The introduction that follows was written and posted in 2014. Not surprisingly, infectious disease outbreaks didn’t stop then – some familiar, some new. Zika and monkeypox (later relabeled “mpox”) fit comfortably under SARS, “Ordinary” Flu, and Other Infectious Diseases. But COVID obviously needed its own section when I came out of retirement in 2020 to write about it.
As I post this intro to the intro in April 2024, bird flu still hasn’t gone pandemic. But it’s spreading to more and more species, most recently (and alarmingly) to cows in the United States. At age 79, I hope I won’t find myself coming out of retirement again to write about it.
Until 2003 my risk communication work only occasionally dealt with infectious disease outbreaks. Even when I got involved in the U.S. government’s response to the anthrax attacks and the possible threat of a smallpox attack, I saw myself as working on terrorism crisis communication, not infectious disease communication.
Then came SARS. Working jointly with my wife, physician Jody Lanard, I started helping the World Health Organization think through its communication efforts on SARS. Pretty soon Jody and I were writing about how various countries, especially Singapore and Canada, had handled their SARS outbreaks. By the time avian influenza caught my attention in January 2004, infectious disease outbreaks were one of my things. In the next couple of years, I had a chance to advise clients or write columns on a polio inoculation program, a hemorrhagic fever outbreak, a flu vaccine shortage, and the effort to “recall” a laboratory test kit that contained a potentially pandemic strain of influenza.
When Jody and I wrote our first pandemic flu column in December 2004, many experts thought a bird flu (H5N1) pandemic might well be impending and might well be catastrophically severe. Between 2005 and 2007 I added a lot of bird flu risk communication writing to this website … and to keep it all organized I added this “Pandemic Flu and Other Infectious Diseases Index.”
As of October 2014, bird flu still hasn’t gone pandemic. It still could. But in the meantime, we got the swine flu (H1N1) pandemic of 2009–2010, which aroused a lot of justifiable concern and then turned out anticlimactically mild.
Then came two false alarms in quick succession: H7N9 (a different bird flu) and MERS. And now, as I write this, an unprecedentedly huge Ebola epidemic in West Africa has sent sparks flying to Nigeria, Senegal, the U.S., and Spain. Those sparks look like they have been extinguished or are in process of being extinguished, but experts are justly worried not just about the ongoing catastrophe in West Africa, but also about what might happen if Ebola sparks ignite in cities that fail to extinguish them, giving us an Ebola pandemic that could spread from Mumbai to Mexico City, Cairo to Karachi.
One way or another, a lot of experts think infectious diseases are likely to be a big issue – and a big risk communication challenge – in the coming decades. Some of them I’ve yet to write about, including dengue, malaria, and chikungunya.
There’s another reason for a separate index. Pandemics and other infectious disease outbreaks don’t squeeze easily into my categories of crisis communication, precaution advocacy, and outrage management.
- Beforehand, the main task is precaution advocacy: trying to arouse concern and motivate preparedness even though there’s nothing bad on the immediate horizon.
- When a serious disease outbreak looks potentially imminent, wise risk communicators segue into pre-crisis communication, an amalgam of precaution advocacy and crisis communication. The trick is to get people ready for something that might be really bad, while simultaneously reminding them that it might also be no big deal.
- In the middle of a serious disease outbreak, the job is mostly crisis communication: helping people bear the outbreak and guiding them through it. But there’s also a lot of precaution advocacy aimed at the segment of the public that isn’t upset enough yet. And there’s a lot of outrage management, aimed at those who are excessively upset, upset about the “wrong” things, or appropriately upset about certain aspects of outbreak response (delayed or misleading information; overpromised and under-delivered protective measures; etc.).
- Afterwards, outrage management is the key. If the outbreak was severe, the outrage focuses on why officials didn’t prepare better and warn us more. If the outbreak was mild, the outrage focuses on why officials wasted money over-preparing, hyped the risk, and provoked unnecessary worry. Precaution advocacy regarding the next outbreak should also accompany the public post-mortem on the last one, though it often doesn’t.
For the most part I haven’t included bioterrorism articles in this index – my writing on the anthrax attacks, for example, can be found in the crisis communication index but not here. But I made some exceptions; I included my column on the risk of H2N2 terrorism here because it’s flu, and I included my columns on the U.S. smallpox vaccination program because it’s vaccination.
The first section of this index is entitled “Especially Important to Read.” These aren’t necessarily introductory articles. (I don’t write enough introductory articles.) They’re the ones I consider most important. All of them are also included under narrower subject headings in the sections that follow.
The second section is on Ebola. As I write this in October 2014, some experts think Ebola may become “The Big One” that bird flu, swine flu, SARS, and MERS all didn’t become. We’ll see. Meanwhile, I have put Ebola near the top because it’s current.
The third and longest section is devoted to “The Swine Flu Pandemic of 2009–2010” – a wonderful case study of every stage in pandemic communication, all applied to a pandemic so mild it was almost a practice exercise. There’s a subsection on “Major Articles.” Then come the “Swine Flu Pandemic Communication Updates” I added to this website periodically throughout the pandemic – almost daily at the start, every few months by the end. The last two subsections are “Other Articles” and “Guestbook Entries.”
(For the handful of readers who may want to immerse themselves in the swine flu risk communication case study, I have added a subsection with links to everything on the website in chronological order, starting with my first two-paragraph alert on April 24, 2009. Everything else is in reverse chronological order as usual.)
The fourth section is on “Influenza Pandemics other than Swine Flu” – which at least so far is mostly about the bird flu pandemic that has yet to materialize. Like the swine flu section, this section has subsections on “Major Articles,” “Other Articles,” and “Guestbook Entries.” There is also a subsection – placed second – containing my “Columns from CIDRAP Business Source Weekly Briefing,” a pandemic preparedness newsletter published in 2006–2007 by the Center for Infectious Disease Research & Policy at the University of Minnesota. Most of these columns are based – sometimes very closely based – on my longer bird flu risk communication writing for this website.
The final section is a catchall, with writing on “SARS, ‘Ordinary’ Flu, and Other Infectious Diseases.” It has two subsections, one with “Articles” and the other with “Guestbook Entries.”
Topical Sections in Infectious Diseases
The Swine Flu Pandemic of 2009–2010
Swine Flu Pandemic Communication Updates
Everything in Chronological Order
Influenza Pandemics other than Swine Flu
Columns from CIDRAP Business Source Weekly Briefing
Especially Important to Read
COMMENTARY: 8 things US pandemic communicators still get wrong
Posted on the website of the Center for Infectious Disease Research and Policy, December 10, 2021
On November 15, I gave a Zoom presentation to the Minnesota Department of Health on COVID risk communication mistakes that I believe are undermining trust in U.S. public health agencies. With the department’s permission, I revised the presentation into a “commentary” article for CIDRAP. The article covers eight mistakes: (1) Overconfidence and failure to proclaim uncertainty; (2) Failure to do anticipatory guidance; (3) Fake consensus; (4) Prioritizing health over other values; (5) Prioritizing health over truth; (6) Failure to own your mistakes; (7) Failure to address misinformation credibly and empathetically; and (8) Politicization. These are all points about public health risk communication that I have made before – some of them for decades – but seldom for audiences as big as CIDRAP’s. The link above is to CIDRAP’s PDF
on this site; CIDRAP’s website post is also available at the CIDRAP site.-
The CDC Tells More of the Truth than Usual about Flu Vaccine Effectiveness
Posted: February 1, 2013
Though far better than nothing, the influenza vaccine is surprisingly ineffective, working only 50–70% of the time in healthy young adults and significantly less than that in the people who need it most, the sick and the elderly. For years the CDC and other public health agencies have hyped flu vaccine effectiveness. And for years Jody Lanard and I have criticized the hype, fearful that it could ultimately undermine the credibility of flu vaccination, vaccination generally, the CDC, and public health itself. So we were surprised and delighted at the tenor of the CDC’s January 11, 2013 flu press briefing, which showcased a preliminary CDC finding that the 2012–2013 flu vaccine was only about 62% effective. It remains to be seen whether the CDC’s unprecedented candor is a one-off or the start of a new era. Either way, this column annotates the press briefing, finding much to praise and, inevitably, some things to criticize as well.
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Vaccination Safety Skepticism: Public Health’s Self-Inflicted Wound
Posted: January 30, 2011
When I was asked to do an interview for a documentary on vaccines and vaccine safety, I agreed on condition that I be allowed to post the entire interview online. I focused my comments on public skepticism about vaccine safety – and especially on what vaccination proponents do that exacerbates the skepticism and what they can do to ameliorate it. The interviewer’s questions have been edited out, but the rest is here, uncut, in three parts.
- Part 1 (37 min.)
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Part One discusses: the kinds of vaccination audiences – apathetic versus hostile; suppressing the other side’s 5% of the truth; being empathic and being accountable; and other risk communication aspects of vaccination safety skepticism.
- Part 2 (29 min.)
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Part Two discusses: vaccination/autism controversies; who’s in charge of vaccine safety research; what’s left out of flu vaccination messaging; and other risk communication aspects of vaccination safety skepticism.
- Part 3 (36 min.)
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Part Three discusses: lying about polio; different messaging for different audiences; why “good guys” mislead more; and other risk communication aspects of vaccination safety skepticism.
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The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives
Posted: June 29, 2010
In June 2010, one year after the World Health Organization declared swine flu a full-fledged pandemic, WHO’s credibility nosedived as even mainstream sources began to take seriously the absurd allegation that WHO had invented a “fake pandemic” in order to enrich the pharmaceutical industry. This column assesses at great length the three main reasons why this allegation made the move from fringe to mainstream: (a) WHO’s failure to acknowledge the ongoing mildness and current low incidence of the pandemic; (b) WHO’s failure to acknowledge that it changed some flu pandemic definitions and descriptions just as H1N1 was emerging; and (c) WHO’s failure to acknowledge until recently the legitimacy of concerns about transparency and conflict of interest. In a nutshell, the credibility of the World Health Organization crashed and burned because WHO mishandled some essential aspects of pandemic risk communication.
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Why did the CDC misrepresent its swine flu mortality data – innumeracy, dishonesty, or what?
Posted: February 2, 2010
Communication Professor Rob Ulmer wrote to me after reading my Swine Flu Pandemic Communication Updates for December 2 and December 15, in which I accused the CDC of misrepresenting its own data about swine flu severity, both overall and for specific age groups. Dr. Ulmer attributed the misrepresentation to innumeracy rather than dishonesty. This long Guestbook entry presents my evidence that the misrepresentation was intentional; my observations and speculations about why “good guys” so often feel entitled to mislead in a good cause; some previously unpublished CDC data about age-specific swine flu population mortality rates; and Dr. Ulmer’s continued conviction that innumeracy rather than dishonesty is probably the culprit.
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U.S. Pandemic Vaccine Supply and Distribution: Addressing the Outrage
Posted: November 18, 2009
As in most other developed countries, the fall rollout of the U.S. pandemic vaccination program has been hampered by a shortage of vaccine. The result is outrage – outrage that there isn’t as much vaccine as people wanted and expected, and outrage that the distribution process feels so chaotic, frustrating, and in some cases unfair. The shortage itself is nobody’s fault; the vaccine virus turned out to be difficult to grow. But officials are very much at fault for having overpromised, frequently predicting that there would be ample vaccine by mid-October. Even before the pandemic began, in fact, the meme was established that it would require only three to six months after the emergence of a pandemic influenza strain to manufacture sufficient vaccine. Managing public (and health care provider) outrage about vaccine supply and vaccine distribution has thus become an important pandemic risk communication task, a necessary distraction from the paramount task of convincing people to get vaccinated. This column describes how officials are handling the outrage so far, and proposes some improvements.
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The meme that this pandemic is “like the seasonal flu”
Posted: October 23, 2009
Like many public health officials around the world (and in the U.S.), officials in Italy often say the ongoing pandemic is “like the seasonal flu.” An Italian science journalist wrote to ask if I share her objections to making the pandemic sound “normal” in this way. I do – and this Guestbook response, written jointly with my wife and colleague Jody Lanard, explains why. Equating the two is technically inaccurate. For example, the pandemic virus is less dangerous than the seasonal flu to seniors, but more dangerous than the seasonal flu to younger people. And the pandemic virus is more likely than the seasonal flu viruses to mutate suddenly into a more virulent strain. Ignoring differences like these is a way of normalizing the pandemic, presumably in order to avoid frightening the public. Like over-reassurance generally, it does harm if it works (because people don’t protect themselves enough) and harm if it doesn’t work (because people learn to mistrust public health officials).
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Distributed by Project Syndicate, July 27, 2009
Project Syndicate is a nonprofit organization that distributes op-ed commentaries on currently hot topics to newspapers around the world, free of charge. They asked me to do one on how public health officials ought to be communicating with the public about the ongoing H1N1 pandemic. The resulting piece briefly discusses nine mistakes officials should stop making: don’t feign confidence; don’t over-reassure; don’t worry about panic; don’t obsess over accusations of fear-mongering; don’t fight the adjustment reaction; don’t oversell what the government is doing; don’t oversell what the public can do; don’t ask the impossible; and don’t neglect the teachable moment.
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Containment as Signal: Swine Flu Risk Miscommunication
Posted: June 29, 2009
The swine flu pandemic started in North America, and by the time the virus was identified it was already widely seeded in the U.S. So the experts judged that it was too late to try to “contain” its U.S. spread; from Day One, the U.S. was focused mostly on coping with the disease, not stopping or even slowing it. Outside North America, on the other hand, an initial containment strategy made public health sense. But containment isn’t just a public health strategy. It is also a risk communication signal of enormous importance. Containment sends a signal that the pandemic can be contained and that it must be contained – that it is stoppable and severe. Instead of countering these misleading signals, the governments of many countries have issued misleading messages to match. This is doing significant damage to the world’s preparedness to cope with the unstoppable (and soon to be pervasive) but so far mild pandemic that is just beginning.
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Swine flu worst case scenarios: warn people now or wait till things start getting nasty?
Posted: May 30, 2009
This description was written when it was unclear whether swine flu was going to turn more severe or stay mild. It stayed mild, but I’ve left the blurb unchanged. Dan Rutz, a communication professional at the U.S. Centers for Disease Control and Prevention, wrote to challenge my view that the CDC (and other authorities) should do more to help people imagine what a severe pandemic might be like, and to motivate people to prepare for the possibility that one might be coming. He argued that warning about worst case scenarios right now, when swine flu has turned out mild so far, is both unkind and futile. Worse, it is likely to squander credibility that will be needed if a severe pandemic does start to look imminent. I responded, and Dan annotated my response. The result is a dialogue that makes both viewpoints clear. Dan also proposed a compromise: Include worst case scenarios as one of the uncertainties mentioned, but without undue emphasis. And “give people permission to stockpile food, etc., but don’t push it on everyone; that way, we’re respecting those who choose to be cautious, but not antagonizing those who decide to wait it out a bit longer.”
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Is swine flu moving slowly? Did the authorities overreact? What should the key messages be now?
Posted: May 10, 2009
A reader expressed doubts about my judgment that swine flu is spreading slowly so far, and accused me of prematurely deciding the authorities had overreacted to the outbreak. My response stresses that I agree with the reader – fervently – that swine flu may yet turn into the virulent, snowballing pandemic we all fear, and that the authorities didn’t overreact at all. If anything, I think they have underplayed the threat, and especially the need to prepare. But I argue nonetheless that so far this swine flu epidemic is mild and it is spreading slowly – facts that many people mistakenly see as evidence that the authorities overreacted. That makes it much harder to persuade people to prepare in case things get worse. Warnings about how bad swine flu could get, I conclude, won’t be credible unless they’re accompanied by acknowledgments that, so far, it’s not as bad as we initially feared … and still fear.
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Posted: April 29, 2009
This was my first substantial piece of writing about swine flu. I have resisted the temptation to update the description that follows. When I started criticizing the government for talking about swine flu as if there were nothing for the public to do but watch and practice good hygiene, we were at WHO Pandemic Phase 3. When I started this column (this morning) we were at Phase 4. When I finished the column (this evening), it was already Phase 5. The focus of this column is why the U.S. government is reluctant to urge the public to prepare now for a possibly imminent pandemic, and why I think the government should overcome its reluctance and do it! If you’re skeptical about advising people to imagine The Big One, get used to that knot in their stomachs, and then get started on preparedness, read this column. If you’re not skeptical and want to know what I think the important messages for right now are, skip this column and instead read “What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five..”
On May 21, 2009, Nature published a major abridgment and minor updating of this column under the title “Pandemics: good hygiene is not enough.” An Adobe Acrobat file (707-kB pdf) of the complete article
is available. (Note: The Nature links require payment. Free access to a copy is available.) French translations of my column and the Nature article, originally posted on the website Zone Grippe Aviaire (which has disappeared) are also available on this site.
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What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five
Posted: March 15, 2007
If and when a serious pandemic arrives, messaging will shift from precaution advocacy (high-hazard, low-outrage) to crisis communication (high-hazard, high-outrage). There will be a transition period between the two, when the pandemic looks imminent and outrage is rising fast. This very long column – split into four parts – identifies 25 “standby messages” for that transition period. It elaborates both the messages and their risk communication rationales. Jody Lanard and I wrote the column with two goals in mind: to help officials prepare their communications for the early days of a pandemic that looks like it might be severe, and to help them decide to be more candid (and thus more alarming) in their pre-pandemic communications now in order to make those early days less of a shock.
A French translation of the 25 messages, originally posted on the website Zone Grippe Aviaire (which has disappeared), is now available on this site.
French translations available
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Bird Flu, Pandemic Flu, and Poultry Markets: Playing Ostrich or Talking Turkey?
Posted: May 29, 2006
When the next influenza pandemic finally arrives, it will be carried by people, not birds. In the meantime, the public is understandably confused about the distinction between the “bird flu” that threatens poultry flocks and the poultry industry (and an occasional unlucky person) right now and the “bird flu” that may someday mutate to facilitate human-to-human transmission and threaten us all. In this column, Jody Lanard and I try to disentangle bird flu from pandemic flu. And then we address the most common risk communication errors committed by government and industry in virtually every country beset by bird flu, when they set out to convince consumers not to worry and not to stop eating poultry.
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The Flu Pandemic Preparedness Snowball
Posted: October 10, 2005
I published this column in late 2005, when the U.S. public’s interest in pandemic preparedness was as high as it’s been so far. This was the teachable moment, I wrote. It wouldn’t last, so preparedness advocates needed to make the most of it. The column discusses nine recommendations to improve pandemic preparedness advocacy. Among the highlights: Focus less on the pharmaceutical fix; focus more on worst case scenarios, non-medical preparedness, and non-governmental preparedness; stop implying that a pandemic is imminent. Much of this advice is relevant even in periods of diminished attention, and most of it will still be on-target the next time pandemic preparedness is hot.
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Bird Flu: Communicating the Risk
Published in Perspectives in Health (Pan American Health Organization), vol. 10, no. 2, 2005, pp. 2–9
PAHO asked us to combine a primer on risk communication with a primer on avian influenza. The resulting article talks about the challenge of alerting the public to bird flu risks, then offers ten risk communication principles, each illustrated with bird flu examples. The PDF file also includes the cover, an editor’s note entitled “Communication: risky business,” and the contents page. (Note the confusion of “bird flu” with pandemic flu in this 2005 article – and this blurb, also written in 2005.)
(There is an online version (same text, but easier to read than a PDF file) posted on the PAHO website. The entire issue is also there.
Spanish translation available
Traducción en Español: La gripe aviar: cómo comunicar el riesgo
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Superb Flu Pandemic Risk Communication: A Role Model from Australia
Posted: July 6, 2005
On May 2, 2005, Australian Health Minister Tony Abbott gave a speech on pandemic preparedness. It wasn’t especially earthshaking; in fact, it attracted fairly little media attention. But Jody Lanard and I thought it was terrific – candid, alarming, tentative, all the things most official pandemic presentations were not (and are not). So we sat down to annotate the speech in terms of 25 crisis communication recommendations we had published previously. If you just read the speech, you’ll discover that good risk communication can sound just as ordinary as bad risk communication. If you read the column’s annotations, you’ll discover how extraordinary this particular speech really was.
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Pandemic Influenza Risk Communication: The Teachable Moment
Posted: December 4, 2004
This is the first column Jody Lanard and I wrote about pandemic preparedness. We wrote it when many experts believed a devastating H5N1 flu pandemic might be just around the corner – and so we thought so too. (We still think the risk is serious, but there’s much less sense of imminence as I write this blurb in mid-2008.) The thrust of this long column is how to sound the alarm. After a primer on why H5N1 is “not your garden variety flu,” the column proposes a list of pre-crisis pandemic talking points. Then it assesses how well experts and officials were addressing those points as of late 2004. The experts, we wrote, were doing their best to arouse the public. But governments and international agencies were undermining the sense of urgency with grossly over-optimistic claims about pharmaceutical solutions.
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Posted: August 28, 2004
Most of this long column is addressed to risk communicators whose goal is to keep their audience unconcerned. So naturally they’d rather not talk about awful but unlikely worst case scenarios. The column details their reluctance even to mention worst case scenarios, and their tendency when they finally get around to discussing them to do so over-reassuringly. It explains why this is unwise – why people (especially outraged people) tend to overreact to worst case scenarios when the available information is scanty or over-reassuring. Then the column lists 25 guidelines for explaining worst case scenarios properly. Finally, a postscript addresses the opposite problem. Suppose you’re not trying to reassure people about worst case scenarios; you’re trying to warn them. How can you do that more effectively?
