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August 17, 2005

Bird Flu: Can We Out-Collaborate a Pandemic?WorldChanging: Another World Is Here

Here's a challenge to the blogosphere:

As you probably know, avian flu (especially the virus H5N1) appears to be on the verge of becoming a severe crisis. 57 people have already been confirmed by labs to have been killed by the virus, and it is rapidly spreading in bird populations. If appropriate measures aren't taken, and we're unlucky, it may boil up into a full-blown pandemic. As the WHO warns:

"Never before [have] so many countries been so widely affected by avian influenza in poultry in its most deadly form... Never before [has] any avian influenza virus caused such extremely high fatality in humans."

This is scary.

Public health experts know a lot about how to prevent and manage pandemics. Unfortunately, public health has taken big funding hits nearly everywhere around the world, and many national and local public health programs are understaffed and underfunded.

This too is scary.

So, is it time to take to the basement safe room and start eating canned beans? Not quite. There is still a good chance that we can avert the next plague by working together. If so, the blogosphere will need to play a key role.

Many of the tasks most needed to prevent a global pandemic are, to greater and lesser degrees, amenable to collaborative efforts. And we are increasingly armed with the kinds of tools that facilitate a networked approach to fighting edpidemics We have, for instance, great simulations of how H5N1 might spread, increasingly better understandings of previous killer flu outbreaks, good foresight work on how a pandemic might unfold and a variety of collaborative tools, for instance the Flu Wiki and WikiPedia Avian Influenza efforts.

Much of the frontline work is (and will continue to be) carried out largely by brave and trained professionals. But in one crucial fight, collaborators of all stripes -- but especially those of us who are already adept at online communication -- can make a huge difference: the battle to build public awareness of the risks and public support for government preparedness and action.

Journalists play a key role here, certainly.

Some things, however, are too important to leave to the pros. The alarm is not being rung either loudly enough or responsibly enough. We can change that. Blogs, listserves and other collaborative communcations projects can play a key role in helping to not only build the public will for action, but in sharing information about bird flu in a way which leaves people inspired to pay attention and act rationally, rather than panic or retreat into denial.

How? The WHO's Peter M. Sandman and Jody Lanard have some suggestions. In their paper Bird Flu: Communicating the Risk, they share tips for spreading the news without spreading unproductive panic. It's long, but worth quoting in depth:

1. Start where your audience starts Instead of ignoring the fact that people think flu is minor, or berating people for thinking that flu is minor, acknowledge that even some public health authorities use the term "flu" in ways that minimize its seriousness. (A senior U.S. health official recently apologized for his wife's absence at an event by saying she was home with "a stomach flu"—a misnomer.) After making common cause with the public—"we have all ignored influenza for too long"—talk about how horrific the next flu pandemic may be compared with the annual flu.

2. Don't be afraid to frighten people
For most of the world right now, though, apathy is the problem—not denial. We can't scare people enough about H5N1. WHO has been trying for over a year, with evermore-dramatic appeals to the media, the public, and Member States. Until a pandemic begins, there's little chance we'll scare people too much.

3. Acknowledge uncertainty
Overconfident overreassurance ("the situation is under control, everything is going to be fine") is terrible risk communication. Paradoxically, people usually find it alarming. They sense its insincerity and become mistrustful even before they know the outcome. But overconfident warnings are also unwise. There is so much we don't know about H5N1. Will it ever achieve efficient human-to-human transmission and ignite a pandemic? If that happens, will it become less lethal in the process, or perhaps not lethal at all? How many people will it infect? How quickly will it spread? How long will it last? How much antiviral medication will be available in different parts of the world, and how well will it work? How long will it take for an effective vaccine to be available? Which countries and which people in those countries will get the vaccine first? How well will health care systems cope? How well will national and international economies cope? And how well will civil society cope?

Bird flu experts and risk communicators cannot answer these questions. But we can and should raise them, acknowledging our uncertainty at every turn.

