Complete Article Lists
Website Columns	Articles On the Web	Sandman In the News	Guestbook Comments	Video and Audio Files

Topical Indexes
Introduction & Orientation	Precaution Advocacy	Outrage Management	Crisis Communication	Infectious Diseases

What to Say When a Pandemic
Looks Imminent: Messaging for
WHO Phases Four and Five

by Peter M. Sandman and Jody Lanard

)

En Français: Quoi dire lorsqu’une pandémie paraît imminente:
Transmission de message pour l’OMS Phases Quatre et Cinq – Page 2 de 4)

Imminent Pandemic Standby Messages

This very long section will discuss the 25 messages we have come up with for deploying when a pandemic looks imminent. Before we start going through them one-by-one, here’s a list of all 25.

1.	It looks like a flu pandemic is about to start.
2.	It’s no longer about the birds.
3.	This is a new warning, more urgent than any warning so far.
4.	The experts still aren’t sure.
5.	We don’t know how bad it will be.
6.	Here’s what we know so far about the severity issue.
7.	It may be very bad. Society will survive, but it may be very bad.
8.	We may have a window of opportunity now to make some practical preparations. We must make the most of it – even though the effort may be wasted if a severe pandemic doesn’t happen.
9.	What matters most is how households, neighborhoods, community groups, and businesses prepare.
10.	Individual and community preparations will focus on three tasks – reducing each person’s chance of getting sick, helping households with basic survival needs during a pandemic, and minimizing and coping with larger societal disruption.
11.	Social distancing will be important but unpleasant.
12.	School closings present a particularly difficult social distancing dilemma.
13.	Hand-washing is far from a panacea. But it’s easy, it’s under your control, and it has no significant downside.
14.	Like washing your hands, wearing a facemask may help a bit. But it has more downside than washing your hands.
15.	Getting ready for a pandemic is largely about preparing for possible shortages.
16.	It’s probably too late to stockpile much now, but do what you can.
17.	Now is also the time to think about how you will care for loved ones at home.
18.	To get ourselves through the hard times that may be coming, we will need volunteers. How can you help?
19.	If the pandemic is severe, the hardest job won’t be coping with the disease itself. It will be sustaining the flow of essential goods and services, and maintaining civil order.
20.	Here’s what the government will be doing.…
21.	Try not to switch off. Try not to overreact.
22.	Even though we hope riots, panics, and other sorts of civil disorder will not be common, it is important to be on guard.
23.	We are going into this pandemic crisis determined to be candid. That means you need to expect bad news, confusing changes in policy, conflicting opinions, and conflicting information.
24.	Listen to stories about what 1918 was like, and to guesses about what the coming pandemic may be like.
25.	Here is some more information you may want to know.… Here is how you can get additional information… Here is how you can give us your feedback and suggestions.…

Imminent Pandemic Standby Message #1

It looks like a flu pandemic is about to start.

This is very important and very alarming news. Until recently, the influenza virus known as H5N1 or “bird flu” was deadly but not very contagious to humans. Only a few hundred people had caught it from birds, and only a handful had caught it from other people. Now that appears to be changing. People in ________ are catching it from each other in increasing numbers.

Most experts think this means that the H5N1 virus is probably not containable. It is likely to spread quickly throughout the world, transmitted from human to human. (That’s called a pandemic.) More than a billion people may catch it, and many of them – we can’t tell yet how many – will die. The potential for societal disruption is huge. And we may have only days to prepare.

This is obviously your news peg. Notice that it’s not enough to say that a pandemic is about to start. You have to tell people that this is an important and upsetting development, and you have to tell them why.

We have participated in many pandemic tabletop exercises. “Officials” in these exercises hardly ever warn the public early on that they are heading into a scary situation. Messaging accompanying the announcement of WHO Phase 4 and even Phase 5 has mostly ranged from purely factual (“here’s what we know and here’s what you should do”) to overtly reassuring (“we’re ready to manage this situation”).

There are three major downsides when officials fail to warn people about hard times to come:

The public suspects that the officials are hiding how worried they really are (which is often true), and wonders what else they are hiding.
Those who are frightened despite official reassurances are left alone with their fears instead of being guided through them.
Those who are persuaded by the official reassurances and remain unafraid miss the opportunity to adjust to the new situation. Instead of going through an early adjustment reaction, an “emotional rehearsal” that will help them absorb later bad news, they postpone their period of adjustment until the situation is dire.

All of these downsides reduce officials’ ability to help the public cope with the crisis when it arrives.