COVID-19 (SARS-CoV-2)
Flu vs COVID: Stark Disparity in Vaccination and Deaths
Published in Medscape, May 2, 2024
Another COVID Booster Versus Your Annual Flu Shot
Email from Peter M. Sandman to freelance medical writer Sara Novak, April 23, 2024
On April 22, 2024, freelance medical writer Sara Novak emailed me to request an interview for “a story for Medscape on the flu and COVID and why the perspective is different on vaccination even though it’s deadlier.” I suggested she send me a few questions that I could answer in writing, which she did. Her questions focused on why patients who get their flu shots routinely are less compliant about COVID boosters, and on how I thought doctors could best persuade them to get the boosters. She used a few quotes from my April 23 answers in her May 2 article.
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What Goes Into an Expert’s Expert Judgment Other Than That Expert’s Expertise (with COVID examples)
Panel presentation (via Zoom) at a conference on “COVID and the Academy: What Have We Learned?” Heterodox Academy Research Symposium, Stanford, California, February 23, 2024
The Heterodox Academy (HxA) has the important mission of fostering respectful debate that includes people with unpopular opinions, especially in academia. So I was delighted and flattered when an HxA official invited me to speak at a February 23, 2024 day-long conference on “COVID and the Academy: What Have We Learned?” I couldn’t make it to the conference venue at Stanford University, but we agreed that I would speak via Zoom, one of three participants in a panel of social scientists. My title was “What Goes Into an Expert ’s Expert Judgment Other Than That Expert’s Expertise.” I covered eight points, all points I have written about before (especially here), but not all in the same place and not illustrated with COVID examples. Since I was assigned only 20 minutes (and graciously granted 31), the speech was sketchy, especially toward the end – so I am also posting my much-less-sketchy notes for the hour-long speech I wished I could give.
Link to the offsite video of the presentation on YouTube (with a machine transcript) (31 min.)
Link launches an on-site audio file of the presentation (44MB, 31 min.)
Link launches an on-site file with the presentation PowerPoint slides (95kB) Link to my much more extensive “notes” for the longer presentation I couldn’t give -
Email from Peter M. Sandman to freelance medical writer Lisa Rapaport, February 2, 2024
On February 1, 2024, freelance medical writer Lisa Rapaport emailed me with four questions for a story she said she was writing for WebMD, “focused on current trends in deaths and vaccinations for COVID versus flu.” All four of her questions were about COVID; two of the four were about COVID vaccination (COVID boosters, really); two had an explicit comparison to flu. I answered three of the four the next day. (One was outside my expertise.) That was more than a month ago, so I figure the story never got published, maybe never got written. Rather than see my effort go for naught, I’m posting the Q&A here.
Risk=Hazard+Outrage: Some Risk Communication Basics (and some COVID comments) – 2024 Edition
Class presented via Zoom to Prof. Michael Osterholm’s course on “Emerging Infectious Diseases: Current Issues, Policies and Controversies,” University of Minnesota School of Public Health, February 5, 2024
Prof. Mike Osterholm of the University of Minnesota Center for Infectious Disease Research and Policy periodically asks me to give a Zoom class on risk communication for his School of Public Health graduate course on “Emerging Infectious Diseases.” I previously posted the March 21, 2022 “edition.” You can access the video, audio, and slide set there.
This is the February 5, 2024 edition. The main difference is this time I got permission to include an audio of the 83-minute Q&A that followed my presentation. This Q&A pretty much ignored my hazard-versus-outrage basics and focused on what went wrong in COVID risk communication. The class reading assignment had included two of my pre-COVID articles on public health dishonesty (here and here), so there was discussion of that topic too. I recorded the Q&A on my phone, so my answers are clear but the students’ questions are barely audible.
Another difference: This time I'm also posting Zoom’s machine transcript of the presentation, for those who’d rather read than watch or listen.
The content of the Q&A is new, of course, but the presentation itself is mostly my trademark explanation of the distinction between hazard and outrage and the resulting paradigms of risk communication: precaution advocacy, outrage management, crisis communication, and public participation. Along the way and at the very end I commented on COVID implications of the various paradigms … a little of which did change between 2022 and 2024.
Link to the offsite Zoom file on Vimeo (66 min.) Link launches an on-site audio file of the presentation (92MB, 66 min.)Link launches an onsite file with the PowerPoint slides (229 kB)
Link to an on-site file with a machine transcript of the presentation (60kB)
Link launches an on-site audio file (71MB, 81min.) of the Q&A following the presentation Why I Hope the COVID Pandemic Isn’t Over
Posted on MedPage Today as a “Second Opinion,” January 24, 2024
News stories and opinion pieces about COVID-19 rarely call it a pandemic anymore, except in the past tense. The ever more popular claim that the pandemic is over is routinely deployed as a reason not to take precautions, while the dwindling minority who disagree are dissed as doomsayers. I think this gets things exactly backwards. COVID is still killing more people than flu. If the pandemic is over, the current death rate is the new normal – whereas if the pandemic isn’t over yet, we have grounds to hope that the COVID death rate will keep dwindling before a better new normal materializes. It’s a pretty minor point, but it bothered me. So one morning I sat down to write an op-ed about it, which MedPage Today was happy to post.
Let’s Stop Insulting Each Other as ‘Anti-Science’
Published in Bloomberg, October 22, 2023
Public Health Lost the Public’s Trust, Especially on the Right – and Blames “Anti-Science”
Composite of two emails from Peter M. Sandman to Bloomberg Opinion columnist Faye Flam, October 10 and October 12, 2023
As the pandemic emergency subsided, I returned to near-retirement; I haven’t posted anything specifically on COVID since late December 2022. But on October 10, 2023, Bloomberg Opinion columnist Faye Flam (who now writes as “F.D. Flam”) decided to write a column about a new book by vaccine scientist Peter Hotez entitled The Deadly Rise of Anti-science: A Scientist’s Warning. She asked for my opinion. I hadn’t read the book, but I had read enough of Peter Hotez’s views on the topic to respond. I answered in two emails, focusing on how public health’s COVID policies undermined public trust – especially on the right; and how self-defeating it was for the public health profession to blame “anti-science” instead of assessing its own errors. Faye’s October 22 column made some use of both emails. I am posting a lightly edited composite of the two.
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COVID Precaution Decision-Making: 15 Theses
Posted: December 29, 2022
I am hard-pressed to claim that this is about risk communication – or even that it’s a column. It’s more a cri de coeur – a list of theses (just 15, not 95) that I’d like to post on CDC’s door. As we enter our fourth COVID calendar year, these theses feel to me like obvious but neglected truths about COVID precaution decision-making. I fervently believe that we would all have fared better in the pandemic if we had taken these theses to heart, and if those in authority over us had taken them to heart. Sadly, I suspect that COVID is not yet done with us, so we will have additional opportunities to reconsider how we make COVID precaution decisions. And sadly, I suspect my 15 theses will remain neglected. I can’t even imagine a place to publish them, except here.
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Ron DeSantis Vaccine Complaint Exploits Public Health Gaffes
Published in Bloomberg, December 17, 2022
Reassess How Public Health Oversold COVID Vaccination – But Not the DeSantis Way
On December 15, 2022, Bloomberg Opinion columnist Faye Flam emailed me for my views on “this recent move by [Florida Governor] Ron DeSantis to investigate the mRNA vaccines via grand jury.” I wrote back that I thought COVID vaccines had been oversold in ways that undermined trust, and I would welcome a neutral or pro-vax investigation of this COVID vaccination dishonesty – but the investigation DeSantis was proposing looked one-sidedly antivax and far from the needed corrective. Faye's follow-up email suggested that in some ways COVID vaccination had been undersold. In my second response I addressed that, and elaborated on public health’s inadequate guidance about who should consider not getting an mRNA COVID shot. Faye’s column made only a little use of my two emails.
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COVID Language Traps
Posted: August 30, 2022
COMMENTARY: Navigating COVID Language Traps
Posted: August 30, 2022
On June 15, 2022, Bloomberg Opinion columnist Faye Flam emailed me that she was writing an article on “confusing or misleading terms or expressions surrounding Covid,” and invited me to weigh in. That started me off on what promised to be an endless catalog of what I decided to call “COVID Language Traps.” I sent Faye a longish response on June 20, parts of which she used in her June 29 column, “Fuzzy Language Is Setting Back the Fight Against Covid.”
I kept writing. I could be writing still, but after topping 11,000 words (in thirteen entries) I decided enough was enough. Then I pared the piece down to less than 5,000 words (in nine entries), which the University of Minnesota Center for Infectious Disease Research and Policy agreed to publish (with some minor editorial changes). Both versions are posted on this site. The original has entries on misinformation, mask, airborne, immunity, herd immunity, natural immunity, sick/ill/illness/disease, case, booster, rare/common, significant, emergency, and pandemic/endemic.
Why the WHO took two years to say COVID is airborne
Published in Nature (vol. 604, pp. 26-31) and posted on the Nature website, April 6, 2022
Email from Peter M. Sandman to journalist Dyani Lewis, August 5, 2021
On August 2, 2021, I got an email from journalist Dyani Lewis about an article she was writing for Nature. “The WHO has been criticized,” she wrote, “for being slow to acknowledge aerosol transmission of SARS-CoV-2 in non-healthcare settings, and now that they have changed their stance, for not adequately communicating that to the public.” Referencing some of my earlier writing about WHO communications regarding SARS and swine flu, she wanted to know what I thought about “the way that the WHO handled the uncertainty regarding airborne transmission of SARS-CoV-2.” My August 5 email in response discussed five reasons why WHO might have hesitated to acknowledge aerosol (airborne) transmission. My email also mentioned my wife and colleague Jody Lanard, so Dyani later interviewed Jody by phone. Her extensive article, “Why the WHO took two years to say COVID is airborne” was finally published on April 6, 2022. It had a lot of sources, including my email and Jody’s interview. I have made a few clarifying edits in the email, but it’s basically what I sent Dyani in August 2021.
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Risk = Hazard + Outrage: Some Risk Communication Basics (and some COVID comments)
Class presented via Zoom to Prof. Michael Osterholm’s course on “Emerging Infectious Diseases: Current Issues, Policies and Controversies,” University of Minnesota School of Public Health, March 21, 2022.
Michael Osterholm of the University of Minnesota Center for Infectious Disease Research and Policy periodically asks me to give a Zoom class on risk communication for his School of Public Health course on emerging infectious diseases. The most recent one on March 21, 2022 was recorded (except for the wonderful Q&A) – so here it is.
It’s mostly my trademark presentation on the distinction between hazard and outrage and the resulting paradigms of risk communication: precaution advocacy, outrage management, crisis communication, and public participation (stakeholder consultation). Along the way and at the very end I commented briefly on COVID risk communication.
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Public Health Tells Noble Lies
Posted: March 4, 2022
I have long believed that do-gooders in general and public health professionals in particular endanger trust by telling too many “noble lies,” prioritizing their altruistic goals over truth. That belief has figured in my writing and consulting for decades – and it figured in my writing and consulting about COVID as well. In December 2021 an opinion editor at the New York Times invited me to submit an op-ed on how COVID messaging prioritized health over truth. After the Times turned it down, I shopped it around to a number of other newspapers and online publications, some general-interest and some health-focused, updating as appropriate. Nobody wanted it. At least part of the reason, several editors told me, was a fear that antivaxxers would weaponize my claim that public health officials and experts are liars. (One acknowledged the irony that she too was prioritizing health over truth.) So here it is, previously unpublished. Freed from publishers’ length restrictions, I’ve added a little extra detail, but it’s basically the op-ed nobody wanted.
Two Messaging Suggestions: “Let’s Enjoy the Lull” and “We’re Not All in the Same Pandemic”
Amalgam of two emails from Peter M. Sandman to Vox politics reporter Li Zhou, February 7, 2022
On February 7 Vox politics reporter Li Zhou emailed me to ask if I had any suggestions vis-à-vis “Democrats’ current messaging about the pandemic.” Dozens of suggestions came to mind. I picked two for a quick response: “Let’s enjoy the lull” and “We’re not all in the same pandemic.” Li asked two follow-up questions, leading me to expand on my thinking. When her article appeared a few days later, I wasn’t in it. This amalgam combines my two emails (and leaves out some of the second email that I decided I didn’t like).
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Posted on the Daily Mail website, February 7, 2022, with a February 8 update
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Wearing an Unnecessary Mask Outdoors Isn’t a Big Deal Even If You’re President
Email from Peter M. Sandman to Daily Mail editor Wills Robinson, February 7, 2022
The Daily Mail is a British right-leaning tabloid newspaper. It has run several articles critical of President Biden for wearing a mask against COVID under conditions when no mask was required or needed – e.g. outdoors and uncrowded. On February 7 one of its New York editors, Wills Robinson, emailed me that the paper was about to run another such article, and invited me to comment. My response explained why I thought Biden wearing an unnecessary mask was no big deal. The story appeared without my comments. On February 8 I sent Wills a slightly snarky email that apparently mine was the wrong viewpoint for the Daily Mail. At his instigation a February 8 updated story included much of what I had written.
8 Things U.S. Pandemic Communicators Still Get Wrong
(Note: This link launches an MP3 audio file (110MB, 1 hr. 20 min.) on this site.)Presentation via Zoom to the Council of State and Territorial Epidemiologists, January 11, 2022
This 80-minute presentation addresses eight COVID risk communication mistakes that I believe are undermining public trust in public health: overconfidence and failure to proclaim uncertainty; failure to do anticipatory guidance; fake consensus; prioritizing health over all other goods; prioritizing health over truth; failure to own your mistakes; failure to address misinformation credibly and empathetically; and politicization.
To listen to specific segments:
- Overconfidence and failure to proclaim uncertainty (11:22)
- Failure to do anticipatory guidance (18:29)
- Fake consensus (25:26)
- Prioritizing health over all other goods (33:13)
- Prioritizing health over truth (42:55)
- Failure to own your mistakes (53:40)
- Failure to address misinformation credibly and empathetically (59:13)
- Politicization (1:14:28)
The presentation got its start as a November 15, 2021 Teams presentation to the Minnesota Department of Health. That was revised into a December 10, 2021 commentary for the University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP), available both on the CIDRAP website and on this website
. I revised it some more for the CSTE presentation. An additional hour of discussion was not taped.CDC leader faces precarious political moment
by Nathaniel Weixel, posted on The Hill website, January 10, 2022
Email from Peter M. Sandman to Nathaniel Weixel, healthcare reporter for The Hill, January 10, 2022
Early January 2022 saw a spate of news stories on the pandemic messaging missteps of the U.S. Centers for Disease Control and Prevention (CDC). On January 10, I received an email from Nathaniel Weixel, a healthcare reporter for The Hill, asking for comment specifically on the January 7 news conference of CDC head Rochelle Walensky, her first solo “presser” (not part of a White House event) since summer 2021. I had written before on how best to resuscitate CDC’s reputation. This time I focused on urging CDC to set itself up once again as the agency most willing to explain scientific and policy complexities to reporters, however long it takes, however hostile or ignorant or repetitive the questions might be. And I emphasized that rebuilding trust requires acknowledging prior screw-ups. Being candid, apologetic, and detailed is a more trust-building strategy for CDC than always working to sell its bottom-line recommendations with “misoversimplified” rationales. As usual, Nathaniel used only a couple of paragraphs from my response.
COMMENTARY: 8 things US pandemic communicators still get wrong
Posted on the website of the Center for Infectious Disease Research and Policy, December 10, 2021
On November 15, I gave a Zoom presentation to the Minnesota Department of Health on COVID risk communication mistakes that I believe are undermining trust in U.S. public health agencies. With the department’s permission, I revised the presentation into a “commentary” article for CIDRAP. The article covers eight mistakes: (1) Overconfidence and failure to proclaim uncertainty; (2) Failure to do anticipatory guidance; (3) Fake consensus; (4) Prioritizing health over other values; (5) Prioritizing health over truth; (6) Failure to own your mistakes; (7) Failure to address misinformation credibly and empathetically; and (8) Politicization. These are all points about public health risk communication that I have made before – some of them for decades – but seldom for audiences as big as CIDRAP’s. The link above is to CIDRAP’s PDF
on this site; CIDRAP’s website post is also available at the CIDRAP site.-
Excerpts from: “Watching the COVID Booster Sausage Being Made”
Watching the COVID Booster Sausage Being Made
Posted: December 4, 2021
I started writing what I thought would be a website column in August 2021, when President Biden first proposed making COVID boosters available to all American adults, and the public health profession responded with considerable outrage. I kept revising it – and lengthening it – as the policymaking process continued. By late October I had a near-final draft that focused largely on what I considered a face-saving set of FDA and CDC decisions that actually allowed anyone who wanted a booster to get a booster, while seeming to impose complicated restrictions on booster eligibility. But the situation kept changing. Now, effective November 19, Biden has the policy he sought in August: universal adult COVID booster eligibility. So my blow-by-blow description of the COVID booster “sausage-making” process is arguably beside the point. I decided to post it anyway.
The “Excerpts” column is made up of excerpts from some of the sections, with each excerpt linked to that section. I hope it might entice a few to read the full essay.
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“Even-Though Risk Communication”: Mandatory COVID Vaccination
Posted: October 17, 2021
I am a strong supporter of COVID vaccination, as is my wife and colleague Jody Lanard. But we are ambivalent about COVID vaccination mandates. We see a strong case for making people get vaccinated … and a strong case against doing so. In this short column we summarize both cases. And then we make our risk communication case that, whichever side you are on, you should acknowledge that the other side has a decent case too, even though you believe that on balance your side’s case is stronger. We call this “even-though risk communication.” Why should you do it? It’s kinder. It’s truer. And when your audience is on the other side, it’s much likelier to work.
Cut Slack for Employees’ Excessive COVID Fears (or Vaccination Fears)
Email from Peter M. Sandman to Bloomberg Opinion science columnist Faye Flam, September 30, 2021
On September 29, Bloomberg Opinion science columnist Faye Flam emailed me about an angry September 23 article in The Chronicle of Higher Education. Written by University of Michigan Professor Silke-Maria Weineck, the article (entitled “The Dystopian Delta University”) criticized her university for forcing obviously COVID-vulnerable professors to return to the classroom. Faye wanted to know what I thought. My response focused on employers’ dilemma when their employees were more fearful than vulnerable. I pointed out that employees who are excessively afraid of returning to their workplace are not so different from employees who are excessively afraid of getting vaccinated. Relying on the concepts of cognitive dissonance and adjustment reactions, I argued that coercion is likely to backfire in both cases. As of October 7, Faye is still working on an article that may or may not end up based in part on my email.
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Firing Healthcare Workers Who Refuse COVID Vaccination
Posted: September 30, 2021
An infectious diseases epidemiologist who appears often in media pandemic coverage interacts periodically on Twitter with my wife and colleague Jody Lanard. On September 27, 2021 he asked Jody what she thinks about whether hospitals should fire nurses or other healthcare workers (HCWs) who refuse to be vaccinated against COVID. Jody passed the inquiry on to me, and I responded with a numbered list. Then I decided to post my response, somewhat revised, as a column. My overall argument is that hospitals should see firing employees as a last resort. I’m especially attached to #1: that managements should beware of how their own outrage might be distorting their judgment. Also #9: that HCWs who have treated COVID patients for 18+ months without benefit of vaccination have probably been infected already or if not must be incredibly careful healthcare workers. Does it really make sense to fire them in their 19th month?
Confidence, complacency, and convenience: part two
Posted on her blog, "The Turnstone," September 12, 2021
COVID Vaccination and Cognitive Dissonance
Email from Peter M. Sandman to Melanie Newfield and posted as a comment on her blog post, September 12, 2021
Melanie Newfield is a weed expert (and therefore a pesticide expert) who worked for the New Zealand government for many years, where she found my approach to outrage management useful in dealing with public pesticide fears. Now a self-employed consultant, she writes a blog called “The Turnstone” that periodically cites my work. Recently she has been writing a lot about COVID-19, including a series of posts about how to talk to vaccine-hesitant people. Her September 12, 2021 post entitled “Confidence, complacency, and convenience: part two” dealt with vaccination incentives (like money) and disincentives (like losing your job). It got me thinking about Leon Festinger’s theory of cognitive dissonance – especially whether too big an incentive or disincentive might “succeed” in getting people vaccinated while totally failing to get them any less committed to their reasons for hesitating. Melanie posted my response. I decided to post it too.
Analysis: White House dominance of pandemic message might feed political divides
Posted on the CNN website, July 30, 2021
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Email from Peter M. Sandman to Maggie Fox, July 20, 2021
Maggie Fox of CNN has sought my views before on how best to resuscitate the reputation of the U.S. Centers for Disease Control and Prevention (CDC). She asked again in a July 19 email, focusing this time on whether it would help for the CDC and other federal agencies to show more independence from the White House. I responded the next day, agreeing that agency independence from the White House was as important – and as evidently lacking – under Biden as it had been under Trump. I added that I didn’t really want to see federal agencies seek or get a reputation for always being right, but rather a reputation for knowing they’re not always right and being open to a wide range of expert opinions. Maggie’s excellent July 30 article used some of what I had to say about agency independence, though not about opinion diversity.
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Public Health Agencies and Professionals Don’t Want to Talk Much about COVID-19 Vaccine Boosters
Posted: July 23, 2021
Jody Lanard and I have been interested in messaging questions about COVID-19 vaccine boosters since the early days of COVID-19 vaccines, but our interest peaked after July 8, 2021, when Pfizer went public about its evidence of waning antibodies and its plan to apply for a booster Emergency Use Authorization (EUA). The U.S. government response to the Pfizer announcement was an immediate “pushback” statement issued jointly by the Centers for Disease Control and Prevention and the Food and Drug Administration. It was clear to us that the CDC and FDA didn’t want to talk about boosters, and didn’t want Pfizer to do so either. After four tries to interest various reporters in covering the booster risk communication story, we converted our final attempt into this column, outlining our four main objections to the way the agencies (and the public health profession generally) were addressing the COVID-19 booster issue.
