Plan B: Turning organizations into
islands of pandemic influenza preparedness

Editor’s note: Peter Sandman, Deputy Editor of the CIDRAP Business Source, originally wrote this piece as an email response to my September 11 Osterholm Briefing, “The reality of pandemic planning: I’ve hit the ‘wall’ but I’m not giving up.” I have long considered Peter my personal mentor with regard to risk communication. In addition, his insights into pandemic influenza preparedness have been invaluable in helping shape my own thinking about this threat. He agreed to let us publish his response as a guest column. If you, too, have comments, please send them to source@umn.edu. You’ll find my response to Dr. Sandman’s comments at the end of the column.

—Michael T. Osterholm, Editor-in-Chief

Mike, I think your perspective on pandemic planning has evolved more gradually than your most recent Briefing suggests – you’re not so much hitting the wall as slowly adjusting to limits. But I definitely agree that neither government nor industry is likely to make pandemic preparedness a Manhattan Project priority. There will always be something more urgent, more certain, and more emotionally/politically/economically compelling to capture our attention.

The case for collateral preparedness

Of course you have always urged companies to focus on collateral effects. Even when you were more optimistic about pandemic preparedness becoming a priority for the United States and other developed nations, you were worried that they’d put too much emphasis on preparing medically for the virus and too little on preparing for nonmedical infrastructure threats and huge “secondary” impacts. I don’t think that’s a change.

Nor is the “triage” tone of your September 11 Briefing a change. You have been saying for several years that a pandemic will require triage. So have I. In the first column I wrote for CIDRAP Business Source, I urged readers to prepare not for business continuity, but for business discontinuity – the readiness to sacrifice most of what the organization does in order to sustain one or two essential activities.

As it becomes clearer and clearer that others’ preparedness is going to be inadequate, the case gets even stronger for emphasizing collateral effects and a triage approach rather than direct effects and a business continuity approach. But the case would still be strong even if everyone were worried about pandemics, even if you had your pandemic preparedness Manhattan Project.

The shift to island thinking

So what is new? I think it’s this:   You are conceding that most governments, companies, and individuals aren’t preparing adequately (if at all) and can’t be persuaded to do so. You’ll keep trying, but you predict failure. And that has a key implication for the people and organizations that are preparing.

It means they need to prepare to be islands of preparedness.

There are real differences between island preparation and preparation that assumes (or at least hopes) that neighbors, governments, employees, suppliers, and customers are also preparing. It means focusing on the things you really can do alone, on the goals that don’t require coordination. It means giving up on cooperation and a do-your-share mentality and replacing them with an every-organization-for-itself mentality.

This is extremely sad.

Questions organizations must be prepared to answer

The island approach means the key planning questions are these:

• If I hypothesize a pandemic striking a minimally prepared planet, what will conditions be like for my organization and my people?
• What can my organization accomplish on its own to get ready to survive those conditions and to help our people survive them?
• What if anything can my organization accomplish on its own to get ready to help our unprepared stakeholders (neighbors, customers, suppliers) survive?
• What can my organization do to prepare to protect itself when less prepared organizations try to seize our resources (when governments want to nationalize our influenza antivirals and our insulin, when neighbors want to take the stockpiles we have built for our employees and their dependants)?

What we can learn from “preppers”

The individual “prepper” community has been talking about the implications of island preparedness for several years already, and there is much to be learned on this topic from prepper websites. Some pandemic preppers were already survivalists; getting ready to go it alone was their natural inclination. Others were (and still are) more communitarian. They, too, slowly recognized that they had no choice but to get ready to go it alone – though there were grounds for hope and efforts aimed at expanding “alone” to mean their neighborhoods, not just their families.

For instance, many writers on websites like Flu Wiki have argued long and loud against official recommendations to stockpile only three days’ worth, or two weeks’ worth, of food and water. Now everyone can look at one city humbled but not destroyed by a hurricane – Houston – and see how valuable it would have been for more individuals and more local organizations to have built larger stockpiles. And of course preppers have long since figured out that self-sufficiency during a severe pandemic will be even more essential – and will need to last much longer – than self-sufficiency after a hurricane.

What I think you’re saying now is that the companies subscribing to the Osterholm Briefing (and the Osterholm viewpoint on pandemics) should explicitly plan to be the only organization around that has made a serious effort to prepare for a pandemic.

Connecting the islands later – if possible

If that overstates the case, if there end up being other local islands of preparedness, well, fine, we can build bridges. We’ll do everything we can to make it so. But we shouldn’t count on it.

Yes, as you say, companies should focus on collateral risks rather than just the influenza virus. And yes, companies should plan on discontinuity, not business continuity. But the real meaning of your hitting the wall, I think, is that companies should plan to be islands of preparedness, ready to help themselves, their employees, and, if possible, their near-neighbors in a sea of devastation.

An internationally renowned expert in risk communication and crisis communication, Peter Sandman speaks and consults widely on communication aspects of pandemic preparedness. Dr. Sandman, Deputy Editor of CIDRAP Business Source, has written many original articles for Weekly Briefing. Most of his risk communication writing is available without charge at the Peter Sandman Risk Communication Website, which includes an index of pandemic-related writing on the site.

Comments from the Editor-in-Chief

Thank you, Peter. You have provided a very thoughtful and helpful perspective on what I was expressing in my most recent column. You are quite correct in concluding that my thinking about the current status of pandemic preparedness has really been more of an evolution than an acute “hitting the wall.”

However, I think many of us on the front lines of business-related pandemic preparedness have been very reluctant to acknowledge publicly – even admit to ourselves – that we are reduced to hoping for only islands of preparedness as opposed to an increased level of community and business-wide preparedness. It clearly resets the preparedness expectation bar and confirms that the impact of the next pandemic will be far worse than need be, even without the availability of an effective vaccine.

While I recognize I had been coming to this position over recent months, I truly did hit the wall several weeks ago. Now, I’m willing to acknowledge our potential for future preparedness – or lack thereof – both personally and professionally. And my preparedness messages will reflect this change. Clearly the events of the past ten days – our financial markets and the subsequent government bailout discussions – only further support the conclusion that the resources for and commitment to pandemic preparedness in both government and the private sector have diminished even more.

To all readers, I welcome your feedback on either Peter’s or my comments and look forward to sharing your insights in my next column.

—MTO

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