That’s how it usually plays out in tabletop exercises. When the exercise is debriefed, participants often note that, in hindsight, they wish their earlier messages had been more candidly alarming.

Imminent Pandemic Standby Message #2

It’s no longer about the birds.

Until it started spreading easily from human to human, the disease caused by the H5N1 influenza virus was called “bird flu.” It was a bird disease that was very difficult for people to catch. Whether we keep calling it that or not, H5N1 is no longer a bird flu. It has changed genetically and is now a human flu.

As with all human influenzas, people will now catch it predominantly from other people who already have it – mostly from droplets or aerosols when they sneeze or cough, sometimes from doorknobs or other objects they have touched. Since people are contagious with the flu before they feel sick, it will be virtually impossible to stop the spread of the disease.

If you catch this flu, in short, it will almost certainly be from a person. The problem isn’t going to be wild birds or pet birds or chicken dinners.

This wouldn’t be a terribly important message, except that so many people have “learned,” mistakenly and only half-consciously, that pandemics are spread by birds. This misimpression can be corrected only if it is explicitly acknowledged and rebutted. (It will help if officials take the blame rather than blaming the audience. “We gave you a misimpression by talking for years about bird flu pandemics,” for instance.)

The reason to correct this misimpression isn’t chiefly to protect poultry markets – though that, too, is worth doing. It’s more fundamental than that. A lot of people think they know what to do about bird flu: Stay away from birds. This false knowledge will be a powerful initial barrier to the public’s acceptance of more useful pandemic precautions.

It is conceivable that the H5N1 virus will mutate in a way that facilitates efficient bird-to-human transmission as well as human-to-human transmission. If that happens, and if the virus makes its appearance in local bird populations, then both birds and humans will be dangerous. It’s also conceivable that bird-to-human transmission will become efficient while human-to-human transmission remains difficult. That would be a “panzoonotic,” not a pandemic, but it would certainly be an unprecedented public health threat … from birds. Most experts consider these scenarios very unlikely, because they have never happened before as far as we know. But if they happen, obviously, “it’s no longer about the birds” won’t be the message.

Imminent Pandemic Standby Message #3

This is a new warning, more urgent than any warning so far.

For several years now experts have been warning that there will inevitably be a flu pandemic sooner or later. This is not just another such warning. It’s the difference between saying that there will always be hurricanes from time to time and saying that a particular hurricane is headed our way and (barring a miracle) will probably hit our town soon. But a pandemic, unlike a hurricane, heads every way at the same time. Barring a miracle, it will hit everywhere.

In tabletop exercises, official sources tend to neglect or downplay this crucial message. But without it, lots of people, and some journalists, will think they’re hearing another iteration of the same old warnings. At stake is an important principle of crisis communication: When officials change their interpretation of what’s happening, they need to say so explicitly. You don’t just stop saying X and start saying Y; you explain why you have moved from X to Y.

By this time WHO will have raised the pandemic phase – a readymade explanation for why you are sounding a louder alarm than your previous warnings. Of course you will also need to explain why WHO did what it did, and why you consider the change so important.

Imminent Pandemic Standby Message #4

The experts still aren’t sure.

The experts still aren’t absolutely sure a pandemic is inevitable. (Analogy: Sometimes a hurricane is headed your way but then fizzles out.) This is the first time scientists have been able to study the possible starting moments of a pandemic, so there’s no way to assess whether it might teeter on the edge and then fizzle, or whether it is already over the edge and will inevitably spread around the world.

Also, a last-ditch effort to contain the outbreak is underway. Most experts believe this “fire blanket” effort will fail, though they agree it’s worth trying.

There is enormous uncertainty about what will happen and how fast it will happen. Nevertheless, most experts are very, very worried.

It isn’t conventional to acknowledge uncertainty and expert disagreement when talking to the public. No matter how much internal debate precedes a decision, official sources usually choose to speak with confidence and to “speak with one voice” when announcing that decision. The concern, of course, is that any sign of indecisiveness or dissention might undermine not just this particular decision but also the public’s overall confidence in your ability to lead.

Despite this concern, most crisis communication experts agree that acknowledging uncertainty does more good than harm. They’re not so sure about acknowledging internal disagreement; “speak with one voice” often shows up on lists of crisis communication best practices, and our judgment that it is wiser to let the opinion diversity show is a minority position. (See Peter’s earlier columns on “Acknowledging Uncertainty” and “‘Speak with One Voice’ – Why I Disagree”)

On an issue this big, you really have no choice. If you try to suppress the doubts and disagreements, the word will get out anyway. And the story won’t be just that you’re not sure and even some of your own people disagree; the story will be that you tried to hide your uncertainty and internal dissent from the public. The resulting controversy will distract people from your precautionary messages, and will appropriately cast doubt on your candor.