Since the CDC’s mid-May guidance on wearing masks, we’re no longer all in this together
Posted on the STAT News website, July 16, 2021
Shortly after CDC issued its bombshell mid-May announcement that vaccinated people could safely take off their masks even indoors, Maggie Fox of CNN asked me if I wanted to write an op-ed on the resulting controversy. I did, and Maggie sent it to CNN’s opinion editors, but they didn’t take it. More than a month later, Faye Flam of Bloomberg News asked me if I wanted to write an op-ed on the same topic, updated to account for the Delta variant and other developments. I did, but what I wrote turned out too similar to a piece Faye herself was writing, so with my permission she sent it to STAT instead. STAT suggested revisions that improved it significantly, then published it. Through its three incarnations, the article’s main thesis didn’t change: Thanks to COVID-19 vaccines, we’re no longer all in this together. But by mid-July I had to add that “thanks” to Delta, we’re a bit more in this together again than we were in May.
Three Paradigms of Risk Communication – and a critique of COVID-19 Crisis Communication
Webinar presented via Zoom, then posted on YouTube, hosted by the Institute for Risk and Uncertainty, University of Liverpool, July 7, 2021
In April 2021, the University of Liverpool Institute for Risk and Uncertainty asked me to give a presentation in its monthly webinar series. We agreed I would divide my time between my “signature risk communication formula” and my criticisms of the way COVID-19 has been communicated. And on July 7 that’s what I did. The first third of this 94-minute webinar is introductory, my “Risk = Hazard + Outrage” formula and the three risk communication paradigms I derive from the formula. The second third is my critique of COVID-19 crisis communication, mostly in the U.S. The final third is Q&A and discussion, much of it focusing on COVID-19 risk communication dilemmas in the U.K.
My hosts promptly posted the webinar on YouTube, as they always do. That link is below. Also below is an audio-only recording of the webinar and my slide set, so you’re free to follow along on your own if you prefer.
Is Covid19 still a threat in a post-vaccinated world?
Video discussion on Bloomberg Quicktake, posted via Twitter, June 2, 2021
‘Covid Zero’ Risks Being ‘Covid Limbo’ Amid Slow Vaccine Uptake
Posted on Bloomberg News, June 3, 2021
Despite its misleading title, this 33-minute video discussion on Bloomberg Quicktake had almost nothing to do with a post-vaccinated world. The Bloomberg News article about the discussion summarized it properly: It was mostly about the pre-vaccinated world of "COVID-Zero" places like Australia and Hong Kong. These are places that have kept COVID-19 out pretty successfully, and now they’re having trouble vaccinating their citizens so they can open up again to travel, tourism, etc. The risk communication perspective was (over)represented in the discussion by both me and my wife and colleague Jody Lanard. The third interviewee was Australian epidemiologist Greg Dore. We all basically agreed that COVID-Zero countries can’t turn themselves into 21st century Hermit Kingdoms, but we had somewhat different perspectives on who should decide when, how, and how much to open up.
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As it fights a pandemic, CDC wages a second battle to win back trust
Posted on the CNN website, May 21, 2021
CDC’s Reputation Takes Another Hit When Walensky Says Vaccinated People Can Take Off Their Masks
Email from Peter M. Sandman to Maggie Fox, May 20, 2021
On May 19, 2021, Maggie Fox of CNN emailed me that she was picking up a topic we had corresponded about months earlier: how best to resuscitate the reputation of the U.S. Centers for Disease Control and Prevention (CDC). Now that she was finally going to write the article, she wanted to know if I had any new thoughts. Aside from summarizing and quoting our earlier correspondence, my May 20 response focused on CDC’s May 13 announcement that vaccinated people could safely remove their masks and stop social distancing – an announcement that was widely criticized and indisputably did CDC further reputational damage. Though she did mention the May 13 announcement, Maggie’s May 21 article focused more on CDC earlier COVID-19 reputation debacles, and on CDC’s failure to resume its customary role as the nation’s premier source of information about infectious disease outbreaks. Maggie quoted me several times on those topics, but not on the May 13 announcement.
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Posted: May 16, 2021
CDC’s May 14 announcement that vaccinated people no longer need to wear masks or socially distance in most situations provoked a wide range of reactions, even among experts. Some exulted at the new freedom. Some thought it was long overdue and still insufficient. Some thought it was excessive and dangerous. Some worried that unvaccinated people would take advantage. Some worried that vaccinated people weren’t as safe as CDC was suddenly maintaining. Some worried that children and immunocompromised people were left in the lurch. Jody Lanard and I brainstormed our own reactions, and then converted our brainstorm into some notes on ways we thought CDC might have done a better messaging job. (A footnote for those who find this column either unduly skimpy or blessedly brief: We wrote it as a thread for Jody’s twitter feed twitter.com@EIDGeek, then decided to post it virtually unchanged as a column.)
A COVID ‘second wave’ that never crashed. Should public health mislead if it saves lives in a pandemic?
Posted on the WHYY (Philadelphia) website, April 30, 2021 (and broadcast on various NPR stations at various times in the days that followed)
On March 8, 2021, Jad Sleiman of WHYY radio in Philadelphia interviewed me by telephone about the ways in which public health professionals “gild the lily” (my phrase, not his), saying things that aren’t strictly true when they believe doing so will help make public health messaging more persuasive and thereby save lives. We talked for an hour and 44 minutes, covering both COVID-19 examples and others from earlier in my career. On March 23 I posted the audio of the complete interview, divided into segments to make for easier listening, as well as an email I had sent to Jad before the interview. Descriptions and links for the original interview and pre-interview email are here.
On April 30, nearly two months after that March 8 interview, Jad finally used it. He posted two versions of his story: a 26-minute podcast and radio program (part of a WHYY series called “The Pulse” for National Public Radio) and a print article on the WHYY website. The two are very similar – and in my judgment, very well done. (Jad’s other source for the piece is Holley Wilkin, a health communications professor at Georgia State University.) Because I like what he produced so much, I didn’t want to bury it – so I decided to write this separate entry in my various indexes, rather than just attaching the new links to my March 23 entry.
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COVID-19 Vaccine Blood Clots: Secrecy versus Pause versus Informed Consent
Posted: April 24, 2021
A rare but potentially deadly side effect materialized in recent weeks among people vaccinated against COVID-19 with the AstraZeneca or Johnson & Johnson vaccine: a specific sort of blood clot problem. In response, many countries including the U.S. paused their rollouts of those two vaccines – even though there was little doubt that the pauses would do more medical harm than the clots. The risk communication question that preoccupies this column is how to address the tiny clot risk in the way that exacerbates vaccine hesitancy the least. The column considers three options: (1) Secrecy, a dangerous option that officials did not choose; (2) Pausing, the pretty bad option they chose; and (3) Informed consent, the good option I wish they’d chosen. Central to the discussion is whether there’s any way to make excessive official precautions – the proverbial “abundance of caution” – reassuring rather than alarming to the public.
Resuscitating CDC’s Reputation
Between January 18 and March 16, 2021, Maggie Fox of CNN exchanged a series of emails with me (and initially also my wife and colleague Jody Lanard) regarding an article Maggie was planning to write about how best to resuscitate the reputation of the U.S. Centers for Disease Control and Prevention (CDC). Maggie may eventually write the article, and may use some of what Jody and I sent her. We may also exchange additional emails about CDC’s continuing reputational problems. (As I write this blurb on April 1, I’m thinking about CDC Director Rochelle Walensky’s March 29 inexplicable worries about COVID-19 “impending doom,” coming on top of her agency's excessively precautionary recommendations on what vaccinees can safely do.) In the meantime, I have collated excerpts from our emails. The main point: People who have been paying attention know that CDC has been responsible for serious errors and misjudgments that cannot be blamed on Donald Trump. To resuscitate its reputation with those people, CDC must first take responsibility.
Reopening as Covid-19 Fades Is Not a Science
Posted on the Bloomberg Opinion website, March 24, 2021
Amalgam of two emails from Peter M. Sandman to Faye Flam, March 22, 2021
Bloomberg News columnist Faye Flam emailed me on March 22 for a piece she was writing about “how and why we need to balance ‘the science’ with people’s need to resume normal life.” I responded that same day with two emails, which I have merged here into one. I argued that the experts’ excessive caution “is much less grounded in ‘the science’ than they would have us believe.” And then I laid out what I consider four bad outcomes of that excessive caution – bad outcomes regardless of whether people bow to the experts’ opinions, try to bow to those opinions but fail, or decide those opinions are obviously crazy and look elsewhere for guidance. Faye made some use of my email in her March 24 column. (She also drew on a March 3 interview I’ve posted separately.)
Public Health Messaging that Aims to Persuade the Audience at the Expense of Truth: Some Examples from COVID-19 and Earlier
Interview with Peter M. Sandman by Jad Sleiman, March 8, 2021
(and a March 2 email from Peter M. Sandman to Jad Sleiman)On March 2, journalist Jad Sleiman sent me a very thoughtful email about “a question I’ve been wrestling with all pandemic: Should public health messaging be objective (telling the public the most precise version of reality according to their best data) or should public health messaging be persuasive (telling the public what is most likely to persuade them to adopt a given life-saving behavior)?” It’s a question I’ve been wrestling with for decades. My emailed response that same day went into some detail on my thinking, with several pre-COVID examples of the conflict between truth-telling and health-selling. It resulted in a one-hour and 44-minute March 8 interview, covering both COVID and pre-COVID examples. A reporter for WHYY radio in Philadelphia, Jad used the interview for both an April 30 episode of “The Pulse” (a WHYY podcast series and National Public Radio program) and an April 30 article on the WHYY website. Jad's podcast/radio show and article are described and linked here. Below are links to my email to Jad and the interview itself.
For those who don’t want to listen to the whole hour and 44 minutes, I have divided the audio tape into 9 segments. The titles are linked below – or see the same links with segment descriptions on the Media page.
These links launch MP3 audio files:
- Some risk communication basics and history (9.6MB, 6:52 min.)
- Gilding the lily – principles (19MB, 13:36 min.)
- Two pandemics – swine flu versus COVID-19 (11.5MB, 8:12 min.)
- Gilding the lily – pre-COVID examples (24.2MB, 17:11 min.)
- Gilding the lily – selling COVID-19 precautions (13.3MB, 9:26 min.)
- The communicative accuracy principle and the facemask example (21.8MB, 15:33 min.)
- Gilding the lily – COVID-19 vaccination (15.4MB, 10:54 min.)
- Gilding the lily – three more examples (16.6MB, 11:47 min.)
- The public’s trust in science; scientists’ trust in the public (18MB, 12:49 min.)
My Top Gripes (some longstanding, some current and fleeting) about How Public Health Professionals Are Communicating COVID-19 Risk
Interview with Peter M. Sandman by Faye Flam, March 3, 2021
Since the COVID-19 pandemic began, Faye Flam of Bloomberg News has periodically checked in with me by email or phone. I posted the audio of our hour-long February 9 (2020) interview, which was mostly about the need to sound the alarm more aggressively; and our 1-1/2–hour July 23 (2020) interview, which was largely about lockdown versus “learning to dance with the virus.”
This time we talked for nearly two hours and covered a lot of ground, under the general heading of “my top gripes about how public health professionals are communicating COVID-19 risk.” The uniting theme insofar as there was one: the many ways experts and officials cherry-pick what to say based less on the truth as they understand it than on other factors: sometimes what they think will most effectively convince the public to do what they think best; sometimes their anger at what other experts and officials are saying; sometimes their values and political opinions; etc.
For those who don't want to listen to the whole 115 minutes, I have divided the audio tape into 11 segments. The titles are linked below – or see the same links with segment descriptions on the Media page.
Faye has a podcast series entitled “Follow the Science.” On March 12 she posted #13 in the series, “When Public Health Officials Lie,” based entirely on the second and third segments of our March 3 interview. I think she covered this material spectacularly well. On March 19 she posted #14, “When Trust in Experts Goes Too Far.” The second half of this podcast is an effort to tie together bits and pieces from the rest of the interview.
These links launch MP3 audio files:
- Claiming all COVID-19 vaccines are equally good (8MB, 5:40 min.)
- Selling health versus telling the truth (23MB, 16:13 min.)
- The bias in favor of pessimistic messaging (9MB, 6:22 min.)
- Science versus values (8.3MB, 6 min.)
- Harm reduction versus aiming for zero risk (12MB, 8:34 min.)
- What we get instead of respectful, tentative debate (23MB, 16:29 min.)
- Could we have crushed the virus? (9.9MB, 7:04 min.)
- Selling COVID-19 vaccination to Trump supporters (10MB, 7:12 min.)
- Resuscitating CDC’s reputation (19MB, 13:49 min.)
- Health versus equity in vaccine prioritization (16MB, 11:31 min.)
- Standard Operating Procedure in an emergency (22MB, 15:39 min.)
Can the arrival of new coronavirus variants scare Americans into better pandemic behavior?
Posted on the CNN website, January 30, 2021
Any Chance of Getting Anybody to Take the New COVID-19 Variants Seriously?
Seven points sent to CNN reporter Maggie Fox, January 29, 2021
On January 29, CNN health reporter Maggie Fox emailed me and my wife and colleague Jody Lanard, asking for a quick comment or two (on a tight deadline) on what it might take “to get people to do the things they need to do right now to prevent a new [COVID-19] surge driven by the new variants.” Jody was busy, so I responded alone with a numbered list of points, which were pretty pessimistic – not just about getting the public to respond as needed, but also about getting government agencies (especially the Food and Drug Administration) to respond as needed. Hence the title I have given what I wrote to Maggie. Maggie’s resulting story was pretty pessimistic too, even though she emphasized the least pessimistic portions of my emails.
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Richard Levick runs a crisis communication consulting firm, and churns out an incredible number of podcasts, including the daily “In House Warrior” series for Corporate Counsel Business Journal. Our 38-minute conversation covered some generic topics, starting with my three paradigms of risk communication and ending with my views on whether corporations should take stands on controversies. In the middle we focused on vaccine communication: what to do about vaccination hesitation; bandwagoning versus finger-wagging; what company COVID-19 vaccination policies should be; the politicization of masks and vaccines; key messages in this dark pandemic winter; etc. One-Dose Two-Dose Vaccine Risk Communication:
Another Impossible Thing to Believe Before BreakfastPosted: January 22, 2021
A mostly thoughtful debate is raging among vaccine experts on the pros and cons of prioritizing first doses of the two-dose Pfizer and Moderna COVID-19 vaccines, versus the current policy of trying to make sure every first dose recipient gets her second dose on schedule, even though that means more people must wait longer without any vaccine protection at all. I’m not entitled to an opinion on this question. But I hate to see experts and officials on television day after day sounding like they’re on both sides at the same time: “We need to get as many people as possible vaccinated as quickly as possible” and “we need to make sure people get their second doses on schedule“ – as if the same dose could go into two different arms. This short column is a plea to stop asking people to believe that impossible mixed message.
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Posted on the Business Insider website, December 28, 2020
COVID-19 Vaccination Messaging
Note: Link launches an MP3 audio file (50.4MB, 1 hr. 13 min.)Interview with Peter M. Sandman by Kimberly Leonard, December 22, 2020
Business Insider reporter Kimberly Leonard emailed me on December 17 to ask for an interview. She was planning an article on how the Biden team might do better with COVID-19 in 2021 than his predecessor did in 2020, and wanted me to address communication aspects of the story. I agreed. I offered a lot of suggestions in our 1-hour, 13-minute December 22 interview, from resurrecting CDC media briefings to recruiting sources who were locally trusted and sources (e.g. Donald Trump) who were trusted by otherwise recalcitrant prospective vaccinees. I also cautioned against overselling, and especially against treating people who just wanted to watch and wait for a while as if they were die-hard antivaxxers. Kimberly included a fair number of my points in her article.
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To End the Pandemic, the COVID-19 Vaccine Must Clear One Final Obstacle
Posted on the Inverse website, December 23, 2020
Emma Betuel writes for Inverse, an online magazine chiefly for millennials. She wanted to ask me about how to build COVID-19 vaccine acceptance. I wanted to tell her about how the U.S. Food and Drug Administration was intentionally dragging its feet in the COVID-19 vaccine approval process. The interview focused mostly on my topic, but covered hers briefly as well. Not surprisingly, the article she eventually posted covered only her topic. This was not the first time I had failed to get the FDA slow-walking story out. I am also posting a brief note – but not brief enough to put here – on the backstory of my unsuccessful, ambivalent efforts to publish the FDA slow-walking story, culminating in this for-the-record audio post of my interview with Emma.
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Posted: December 20, 2020
As COVID-19 vaccines started rolling out, while the virus itself racked up unprecedented numbers, my friend Bruce Hennes asked me what I thought the key pandemic messages should be right now and for the next few months. This is my answer, in four parts: (1) It’s an awful time for almost everybody. (2) Things are going to get better, but not right away. They will get worse first. (3) We’re all the victims here. And we’re all the perpetrators. We need a truce. (4) We are all in charge of ourselves. At Bruce’s urging, I edited this column down to a shorter version about half its length. Both versions are linked above. Naturally, I recommend the original.
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COVID-19 from Frozen Fish: Fascinoma or Serious Risk?
Posted on this site in English, and on Weibo and WeChat in Mandarin, October 22, 2020
This is the first article I’ve ever written to be published first in China (in Mandarin). Andre Shen, CEO of the Chinese public relations consultancy Bridge Consulting, has been translating some of my COVID-19 risk communication articles into Mandarin and posting them on Chinese social media platforms Weibo and WeChat. On October 20, he sent me an email asking me to write a short article on an emerging Chinese COVID-19 issue: the possibility that imported frozen fish might be a SARS-CoV-2 transmission source. The risk communication questions here are generic: Should authorities go public about a small risk that’s likely to lead to a big overreaction? And if they do go public, how can they minimize the overreaction? Andre translated the article and posted it. I’m posting it on this website in English.
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Mayor de Blasio and Governor Cuomo: A Plague on Both Their Houses – or Not?
Posted: October 5, 2020
After a devastating spring, New York City successfully beat back the COVID-19 virus. But as I write this in early October, the virus is beginning to make a comeback in a number of the city’s neighborhoods. Mayor Bill de Blasio has just proposed lockdown-like precautions in those neighborhoods. To go into effect the precautions need to be okayed by the state’s governor, Andrew Cuomo. The governor’s okay isn’t a foregone conclusion, mostly because de Blasio and Cuomo have been feuding for years. In an effort to help get the okay, my wife and colleague Jody Lanard quickly drafted this short column. I revised it some and posted it so Jody could tweet it.
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Posted on the Washington Post website, September 28, 2020
The CDC’s Massive Loss of Credibility Is Partly Because of the Spokespeople It Used
Email from Jody Lanard to Washington Post reporter Lena H. Sun, September 25, 2020
On September 22, Washington Post national health reporter Lena H. Sun wrote to my wife and colleague Jody Lanard for comments about the “crisis of trust for CDC at this pivotal juncture.” Jody’s September 25 response focused mostly on the CDC’s failure to use or develop trusted spokespersons. Several quotes from Jody’s response were used in the resulting September 28 article by Lena and Joel Achenbach. The article covered a number of reputation-undermining aspects of the CDC’s handling of the COVID-19 pandemic – many of them controversies over messaging. Some were a function of political interference, but others were simply the result of the CDC’s own mismanagement. The article’s title says it all: “CDC’s credibility is eroded by internal blunders and external attacks as coronavirus vaccine campaigns loom.” A slightly edited version of Jody’s response is posted here.
The company of the dead: part three
Posted on The Turnstone (Melanie Newfield’s blog), August 16, 2020
The subtitle of this short essay is more informative than its title: “Why we shouldn’t ignore the risks of vaccines.” The title makes sense if you read part one, which begins with all the childhood infectious disease deaths memorialized in a nineteenth century New Zealand cemetery. All three parts are about the value of vaccines and why it’s sometimes hard to convince people to accept vaccination – a topic Melanie was drawn to by the likely imminence of a Sars-CoV-2 vaccine. Melanie’s day job is as a plant biologist for the New Zealand government, focusing mostly on invasive species. Part three begins with some lovely examples of her efforts to persuade people that it’s okay to destroy beautiful weeds with toxic pesticides. She writes with respect for people who resist her pleas – and even with respect for people who lack respect for those resistors. She similarly urges respect for anti-vaxxers even as she admits sometimes laughing at the snarky anti-antivax jokes her friends send her. Melanie credits my book on Responding to Community Outrage with helping form her approach to risk communication, which gives me an excuse to tell readers about this essay.
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COMMENTARY: Public health’s share of the blame: US COVID-19 risk communication failures
(155kB)Posted on the website of the Center for Infectious Disease Research and Policy, August 24, 2020
On August 4, I posted a column on this website entitled “Public Health’s Single Biggest COVID-19 Risk Communication Failure.” It told the story of how public health professionals drastically underreacted to COVID-19 at first and left us unprepared, then overreacted and sent us into lockdown, and then justified the lockdown by switching from a “flatten the curve” narrative to a “prevent infections at all costs” narrative instead of teaching us to balance priorities and “dance” with the SARS-CoV-2 virus. After digesting some comments from public health officials and others, I produced this new version for CIDRAP – which gets orders of magnitude more readers than my website. It’s shorter than the original and has a lot of new content, though it makes the same main points. The link above is to CIDRAP’s PDF on this site; CIDRAP’s website post is also available at their site.
