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? WHO risk communication advisors 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 problemnot 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 realizeand sayhow 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 rehearsallearning about H5N1 and thinking about what a pandemic might be like and how you'd copeis a kind of preparedness and a kind of involvement.
6. Be willing to speculateresponsibly
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 barriersfear 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.
Good effort to try a prop up the WHO, but if you go to http://www.recombinomics.com/whats_new.html it will be evident that they are part of the problem and that if any country depends on them, they will be a year too late in doing something.
Also, this web site argues that the pandemic is also raging in China.
I'm not trying to prop up anyone.
The WHO has plenty of problems, but that's not the issue here. The issue is a serious global health risk that's not getting adequate attention in the media, and the opportunity to help spread the word.
Bravo! Good work, Alex.
We're going to need a lot more blogposts like this to alert and inform people about the potential influenza pandemic. Here's mine.
Under the terms of your comment policy, you might consider deleting Diane Hiller's comment above. If praying for the destruction of half of the world's humans isn't insulting and abusive, I don't know what is...
In any case, I applaud your efforts to raise awareness. I also would like to add an idea about what the blogosphere can do to help. In the event of a pandemic, up-to-date knowledge about when and where it is spreading will be extremely important. I hope that someone will create a sophisticated map wiki of some kind where any old citizens can report cases of bird flu in real time. There could be color codes for confirmed cases (in, let's say red) and unconfirmed (in let's say, orange). Then you could look at a map of the world and see anywhere and everywhere that the disease might be spreading, with an infinitely large group of people reporting cases. It could make a big difference--for instance, people might decide to avoid North Carolina or wherever this weekend if a bunch of new cases are popping up there. That kind of real-time knowledge won't come from the government, but could do wonders to help an informed take steps to prevent the spread of bird flu. And it wouldn't cost much at all!
Here's a link to an essay that I found very interesting, and made me really understand the scale and unpredictability of the danger we face:
Thanks, Henry, I agree.
In general, folks, no more of the "this is God's wrath"/ "this is Gaia's wrath"/ "this is Mars' wrath"/ "this is a government plot to tag us with RFID chips" sort of posts, okay?
I have an itchy delete finger today. Don't make me use it.
Perhaps it's just a case of the media not wanting to cry wolf again (I mean Y2K didn't bring down civilization and neither did SARS, scary as that was), but somebody needs to convince these folks that the threat of an avian flu pandemic is real and the general public needs to hear about it. I've been following the progress of H5N1 daily for months now and quite frankly, I'm scared. Scared enough that I've stockpiled several months of food and supplies and planned for the worst with regard to electricity and water. In an attempt to share my knowledge (and survival skills) I even wrote a 10-page Personal Pandemic Preparedness Plan to hand out to family, friends and clients to warn them of the potential danger of avian flu and encourage them to begin their own preparations. I've begun passing it out and you know what I've discovered? NO ONE KNOWS WHAT I AM TALKING ABOUT!!! Forget planning, they don't even know what avian influenza is, much less its pandemic potential. Some of them don't even know what a pandemic is. Some of them even look at me like I'm a little crazy... Alex is right, we need to spread the word and spread it fast. Hopefully the media will catch on soon and educate the public on what's really going on - before someone decides to lock me up in a padded cell!!!
Can you advise as to which companies are leading the fight for a cure or innoculation
Excellent suggestion, getting the blogosphere involved in public health education about avian flu; we're trying to do our part at enrevanche.
Shaman: willing to share your Plan with the rest of us?
Barry's excellent content redistributed under CC-SA 2.0 license at http://www.safnet.com/writing/archives/000091.html. Thanks Barry.
Stephen: I don't have my website up and running yet and my "Personal Pandemic Preparedness Plan" hasn't been posted anywhere (that I know of) but if you want I can try e-mailing it in the meantime...
At IDFuel, we recently pointed out that designers have a lot to learn, not only about ho better to use virii tactics for implementing designs (viral marketing, etc) but also how our design choices can effectively change the danger we face from virus epidemics:
Obviously, this burden falls on everyone who works to design things, not just product designers. Policymakers, journalists, children's book authors, gardeners, even entrepreneurs setting up grocery stores. We can all play a part.
Hi - I think it's great that part of the blogosphere is proactively engaging itself around this particular issue. http://www.fluwikie.com (currently not available - slashdotted from WC?) is a good place to work at.
One of the projects there is to be able to create translations quickly - into many languages etc - just imagine a pandemic is confirmed today, and 5 days later all current knowledge is printed in your own language in your own local newspaper - free(dom) content!
Mapping out cases would be a really advanced form of "epidemiological surveillance" - currently influenza is "monitored" through compulsory notification (from doctors), voluntary notification (from sentinel networks), outbreak notification (usually from doctors too), and laboratories. Bloggers notification or mapping would be some kind of "patient or at-risk person" notification - not without its peculiar concerns regarding the quality of information etc. Something to be worked out in advance, methinks.
Also, "personal pandemic preparedness plans" (p4?) are useful ... to raise one's own awareness. But personally I believe it's even better to think of it in terms of "herd immunity" or at least "herd protection": if we cooperate, each of us has a better chance. And please let's keep in mind that the only protection is to isolate oneself completely from other humans - which would probably kill us faster - that's the "social disruption" the WHO talks about ("morbidity, mortality and social disruption"). Such disruption is caused precisely because we take preventive measures such as closing down schools or whatever - so how do we cope with the secondary effects of that? Tricky, but doable. We hope.
Maybe resilience can be used for things other than a flu pandemic? I mean, growing food locally certainly helps those who need to reduce travel, right? So we can tell folks it's just a hypothetical excersise we're working at, grab their attention, and get down to work. After all, either the virus is passed on or it isn't, and that's what matters from virus perspective.
Good inititive - let's see how it worked!