Influenza is notoriously unpredictable, and every pandemic is different. Most messages about the next flu pandemic need to include acknowledgments of uncertainty and expert disagreement. The crucial Communication Phase 4 message that the next pandemic now looks imminent is no exception.

But won’t the public seize on all that uncertainty as an excuse not to take precautions? Those who are in denial may do exactly that – like a determined smoker who reasons that “if they’re not absolutely sure that cigarettes give you cancer, I guess I can keep smoking.” But most people become more worried, not less, when they learn how much uncertainty and expert disagreement there is. This increase in worry will certainly be appropriate at the possible start of a pandemic of unknown severity.

Here are three key points to keep in mind:

If the approaching pandemic really does fizzle, your reputation will suffer less if you were upfront about that possibility from the start. And your reputation is important to your ability to lead during the next crisis.
If you get caught suppressing uncertainty and dissent (and if you do it you will probably get caught), that will undermine your credibility, your ability to lead, and your precautionary recommendations – even if you turn out right about the approaching pandemic.
You are not going to get through a pandemic without making some “bad” decisions that you’ll later have to reverse based on new information. Best to establish from the outset that we’re all muddling our way together through a thicket of uncertainties.

None of this means you should let your acknowledgment of uncertainty overshadow your warning that a pandemic looks imminent. You need to find a middle ground between overconfidence and over-tentativeness. Either can undermine your effort to help people prepare.

But the more common mistake by far is overconfidence.

Imminent Pandemic Standby Message #5

We don’t know how bad it will be.

Even if we are on the brink of a pandemic, as most experts now think is likely, we still don’t know how severe the pandemic will be. Some pandemics are fairly mild; they infect a lot of people but kill comparatively few. Other pandemics are much more deadly, like the one in 1918.

Since it appeared in Hong Kong in 1997, the H5N1 bird flu virus has been extremely deadly to the very small number of humans who caught it. Now that it is spreading much more easily between people, the experts hope it will become much less deadly. But they don’t know yet whether or how much that will happen.

Note that this acknowledgment of uncertainty is very different from the one in #3. In the scenario we’re working on now, Communication Phase 4, most experts think a pandemic is probably imminent, but they’re not absolutely sure. By contrast, they really haven’t a clue yet what the case fatality rate is going to be. (The attack rate is also unknown, but that has varied less in past pandemics.)

Uncertainty, in short, isn’t a dichotomy. Some things are almost certain; some are completely unknown. The communication goal is to reproduce in the audience’s minds the same level of uncertainty the experts are currently experiencing.

Imminent Pandemic Standby Message #6

Here’s what we know so far about the severity issue.

Before it recently became more transmissible between humans, the H5N1 virus killed over half the people it infected. By contrast, viruses that caused the two most recent flu pandemics, in 1957 and 1968, killed roughly one percent of the people they infected – one fiftieth as bad. The worst flu in modern history, the 1918 “Spanish Flu,” is thought to have killed about 2.5% of infected people – much, much more severe than 1957 and 1968, but still about 20 times less deadly than H5N1 while it was spreading – rarely – from birds to humans.

Here’s the crucial question we can’t answer yet: When H5N1 changed genetically in a way that made it able to pass more easily from person to person, did that change also make it less deadly – and if so, how much less deadly? We are all (experts and officials and citizens alike) desperate to know the answer to this question, on which everything else depends. And yet we need to move forward, to make our preparations, without that all-important answer. All we have so far are fragmentary, unreliable hints.

The worst case scenario is almost unimaginably bad: a highly contagious H5N1 that remains just as deadly as when it wasn’t very contagious. Many experts consider that very unlikely, since no influenza pandemic has ever killed over half the people it infected. On the other hand, the H5N1 virus has broken other records and surprised experts many times already.

On the opposite extreme, the pandemic could turn out really mild and anti-climactic, leaving people to wonder what all the fuss was about.

Or, of course, it could turn out somewhere in the middle. Or the pandemic virus might start out mild and become highly virulent the second time it rolls around the world – or vice versa. We simply don’t know yet.

We’ll start to find out by monitoring how the new pandemic virus affects its first human victims – how the illness progresses, how it is transmitted, and how many die. Based on the preliminary evidence so far….