Outdoor Masking Isn’t Always Needed
Posted on the Bloomberg Opinion website, August 19, 2020
Pro-Mask Advocacy When Even COVID-19 Is Polarized
Email (with small edits) from Peter M. Sandman to Bloomberg News reporter Faye Flam, August 15, 2020
On August 13, Joe Biden called for a national mandate for everyone to wear a mask outside. The evidence was overwhelming, he said, that doing so would exponentially reduce COVID-19 transmission. Two days later, Bloomberg reporter Faye Flam sent me an email asking what I thought of Biden’s remarks. In my reply later that day I said it was puzzling that Biden emphasized mask-wearing outdoors rather than indoors, and poor risk communication for him to overstate the value of masks and the certainty of the evidence; I also suggested that a national mask requirement might well be unconstitutional. I added a few additional points about pro-mask advocacy, including my beliefs that bandwagoning works better than finger-wagging and that harassing the holdouts was probably less productive than helping the compliant majority choose more effective masks. Faye’s resulting August 19 story used only a little of my email, a slightly edited version of which is posted here.
The U.S. Can Control Covid Without a Second Lockdown
Posted on the Bloomberg Opinion website, July 30, 2020
Interview with Peter M. Sandman by Faye Flam, July 23, 2020
Since the COVID-19 pandemic began, Faye Flam of Bloomberg News has periodically checked in with me by email or phone. I posted the audio of our hour-long February 9 interview, which was mostly about the need to sound the alarm more aggressively. Our July 23 interview, which ran almost 90 minutes, is a good follow-up. We focused on how I think the U.S. public health profession has mishandled and miscommunicated COVID-19 in the intervening months. First it underreacted and left us unprepared. Then it overreacted and sent us into lockdown. Then it justified the lockdown by promulgating a suppression narrative (prevent infections at all costs) instead of teaching us to balance priorities, flatten the curve, and “dance” with the SARS-CoV-2 virus. Faye’s July 30 article is mostly in her voice, with few quotes from me or anyone else. But it captures much of what we talked about. I have divided the MP3 linked above into five segments; the titles are linked below – or see the same links with segment descriptions on the Media page.
These links launch MP3 audio files:
- Five ways public health misled us. (10.9MB, 7.5 min.)
- Suppression versus balance. (25MB, 17.5 min.)
- Tradeoffs. (24MB, 17 min.)
- Learning to dance. (19.5MB, 13.5 min.)
- How public health went wrong. (21MB, 15 min.)
What to make of Trump’s “new tone” at the Covid-19 briefings
Posted on the Vox website, July 22, 2020
My Fantasy: What if President Trump Unexpectedly Did Excellent COVID-19 Risk Communication
Email exchange between Peter M. Sandman and Dylan Scott, July 21, 2020
On July 21, a few hours before President Trump took the podium for his first COVID-19 briefing in some weeks, I got an email from Vox reporter Dylan Scott asking me – in essence – what I thought was likely to result from the resumption of these presidential briefings, in public health terms as well as politically. I responded with my fantasy of what I would most like to see the president say and how I thought various audiences would respond if he actually said it all (or even some of it). Dylan wrote back with follow-up questions that focused on whether I thought it was too late for Trump to do any good, especially if he was changing his tune only under pressure. I answered those questions too. Dylan’s July 22 story made only a little use of my comments, and no use at all – not surprisingly – of my fantasy. Our emails are posted here, slightly edited to take out some irrelevancies.
The muddled public message on coronavirus isn’t just confusing. It’s harmful
Posted on the CNN website, July 16, 2020
Email from Peter M. Sandman to Ivana Kottasová, July 13, 2020
CNN reporter Ivana Kottasová emailed me on July 10 with three questions relevant to a story she was writing “about the way public health authorities have been communicating throughout this pandemic.” On July 13 I emailed back answers to all three questions. Ivana’s July 16 story on the CNN website made use of only the first of my three answers, on what she called “muddled messaging” about issues like masks, airborne transmission, and social distancing. Are the sources “failing as crisis communicators,” she wanted to know, or “is it simply that the message evolves as we find out more about this virus?” My response started with advice to avoid overconfidence and warn the audience that your messages will inevitably change as more is learned. Then I segued to why I think public health messaging about masks changed for reasons that had little to do with changing evidence, and everything to do with dishonesty. Her story used some of both parts. (She also used a different quote for CNN’s daily coronavirus update.) This is my answer to Ivana’s first question. I may eventually find a different use for my answers to the other two.
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Peter Sandman: How Your Ability To Process Risk Can Save Your Life
Interview with Chris Martenson of Peak Prosperity, podcast posted July 7, 2020
Chris Martenson’s “Peak Prosperity” YouTube channel currently claims 368,000 subscribers. Chris is best known for his “Crash Course” on how pretty much everything is in rapid decline. In 2020, not surprisingly, he has posted dozens of videos on COVID-19. One of these, posted in March, was devoted entirely to my 2005 article on the adjustment reaction concept. Entitled “Coronavirus: How To Inform Your Friends & Family Without Creating Pushback,”
it got 330,000 views and 4,428 comments in three months – way out of my league. So when Chris said he wanted to interview me via Zoom for an hour-long podcast, I said yes. We did it on June 29. Chris wanted to talk (again!) about adjustment reactions. I wanted to talk (again) about the basics of risk communication. We both wanted to talk about the ways the U.S. is mismanaging the COVID-19 pandemic. So we did all three. Our COVID-19 discussion focused mostly on a risk communication analysis, but we inevitably veered into risk management and epidemiology as well.
Why So Much COVID-19 Crisis Communication Has Failed: An Expert Explains
Email responses by Peter M. Sandman to questions posed by Eric Lebowitz of Critical Mention, posted verbatim as a Critical Mention “eBook,” July 1, 2020
Jody Lanard and I posted an article on “Effective COVID-19 Crisis Communication”
on May 6, 2020. On May 12, Eric Lebowitz of Critical Mention emailed me three follow-up questions, focusing on why the crisis communication principles Jody and I had emphasized were so seldom followed. The answers I sent him on June 5 covered some familiar ground with new COVID-19 examples, including the case for admitting mistakes instead of trying to hide them. But I also included information on two topics I hadn’t written about in so much detail previously: arguments I used to use when trying to convince my consulting clients to avoid over-reassurance and overconfidence; and why traditional public relations paradigms make PR people bad crisis communicators unless they have reoriented their approach. Critical Mention reformatted my answers as a short “eBook” for their clients, with permission to post the eBook on this website as well.COVID-19 Risk Communication Q&A
Email “interview” of Peter M. Sandman by Alan Crawford of the Public Affairs Council, May 31, 2020
I used to do an annual one-day risk communication seminar for the Public Affairs Council (PAC). When PAC’s Alan Crawford asked me to do a telephone interview on COVID-19 risk communication for the organization’s monthly online newsletter, Impact, I asked him to email me a set of questions instead. On May 25, he sent me 17 challenging questions, pretty much running the gamut. I got my responses back to him on May 31. Alan scheduled a “somewhat edited” version of the Q&A as a two-parter for the June and July/August editions of the newsletter, but gave me permission to post the whole unedited Q&A as soon as his first installment appears. So here it is. If you want to read the edited version, both current and past issues of Impact are archived at https://pac.org/impact/archive.
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Scientists caught between pandemic and protests
Posted on the Axios website, June 10, 2020
Email from Peter M. Sandman to Bryan Walsh, June 9, 2020
On June 8, I posted a website column entitled “Public Health Professionals Should Be Saying THIS about the Public's COVID-19 Risk Choices,” arguing against a double standard for mass events the profession approves of (the George Floyd protest marches) versus mass events it disapproves of (such as anti-lockdown demonstrations). That same day, Bryan Walsh of Axios sent me an email asking for follow-up comment. Bryan asked two questions, which I answered the next day. The resulting June 10 article by Bryan and Alison Snyder quoted several other people as well, and relied on my email for just one paragraph. My email is posted here.
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Public Health Professionals Should Be Saying THIS about the Public’s COVID-19 Risk Choices
Posted: June 8, 2020
I have watched with dismay as public health professionals failed abysmally to “stay in their lane" when expressing opinions about the public’s COVID-19 risk choices – especially vis-à-vis demonstrations against state lockdown policies and the police murder of George Floyd. So when asked what I thought they should be saying, I drafted this short list of message points.
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Posted: May 23, 2020
Postscript: Masks as Virtue-Signaling
Posted: June 7, 2020
A state health department official I work with from time to time sent me an email on May 20, asking how I would advise doctors’ offices to respond to patients who refused to wear masks. I sent her a list of suggestions on whether and how to make patients wear masks. When I refashioned the list into a column, I couldn’t resist adding an introduction about the opposite problem, the long history of opposition on the part of experts and public health officials to letting people to wear masks during respiratory disease outbreaks when they wanted to. In the two weeks after the column was posted, I saw more and more evidence that mask-wearing (in everyday life, not in doctors’ offices) was becoming a partisan issue, with virtue-signaling on both sides. So I added a “postscript” on that.
How We Can Get the Next Phase of the Coronavirus Right
Published in The New York Times, May 14, 2020
I rarely post articles that simply reference things I’ve written previously, even if I think they got me right and used me well. And this New York Times op-ed doesn’t even mention my name. But it’s an excellent summary by Charlie Warzel of the report Jody Lanard and I published recently for the Center for Infectious Disease Research and Policy on “Effective COVID-19 Crisis Communication.”
(You can read the same piece on this website if you prefer.) And it embeds the summary in Warzel’s thoughtful discussion of how to talk to people who accepted the sacrifices of lockdown to “flatten the curve,” got the impression that would be the end of the pandemic, and now resent demands for further sacrifices even after the curve has been flattened where they live. We Can’t Wait Until It’s Safe to Lift Lockdowns
Posted on the Bloomberg Opinion website, May 11, 2020
Bloomberg News reporter Faye Flam checks in with me periodically to talk about COVID-19. Our May 5 conversation focused on our shared sense that the purpose of lockdowns – and more broadly, the purpose of social distancing – had never been successfully communicated in the U.S., setting up unrealistic expectations for the reopening of the economy. In a grossly oversimplified nutshell, social distancing aims to “flatten the curve” – to slow the spread of the virus so fewer people are infected at the same time, keeping hospitals from getting so overwhelmed they can’t save lives they could otherwise have saved. Lockdowns are an extreme version of social distancing that make temporary sense in places where hospitals are already close-to-overwhelmed. But pandemics keep infecting people until herd immunity is achieved, so coming out of lockdown inevitably means an increase in infections and therefore in deaths. The best you can do is to keep hospitals functioning and the most vulnerable people protected, so you get to herd immunity with the fewest possible deaths. Faye’s May 11 article tries to explain some of this. I wish she’d stressed more the stunning failure of officials and experts to explain it … to the point where most eventually stopped trying, accepting the false premise that we shouldn’t come out of lockdown until we can do so “safely.”
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Why People Feel Misinformed, Confused, and Terrified About the Pandemic
Posted on the Nautilus website, May 7, 2020
Outrage Management: The Next Stage in COVID-19 Pandemic Risk Communication
Email from Peter M. Sandman to Robert Bazell, May 2, 2020
On April 24, I received an email from Robert Bazell (NBC News’s longtime science correspondent, now teaching at Yale University), about an article he wanted to write about COVID-19 risk communication. After an exchange of emails, he wound up producing a May 7 article in the online science magazine Nautilus that relied partly on a piece Jody Lanard and I had just written on “Effective COVID-19 Crisis Communication” and partly on an email I had sent him on May 2, commenting on what I thought was coming next: COVID-19 outrage management. The version of the email posted here has been modestly revised.
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Effective COVID-19 Crisis Communication
Posted on the website of the Center for Infectious Disease Research and Policy, May 6, 2020
In late April 2020, some three months into the COVID-19 pandemic, the University of Minnesota Center for Infectious Disease Research and Policy decided to produce a series of reports under the collective title “COVID-19: The CIDRAP Viewpoint.” CIDRAP head Michael Osterholm asked Jody and me to write the second entry in the series, on COVID-19 crisis communication. We focused on six crisis communication basics: Don’t over-reassure; proclaim uncertainty; validate emotions; give people things to do; admit and apologize for errors; and share dilemmas. Throughout the report, we emphasized the most glaring problem of COVID-19 communication in the U.S. so far – nurturing the dangerous myth that COVID-19 will be a one-peak pandemic that’s about halfway over already. We also stressed that crisis communication is a field of study and practice and it’s past time for officials and experts to learn the basics.
Post-Virus Reopening Is More About Ethics than Science
Posted on the Bloomberg Opinion website, April 14, 2020
Email from Peter M. Sandman to Bloomberg News reporter Faye Flam, April 13, 2020
On April 13, Bloomberg News reporter Faye Flam sent me an email asking for my thoughts on when and how to transition the U.S. from COVID-19 lockdown to some kind of New Normal. I answered immediately. Since I have no expertise on the scientific questions involved in this decision, I focused on a risk communication aspect of the decision: the fact that so much of the public had gotten the misimpression that ending lockdown should be done “safely” – that is, in such a way that no one or nearly no one dies as a result. In reality, ending lockdown means killing people. Doing it right doesn’t mean stopping the spread of the virus; it means keeping the spread slow enough that hospitals aren’t overrun. The tradeoff between saving the most lives and saving the most of our way of life is not a scientific question, I wrote. It is a political question. So it would help if the public had a better understanding of what’s at stake. Faye’s story naturally focused on the scientific questions, but she also included some of what I had to say.
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CDC’s Public Communication about COVID-19: Maybe Going Silent Is an Improvement
On April 6, John Tozzi of Bloomberg News asked if he could interview me for a story “about CDC’s public communications in the COVID-19 pandemic.” I suggested he email me a few questions instead, which he did. He wanted to know what I thought was different in the way the CDC was communicating about COVID-19, compared to other outbreaks and epidemics. He focused especially on the agency’s comparative silence in recent weeks, asking whether I thought that had left a vacuum filled by competing voices, and whether I thought the competing voices had led to harmful consequences “that could have been avoided or reduced with more clear communication from CDC.” I wasn’t as convinced as John’s questions suggested he expected me to be that the CDC’s silence had done harm. In fact, my April 7 responses wondered whether widespread debate might actually serve the public better than CDC communication dominance would have done, given what I saw as the CDC’s less-than-sterling COVID-19 communication record before it went silent. John’s story didn’t use any of my comments.
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Talking to Frightened (or Miserable) People about COVID-19
Posted: April 13, 2020
Two different reporters recently asked me to comment on how officials should talk to the public about COVID-19. One was asking specifically about the governor of Florida, the other about the U.S. Centers for Disease Control and Prevention. I sent them both pretty much the same crisis communication fundamentals about talking to frightened (or miserable) people. Neither reporter found use for my comments, so I decided to post them as a column. Even more than information, frightened (or miserable) people seek guidance – about what to do, what to expect, even what to feel. My advice on how to provide that guidance: Validate our fear; express your own fear; be candid about how bad things are; provide any genuine reassurance you can find; give people things to do; give people choices of things to do; and, oh yes, explain what the government is doing too.
How to Talk to Patients About COVID-19
Posted in ENTtoday, April 8, 2020
On March 26, freelance medical writer Mary Beth Nierengarten emailed me some questions about how ear, nose, and throat doctors “can talk to their patients in ways that will be clear, effective, and transparent” about the effects of the COVID-19 pandemic. Several question were focused on helping patients deal with the likely need to postpone their ENT procedures, but Mary Beth was also interested in how to talk about patients’ pain and about COVID-19 itself. I emailed some answers on March 31, which she crafted into a Q&A article published in ENTtoday on April 8. My answers certainly didn’t break new ground, but they might be of some use to any professional trying to communicate empathically with clients, customers, or patients about pandemic cancelations. They were grounded in three crisis communication basics: (a) Candor is paradoxically more comforting than over-reassurance to people who are anxious or frightened; (b) When people are feeling an acute loss of control, it helps to find ways they can feel more in control; and (c) Instead of guessing or assuming you know what a patient (or anyone) wants from you, it’s often better to ask.
Carefree Amid a Contagion: How to Talk to Covid-19 Skeptics
Posted on the Undark website, March 24, 2020
Pandemic Apathy, Denial, Skepticism, and Ideology
Email exchange between Teresa Carr and Peter M. Sandman, March 23, 2020
On March 23, Teresa Carr of the online magazine Undark emailed me some thoughtful questions for her column on how to get through to people who aren’t taking COVID-19 seriously enough. I wanted to answer at length, but she was on a tight deadline, so I stuck to two topics. My first topic was the distinction between apathy and denial – and the risk of assuming people are unconcerned when they may be exactly the opposite: too frightened to bear their fear. My second topic was a reaction to Teresa seeming to equate apathy, skepticism, and rightwing ideology as all pretty much the same objectionable thing. I offered a brief defense of pandemic skepticism, and a critique of dismissing it as merely apathy or, worse, as rightwing ideology. She used some of my comments in her resulting article, despite its title: “Carefree Amid a Contagion: How to Talk to Covid-19 Skeptics.”
When It Comes to the Pandemic, Scared Is Good
On March 11, I received an email from an editor at London’s Sunday Times asking me to “write a piece on why panic is useful in the coronavirus epidemic.” Within the 1,200-word limit he set me, I ended up writing about why fear is useful – and why fear isn’t panic. I also worked in adjustment reactions and the strange mix of gnawing anxiety and insufficient action I was seeing in so many people’s response to COVID-19. I hate writing short – for me, 1,200 words is a tweet – but I thought the op-ed ended up a fairly decent overview of topics I’ve written about at greater length elsewhere. So when the Sunday Times decided not to use the piece (my editor says he was off that day), I decided to post it anyway.
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Strange COVID-19 Bedfellows: Gnawing Anxiety and Under-Reaction
Posted: March 11, 2020
In an email exchange with a journalist friend a few days ago, Jody commented that a lot of people seemed to be reacting to the COVID-19 pandemic with a strange mix of gnawing anxiety and under-reaction. Her friend thought she nailed it. So we decided to try to capture it in a short column. This isn’t the usual adjustment reaction. Instead of temporarily overreacting, people are hesitating, preparing less and taking fewer precautions than the knots in their stomachs say they should – beset by self-doubt that maybe they’re wrong and fear of embarrassment that maybe others will mock them. Perhaps the most challenging job public health officials face right now is helping us bear these feelings and ambivalences – and, of course, bearing their own.
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Telling the Public Hard Truths about COVID-19: Advice to a Public Health Agency Director
Posted: March 9, 2020
Over the years I have worked with a number of city, state, national, and international public health agencies. I am working with several now, trying to help them communicate hard truths about COVID-19. One of these clients has given me permission to reproduce three emails I sent to the agency director on March 6, 7, and 8. (I have also been reviewing draft documents on COVID-19 for the client, and the director and I have talked on the phone.) Other than some added links and a few small changes to make them anonymous, these emails are unedited. They are some of what I would want to say right now to every public health agency director.
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Are People Panicking? Is Government Overreacting? Are the Media Sensationalizing? A Short Radio Debate with Someone Who Thinks So (Note: Link launches an MP3 audio file (8.8MB, 6:16 min.)
Posted: March 7, 2020
On March 5 I received a phone call, a text, and an email from the BBC World Service radio program “Newshour,” asking if I could go on the air minutes later to debate COVID-19 fears and preparations with Clare Wenham, a London School of Economics professor. The producer quickly sent me Dr. Wenham’s article, “Is reporting of the coronavirus producing viral panic?” which I skimmed just before we started. Our six-minute conversation skimmed lightly over the usual topics: Is the public panicking or going through a normal and useful adjustment reaction? Are governments overreacting or underreacting, and which is worse? What role is media sensationalism playing?
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Posted: February 29, 2020
For weeks, while other countries found community transmission of the novel coronavirus COVID-19, the United States found none. This meant practically nothing, because the United States did not permit testing of any cases other than travelers or contacts of confirmed cases. Only in the past 48 hours have U.S. community transmission cases been reported. This led to a February 29 news conference headed by Nancy Messonnier of the U.S. Centers for Disease Control and Prevention (CDC). Jody Lanard and I listened to the presser. This is our immediate and strongly negative reaction, which we started writing minutes after it ended. Our main criticism: In the absence of widespread testing, CDC has no right to insist that the United States does not have many locations with community transmission. Doing so – sounding like you think that “absence of evidence” is “evidence of absence” when you haven’t gone looking for evidence – isn’t just over-reassuring. It is close to dishonest.
It’s dangerous for governments to claim the coronavirus outbreak is under control
Posted on the Quartz website, February 26, 2020
On February 22, my wife and colleague Jody Lanard received an email from Mary Hui, a reporter for Quartz based in Hong Kong, asking to interview her about coronavirus risk communication. They talked on February 24 about a variety of relevant issues. Mary’s story emphasized one key one, the need for candor rather than over-reassurance about the likely hard time ahead. The story was published early on February 26, Hong Kong time, two days before President Trump’s over-reassuring press briefing.
Four COVID-19 Emails to Four Journalists
Jody Lanard and I have been fielding inquiries from reporters covering various aspects of COVID-19. We decide which ones to respond to based mostly on whether the questions they ask provoke us to want to respond. Mostly we respond with emails rather than telephone interviews. As events overtake their stories – events more relevant to the general public than the musings of a couple of newly unretired risk communication experts – most of the reporters end up using little or nothing of what we send them. Here in chronological order are four of our recent emails:
- “Allaying Panic Is Not a Key Goal of COVID-19 Risk Communication Right Now” (to Ed Cara of Gizmodo, February 25)
- “How Should Anxious Doctors Talk to Anxious Patients about COVID-19; The Risk of Overreacting” (to Kate Johnson of Medscape Medical News, February 25)
- “Comparing COVID-19 to Seasonal Flu; Transitioning from Containment to Mitigation; the Powers of Local Public Health Officials” (to Nicoletta Lanese of Live Science, February 26)
- “Determination, Not Cheerleading: A Reaction to President Trump’s February 26 COVID-19 News Conference” (to Sarah Owermohle of POLITICO, February 27)
Past Time to Tell the Public: “It Will Probably Go Pandemic, and We Should All Prepare Now”
Email from Jody Lanard and Peter M. Sandman to Australian virologist Ian Mackay, February 22, 2020
Ian Mackay is an Australian virologist with a distinguished record of explaining virology to non-virologists. “Virology Down Under,” his blog and podcast, is always useful and often wonderful. On February 22, 2020, he wrote to ask whether we agreed that it was time to call COVID-19 (“Wuhan coronavirus”) a pandemic. We replied that it was past time. In the resulting email exchange, we proposed to write something that he could post on his blog and we could post on this website. This is what we wrote.
