The Fear Factor
Preparing the public for a major disaster like pandemic flu without inciting panic is tricky. But the truth goes a long way
Obsessed. When people become aware of a threat, they typically seek out information on it and start figuring out what to do. Some might obsess; Internet chat rooms are now awash with people debating the merits of various bird flu treatments or trading tips on how best to heat the house if fuel supplies are interrupted during a pandemic. But in most cases, risk experts say, people soon settle into a "new normal" and get on with life.
Preparing for a pandemic is problematic because even the experts don't know when it will hit or how bad it will be. "The case for taking precautions isn't that you expect the bad outcome," says Sandman, who has advised numerous countries, including the United States, on pandemic communications, "but rather that you can't afford to take the chance, and that it will be too late to protect yourself by the time you know whether the bad outcome is going to happen or not."
Until very recently, the federal government has been loath to scare its citizenry. Its draft pandemic flu plan, unveiled in 2004, talked of only a mild pandemic with 89,000 to 207,000 deaths in the United States, similar to the 1957 and 1968 pandemics. The report included statements that are astonishingly optimistic: "Pandemic influenza can be controlled by rapid, appropriate public-health action that includes surveillance, identification and isolation of influenza cases, infection control, and intense contact tracing. These measures can be a temporary inconvenience to those involved but are essential for containing a pandemic outbreak."
In fact, no pandemic has ever been controlled or contained. Although infectious disease experts are hoping to try to do that using vaccines and antiviral drugs, none of them are sure that those measures will work. A pandemic in which one third of the population falls ill, with waves of outbreaks lasting months, would be far more than a "temporary inconvenience."
But the final flu plan, released earlier this month, is much more dire. It estimates that pandemic deaths in the United States could approach 2 million, more on a par with the 1918 contagion. The plan also talks about the widespread breakdown in municipal services and social order that could occur, including the loss of public transportation and electricity, and food shortages.
Flu experts have criticized the U.S. plan for relying too much on the antiviral drug Tamiflu. No one knows if it would work against a pandemic flu strain, and even in the best-case scenario the United States would have enough for only about 1 in 4 people. A pandemic flu vaccine, another cornerstone of the federal response, wouldn't be widely available until 2010 at the earliest. But the final plan does acknowledge shortcomings: In a pandemic, communities would be on their own, with little or no help from state or federal authorities.
Over the summer, HHS polled 60,000 people and 20,000 doctors and asked them what they knew about avian flu or flu pandemics. The answer: not much. They also asked them what they thought about the department's "priority groups" for handing out a potential pandemic flu vaccine. Respondents were offended by the notion of priorities, even though they agreed that first responders like doctors should be at the head of the line. HHS now calls them "predefined groups."
In the next three months, HHS's Leavitt will travel to communities around the country, urging people to start querying their workplaces or neighborhood schools on how each would handle a pandemic. The risk, Sandman says, is having people turn around five or 10 years from now and say, "Why did you scare us? Why did we spend all this money? This pandemic was no big deal." But, he adds, "it is better to waste time, money, and emotional energy than to risk stumbling into a crisis unwarned and unprepared."
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