Severity is going to be the key question during Communication Phase 4. The fact that we will know a lot more in a few weeks won’t keep officials and citizens from demanding that the experts provide informed guesses in the meantime. Our messaging must empathically acknowledge how badly everyone wants the answer. And we must provide whatever fragments of the answer we have.

Telling people how deadly a pandemic might be when it hasn’t yet claimed its first few dozen victims is, of course, speculation. Some experts will refuse to speculate. Instead, they will insist on a wait-and-see approach. But the public will be desperate for early indications and expert judgments based on those indications. So will officials. No one can make intelligent decisions about how to prepare without a tentative, preliminary prediction of the pandemic’s severity.

The more extreme sources on both ends of the spectrum tend to be more willing to speculate. Reasoning from the 60%+ (bird-to-human) pre-pandemic case fatality rate, some will predict Armageddon. Reasoning from the historical record of the two most recent pandemics, others will predict a blip on the charts noticeable only to public health professionals and stressed-out hospital managements. Many experts closer to the middle of the distribution will find it uncomfortable – but essential – to join in the speculation. (See our column on “It Is Never Too Soon to Speculate.”)

As you speculate, remember the two key rules of responsible speculation. First, be emphatically clear that you’re speculating, that you don’t actually know the answer. And second, focus your speculation on two scenarios – the outcome you think is likeliest, and the worst outcome you think is credible. “What do you expect” and “what do you fear” are the anchors of responsible speculation. Along the way, be sure to mention the other scenarios too – the anticlimactically mild one (your fondest hope) and the incredibly horrific one (your darkest fear).

Imminent Pandemic Standby Message #7

It may be very bad. Society will survive, but it may be very bad.

While hoping for the best, we must prepare ourselves for the worst. That means taking what steps we can to get ready logistically, preparing to do what we can to reduce the death toll and preserve as much of normal life as possible.

It also means preparing ourselves emotionally and even spiritually. Many people have lived through devastating periods in the lives of their communities – natural disasters, wars, famines, etc. Many have not. If this turns out to be the start of a severe pandemic, the entire world will be severely tested. We will be frightened; we are frightened already, and with good reason. Our goal is to face whatever happens with courage, together. Our goal is to survive not just as individuals but as a society.

In the fortunate West, we have little recent experience helping societies prepare for widespread catastrophes. It may help to look back at the war speeches of Winston Churchill and even Abraham Lincoln. And we can look for role models from less fortunate countries.

The language of emotional determination doesn’t come naturally to most experts and officials. Why “resort” to this kind of language? Because people don’t only need help deciding what to do; they also need help deciding how to feel.

The run-up to a potentially severe pandemic will be a very fearful time. Authorities will need to legitimize the fear, not leave people alone with it. Along with providing factual information, they will need to show that they share the fear and are determined to bear it and take appropriate action. They will need to be emotional role models, not just sources of technical information and advice – and certainly not sources of over-reassurance. (See our earlier column on “Fear of Fear.”)

Imminent Pandemic Standby Message #8

We may have a window of opportunity now to make some practical preparations. We must make the most of it – even though the effort may be wasted if a severe pandemic doesn’t happen.

Even though we don’t know yet how severe the pandemic will be, even though we’re not absolutely sure that it will come at all, we must do what we still can to prepare. We don’t know how long we have before the pandemic (if it is a pandemic) engulfs us – days, weeks, conceivably even months.

In recent years we have emphasized pandemic preparedness as part of an all-hazards approach to emergency preparedness. It was one priority among many. And there was no time frame. Now we must focus on getting ready to endure a flu pandemic that looks imminent. We must put aside many other priorities until this crisis has passed. Now the time frame is urgent.

There is no guarantee that the urgent preparations now being recommended will in fact be needed. If this imminent pandemic fizzles out, or if it turns out mild, people will have spent a lot of money and emotional energy for very little benefit. The advice to prepare comes in spite of that fact.

In the face of uncertainty, we must all choose between two ways of possibly turning out wrong: the risk of over-preparing for a crisis that doesn’t come versus the risk of under-preparing for a crisis that does. One way of being wrong may end up wasting money and emotional energy; the other may end up killing people who might have been saved. Since most experts think a pandemic is probably imminent and may be severe, the risk of over-preparing is the wiser choice.

No matter how much we prepare now, if a severe pandemic does happen, we will all feel that we under-prepared. We know we may do more than will be needed if the pandemic is mild, and we know we cannot do as much as will be needed if the pandemic is severe. Neither of these facts should prevent us from doing what we can.