Spanish translation (by Daniel Romero-Alvarez)
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Coronavirus Complacency Arrives Ahead of Schedule
Posted on the Bloomberg Opinion website, February 11, 2020
A Wide-Ranging Interview on the Coronavirus Pandemic-To-Be
(Note: Link launches an MP3 audio file (80.1MB, 57 min.)Interview with Peter M. Sandman by Faye Flam, February 9, 2020
Faye Flam of Bloomberg News has interviewed me on several risk communication issues over the years, so I wasn’t surprised when she said she wanted to talk to me about coronavirus risk communication. Our February 9 telephone conversation ran 57 minutes, and covered a range of topics, some of them more about the pandemic-to-be itself than about its risk communication implications. Faye’s February 11 article made very little use of the interview. She may or may not use it for additional articles to come; if she does, I’ll post the links. In the meantime, I have divided the hour-long MP3 linked above into six segments; titles linked below or see the same links with segment descriptions on the Media page.
These links launch an MP3 audio file:
- Why worry now. (13MB, 9.55 min.)
- Why tell now. (17.5MB, 12.2 min.)
- Containment. (15.3MB, 10.5 min.
- Scaring people. (16.8MB, 11.6 min.)
- Preparedness. (9MB, 6.2 min.)
- Conspiracy theories. (9MB, 6.3 min.)
A Coronavirus Risk Communication Role Model in Singapore
Email from Jody Lanard and Peter M. Sandman to Bloomberg News reporter Jason Gale, February 9, 2020
In 2003, Jody Lanard and I wrote an article about "SARS Communication: What Singapore Is Doing Right" for Singapore’s dominant English-language newspaper, the Straits Times. So of course we have been following Singapore’s handling of another coronavirus (this one spreading from Wuhan, China) with great interest. Once again, in our judgment, Singapore is doing a wonderful risk communication job – not perfect, but amazingly close, a role model for any country – or any city – willing to treat its public with respectful candor instead of condescending over-reassurance. So when Bloomberg News reporter Jason Gale emailed us on February 9, 2020, asking for our assessment of a spectacular speech by Singapore’s prime minister, we jumped at the chance to respond. The resulting short article in Bloomberg Quint made no use of our response. We hope others will make some use of Singapore’s spectacular example.
Wuhan Coronavirus: Some Lessons from SARS, Swine Flu, Bird Flu, Ebola, etc.
Email from Peter M. Sandman to New York Times reporter Amy Harmon, January 25, 2020
On January 24, New York Times reporter Amy Harmon emailed me for comment on an article she was writing about the Wuhan coronavirus, especially lessons to be learned from the way past infectious disease outbreaks were communicated. I responded on January 25. After some introductory context grounded in risk communication basics, I focused on over-reassurance and overconfidence, two of the biggest errors in risk communication about SARS, swine flu, bird flu, Ebola, etc. Amy had asked in particular about local decision-making versus CDC policy, and about school and university infection control policies. So I addressed those two as well, emphasizing the value of local control and the dangers of stigmatizing stigma.
Amy hasn’t yet written a story on any of this, and may never write one. (If she does, I’ll link to it here.) As I wrote to her: “What I have to say about risk communication is really for officials, activists, experts, and journalists, not for the audience that attends to them. I don’t see any harm in telling the public what risk communicators think about what their sources are telling them. But I don’t see a helluva lot of value or newsworthiness either.”
Risk Communication about Containment – 2019 Novel Coronavirus
Posted: February 4, 2020
Jody Lanard and I have long argued that experts and officials should avoid sounding confident that containment measures are likely to “work” against pandemics-to-be – whether they’re conventional measures like contact tracing or controversial ones like travel restrictions. When the swine flu pandemic was emerging in 2009, we wrote a long column explaining why this is so. Containment, we said, is still worth trying, partly as a Hail Mary that might conceivably stop the spread of the virus, but mostly as a way to slow it a little, buying time for preparedness and maybe reducing the intensity of disruption. Here’s a short version, applying the same reasoning to the novel coronavirus that emerged in Wuhan, China.
Coronavirus – Crisis Management, Risk Communications & Practical Advice for Key Executives
Posted on the Hennes Communications blog, February 2, 2020
Tell People Now that We Probably Can’t Stop the Coronavirus Pandemic that’s Probably Coming
Email from Peter M. Sandman to Bruce Hennes, February 2, 2020
On February 2, crisis communication consultant Bruce Hennes sent me two drafts about the Wuhan coronavirus that he wanted to post on his blog. One was basically excerpts from my recent post, “ No Reason for Alarm” Is a Foolishly Over-Reassuring Message about the Novel Coronavirus Spreading from Wuhan, China. The other was Bruce’ s own thinking about how business leaders should prepare for the pandemic that might well be imminent. I emailed him comments on both, plus one longer suggestion for an insert in the second, launching from what he had written about the severe 1918 pandemic and the mild 2009 pandemic (both flu). He inserted it all.
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Published in the National Post, January 30, 2020
Email from Peter M. Sandman to Sharon Kirkey, January 29, 2020
In 2003, Jody Lanard and I wrote a website column entitled “‘Fear Is Spreading Faster than SARS’ – and So It Should!” Our critique of SARS risk communication advised officials and journalists not to be contemptuous of the public’s fears and not to underestimate the risk in a misguided effort to allay the public’s fears. These points were topmost in my mind when National Post reporter Sharon Kirkey emailed me on January 29, 2020 about the “new SARS,” a novel coronavirus spreading from Wuhan, China. Sharon’s January 30 article, an overview of “Coronavirus risk to Canadians,” devotes its last third or so to my core advice not to tell Canadians they shouldn’t worry.
Dr Norman Swan explains the risks versus the benefits of the AstraZeneca vaccine
Posted on the ABC (Australian Broadcasting Corporation) website and broadcast on the ABC television program “7:30,” May 5, 2021
Having posted a website comment on “COVID-19 Vaccine Blood Clots: Secrecy versus Pause versus Informed Consent,” I wasn’t too surprised to get an email from a producer of “7:30,” Australia’s leading nightly public affairs program, asking if their medical expert Dr. Norman Swan could interview me on the controversy – and on the risk communication challenge of convincing people not to overreact to tiny but scary risks. In our half-hour conversation, I emphasized that while the blood clot risk of some COVID-19 vaccines was indeed tiny, in Australia the risk of COVID-19 itself was also pretty small. So unlike Americans and Europeans, I said, most Australians could afford the luxury of waiting for a vaccine that scared them less to become available. ABC wouldn’t let me post the interview, but I did get permission to post the five-minute segment. There’s also a transcript of the segment on the ABC website.
Public Health’s Single Biggest COVID-19 Risk Communication Failure
Posted: August 4, 2020
In early July a reporter asked me what I consider the single biggest COVID-19 risk communication failure of public health experts and officials. It took me a month to think through my answer and draft this column. (Along the way I tested out some of my thinking in a telephone interview with Bloomberg reporter Faye Flam.) It’s a five-part answer: (1) First public health over-reassured the public and left us unprepared. (2) Then public health panicked and overreacted, locking down even places without much spread of the virus. (3) Then public health flubbed the rationale for lockdowns, adopting a suppression narrative instead of teaching us how to balance priorities and “dance” with the virus. (4) As part of its defense of lockdowns, public health abandoned the goal of “flattening the curve” in favor of the goal of minimizing transmission in every way possible. (5) Along the way, public health insisted that public policy and individual decisions should be grounded exclusively in “The Science” – that is, in the advice coming from public health itself.
Ebola
Subsections
Articles
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U.S. Public Health Professionals Routinely Mislead the Public about Infectious Diseases: True or False? Dishonest or Self-Deceptive? Harmful or Benign?
Presented to the Leadership Forum, University of Minnesota Center for Infectious Disease Research & Policy, Minneapolis MN, October 5, 2016
This is the uncut video – 101 minutes long – of an October 5, 2016 presentation I gave to the CIDRAP Leadership Forum. It continues and updates an argument I have been making for years: that the public health profession is far too willing to say or imply untrue things in its communications with the public.
In my introductory comments I discuss the dishonesty of public health professionals generically: why they do it; why they get away with it (compared to corporate leaders who are far likelier to be caught and crucified); how they feel about it; whether it undermines their credibility; whether they’re intentionally dishonest or self-deceptive or deceived by their leaders; the relationship between dishonesty and disrespect; etc.
Then comes the meat of the presentation. I intended to focus on four detailed examples:
- The oral polio vaccine (see also this 2012 discussion)
- The measles-mumps-rubella vaccine (see also this 2011 discussion)
- Ebola quarantine (see also this 2014 discussion)
- Zika funding (see also this June 2016 discussion, especially endnote 14)
But I ran out of time toward the end and had to settle for a very short summary of my views about Zika funding.
Throughout the presentation, my position wasn’t that public health professionals are wrong about these four controversies, but rather that they are too often dishonest and disrespectful in the way they make their case.
The text of my speech notes contains a lot of detail that I skipped in the actual presentation – both additional points and additional proof (with links) for the points I actually made in Minneapolis. It also has a Foreword written later. And it covers Zika funding; by the time I got to Zika funding in Minneapolis, I was nearly out of time.
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Journal of Risk Research, 2015 (published online November 5, 2015)
After an introduction with quotes from me, my wife and colleague Jody Lanard, and others, this is a content analysis of one U.S. Ebola controversy – New Jersey’s quarantine (and later isolation) of returning volunteer nurse Kaci Hickox – as it was covered in two New York City newspapers. The article focuses on the contrast between the news coverage of the controversy and the hundreds of readers’ comments in the online editions of the two papers. The news coverage depicted the controversy as a battle between science and fear: the mainstream public health position that there’s no need to quarantine people who have been exposed to Ebola unless they already show symptoms versus the demands of the irrational, panicky public that asymptomatic volunteers returning from West Africa be quarantined anyway. By contrast, the content analysis suggests – and extensive examples illustrate – that pro-quarantine reader comments showed the same mix of evidence and emotion as anti-quarantine comments. While qualitative content analysis of reader comments in two newspapers can’t be considered definitive evidence, I certainly agree with the authors that the anti-quarantine position was articulated overconfidently and even arrogantly - and that there was a sound case to be made for either position, depending mostly on how cautious a citizen, health official, or governor wanted to be in the face of considerable scientific uncertainty. (Note: The link takes you to an abstract; the article itself is behind a firewall.)
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COMMENTARY: When the Next Shoe Drops – Ebola Crisis Communication Lessons from October
by Peter M. Sandman and Jody Lanard
Posted on the website of the Center for Infectious Disease Research and Policy, December 9, 2014
For more than a month the University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP) and its director, Mike Osterholm, urged me to write a CIDRAP commentary on crisis communication lessons from the U.S. bout with Ebola in October 2014. I hesitated – partly because it wasn’t much of a crisis, partly because it was over and I was tired of writing about it, and partly because I doubted CIDRAP’s principal audience of public health professionals wanted to hear my complaints about how they handled it (especially their uncivil response to the quarantine controversy). But in early December I decided to go ahead, jointly with my wife and colleague Jody Lanard. The resulting article focuses on four main crisis communication errors: over-reassurance; over-confidence and even absolutism instead of acknowledging uncertainties about Ebola science; misdiagnosing the public as panicking; and ridiculing the public’s Ebola fears instead of accepting and guiding them.
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Ebola in the U.S. (So Far): The Public Health Establishment and the Quarantine Debate
Posted: November 15, 2014
This column is a slightly edited version of an email I sent on November 12, 2014 to the editor of Emergency Management magazine, in response to a November 10 email asking to interview me about Ebola risk communication in the U.S. It includes some brief points about risk communication errors with regard to the first U.S. case in Dallas, describing these as “the ordinary first half of this crisis communication story.” But the bulk of the column is devoted to the quarantine debate that arose after returning volunteer Craig Spencer was diagnosed in New York City. It focuses on my belief that the U.S. public health establishment was dishonest and uncivil in the way it misappropriated “the science” on behalf of the anti-quarantine position in the debate, and ridiculed the pro-quarantine position as unscientific and even idiotic.
Why It’s OK To Worry About Ebola, And What’s Truly Scary
Posted on the NPR website, October 30, 2014
Nancy Shute of NPR emailed me on October 28 to arrange an interview about Ebola, not for radio but for the NPR website. We agreed to focus on both what I thought about Americans’ Ebola fears and what I thought was worth fearing. Our October 29 phone conversation lasted about an hour and wasn’t taped. I tried to connect the two topics by emphasizing that when people are learning about a new risk they often emphasize the aspects that are most immediate, nearby, and personal, rather than the aspects that will ultimately be most important. I said the job was to use the teachable moment by helping people transition to the most worrisome aspects – which for Ebola, in my judgment, is the possibility of more epidemics throughout the developing world. I criticized officials, experts, and the media for trying to squelch people’s Ebola fears instead of trying to guide them, thus sacrificing the teachable moment. Nancy did a good job of condensing that and more into the short article she posted on the 30th.
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Ebola: Failures of Imagination
Posted: October 24, 2014
Almost since we started worrying about the Ebola epidemic in West Africa, my wife and colleague Jody Lanard and I have been worrying about the prospect of its spreading to developing countries around the world – countries less able than the U.S. and Spain to extinguish Ebola “sparks.” This column fleshes out that worry a bit. It also addresses some reasons why our leaders might be reluctant to raise the possibility of an Ebola pandemic in the developing world, much less to discuss its likely impacts on the developed world. But mostly the column is about how difficult it is for anybody (officials, experts, reporters, us) to stay focused on something that horrible … and how important it is to try harder to sound the alarm.
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Aired on PBS, October 16, 2014
“Here & Now” telephoned my wife and colleague Jody Lanard on October 14, asking her to come into a New York City studio to tape an
interview about whether Americans are overreacting to a domestic Ebola “crisis” that has so far resulted in just one death. She did the interview the next day. Jody stressed that it’s rational to pay attention to a risk you’re newly aware of, even if that attention is temporarily excessive, and that people will get past their temporary adjustment reaction more quickly if officials don’t label it irrational or panic. We have already decided how worried to be about flu, car crashes, and other familiar risks, she said. “We’re not going to decide … that this is the week we should pay more attention to driving safety. This is the week we are going to learn about Ebola.” 
Official Ebola Risk Communication: “Don’t Scare the Children”
Note: Link launches an on-site audio file (52MB, 38 min.) Interview with Peter M. Sandman by Betsy McKay of the Wall Street Journal, October 13, 2014
On October 13, 2014, at her request, I did a telephone interview with Betsy McKay of the Wall Street Journal on the way U.S. officials at the CDC were communicating about Ebola in Dallas. I focused at the start on my opinion that officials weren’t emphasizing Ebola uncertainties sufficiently; I relied especially on two examples of what I consider over-confident over-reassurance: whether Ebola sufferers always have a sudden onset of symptoms, and whether they’re never able to transmit the disease before those symptoms arrive. Later in the interview I turned to other Ebola risk communication issues. Among them: (a) The CDC’s rush to blame the nurse and the hospital system for a “breach of protocol” when she caught the disease from her patient, rather than suggesting that maybe the equipment or protocol might themselves be to blame; (b) My view that the widespread public fear about Ebola was not panic but simply a temporary adjustment reaction, and that the CDC should say so; and (c) My desire to see the CDC urge people to worry more about the possibility that the West African epidemic could spread through the developing world, instead of urging people simply to stop worrying about Ebola. Betsy didn’t end up writing any stories that made use of this interview, though maybe it was useful background for her. With her permission, I recorded my answers without her questions. I have cut some desultory conversation from the beginning and end of the audio file, but otherwise this is the whole interview. Remember, it took place on October 13: before the second nurse got sick, before the CDC decided it should recommend more protective PPE, etc.
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Two unsolicited emails to Lisa Schnirring of CIDRAP News, October 12 and October 13, 2014
After a Dallas nurse who had helped care for America’s first Ebola patient became America’s second Ebola patient (not counting the ones who have been airlifted in pods from West Africa to special high-tech facilities), the CDC held an October 12 press briefing at which CDC head Tom Frieden repeatedly attributed the case to a “breach of protocol.” Together with my wife and colleague Jody Lanard, I sent an unsolicited email to Lisa Schnirring of CIDRAP News criticizing what he had said. Frieden was widely criticized by others as well for blaming the victim, the hospital, and the healthcare profession – and for not even mentioning the possibility of equipment failure. So on October 13 he briefly apologized, saying he hadn’t meant to blame anybody. I didn’t think the apology went far enough, and sent Lisa another email (without Jody) to that effect. Lisa didn’t use either email in her October 12 and October 13 articles, but here they are.
Health officials struggle to control the media narrative about Ebola
Published in The Hill, October 12, 2014
Three Priorities for Ebola Messaging
Email in response to a query from Elise Viebeck, October 10, 2014
Reporter Elise Viebeck of The Hill emailed me on October 10, asking for input to an article she was writing on “how the CDC is struggling to control the media narrative on Ebola,” especially what she called “the balancing act they face between maintaining public calm and pressing for a greater response to the epidemic.” I replied that same day with an email outlining “three themes for CDC’s Ebola messaging that I think are not coming across well enough yet”: that Americans are resilient; that there is a huge amount we don’t know yet about Ebola; and that the biggest threat is the possibility of seeing similar epidemics in other parts of the developing world. Elise’s story made some use of the first two themes.
How to talk to the public about Ebola: Five tips from risk communication experts
Posted on ScienceInsider, October 9, 2014
What Needs to Change in Ebola Risk Communication: Pivoting away from Dallas
Email response to query from Kai Kupferschmidt, October 5, 2014
Kai Kupferschmidt emailed me on October 5 asking to interview me about Ebola risk communication, especially with regard to uncertainty and future scenarios. I got his okay to respond via a joint email with my wife and colleague Jody Lanard. Our email outlined what it would take for U.S. Ebola coverage to pivot away from one case in Dallas to thousands in West Africa and the threat of a global Ebola pandemic. We also described four competing responses to the West Africa epidemic: vaccine development, “spark suppression” (trying to confine the epidemic to West Africa), patient isolation and contact tracing, and treatment. We emphasized our view that, post-Dallas, spark suppression would be the big story. We concluded the email with five recommendations for improving Ebola risk communication and a short list of relevant risk communication principles. Kai’s post quoted the five recommendations verbatim, and summarized much of the rest – along with some additional content documenting what he called the “media frenzy” in the U.S. Our complete email is on this site.
Ebola Outbreak As Black Swan: How To Think Clearly About An Unpredictable Hazard
Posted on the Forbes website, October 7, 2014
Science writer Faye Flam interviewed me for almost an hour on October 6, ranging widely from the basics of risk communication to the specifics of Ebola news coverage. Then she harvested the interview for a short Forbes website post that framed Ebola in terms of my signature hazard-versus-outrage distinction. Two other points she took from the interview that aren’t stressed enough in most Ebola stories: (1) that risk is a future-oriented concept, so what matters isn’t the current U.S. prevalence of Ebola but its possible future impact on our lives; and (2) that all the uncertainties of Ebola mean reporters should be focusing on both likeliest scenarios and worst case scenarios (the ones that aren’t vanishingly unlikely), and on the high probability of surprises to come. There was a lot more in the interview; if Faye gets me the audio I will post it.
Health Care Risk Expert: There Are Little If Any Signs of Ebola Panic in the U.S.
Published in Seattle Weekly, October 7, 2014
Ellis Conklin called me on October 7 with a very specific story in mind: Why are Americans getting all panicky and hysterical about new diseases like Ebola and EV-D68? I gave him only ten minutes or so, running through my usual litany: People aren’t panicky or hysterical, they’re only worriedly interested; looking up a disease on Google isn’t panicking; reporters who write that “the public” is panicking invariably tell me they don’t personally know anyone who is panicking; it’s both natural and useful to have a brief “adjustment reaction” to a new risk; etc. Ellis took it all in, and wrote what I consider an excellent story.
Media goes overtime on Ebola coverage, but not necessarily overboard
Published in the Washington Post, October 6, 2014
Three Ebola News Stories: Dallas, West Africa, and What-If
Email reponse to query from Paul Farhi of the Washington Post, October 6, 2014
Paul Farhi emailed me on October 6 asking what I thought of Ebola media coverage. He was especially interested in whether I agreed that there was too much attention to one U.S. Ebola sufferer, especially compared to other U.S. health risks. I replied that same day, outlining three different Ebola stories: the domestic Ebola story in Dallas, the epidemic Ebola story in West Africa, and the what-if Ebola story in the rest of the world. I explained why I thought all three deserved coverage, but especially the third, which was badly under-covered. Paul’s article stuck to the emphasis in his email, contrasting Ebola in the U.S. with other diseases that are currently afflicting far more Americans, especially a previously rare enterovirus with the unexciting label “D68.” He used me only at the end of his piece, briefly, as the expert who disagreed with everyone else and thought Ebola wasn’t being over-covered. Even then he focused on the small part of my reply that had noted how scary Ebola is, deemphasizing my main point that Ebola poses genuinely important risks. But at least my view – “not necessarily overboard” – got into his article’s headline. My complete email to Paul is on this site.
