of business with content and speed. It’s critical to build an architecture today that can be put into quick motion tomorrow.”

Hill & Knowlton’s Tony Burgess-Webb says there has been considerable discussion of business continuity, financial and brand and reputation implications of a pandemic, but that “the Cinderella of the group is communications planning. Yet experience shows that proactive communications is not only essential to manage the social consequences of pandemics but can both mitigate the damage for vulnerable brands and help avoid pitfalls for those that stand to benefit….

“If the pandemic is as serious as is envisaged, the Asian region would probably lead the world into recession. Information will be a potentially powerful weapon against this. Good communications will obviously not affect the purely health-related aspects of an outbreak but they can help tackle the fear factor and mitigate the follow-on economic and social costs. Clearly governments and health authorities carry a heavy responsibility here but so too do employers as they will be an important and trusted conduit for information.

“At the purely commercial level, companies that fail to plan for effective marketing and communications which are not dependent on ‘face to face’ will be more badly affected and slower than competitors to recover.”

He urges senior communicators to “make this someone’s job, or take it on yourself…. Get advice from heath, government and industry groups so you can assess the real risks. Make sure that your organization is informed, realistic, ready. Understand the science, in order to be able to assess new information properly and react rationally. But accept that others may not and their actions may have serious business implications.”

When it comes to developing a crisis plan, “there are two primary areas to consider,” says Barritt. “Communicating alternative business continuity plans to key customers, and ongoing outreach to employees. If a pandemic were to shut down access to a particular region, or disable a large group of employees, a company would need to inform customers about their contingency plans.  Most companies are not accustomed to communicating with their employees about health issues, but a pandemic would require regular communication about good hygiene to prevent the spread of disease.”

Senak advises companies to think now about how they will communicate with stakeholders, and how communication can support business continuity plans.

According to Robert Wesselkamper, director of international consulting at Watson Wyatt, “Companies should also sure to communicate their formal plans to manage through any business interruption—including alternative work arrangements and reimbursement for preventive and onset treatment—to the entire workforce.”

As for employee communications, consultant Robert Holland, who owns Virginia-based Holland Communication Solutions, suggests a series of questions:
• If a flu outbreak strikes your business, how will employees know if and when they should come to work?
• How will employees know what is acceptable in terms of caring for sick family members?
• How will employees know if they should report to their usual places of work or if they will be reassigned to cover employees who are sick or tending to ill family members?
• How will employees know what to do about picking up sick kids from school?
• What if a business facility is turned into a quarantine area or an overflow healthcare center? How will employees know what to do?
• Who should employees turn to for reliable information about public-health matters?
• How will your business ensure consistent messages are being communicated to employees, customers, partners, vendors, stockholders and the community?
• How will your organization work with public-health officials and other groups to manage the crisis?
• If hundreds or even thousands of local people die as a result of a flu outbreak, how will businesses respond to issues of grief? And without seeming cold and heartless, how will deceased employees be replaced?

“Before an outbreak, organizations should determine how they will communicate with employees and put a communication mechanism in place,” says James Reynolds, a principal at Mercer. “A solid employee-centered communication strategy will be critical to maintaining confidence and productivity before, during and after an avian flu outbreak.

“Employers will need to disseminate consistent guidance, convey leadership, avoid confusion, reduce fear and discourage attempts to exploit the situation. An internal communication plan that shares meaningful information promptly and professionally can support transmission prevention efforts, help maintain productivity and foster employee loyalty and confidence.”

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