One crucial phrase here is “put aside many other priorities.” People will judge the seriousness of the situation largely by what their leaders decide to cancel or postpone to make room for final pre-pandemic efforts to prepare. Several years ago we urged the World Health Organization to dramatize the seriousness of its pandemic concern by publicly postponing a few other health campaigns to make room for pandemic preparedness efforts. That didn’t happen. The suggestion stands a better chance in Communication Phase 4, when a pandemic looks imminent.

The other crucial phrase in this message is “choose between two ways of possibly turning out wrong.” We have written often that pandemics happen from time to time, but over the course of known history a severe pandemic has to be considered a low-probability high-magnitude risk. (See particularly Peter’s August 2004 column on “Worst Case Scenarios.”)

When we get to Communication Phase 4, the probability of a pandemic will be very high, but the probability that it will turn out severe will be impossible to estimate. Under such circumstances it is neither honest nor effective to urge people to prepare by telling them that the coming pandemic is sure to be severe, or even that it is sure to come. The case for preparedness should be grounded in the unbearable cost of facing a severe pandemic unprepared, versus the far more acceptable cost of preparing unnecessarily. The public should be helped to face this preparedness dilemma squarely and resolve it wisely – not to imagine that there is no such dilemma.

Imminent Pandemic Standby Message #9

What matters most is how households, neighborhoods, community groups, and businesses prepare.

A severe flu pandemic will be different from most emergencies in two crucial ways. First, the whole world will be going through the pandemic at more or less the same time. As a result, there won’t be a lot of outside help – because there won’t really be any “outside.” And second, the flu spreads through contact with infected people, often before they are feeling or showing any symptoms. As a result, people will try to avoid other people as much as possible (“social distancing”), as a key way to slow the spread of infection.

Because of these two factors, many households will face the pandemic largely on their own. Federal, state, and municipal governments will help where they can, but neighborhoods and community groups will often be able to do more. And business preparedness will be absolutely essential to keep the infrastructure of society going – to make sure people have food, water, energy, medicines, and other essential goods and services.

This may be a hard message to deliver credibly. People have learned to expect, and demand, endless help from all levels of government. The response to HHS Secretary Michael Leavitt’s “you’re on your own” messaging in 2006 was mixed. Some listeners appreciated his candor; others resented what felt to them like passing the buck. And those were comparatively well-informed audiences, considering the matter abstractly with no pandemic in sight. A broader audience facing an imminent pandemic is more likely to resent the buck-passing than to appreciate the candor.

Nonetheless, a severe pandemic (if that’s what we get) will be the ultimate decentralizer. Leaders must not shrink from this message. One strategy that may help a little is called counter-projection: acknowledging the audience’s likely negative feelings. “I know a lot of people will accuse me of passing the buck. A government’s most fundamental job is to protect its citizens, and here I am telling you we can’t, you’ll have to do it yourself….”

The decentralization message will be easier to hear when it comes from those who are trying to fill the breach. We hope every neighborhood group, every fraternal order, every Parent-Teacher Organization, every church and mosque and synagogue, every block association, every local company and local union and local grange, will be ready with its “here’s how we think we can help” messaging.

Imminent Pandemic Standby Message #10

Individual and community preparations will focus on three tasks – reducing each person’s chance of getting sick, helping households with basic survival needs during a pandemic, and minimizing and coping with larger societal disruption.

There are three main strategies that can reduce a person's chance of getting sick in a pandemic:

social distancing;
hand-washing; and
masks and respirators.

Two main strategies can help individuals and families cope better with the illnesses and shortages a pandemic is likely to cause:

stockpiling; and
home health care.

Two other strategies aim at keeping the larger society going during a pandemic:

organizing civil society to facilitate the recruitment of volunteers; and
organizing work to focus on essential tasks and let nonessential tasks go undone.

The conventional wisdom is that there’s no place in mass communication for this kind of structural message: “There are three of these and two of those and two of those other.” We concede that short sound bites can’t be that organized; reporters gnash their teeth when sources like us (like Peter, really) start an answer with “There are three answers to that question….”

But when people’s thinking ability is stressed by strong emotion, they need more organizational help, not less. Many doctors find it useful to organize their instructions to patients: “There are five things I want you to do. Write them down, please!” While a TV news interview doesn’t lend itself to clear structural signposting, other media do. Your website is one example; a pamphlet or brochure is another. And if your TV news interview turns into hours of pandemic explanation, with lots of repetition of key message points, a couple of PowerPoint slides wouldn’t be amiss.