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Ebola Risk Communication: Talking about Ebola in Dallas, West Africa, and the World
Website column by Peter M. Sandman and Jody Lanard
Posted: October 6, 2014
In early October, I started getting media inquiries about Ebola risk communication. Three such inquiries led me to write emails (two of them jointly with my wife and colleague Jody Lanard) that collectively summarized most of our thinking about how U.S. sources and the U.S. media were handling Ebola – the first U.S. case in Dallas, the disastrous epidemic in West Africa, and the global pandemic risk. Included in this column are: (a) Our October 3 response to Sharon Begley of Reuters; (b) Our much shorter October 5 response to Kai Kupferschmidt of Science; and (c) My short October 6 response to Paul Farhi of the Washington Post. The articles that Sharon, Kai, and Paul wrote are referenced and linked at the very end of this column, or will be once they’re published. (Note that I had some follow-up communications with Kai, by phone and email, that he relied on in his article but are not included in the column.)
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An Ebola Empathy Exercise (pure speculation, based on hypothetical what-ifs)
Website column by Peter M. Sandman and Jody Lanard
Posted: October 3, 2014
Throughout August and September, my wife and colleague Jody Lanard and I obsessed over Ebola. We wrote part or all of several Ebola risk communication columns, only to have our thinking overtaken by events. This short column, completed in one day, focuses on a very narrow question: What might have happened at Texas Health Dallas Presbyterian Hospital on September 25–26, 2014, when Thomas Eric Duncan came to the emergency room with fever and abdominal pain, said he was visiting from Liberia (the heart of West Africa’s Ebola hot zone), and was nonetheless sent home? Two days later, days in which he might have infected other people, Duncan was brought back to Texas Health Dallas by ambulance. That time Ebola was suspected, and later confirmed, making Duncan the first Ebola patient to be diagnosed outside Africa. Commentary has been understandably hostile to both Duncan and the hospital staff for what may turn out to have been a tragic miscommunication. Jody and I felt that anger too. We have tried to temper it with this Ebola empathy exercise, a purely speculative effort to look at a ghastly mistake without assuming reckless irresponsibility on either side. As more facts come out, our speculations may well be proven entirely false. Even so, the need for people to respond empathically to Ebola will not go away. Empathy is needed for the horrific conditions West Africans are enduring; for the threat to the rest of us; for the ways people at overwhelming risk may resort to denial, while people whose risk is much smaller may temporarily overreact; even for the officials who yield to the temptation to oversimplify or over-reassure. The column isn’t about all that, though. It’s just an attempt to imagine empathically what might have happened in that Dallas emergency room.
Guestbook Entries
2015
2014
The Swine Flu Pandemic of 2009–2010
Subsections
Major Articles
(The Swine Flu Pandemic of 2009–2010)
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The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives
Posted: June 29, 2010
In June 2010, one year after the World Health Organization declared swine flu a full-fledged pandemic, WHO’s credibility nosedived as even mainstream sources began to take seriously the absurd allegation that WHO had invented a “fake pandemic” in order to enrich the pharmaceutical industry. This column assesses at great length the three main reasons why this allegation made the move from fringe to mainstream: (a) WHO’s failure to acknowledge the ongoing mildness and current low incidence of the pandemic; (b) WHO’s failure to acknowledge that it changed some flu pandemic definitions and descriptions just as H1N1 was emerging; and (c) WHO’s failure to acknowledge until recently the legitimacy of concerns about transparency and conflict of interest. In a nutshell, the credibility of the World Health Organization crashed and burned because WHO mishandled some essential aspects of pandemic risk communication.
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Swine Flu Pandemic Communication Challenges and Lessons Learned
Posted: May 5, 2010
Responses to emailed questions from Lisa Schnirring of CIDRAP News
On April 21, 2010, Lisa Schnirring of CIDRAP News (part of the Center for Infectious Disease Research & Policy at the University of Minnesota) wrote me that she was working on an article on communications challenges and lessons learned from the swine flu pandemic – one of a series of CIDRAP News retrospectives to mark the first anniversary of the emergence of the new H1N1 virus. Would my wife and colleague Jody Lanard and I like to be interviewed? I replied that if she would email us some questions, we would answer in writing. No article ever materialized, but here are Lisa’s questions and our answers.
European hearing airs WHO pandemic response, critics’ charges
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), January 26, 2010
Charges that the World Health Organization (WHO) exaggerated the risk of the H1N1 pandemic in collusion with drug companies came to a head in a January 26 hearing of the Council of Europe’s Committee on Social, Health and Family Affairs. Lisa Schnirring covered the story for CIDRAP News. While she was working on her article, I sent her an email offering some comments. My wife and colleague Jody Lanard did so as well (at Lisa’s request), and Lisa wound up quoting us both – Jody mostly on the normal antipathy between WHO and Big Pharma and thus the irony of the conflict-of-interest charge; and me mostly on WHO’s failure to concede two valid charges among the invalid ones: that WHO hadn’t sufficiently acknowledged the pandemic’s mildness and that WHO had dropped severity from its characterization of flu pandemics at the last minute.
After Lisa’s article was published, Jody and I decided to expand my email to document more thoroughly the two valid charges, the risk communication case for acknowledging them, and WHO’s failure to do so. The resulting critique (“It’s Not a Fake Pandemic – but WHO’s Defense Lacks Candor”) is a lot tougher on WHO than the CIDRAP News article.
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Posted: December 18, 2009
On December 2, 2009, and again on December 15, I criticized the U.S. Centers for Disease Control and Prevention in my “Swine Flu Pandemic Communication Update” for (in my view) intentionally misinterpreting its own data on the severity of the swine flu pandemic and on which age cohorts were most at risk. These criticisms aroused surprisingly little media interest. But a couple of reporters did call for interviews. Here are some excerpts from my side of one telephone interview. No story based on this interview ever materialized. The details are no longer of much interest, except as a pristine case study of successful CDC dishonesty.
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U.S. Pandemic Vaccine Supply and Distribution: Addressing the Outrage
Posted: November 18, 2009
As in most other developed countries, the fall rollout of the U.S. pandemic vaccination program has been hampered by a shortage of vaccine. The result is outrage – outrage that there isn’t as much vaccine as people wanted and expected, and outrage that the distribution process feels so chaotic, frustrating, and in some cases unfair. The shortage itself is nobody’s fault; the vaccine virus turned out to be difficult to grow. But officials are very much at fault for having overpromised, frequently predicting that there would be ample vaccine by mid-October. Even before the pandemic began, in fact, the meme was established that it would require only three to six months after the emergence of a pandemic influenza strain to manufacture sufficient vaccine. Managing public (and health care provider) outrage about vaccine supply and vaccine distribution has thus become an important pandemic risk communication task, a necessary distraction from the paramount task of convincing people to get vaccinated. This column describes how officials are handling the outrage so far, and proposes some improvements.
Sorting through panic and anxiety
Published in the Toronto Star, October 30, 2009
When a healthy 13-year-old soccer player in Toronto suddenly got swine flu and died, both major Toronto newspapers ran front-page stories urging people not to panic. Until then, public health authorities had been desperately trying to get people to take the pandemic seriously enough; now they reversed direction and started making reassuring statements. Instead of seizing the teachable moment, they succumbed to their own “fear of fear.” Judy Gerstel of the Toronto Star called me to ask about the mixed messages. The resulting story suffers a bit from ham-handed editing – but it is still on target.
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Flu Preparedness: An Even Tougher Sell than Usual
Posted: September 9, 2009
I wrote this short column in early June 2009 for The Synergist, a magazine for industrial hygienists, on some ways of communicating about flu – seasonal and pandemic – in the workplace. When I wrote it, most people had “recovered” from what they considered the spring “swine flu scare,” and they were in no mood to listen to any more influenza warnings. By the time the column was published in September 2009, some of the complacency had waned, and people were actually girding up (a bit) for another wave of mild-but-pervasive pandemic illness. So the column’s claim that flu preparedness is a tough sell needs to be modified somewhat. But its actual recommendations still stand.
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Distributed by Project Syndicate, July 27, 2009
Project Syndicate is a nonprofit organization that distributes op-ed commentaries on currently hot topics to newspapers around the world, free of charge. They asked me to do one on how public health officials ought to be communicating with the public about the ongoing H1N1 pandemic. The resulting piece briefly discusses nine mistakes officials should stop making: don’t feign confidence; don’t over-reassure; don’t worry about panic; don’t obsess over accusations of fear-mongering; don’t fight the adjustment reaction; don’t oversell what the government is doing; don’t oversell what the public can do; don’t ask the impossible; and don’t neglect the teachable moment.
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Containment as Signal: Swine Flu Risk Miscommunication
Posted: June 29, 2009
The swine flu pandemic started in North America, and by the time the virus was identified it was already widely seeded in the U.S. So the experts judged that it was too late to try to “contain” its U.S. spread; from Day One, the U.S. was focused mostly on coping with the disease, not stopping or even slowing it. Outside North America, on the other hand, an initial containment strategy made public health sense. But containment isn’t just a public health strategy. It is also a risk communication signal of enormous importance. Containment sends a signal that the pandemic can be contained and that it must be contained – that it is stoppable and severe. Instead of countering these misleading signals, the governments of many countries have issued misleading messages to match. This is doing significant damage to the world’s preparedness to cope with the unstoppable (and soon to be pervasive) but so far mild pandemic that is just beginning.
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Communication expert endorses WHO’s delay on pandemic declaration
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), June 12, 2009
On June 11, the World Health Organization finally let the other shoe drop, formally declaring H1N1 a pandemic. CIDRAP’s Robert Roos sent me an email asking for my comments. I responded that the delay itself had been pretty sensible – which turned into Bob’s lead angle. But I had mixed feelings about some of what Director-General Margaret Chan and Interim Assistant Director-General Keiji Fukuda said in making the announcement. What had motivated WHO to delay in the first place had been its twin concerns that the declaration might frighten people unduly (“Oh my God a pandemic!”) and that the declaration might reinforce people’s complacency (“This is a pandemic? What’s the big deal?”). Yet the announcement did relatively little to address either concern. My original exchange of emails with Bob Roos (“Reactions to the WHO’s Phase 6 Declaration”) is posted on this site.
Avoiding “warning fatigue” over swine flu
Posted on Emerging Health Threats Forum, May 8, 2009
Anita Makri of Emerging Health Threats Forum asked some of the most thoughtful questions I have been asked anywhere about the risk communication implications of the fact that swine flu has been mild so far, about what governments might have done differently in the way they warned people, about what they ought to be saying now, and about how to handle any future warnings that might be needed. She compiled my answers with answers from the CDC’s Barbara Reynolds into an excellent article on swine flu warning fatigue. This sentence from the article captures the problem best: “‘We need to persuade people who became alarmed (wisely) and then became less alarmed (also wisely) that they have nothing to feel foolish about and nothing to feel angry about … but good reason to remain vigilant,’ says Sandman.”
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Broadcast on KUNC radio, May 5, 2009
Grace Hood made a mistake at the start of this four-minute interview when she said I told her some people are panicking about swine flu. And I overstated things pretty badly myself when I said that at the start of the outbreak the experts were “on the phone in the middle of the night” worrying that swine flu might be “the granddaddy of all pandemics.” Despite both errors, this is a pretty solid interview on two key points I keep stressing: (a) that a good pandemic warning needs to be simultaneously scary and tentative; and (b) that the U.S. government didn’t do much to urge people to prepare when it looked like a severe pandemic might be imminent, so it’s hard to imagine it’ll do more now that the sense of imminence has gone.
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What’s in a name: H1N1 versus swine flu
Posted: May 3, 2009
One inevitable effect of the swine flu crisis that began in late April 2009 was public concern about eating pork products. In an effort to reassure people, international authorities decided that “swine flu” would henceforth be known instead as “A/H1N1.” An international financial manager wrote to the website Guestbook in support of the switch. Jody and I disagreed, arguing (a) that the new virus is in fact a swine flu, and it’s a mistake to pretend otherwise; (b) that there is already a seasonal A/H1N1, and it’s a mistake to give two circulating viruses the same name; and (c) that risk communication offers some better ways than linguistic cover-up to cope with the stigmatization of pork. Our answer grew too long for the Guestbook, so here it is. (We had to revise the half-written answer when Canada discovered human-to-pig transmission of the new virus. Other developments may strengthen our argument, as that one did – or, perhaps, weaken it.)
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Posted: April 29, 2009
This was my first substantial piece of writing about swine flu. I have resisted the temptation to update the description that follows. When I started criticizing the government for talking about swine flu as if there were nothing for the public to do but watch and practice good hygiene, we were at WHO Pandemic Phase 3. When I started this column (this morning) we were at Phase 4. When I finished the column (this evening), it was already Phase 5. The focus of this column is why the U.S. government is reluctant to urge the public to prepare now for a possibly imminent pandemic, and why I think the government should overcome its reluctance and do it! If you’re skeptical about advising people to imagine The Big One, get used to that knot in their stomachs, and then get started on preparedness, read this column. If you’re not skeptical and want to know what I think the important messages for right now are, skip this column and instead read “What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five..”
On May 21, 2009, Nature published a major abridgment and minor updating of this column under the title “Pandemics: good hygiene is not enough.” An Adobe Acrobat file (707-kB pdf) of the complete article
is available. (Note: The Nature links require payment. Free access to a copy is available.) French translations of my column and the Nature article, originally posted on the website Zone Grippe Aviaire (which has disappeared) are also available on this site.
Swine Flu Pandemic Communication Updates
(The Swine Flu Pandemic of 2009–2010)
On April 24, 2009, when a swine flu pandemic looked imminent and potentially very serious, I posted a two-paragraph alert on my website home page. This was the first of several dozen “Swine Flu Pandemic Communication Updates” I posted on the site. They soon got much, much longer and moved off the home page. They were no longer “alerts,” really, but rather essays on how the swine flu pandemic was evolving, how it was being communicated, and how I thought it should be communicated.
Other Articles
(The Swine Flu Pandemic of 2009–2010)
H1N1 cases in India sparking media hype
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), April 9, 2012
India’s Response to Swine Flu – Still Weird
Email to Lisa Schnirring, April 9, 2012
When CIDRAP News decided to do a story about recent hype in India’s media coverage of swine flu, I pointed out that it wasn’t just recent and it wasn’t just the media. So reporter Lisa Schnirring asked if I wanted to comment on the record. This is the response I sent her. She used most of it in her story, along with a lot of other good material on Indian pandemic H1N1 hype.
Why Seniors Really Should Fear Swine Flu
Blogged on the Newsweek website, January 8, 2010
I continue to be surprised that the mainstream media have paid so little attention to the CDC’s evidence that children are actually less at risk of catching a deadly case of swine flu than adults and seniors – and so little attention to the CDC’s decision not to change its vaccination messaging in response to that evidence. Even after I posted a Swine Flu Pandemic Communication Update on the subject, I was unable to arouse much of a reaction. This excellent blog post by Newsweek’s science editor is an exception … or perhaps a watershed. Starting from my update, Sharon Begley nailed the evidence that seniors are being dangerously misled into thinking they’re too old to worry about swine flu.
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Broadcast on NPR’s “Morning Edition,” November 6, 2009
The CDC website has detailed advice for parents with a child home sick with swine flu. But it’s not necessarily very practical or user-friendly advice. Deborah Franklin’s story on NPR’s “Morning Edition” features some of the ways the CDC’s recommendations might be a tad unrealistic. She used me to say the obvious: that there’s nothing wrong with telling parents how to achieve maximum infection control at home, but it would help to offer a Plan B for parents who can’t or won’t do it all. The link includes both the audio clip and a print version of the story from NPR’s website. Available on this site: An email I sent the reporter before the interview with some thoughts on public health professionals’ reluctance to help people prioritize among their recommended precautions.
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Broadcast on NPR’s “All Things Considered,” November 2, 2009
Richard Knox interviewed me for nearly an hour on how I think the Centers for Disease Control and Prevention should speak to people who aren’t just worried about the safety of the swine flu vaccine, but are also mistrustful of government and not inclined simply to take the CDC’s word that the vaccine is safe. I talked a lot about the sorts of accountability mechanisms smart corporations use, and how the CDC could use similar approaches if it weren’t so deeply offended by people’s mistrust. The resulting story in “All Things Considered” used only a little of the interview, of course. The link includes both the audio clip and a print version of the story from NPR’s website.
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Uncertainty over H1N1 warranted, experts say
Published in the Toronto Star, October 9, 2009
I’ve pretty much stopped posting news stories that quote me about pandemic risk communication, since neither the stories nor the quotes say much that’s new. But this Toronto Star “Analysis” story by Judy Gerstel swims against the tide. Like many other stories, this one covers official uncertainty about many aspects of the swine flu pandemic. It focuses particularly on an unpublished Canadian study that seems to show the seasonal flu vaccine might increase vulnerability to the pandemic virus, which has led to significant changes in some provinces’ vaccination policies despite contrary (also unpublished) studies. But instead of criticizing the uncertainty as official “double messages” leading to public “confusion,” Judy praises it as “transparency, responsiveness, agility and acknowledgement of uncertainty.” I was pleased to be part of the story. (I’m also in a less interesting Judy Gerstel swine flu story published the same day, “Swine flu squeezing out the seasonal bug,” which despite its headline actually focuses on what to call the pandemic virus.)
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Fundamentals of risk communication: How to talk to patients and the public about pandemic H1N1
Presented to the European Respiratory Society international conference, Vienna, Austria, September 14, 2009
The European Respiratory Society invited me give a 20-minute presentation on pandemic communication at its annual conference, as part of a panel on various aspects of pandemic H1N1. I pleaded for an extra hour right afterwards to go into more detail for those who wanted it. Some 20,000 respiratory disease doctors attended the conference; roughly 2,000 of them were at the panel; about 200 followed me to a smaller room for my extra hour (which I did jointly with my wife and colleague Jody Lanard, an M.D.). Only the panel presentation is posted on the ERS website. It’s mostly an introduction to the basics of risk communication (hazard versus outrage; precaution advocacy versus outrage management versus crisis communication), with some quick comments on the implications for pandemic communication. The meat was in the hour that followed, which unfortunately wasn’t recorded.
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British public slow to respond to pandemic
Posted on Emerging Health Threats Forum, July 16, 2009
A survey of pandemic attitudes in the U.K found people not very concerned and not very inclined to take precautions. Holly Else of the Emerging Health Threats Forum sent me an email asking what I thought of these results. I replied that they were unsurprising, since it often takes a generation to inculcate a new precaution in a society, especially with regard to a risk that isn’t obviously serious (yet). On the date this news story was being prepared, the U.K. had just experienced two pandemic deaths in previously healthy people (one of them a child), and the level of public anxiety was apparently higher than it was in early May, when the survey had been conducted – so I commented on that too, noting that a temporary adjustment reaction does not constitute panic. My original response (“It Isn’t Easy to Arouse Pandemic Concern. What Do We Need People to Know?”) is posted on this site. It also identified what I considered the three key things the U.K. public needed to know about the pandemic; that was a little beside the point and didn’t make it into the story.
WHO suspends reporting of H1N1 case counts
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), July 16, 2009
On July 16, the World Health Organization advised countries to stop routinely testing suspected pandemic flu cases to confirm the diagnosis. WHO’s main reason was to conserve laboratory resources better used for other purposes, once widespread community transmission has already been established. But there is also a risk communication angle to the story. The tally of confirmed cases is a much smaller number than the actual number of people who have had the disease. As I explained to Lisa Schnirring of CIDRAP News, overuse of the confirmed case count has given many people the misimpression that the pandemic is much less pervasive than it actually is, and has made sources who tried to explain its actual pervasiveness sound like fear-mongers. The emphasis on confirmed cases has also made the disease look more deadly than it actually is (so far), since the unconfirmed cases are missing from the denominator of the “case fatality rate” fraction.
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Critics say “mild” a misleading term for H1N1
Distributed by Canadian Press, June 28, 2009
Canadian Press reporter Helen Branswell (the dean of the pandemic press corps) sent me an email asking my opinion on all the official statements that pandemic H1N1 is “mild” and that it attacks mostly people with “underlying health conditions.” I wrote back that both claims are accurate but misleading. When applied to a flu pandemic, “mild” doesn’t mean what we think it does, and an awful lot of people have “underlying health conditions.” And anyway, why were officials trying so hard to reassure the public, when the real problem was public complacency? Helen used only a little of my email in her article. My original email to Helen (Is Swine Flu “Mild”? Are We Safe If We Have No “Underlying Conditions”?) is posted on this site.
We’re Living in a Pandemic: Now What Do We Do?
Blogged in Nancy Shute’s “On Parenting” blog, U.S. News & World Report, June 11, 2009
After WHO declared H1N1 a pandemic, Nancy Shute asked me what the declaration meant for how worried parents should be. I answered that it shouldn’t have any effect at all; the reasons to worry were just as compelling before the declaration as after, and the reasons to worry were mostly about what might happen, not what had happened so far. When the story appeared on Nancy’s “On Parenting” blog, it left the impression I thought there was little or no reason to worry, period. So I sent her a longer, more alarmist comment, entitled “Swine flu is more serious than many people think.”
WHO under pressure from member states to rewrite pandemic requirement
Distributed by Canadian Press, May 22, 2009
For weeks, a number of governments have been urging the World Health Organization to redefine “pandemic” so it wouldn’t have to declare H1N1 a pandemic. Their main worry: that a pandemic declaration would panic their publics, leading to demands for border closings and other such ineffective and economically damaging infection control measures. On May 22, WHO announced that it would reconsider its pandemic definition. I thought the rationale for doing so was mistaken. But I saw some merit in the decision itself, for exactly the opposite reason: that a pandemic declaration while H1N1 remained mild would “teach” people that pandemics are no big deal. This CP story by Helen Branswell quotes me briefly to that effect. My original email to the reporter (“On WHO Changing the Definition of ‘Pandemic’”) is on this site.