4. Share dilemmas
Sharing dilemmas is a lot like acknowledging uncertainty. Not only are we unsure about what will happen; we're also unsure about what to do. Everyone finds this hard to admit. But dilemma-sharing has huge advantages:
*It humanizes the organization by letting the pain of difficult decisions show.
*It gives people a chance to make suggestions and be part of the process.
*It moderates the conflict between opposing recommendations.
*It reduces the outrage if you turn out to be wrong.

5. Give people things to do
One reason sometimes given for not alarming the public is that there's nothing for people to do anyway. A Jan. 13, 2005, Wall Street Journal article quoted Canadian infectious disease expert Richard Schabas as saying: "Scaring people about avian influenza accomplishes nothing, because we're not asking people to do anything about it." But the error isn't scaring people. The error is failing to realize—and say—how much they can do to prepare.

Helping resolve government policy dilemmas is just the beginning. Thailand, for example, has trained almost a million volunteers to reach out to every village in the country to inform people about the risks and signs of bird flu and how to try to protect themselves and their flocks. Many companies, hospitals, schools, and local governments around the world are starting to plan for "business continuity" in the event of a pandemic. Even cognitive and emotional rehearsal—learning about H5N1 and thinking about what a pandemic might be like and how you'd cope—is a kind of preparedness and a kind of involvement.

6. Be willing to speculate—responsibly
Warnings are intrinsically speculations. Like hurricane forecasters, we have to offer both worst-case scenarios and likelier scenarios, always acknowledging that we may turn out to be wrong.

7. Don't get caught in the numbers game
Battles over how many people an H5N1 pandemic might kill are pointless. What matters is that flu pandemics are horrific, and for the first time ever we can see one coming and start getting ready.

8. Stress magnitude more than probability
The rationale for H5N1 pandemic preparedness isn't that we're sure it's coming, but how bad it could get. Overconfidence about risk probability is a mistake. Dramatic warnings about risk magnitude are more justified. (There are times when it's best to stress probability. But the uncertain prospect of a catastrophe should be about magnitude.)

9. Guide the adjustment reaction
Once people get past their apathy and start taking a new risk seriously, the normal response is an "adjustment reaction"—a temporary fearfulness, sometimes accompanied by misplaced or excessive caution. This is the teachable moment. Don't ignore it or ridicule it; guide it. Then we settle into the "new normal."

10. Inform the public early and aim for total candor and transparency
These are two of the hardest risk communication recommendations for governments to adopt. There are so many barriers—fear of damaging the economy, looking incompetent, turning out to be wrong, causing undue alarm. But the price of informing the public late, of covering up or minimizing the problem, is high: diminished credibility, just when you need it most to help your people through an influenza pandemic.

>I'd submit that these are pretty damn good guidelines for how to blog about pandemic preparedness. (If you're interested in learning more, there's an online tutorial available in English, Spanish and Portuguese.)

So here's the challenge: we know we need a bigger, wider and better debate about bird flu and its dangers. We know time is short. Can we prove ourselves up to the task of not only spreading the word more rapidly, but of helping people think more clearly about what they can do, alone and together, to face what many believe is a looming crisis?

Can we calmly and quickly out-collaborate the pandemic?

Here's one modest proposal: Let's sound the alarm this week. If you're reading this and you have a blog, make a point of posting something about bird flu this week (feel free to use the links we mention here, if that makes life easier). If you maintain a list, perhaps consider include a small note about starting to prepare for bird flu the next time you send something out. If you're active in an online discussion, think about raising the topic there. Then trackback to this post, or leave a note in the comments, so others can see what you're done. Simple, quick, easy, and -- if enough of us do it -- perhaps enough to make a difference.

(Posted by Alex Steffen in Big Systems - Global Institutions, Governance and History at 09:12 PM)

Posted by dymaxion at August 17, 2005 12:59 PM

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