Imminent Pandemic Standby Message #11

Social distancing will be important but unpleasant.

Social distancing – avoiding crowds and keeping people apart whenever possible – cannot prevent the spread of influenza. But it may slow it down, which has two huge benefits if it works:

It decreases the number of people who are sick at the same time, which will lighten the load on hospitals and reduce absenteeism. Why is absenteeism important? Because we need to keep the society going; we need enough workers to sustain our power system, our water treatment system, our telecommunications system, our food distribution system, etc.
It buys time for the development of a vaccine.

The most obvious social distancing strategy is for people who are sick to stay away from people who are healthy. It is extremely important not to go out when you think you might have the flu.

Quarantines – keeping people who may have been exposed away from others for a few days – are not likely to slow the spread of the disease, except perhaps right at the start of the pandemic. So many people will have come into contact with flu victims that it will be impractical to quarantine them all until they know if they were infected. Some employers, however, will probably decide that employees whose family members are sick should stay home.

With the flu, people are infectious before they have any symptoms. Since we won’t know who is infected and who isn’t, social distancing will mean more than avoiding people who are visibly sick. It will mean coming into contact with as few people as practicable.

We encourage everyone to find ways to accomplish this goal. Obvious strategies include:

Closing schools.
Canceling public events, possibly even funerals and church services.
Arranging for people to work from home wherever possible.
Reducing trips to the market by stockpiling supplies and using delivery services.

The dilemma is that all these strategies disrupt normal life and increase social dislocation. So there will need to be compromises between social distancing and other important goals.

All too often in an emergency, people are told what to do without being told why. When they don’t comprehend the rationale behind the instructions, they are less likely to comply. They are also less able to adjust and innovate, to come up with alternative ways of meeting the same objectives. And they are less able to understand that when the situation changes, the instructions may change to match.

In a pandemic, many people will need to manage their own pandemic preparedness, deciding whether to obey or ignore official recommendations. And official recommendations are likely to change as we learn what works and what doesn’t in this particular pandemic. It will therefore be important to give people reasons, not just instructions.

Imminent Pandemic Standby Message #12

School closings present a particularly difficult social distancing dilemma.

Most local governments will probably close the schools if a severe pandemic is raging through their communities. There are several reasons for this. Schools have always been hotbeds of contagion; children pass infectious diseases to each other very easily. Influenza in particular spreads easily from child to child, and infected children bring it home to their families. In addition, some pandemic flu viruses have attacked children at a higher rate than the seasonal flu, and a higher rate than some other age groups. It may also be difficult to keep schools open if teachers and other employees are absent. And schools can’t do much useful teaching when many students are out sick.

But some experts argue that school closings may be only minimally useful, especially if students end up congregating in malls or at each other’s homes. There is also a concern that children not in school may strain the capacity of overburdened telephone and internet systems. Most important, if children are home instead of at school, many parents will need to stay home as well. With the flu itself keeping sick employees from their jobs, it will be all the more important for healthy employees to be free to go to work (or to volunteer for other essential tasks).

Attempts to increase social distancing by closing schools, in other words, may do a lot of good by keeping some children from catching and spreading the flu, and a lot of harm by keeping parents from taking on important work outside the home.

Unless emergency orders are issued by higher levels of government, every school system will have to resolve this dilemma for itself. If school stays open, every parent will have to choose whether to send the kids to school or keep them home. And every employer will have to judge how many of its employees are going to be home caring for their children.

This is a good example of the crisis communication strategy of dilemma-sharing. (See Peter’s April 2006 column on “How Safe Is Safe Enough: Sharing the Dilemma.”) Authorities usually face difficult dilemmas privately, make a decision, and then pretend publicly that it was a no-brainer. But there are many advantages to sharing the dilemma instead. It moderates the debate; it makes those who prefer another option feel respected; it makes it easier to change course if you turn out wrong.

When a decision hasn’t been made yet, it is sensible to share the dilemma before deciding. Maybe somebody will think of a good reason to decide one way instead of the other, or suggest a new choice that’s better than either. But even when the decision is a done deal, dilemma-sharing is feasible and useful. “This was a tough call. There were these good reasons to close the schools, and these good reasons to keep them open. We finally decided to [close them] [keep them open]. Here’s why….”

Page 1

Page 2

Page 3

Page 4

For more on infectious diseases risk communication:

What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five