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Pandemics: good hygiene is not enough
Published in Nature, May 21, 2009, pp. 322–323
This is a pretty drastic abridgment and a very minimal updating of my April 29, 2009 column, “The Swine Flu Crisis: The Government Is Preparing for the Worst While Hoping for the Best – It Needs to Tell the Public to Do the Same Thing!“ But a Nature commentary can be a lot more influential than a website column, so I was happy to seize the opportunity. The focus, of course, is the same: that the authorities (for example the CDC in the U.S.) are being candid about swine flu but are not urging people to prepare, and not giving people a visceral sense of what a serious swine flu pandemic might be like. Why? Partly because they’re (mistakenly) afraid of frightening the public, and partly because they’re (correctly) afraid of being accused of frightening the public. I argue that they should get over both fears and use the teachable moment … a position I feel even more fervently on May 21 than I did on April 29.
An Adobe Acrobat file (707-kB pdf) of the complete article
is also available. (Note: The Nature links require payment. Free access to a copy is available.) A French translation of this article, originally posted on the website Zone Grippe Aviaire (which has disappeared) is now available on this site.French translation available
En Français: Pandémie: une bonne hygiène ne suffit pas (Nature)
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Posted on newmatilda.com, May 12, 2009
I’m not sure what to say about this Australian website posting. Its tone is awfully flip. And author Jess Hill got some details wrong. (For example, she writes about my “‘Watch out! Stop Worrying’ approach” – which is actually two antithetical approaches.) Still, she really does seem to understand the dilemma WHO faces as it tries to warn people about a situation that looks quite mild at the moment. And she has condensed a lot of my website writing on pandemics into two risk communication strategies she thinks WHO is using with regard to swine flu: “Get Your Slice of the ‘Fearfulness Pie’” and “Use ‘Teachable Moments’ to Establish ‘The New Normal.’” Once I got past the tone, I found this short article a very thoughtful assessment.
By the way, Hill quotes me as saying that I have worked on over 500 crises. It’s an accurate quotation, but it’s not so. I have worked on over 500 controversies that felt like crises to my clients, because their reputations or their profitability was threatened – but far fewer actual crises that seriously threatened public health. Swine flu is one of the latter.
- Health Check
(Note: This link is to an 8.1-MB, 8:40-min. MP3 audio file on this site.)Broadcast on BBC World Service, May 10–12, 2009
“Health Check” is a weekly program on BBC radio. This audio clip deals with people’s emotional reactions to swine flu. It starts with a report from Mexico City, followed with an interview with me. I point out that officials suffer from “panic panic,” excessively worried that the public will panic, but that in most crisis situations (this one included) apathy is a much bigger problem than panic. I also talk about the role of denial, and emphasize that what officials need to do is to legitimize people’s fears – not tell them they shouldn’t be afraid.
H1N1 flu – are we preparing for the worst or hoping for a break?
Published in the Jamaica Observer, May 9, 2009
Jamaica Observer columnist Clare Forrester is the former Media and Communication Advisor of the Office of Caribbean Program Coordination of the Pan American Health Organization, where she worked with my wife and colleague Jody Lanard. This is a thoughtful and level-headed column arguing that the swine flu threat is still serious, that officials need to be candid rather than over-reassuring, and that the real danger isn’t panic but apathy – and loss of trust if officials over-reassure and then things get bad. She interviewed Jody and looked at my website to get some additional quotes, but she had it right to start with.
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Flu overhyped? Some say officials ‘cried swine’
Distributed by the Associated Press, May 7, 2009
Unlike many stories on the widespread conviction that the swine flu risk was overblown by officials and the media, this AP story pays attention to why that conviction is mistaken. It quotes me – my website, actually – on how skeptical people are likely to be if things start looking bad again and officials try to renew their warnings.
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Published in Haaretz, May 7, 2009
This article from an Israeli newspaper is more balanced than most media stories about “swine flu hype.” Reporter Assaf Uni interviewed my wife and colleague Jody Lanard, who pointed out that preparing isn’t panicking, and that it’s better to warn people about a risk that doesn’t materialize than to leave them unaware of one that does.
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Between a virus and a hard place
This editorial in the May 7 issue of Nature argues that “complacency, not overreaction,” is the greatest swine flu danger – and uses me to make the point that WHO and the CDC have actually done an excellent job of acknowledging how uncertain the experts are about the future course of this new virus.
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Broadcast and posted on Minnesota Public Radio, May 6, 2009
This overview of recent swine flu developments discusses people’s sense that initial warnings were overblown, and includes my concern that authorities will hesitate to risk still more credibility by doing what they should do: warn people that swine flu may still pose a serious threat and that they should use the current calm to get better prepared. This site has both a transcript and an audio file.
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What happens if swine flu goes away?
Distributed by Reuters, May 4, 2009
This “Analysis” piece by Reuters Health and Science Editor Maggie Fox quotes me on my hope that “the government is more worried about the public being caught with its pants down than the government being called fear-mongers.”
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Blogged on May 3, 2009
This blog entry is only casually about swine flu; mostly it’s a summary of some of my old writing on hazard versus outrage, panic, and “panic panic,” as applied to everything from swine flu to education.
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5 Ways to Manage the Family’s Swine Flu
Blogged on the U.S. News & World Report website, May 1, 2009
Nancy Shute called to ask me about three things: whether parents should worry about their children in connection with swine flu, what they should do about it, and how they should talk to their kids about the situation. She really wanted to interview my wife and colleague Jody Lanard, but Jody’s in Asia and Nancy figured maybe a three-time father might be able to gin up some child-sensitive risk communication answers too. I tried. She captured what I said very well, I think, except that I didn’t say you should “sympathize” with a child’s legitimate swine flu worries; I said you should share them – not the same thing at all.
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Broadcast on PRI’s “The World” (National Public Radio), April 30, 2009
Long-time health journalist Christine Gorman and I chatted with host Lisa Mullins for about 20 minutes. PRI used about half of it. I spent a lot of my time riding my hobbyhorse that the government needs to do more to urge people to prepare in case a serious pandemic is around the corner. But Lisa got us talking about other things as well, notably why it doesn’t make a lot of sense to close the Mexican border when lots of people on this side of the border are already carrying the flu virus, while lots of trucks on the other side are carrying goods we need.
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Behavioral research can help curb the spread of swine flu – but is anyone listening?
Posted on the American Psychological Association website, April 30, 2009
Michael Price discussed what behavioral science has to offer swine flu risk communication with me and Carnegie Mellon University expert Baruch Fischhoff, then wrote this feature on some of our swine flu communication recommendations.
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Broadcast on BBC World Service “Business Daily,” April 29, 2009
This is only marginally about risk communication. The “Business Daily” reporter’s working hypothesis was that swine flu precautions – individual and societal – are excessive given how few people have died compared to the fatalities from many other risks (worker accidents, for example, not to mention the seasonal flu). I tried to explain that what’s scary about swine flu isn’t what has already happened; it’s what might (or might not) happen. It’s hard to choose precautions when the risk in question could end up catastrophic or trivial or anywhere in the middle. Going further and further beyond my field of expertise, I ended up explaining why I think dispersing antivirals nearer to population centers probably makes sense and closing airports probably doesn’t. The editors pretty much left my risk communication points on the cutting room floor (the psychological benefits of taking precautions, for example), and ran with my off-the-cuff amateur opinions about infection management. Not their fault, of course; I was the one answering the damn questions.
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Experts worry mild disease outside of Mexico hampers bid to get people to prepare
Distributed by Canadian Press, April 29, 2009
For days I have been haranguing Helen Branswell of Canadian Press (and everyone else I can buttonhole) about the need for officials to be simultaneously scary and tentative in what they tell the public about the swine flu pandemic that might (or might not) be impending. She eventually decided to do the story, pegged to the potentially misleading mildness of the non-Mexican cases so far. When she called to interview me, I also stressed the importance of urging people to undertake their own preparedness efforts, not just to watch the government prepare and practice good hygiene. And I criticized the government’s excessive fear of frightening the public. She managed to squeeze all three points into the story.
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Is America Prepared for a Pandemic?
Published in the Washington Post, April 28, 2009
The Washington Post asked me to write a 200-word piece on how I thought the U.S. government was doing on swine flu risk communication. My first draft was 600+ words. Then I revised to around 200, and sent the editor both. He used the short one. I’m posting the long one (“The Government is Preparing for the Worst While Hoping for the Best – Now It Needs to Tell the Public to Do the Same Thing!”) here too. Both emphasize my sense that the government has been preparing for the worst while hoping for the best – but hasn’t yet urged the public to do the same thing.
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WHO raises pandemic alert to phase 4
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), April 27, 2009
In the face of a very scary swine flu outbreak spreading from Mexico, the World Health Organization on April 27, 2009 did two things to its index of six pandemic phases: It implemented some changes in phase definitions (long in the works) that – among other effects – made the criteria for Phase 4 more demanding; and in spite of that it finally ratcheted up to Phase 4. Bob Roos of CIDRAP News sent me an email asking for comment on the likely impact of the latter change. His published article used some of what I said about my hope that the shift would signal organizations to trigger their pandemic plans and individuals to launch their own preparations. My original email (“Impacts of the WHO Ratchet from Pandemic Phase 3 to Phase 4”) is also on this site.
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WHO declares public health emergency as US swine flu cases rise
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), April 25, 2009
CIDRAP’s Lisa Schnirring quotes me here arguing that it’s important to help people envision how bad things might (or might not) get.
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More US swine flu cases, Mexico illnesses raise pandemic questions
Posted: Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), April 23, 2009
In this article near the start of the swine flu outbreak, CIDRAP’s Lisa Schnirring quotes me criticizing the CDC for missing the teachable moment to promote pandemic preparedness – a theme that I developed in detail in my April 29 column, The Swine Flu Crisis: The Government Is Preparing for the Worst While Hoping for the Best – It Needs to Tell the Public to Do the Same Thing!
Guestbook Entries
(The Swine Flu Pandemic of 2009–2010)
2011
Warning people about swine flu … again (April 2011)
2010
WHO: Hyping the pandemic or helping the world prepare? (June 2010)
Was it wrong to warn people even though the swine flu pandemic was turning out mild? (May 2010)
Making health care workers get vaccinated against the flu (March 2010)
Making pandemic communications (and all crisis communications) provisional (February 2010)
How should WHO have integrated severity into its pandemic communications? (January 2010)
2009
What should we tell people about vaccination if the pandemic wave is ebbing? (November 2009)
The meme that this pandemic is “like the seasonal flu” (October 2009)
Mandatory vaccination for health care workers (October 2009)
The importance of telling people about pandemic flu precautions (August 2009)
Pandemic prioritizing: Vulnerable people versus essential people (July 2009)
Swine flu worst case scenarios: warn people now or wait till things start getting nasty? (May 2009)En Français: Pires scénarios de grippe porcine: avertir les gens maintenant ou attendre que les choses commencent à mal tourner?
WHO’s “Outbreak Communication Guidelines” – and calling a pandemic a pandemic (May 2009)
Selling pandemic prep to family and friends (May 2009)En Français: Vendre l’état de préparation à une pandémie, à la famille et aux amis
Visualizing a mild pandemic: The risk comparison to 36,000 U.S. annual flu deaths (May 2009)En Français: Visualiser une pandémie légère: la comparaison de risques avec 36,000 décès annuels aux États-Unis, causés par la grippe [saisonnière]
What’s in a name: H1N1 versus swine flu (May 2009)
Trying to get Tamiflu in case of a swine flu pandemic (April 2009)
Everything in Chronological Order
(The Swine Flu Pandemic of 2009–2010)
More US swine flu cases, Mexico illnesses raise pandemic questions
Swine Flu Pandemic Scare Gets Serious
WHO declares public health emergency as US swine flu cases rise
Swine Flu Pandemic Scare Gets Serious
WHO raises pandemic alert to phase 4
Swine Flu Pandemic Scare Gets Serious
Impacts of the WHO Ratchet from Pandemic Phase 3 to Phase 4
Is America Prepared for a Pandemic? Is America Prepared for a Pandemic?
Trying to get Tamiflu in case of a swine flu pandemic
Experts worry mild disease outside of Mexico hampers bid to get people to prepare
Swine Flu Pandemic Scare Gets Serious
Behavioral research can help curb the spread of swine flu – but is anyone listening?
5 Ways to Manage the Family’s Swine Flu
What’s in a name: H1N1 versus swine flu
What’s in a name: H1N1 versus swine flu
What happens if swine flu goes away?
Communicating the Message of Swine Flu: An Expert’s Opinion
Swine Flu Pandemic Prospects: Nobody Knows
H1N1 outbreak revealed seasonal flu lingered in Minn.
Between a virus and a hard place
Flu overhyped? Some say officials ‘cried swine’
Avoiding “warning fatigue” over swine flu
H1N1 flu – are we preparing for the worst or hoping for a break?
Is swine flu moving slowly? Did the authorities overreact? What should the key messages be now?
Visualizing a mild pandemic: The risk comparison to 36,000 U.S. annual flu deaths
Swine Flu Pandemic Prospects: Nobody Knows
Selling pandemic prep to family and friends
Pandemics: good hygiene is not enough
WHO under pressure from member states to rewrite pandemic requirement
On WHO Changing the Definition of “Pandemic”
Swine Flu Pandemic Prospects: Nobody Knows
WHO’s “Outbreak Communication Guidelines” – and calling a pandemic a pandemic
Swine flu worst case scenarios: warn people now or wait till things start getting nasty?
Swine Flu Pandemic Prospects: Nobody Knows
Reactions to the WHO’s Phase 6 Declaration
We’re Living in a Pandemic: Now What Do We Do?
Swine flu is more serious than many people think
Communication expert endorses WHO’s delay on pandemic declaration
Would you like another wakeup call?
Critics say “mild” a misleading term for H1N1
Is Swine Flu “Mild”? Are We Safe If We Have No “Underlying Conditions”?
Containment as Signal: Swine Flu Risk Miscommunication
Pandemic prioritizing: Vulnerable people versus essential people
Why Pandemic Complacency Isn’t Okay
WHO suspends reporting of H1N1 case counts
British public slow to respond to pandemic
It Isn’t Easy to Arouse Pandemic Concern. What Do We Need People to Know?
The Three-Legged Stool of Pandemic Messaging
The importance of telling people about pandemic flu precautions
Talking about Pandemic H1N1 Vaccination
Flu Preparedness: An Even Tougher Sell than Usual
Overselling Seasonal Flu Vaccination in a Pandemic Season
Swine flu squeezing out the seasonal bug
Uncertainty over H1N1 warranted, experts say
Mandatory vaccination for health care workers
The meme that this pandemic is “like the seasonal flu”
Sorting through panic and anxiety
Marketing Flu Vaccine: A Tough Sell for Many
Prioritizing among Precautions: The Best Is the Enemy of the Good
Flu Precautions: Making Sense of CDC Advice
U.S. Pandemic Vaccine Supply and Distribution: Addressing the Outrage
U.S. Pandemic Vaccine Supply and Distribution: Addressing the Outrage
What should we tell people about vaccination if the pandemic wave is ebbing?
It’s Official (sort of): The Swine Flu Pandemic Is Mild So Far
Update on the December 2 Update
What the CDC Is Saying about Swine Flu Severity
The CDC’s Pandemic Data versus the CDC’s Pandemic Communications: Outtakes from a Media Interview
Why Seniors Really Should Fear Swine Flu
Pandemic Interruptus: It Ain’t Over Till It’s Over
European hearing airs WHO pandemic response, critics’ charges
It’s Not a Fake Pandemic – but WHO’s Defense Lacks Candor
How should WHO have integrated severity into its pandemic communications?
Why did the CDC misrepresent its swine flu mortality data – innumeracy, dishonesty, or what?
Making pandemic communications (and all crisis communications) provisional
Making health care workers get vaccinated against the flu
When a government decides swine flu is mild: Talking about crisis management policy changes
Swine Flu Pandemic Communication Challenges and Lessons Learned
Was it wrong to warn people even though the swine flu pandemic was turning out mild?
Further debate on whether the CDC misled people about age-specific death rates of pandemic H1N1
WHO: Hyping the pandemic or helping the world prepare?
The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives
The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives
Warning people about swine flu … again
Why U.K. nurses resisted swine flu vaccination – and why health care workers resist flu vaccination
H1N1 cases in India sparking media hype
India’s Response to Swine Flu – Still Weird
Influenza Pandemics other than Swine Flu
Subsections
Major Articles
(Influenza Pandemics other than Swine Flu)
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H7N9 Risk Communication: Candor but No Push to Prepare
Posted: May 16, 2013
This is a sequel to my April 8, 2013 column, “H7N9: A Tale of Two CDCs.” My focus then was on the ways the U.S. CDC was over-reassuring the public about the possibility of an H7N9 pandemic – even avoiding the word “pandemic” as much as possible. As this follow-up column documents, the CDC has become much more candid about the pandemic risk posed by this newly discovered influenza virus; other officials and experts around the world are being similarly candid. The column then discusses two remaining concerns about H7N9 risk communication: the failure to be candid about the likelihood that we’ll face the pandemic, if it comes, without vaccine; and – more important still – the failure to make any attempt to involve the public in pandemic preparedness. The column also documents that public interest in H7N9 has already declined from its (modest) peak in early April.
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Posted: April 8, 2013
As I write this on April 8, 2013, I have no idea – nor does anyone else – whether H7N9 will launch a devastating pandemic, or become endemic and minor, or disappear without a trace, or what. What we all know so far is that a strain of flu never before seen in humans has made a sudden appearance in eastern China, where it has infected 24 people and killed seven of them so far. This column reports on the first week of H7N9 messaging of two national health agencies: The Center for Disease Control and Prevention in China and the Centers for Disease Control and Prevention in the United States. China CDC was surprisingly candid in its prompt release of information and its avoidance of the temptation to over-reassure the very anxious Chinese public. The U.S. CDC, faced with a much less anxious (and perhaps even skeptical) U.S. public, chose to go along with the mood of mild, casual interest. It didn’t withhold any information that I am aware of, but it certainly didn’t seize the opportunity to warn people to prepare for a possible pandemic. Its first H7N9 press briefing sounded much less concerned than I believe its experts actually are.
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What to Say When a Pandemic Looks Imminent: Messaging for WHO Phases Four and Five
Posted: March 15, 2007
If and when a serious pandemic arrives, messaging will shift from precaution advocacy (high-hazard, low-outrage) to crisis communication (high-hazard, high-outrage). There will be a transition period between the two, when the pandemic looks imminent and outrage is rising fast. This very long column – split into four parts – identifies 25 “standby messages” for that transition period. It elaborates both the messages and their risk communication rationales. Jody Lanard and I wrote the column with two goals in mind: to help officials prepare their communications for the early days of a pandemic that looks like it might be severe, and to help them decide to be more candid (and thus more alarming) in their pre-pandemic communications now in order to make those early days less of a shock.
A French translation of the 25 messages, originally posted on the website Zone Grippe Aviaire (which has disappeared), is now available on this site.
French translations available
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Bird Flu, Pandemic Flu, and Poultry Markets: Playing Ostrich or Talking Turkey?
Posted: May 29, 2006
When the next influenza pandemic finally arrives, it will be carried by people, not birds. In the meantime, the public is understandably confused about the distinction between the “bird flu” that threatens poultry flocks and the poultry industry (and an occasional unlucky person) right now and the “bird flu” that may someday mutate to facilitate human-to-human transmission and threaten us all. In this column, Jody Lanard and I try to disentangle bird flu from pandemic flu. And then we address the most common risk communication errors committed by government and industry in virtually every country beset by bird flu, when they set out to convince consumers not to worry and not to stop eating poultry.
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The Dilemma of Personal Tamiflu Stockpiling
Posted: January 10, 2006
When Jody Lanard and I wrote this long column, there was a shortage of Tamiflu. Officials and physicians argued that the available supply should be saved for current use against the seasonal flu and government stockpiles against a possible pandemic – but should not be stockpiled by individuals. We wrote the column to expose the many illogical, inconsistent, and inaccurate arguments being used against personal Tamiflu stockpiling, but we conceded that the competition with other uses was a valid issue. Now the Tamiflu supply exceeds the demand; “excess” manufacturing capacity has been mothballed. The competition argument is dead in the water. Officials and physicians still oppose personal Tamiflu stockpiling, but the only arguments they have left are the specious ones analyzed in this column.
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The Flu Pandemic Preparedness Snowball
Posted: October 10, 2005
I published this column in late 2005, when the U.S. public’s interest in pandemic preparedness was as high as it’s been so far. This was the teachable moment, I wrote. It wouldn’t last, so preparedness advocates needed to make the most of it. The column discusses nine recommendations to improve pandemic preparedness advocacy. Among the highlights: Focus less on the pharmaceutical fix; focus more on worst case scenarios, non-medical preparedness, and non-governmental preparedness; stop implying that a pandemic is imminent. Much of this advice is relevant even in periods of diminished attention, and most of it will still be on-target the next time pandemic preparedness is hot.
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Bird Flu: Communicating the Risk
Published in Perspectives in Health (Pan American Health Organization), vol. 10, no. 2, 2005, pp. 2–9
PAHO asked us to combine a primer on risk communication with a primer on avian influenza. The resulting article talks about the challenge of alerting the public to bird flu risks, then offers ten risk communication principles, each illustrated with bird flu examples. The PDF file also includes the cover, an editor’s note entitled “Communication: risky business,” and the contents page. (Note the confusion of “bird flu” with pandemic flu in this 2005 article – and this blurb, also written in 2005.)
(There is an online version (same text, but easier to read than a PDF file) posted on the PAHO website. The entire issue is also there.
Spanish translation available
Traducción en Español: La gripe aviar: cómo comunicar el riesgo
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Published in The Christian Science Monitor, July 7, 2005
This short news story deals with the controversy over how much to try to alarm the public about a possible flu pandemic. Predictably, I anchor the go-ahead-and-scare-them side of the debate.
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Superb Flu Pandemic Risk Communication: A Role Model from Australia
Posted: July 6, 2005
On May 2, 2005, Australian Health Minister Tony Abbott gave a speech on pandemic preparedness. It wasn’t especially earthshaking; in fact, it attracted fairly little media attention. But Jody Lanard and I thought it was terrific – candid, alarming, tentative, all the things most official pandemic presentations were not (and are not). So we sat down to annotate the speech in terms of 25 crisis communication recommendations we had published previously. If you just read the speech, you’ll discover that good risk communication can sound just as ordinary as bad risk communication. If you read the column’s annotations, you’ll discover how extraordinary this particular speech really was.
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Pandemic Influenza Risk Communication: The Teachable Moment
Posted: December 4, 2004
This is the first column Jody Lanard and I wrote about pandemic preparedness. We wrote it when many experts believed a devastating H5N1 flu pandemic might be just around the corner – and so we thought so too. (We still think the risk is serious, but there’s much less sense of imminence as I write this blurb in mid-2008.) The thrust of this long column is how to sound the alarm. After a primer on why H5N1 is “not your garden variety flu,” the column proposes a list of pre-crisis pandemic talking points. Then it assesses how well experts and officials were addressing those points as of late 2004. The experts, we wrote, were doing their best to arouse the public. But governments and international agencies were undermining the sense of urgency with grossly over-optimistic claims about pharmaceutical solutions.
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Psychological Barriers Getting in the Way of Pandemic Preparations: Experts
Posted: Distributed by Canadian Press, November 20, 2004
Helen Branswell initially wrote to me for my comments on the psychology of flu pandemic preparedness. My complete response is on this site.
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Posted: August 28, 2004
Most of this long column is addressed to risk communicators whose goal is to keep their audience unconcerned. So naturally they’d rather not talk about awful but unlikely worst case scenarios. The column details their reluctance even to mention worst case scenarios, and their tendency when they finally get around to discussing them to do so over-reassuringly. It explains why this is unwise – why people (especially outraged people) tend to overreact to worst case scenarios when the available information is scanty or over-reassuring. Then the column lists 25 guidelines for explaining worst case scenarios properly. Finally, a postscript addresses the opposite problem. Suppose you’re not trying to reassure people about worst case scenarios; you’re trying to warn them. How can you do that more effectively?
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Avian Flu Exercise: What Are They Doing?
In “Crisis Communication: Guidelines for Action – Planning What to Say When Terrorists, Epidemics, or Other Emergencies Strike,” a CD/DVD produced by The American Industrial Hygiene Association, May 2004
This exercise provides quotations from early avian flu/pandemic flu communications and asks the reader to decide what crisis communication principles each quotation either illustrates or violates. It was prepared to accompany a crisis communication CD/DVD produced by the American Industrial Hygiene Association.
Columns from CIDRAP Business Source Weekly Briefing
(Influenza Pandemics other than Swine Flu)
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Read “FAFfing About” if you need some motivation
Published by CIDRAP: July 17, 2007
Whenever my commitment to pandemic preparedness starts to flag, I read something wrongheaded by an opponent of preparedness. Here’s my take on an example from a major medical journal.
The bird flu / pandemic flu confusion
(Never published by CIDRAP)
We have told people to worry about a “bird flu pandemic.” No wonder they think the danger comes from birds.
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Published by CIDRAP: June 14, 2007
Far from being fatigued by pandemic warnings, the public is just beginning to hear the message. As planners, we’re the ones at risk of pandemic fatigue, as we slog our way forward.
Why talk now: The case for communicating with employees before the pandemic arrives
Published by CIDRAP: June 7, 2007
Your company is preparing for a pandemic, but your employees aren’t. Can that possibly make sense?
Corporate pandemic precaution advocacy: The time is now
Published by CIDRAP: May 17, 2007
Business continuity planners say they’re talking to their employees and other stakeholders about pandemic preparedness. Is it really happening?
What kind of risk communication does pandemic preparedness require?
Published by CIDRAP: May 3, 2007
When the virus hits the fan, it’ll be crisis communication. But what it is now depends on your opinions and your audience.
Start thinking in phases – risk communication phases
Published by CIDRAP: April 19, 2007
You have a few crucial moments for talking about pandemic preparedness. Use them well.
Riding the many pandemic seesaws
Published by CIDRAP: April 5, 2007
Because most people feel ambivalent about possible future pandemics, communicating effectively with them requires skillful balance on a wide range of communication “seesaws.”
Seesaw your way through ambivalence
Published by CIDRAP: March 22, 2007
Most people think about possible future pandemics – when they think about them at all – with a good deal of ambivalence. To communicate with ambivalent people, you need to understand the “risk communication seesaw.”
Talking about a flu pandemic worst case scenario
Published by CIDRAP: March 8, 2007
The pandemic worst case is: (a) Truly horrific, (b) Truly unlikely, (c) Truly worth planning for, (d) All of the above. The right answer: (d) All of the above.
A severe pandemic is not overdue – it’s not when but if
Published by CIDRAP: February 22, 2007
We have no grounds for confidence that a severe pandemic is imminent. Our communications shouldn’t imply otherwise.
“Might help a lot, might help a little, might not help at all – and worth trying!”
Published by CIDRAP: February 7, 2007
There are no perfect pandemic precautions. We need to say so – and push hard for imperfect precautions.
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Published by CIDRAP: January 24, 2007
Bird flu is four problems, not one. Keeping them straight is a prerequisite to sensible risk communication – and sensible preparedness.
Get your slice of the “fearfulness” pie
Published by CIDRAP: January 10, 2007
Fear is like a pie (or money): There’s usually not enough to go around. If you want people to take precautions, you have to compete for your share.
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Published by CIDRAP: December 20, 2006
We are all likeliest to take precautions when we’re frightened. But “fear of fear” is widespread – and a major barrier to pandemic communication.
How’s your business discontinuity program?
Published by CIDRAP: November 29, 2006
More and more companies are starting to integrate pandemic preparedness into their business continuity programs. That’s good news – and helping to facilitate it is one of the reasons this newsletter was launched. But….
Other Articles
(Influenza Pandemics other than Swine Flu)
Why We’re Still So Unprepared for Flu and Other Crises
Posted on Bloomberg View, February 1, 2018
Journalist Faye Flam reached out to me on January 25, 2018, regarding a story she wanted to write “about the world’s lack of preparedness for a flu pandemic.” The result was a telephone interview that focused (among other topics) on the difficulty of figuring out which risks are more worth preparing for or protecting against than other risks. Risk analysis isn’t my field, but that didn’t keep me from pointing out that there are dozens of factors relevant to deciding how much of your limited budget to spend on – for example – hurricane preparedness versus nuclear attack prevention versus vaccine manufacturing capacity. Even if you had good measures of all the relevant factors, I added, prioritizing among them would still be a values question on which risk analysts are no more entitled to an opinion than ordinary citizens. I also emphasized my longstanding complaint that experts making a case for greater attention to one risk almost never nominate some other risk (especially one that’s also in their bailiwick) for less attention. “We need more money for X” is rarely accompanied by “we’re willing to cut our expenditures on Y.” Faye used most of that in her February 1 story.
Tamiflu report comes under fire
Posted on the Nature website, April 22, 2014; published in the print edition of Nature, vol. 508, pp. 439–440 (April 24, 2014).
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by Peter M. Sandman and Jody Lanard
Email to Declan Butler, April 15, 2014
In early April 2014, BMJ (British Medical Journal) published two articles reporting a research review by the Cochrane Collaboration, arguing that antiviral drugs are of minimal use against influenza. When reporter Declan Butler of Nature emailed me and my wife and colleague Jody Lanard asking for comment on how the Cochrane Review was communicated, we quickly sent back a response summarizing two key criticisms of the Cochrane researchers: that they ignored the downsides of the Cochrane methodology, which considers only randomized controlled trials; and that they massaged and cherry-picked their own results to make them look worse for antivirals. Declan’s article addressed many aspects of this complicated story, and he had room for only a little of what we had sent him. Meanwhile, we had written a more comprehensive assessment, which we are posting on this website as an introduction to what we originally sent Declan.
H7N9 cases grow by 7, along with China poultry industry outcry
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), February 6, 2014
Forgoing Trust, China’s Poultry Industry Lobbies for an H7N9 Cover-Up
Email to Lisa Schnirring, February 6, 2014
Lisa Schnirring of CIDRAP News (part of the Center for Infectious Disease Research & Policy at the University of Minnesota) has been writing frequent articles about H7N9 since that novel bird flu virus reappeared in China in late 2013. Among the developments she decided to cover in her February 6, 2014 article was a new lobbying effort by China’s poultry industry to suppress some information about new H7N9 cases, especially information it feared would exacerbate Chinese consumers’ growing avoidance of poultry. When I asked if her article could use a risk communication perspective, Lisa said yes. So my wife and colleague Jody Lanard and I sent her an email, emphasizing that cover-ups never reassure the public. To the contrary, people become much more concerned about a risk when they discover that potentially alarming information is being covered up. Lisa’s article included several quotes from our email elaborating on this point.
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With Chinese New Year H7N9 cases soar, but experts struggle to assess the risk
Distributed by The Canadian Press, January 31, 2014
Email to Helen Branswell, January 30, 2014
Helen Branswell of The Canadian Press is almost universally considered the “dean” of flu reporters. So of course she has paid close attention to H7N9, a novel bird flu virus that emerged in China about a year ago. H7N9 is harmless to poultry but often deadly to humans on those rare occasions when it passes from one to the other. On January 30, 2014, Helen sent an email jointly to me and my wife and colleague Jody Lanard, asking us to comment on “the challenge it [H7N9] poses in terms of risks communications.” Our answer focused on the difficulty of warning people about what might happen while reassuring people about what has happened so far. Helen used a few quotes from our answer in her story, along with others from flu experts (as opposed to risk communication experts) she had interviewed.
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Presented via telephone at a conference on “Freedom in Biological Research: How to Consider Accidental or Intentional Risks for Populations,” Fondation Mérieux and Institut National de la Santé et de la Recherche Médicale, Veyrier-du-lac, France, February 8, 2013
The controversy over whether scientists should be allowed to bioengineer potentially pandemic bird flu viruses had pretty much died down by the time I was asked to speak at a February 2013 conference on the issue in France. Since I had criticized the controversy’s consistently miserable risk communication, I was delighted that at least one post mortem conference wanted a risk communication perspective. But I had prior commitments and couldn’t go. When the organizers invited me to present by telephone instead, I jumped at the chance. My speech notes are more extensive than I had time for in the actual presentation. On the other hand, the MP3 recording of the actual presentation includes about 25 minutes of Q&A. My presentation was mostly borrowed from my previous articles and Guestbook entries on the controversy, all of which are listed and linked at the end of the notes.
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H5N1 Researchers Ready as Moratorium Nears End
Published in Science, January 4, 2013, pp. 16–17.
The Moratorium on H5N1 Bioengineering Research: What Was It For? What Did It Accomplish?
Email to David Malakoff, December 26, 2012
H5N1 (“bird flu”) is an especially deadly strain of influenza that could pose a huge human health risk if it ever acquired the ability to spread easily in humans – which so far it has not done. But in early 2012 a controversy arose over research aimed at bioengineering a new kind of H5N1 that would be more readily transmissible in mammals. The debate focused on the potential value of the research (for example, it might help scientists better understand how to stop H5N1 from becoming transmissible) versus its potential risks (an accident or an intentional release might launch an H5N1 pandemic). While the debate raged, a voluntary moratorium on similar research was instituted, while scientists, policymakers, and interested citizens tried to thrash out how this sort of research should be regulated. By the end of 2012, new rules had been proposed and the moratorium was pretty obviously about to end. That’s when David Malakoff of Science contacted me for comment on what I thought the moratorium had accomplished. His January 4, 2013 story used only one quotation from the email I sent him in response. Both David’s story and my email to him are on this site.
A German translation of my email to David, somewhat edited, was posted January 19, 2013 on the website of Frankfurter Allgemeine Zeitung and published in that newspaper’s January 20, 2013 print issue.
German translation available
In der Deutschen: Forschung mit Vogelgrippe-Virus: Reine Augenwischere
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Re-edited excerpt from a May 17, 2012 Guestbook entry
Posted: June 7, 2012
In 2011, two papers were submitted to major journals detailing how scientists created mutations of H5N1 avian influenza (“bird flu”) that could transmit through the air between mammals. In the controversy that followed over whether the papers should be published, scientists on both sides frequently used evidence as ammunition, one-sidedly briefing their cases instead of objectively assessing the science. Ron Fouchier, the senior author of one of the two papers, was particularly guilty of this scientific sin – making very different claims about his research early on when he was trying to arouse interest than later when he was trying to allay concern instead. This article – excerpted and adapted from a May 17, 2012 Guestbook entry – tracks Fouchier’s public miscommunications about his H5N1 bioengineering study.
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Misoversimplification: The Communicative Accuracy Standard Distinguishes Simplifying from Misleading
Posted: June 5, 2012
The need to simplify technical content is not an acceptable excuse for “simplifying out” information that is essential to credibility – especially information that seems to contradict your message, and that will therefore undermine your credibility if you leave it out and your audience learns it elsewhere. The obligation to include that sort of information is called the communicative accuracy standard; the failure to include it might appropriately be called “misoversimplification.” The column distinguishes three levels of misoversimplification, depending partly on how controversial the issue is and partly on whether you’re on the warning (precaution advocacy) or reassuring (outrage management) side. The three levels are illustrated with infectious disease examples: whooping cough, bird flu, and polio.
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Talking to the Public about H5N1 Biotech Research (original longer version)
Submitted to Genetic Engineering & Biotechnology News, March 18, 2012
Talking to the Public about H5N1 Biotech Research
(accepted shorter version)Published in Genetic Engineering & Biotechnology News, April 15, 2012
The H5N1 (“bird flu”) virus is incredibly deadly to humans, but almost never transmits from human to human – at least until late 2011, when two teams of scientists bioengineered H5N1 to make it transmissible in mammals. Now a battle rages over whether the two papers detailing this work should be published, and whether the work itself should continue – and whether the concerns of the general public should be considered in making these decisions. When I was quoted in Nature urging proponents to dialogue with critics rather than merely trying to “educate” them, Genetic Engineering & Biotechnology News asked me to write a brief opinion piece expanding on my view. Both the short version accepted for publication and a somewhat longer version (with a little more background on the controversy) I submitted at the same time are posted on this site.
WHO H5N1 study group extends moratorium, calls for full publication
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), February 17, 2012
The H5N1 Debate Needs Respectful Dialogue, Not “Education” or One-Sided Advocacy
Email to Lisa Schnirring, February 17, 2012
When laboratory researchers succeeded in creating a potentially pandemic strain of bird flu, a U.S. government agency recommended editing out methodological details before the two papers were published. Others suggested the research should never have been done and should not be pursued. The result was a pitched battle over what limits, if any, should be put on research and publication. The World Health Organization responded in part with a two-day meeting of public health officials and flu experts. At the end of the meeting the group announced some recommendations of its own. Lisa Schnirring of CIDRAP News asked for my comments, so I sent her an email – parts of which she used in her story on the WHO meeting.
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Study: Media can distort public’s views on infectious diseases
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), November 5, 2008
CIDRAP’s Lisa Schnirring asked me to comment on a new research paper showing that students take infectious diseases that have been much-covered in the media more seriously than diseases that have had less media attention. The paper’s authors interpreted this as evidence that media coverage distorts people’s perceptions of infectious diseases. I thought it was likelier that some characteristics of some infectious diseases – such as the potential to launch a pandemic! – rightly make them a bigger concern for both the media and the public than diseases without those characteristics. I sent Lisa a fairly blistering critique of the paper. She toned it down in what she published.
Businesses urged to avoid pandemic planning pitfalls
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), October 9, 2008
CIDRAP’s Michael Osterholm asked me to join him in hosting an October 9 webinar entitled “Avoiding the Big 7 Pandemic-Planning Mistakes: How Set-to-Survive Companies Sidestep These Missteps.” I focused on two of the mistakes/missteps – fearing to frighten stakeholders and failing to involve employees – and commented on the other five. I also contributed my depressing judgment that pandemic planners need to plan to be islands of preparedness.
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Physician survey shows mixed views on pandemic risk
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), June 6, 2007
This is a news report about a survey of European physicians, focusing on their estimates of the probability of a flu pandemic “in the next few years.” Slightly more than half thought it wasn’t very likely. The survey results were interpreted by the authors as indicating that the respondents weren’t as concerned as they ought to be. That might be true for all I know – but it’s not necessarily complacent to think a pandemic is inevitable sooner or later, while doubting that it’s imminent. In fact, I told the reporter, it’s a huge mistake to ground the case for pandemic preparedness in the hunch that it’s coming soon, rather than in the well-founded conviction that it’s coming. I expanded on this point in an email to the reporter.
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Understanding the Risk: What Frightens Rarely Kills
From the edited transcript of a conference on pandemic media coverage, published in Nieman Reports, vol. 61, no. 1, Spring 2007
For three days starting 30 November 2006, Harvard University’s Nieman Foundation for Journalism ran a conference on how the news media cover (and should cover) the risk of an influenza pandemic. I spoke twice, a stand-alone presentation on “Risk Perception, Risk Communication, and Risk Reporting: The Role of Each in Pandemic Preparedness” and a panel presentation on “Fear of Fear and Panic Panic: Is It Okay to Scare People about Pandemics?” The two were abridged and combined into one article when Nieman Reports published an edited transcript in Spring 2007. As compiled by the Nieman Foundation, the published article focuses on two topics – the four kinds of risk communication as applied to pandemic risk and the importance of fear in pandemic preparedness. For the (nearly) unedited transcripts of the two presentations, see below.
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Risk Perception, Risk Communication, and Risk Reporting: The Role of Each in Pandemic Preparedness
Posted: Originally presented at a conference on “Avian Flu, a Pandemic & the Role of Journalists,” Nieman Foundation for Journalism, Harvard University, Cambridge MA, December 1, 2006
An abridged version (
above) of this presentation was published in the Spring 2007 issue of Nieman Reports (see the previous entry). The Nieman Foundation for Journalism also made the original transcript available to me. I edited it very lightly so it makes sense – but it’s still very much a transcript, not a polished article. -
Understanding Human Responses [to pandemic risk]: Communication Focus
Panel discussion at a conference on “Avian Flu, a Pandemic & the Role of Journalists,” Nieman Foundation for Journalism, Harvard University, Cambridge MA, December 2, 2006
I was joined in this panel discussion by three experienced risk communication practitioners, Howard Koh, Glen Nowak, and Dick Thompson. My contribution was entitled “Fear of Fear and Panic Panic: Is It Okay to Scare People about Pandemics?” An abridged version of my presentation and a tiny bit of the Q&A were published in the Spring 2007 issue of Nieman Reports (look two entries up). The Nieman Foundation for Journalism also made the original panel discussion transcript available to me, very slightly edited by them. I edited my parts a bit more thoroughly, though it’s still very much a transcript, not a polished article. I left other people’s presentations and comments alone – so blame any garbles on the transcription process, not the speakers. The conversation ranged widely over the various challenges of pandemic communication.
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Internet rumours of bird flu case in Rimouski, Que., are ‘totally untrue’
Distributed by Canadian Press, November 29, 2006
Helen Branswell’s story focuses on the pros and cons of alarmist rumors, especially those found on the website of Henry Niman, a favorite site for people obsessed with pandemic risk. Helen didn’t use what I thought was the best line I gave her, so here it is: “Before the Internet the problem was getting information. Now the problem is vetting information.”
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Recent H5N1 Outbreaks: The Evolving Challenge of Defining and Communicating Pandemic Risk
Transcript of a June 22, 2006 teleconference sponsored by Bio Economic Research Associates
As part of its pandemic preparedness consulting business, Bio Economic Research Associates (“bio-era”) conducts periodic teleconferences for clients and prospective clients. Its June 2006 session featured an illustrated presentation by Jim Newcomb of bio-era, with a detailed update on bird flu developments and pandemic risks. But bio-era managed to squeeze in three other speakers – United Nations pandemic coordinator David Nabarro, the Wildlife Conservation Society’s Billy Karesh, and me. My piece runs from page 23 to page 27. It focuses on the different “kinds” of bird flu/pandemic flu problems, but also includes my answers to questions about how companies should talk about these problems – how restaurants should talk to their customers about bird flu and how manufacturers should talk to their employees about pandemics.
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Skeptics warn bird flu fears are overblown
Posted on MSNBC.com, April 20, 2006
Subtitled “Chicken Little alert? Hysteria could sap money from worse health threats,” this article was part of an MSNBC package on pandemic flu. Reporter Rebecca Cook Dube warned me when she interviewed me that she was covering “the other side” – the people who claim the risk is overblown. My job was to represent the other side of the other side – to explain why a virus that has so far killed only a handful of people could nonetheless deserve to be taken seriously. I get awfully tired of this particular non sequitur; it’s as if somebody thought hurricane preparations were self-evidently pointless until the hurricane hit land and started claiming victims ... or self-evidently pointless so long as it remained debatable whether the hurricane would ever hit land at all. I tried to explain that people buy fire insurance not because they think it’s inevitable that their house will catch fire, and not because the fire is already raging, but because they think a fire is possible and could be devastating. Some of what I said about low-probability high-magnitude risks made it into the end of the story.
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Talking risk: avian flu advice from a risk communicator
Published in Food Chemical News, March 27, 2006, p. 29. Copyright © 2006 by Agra Informa, Inc. Posted with permission. For more information, go to www.foodchemicalnews.com.
Carole Sugarman of Food Chemical News interviewed me in March about how the poultry industry should talk about bird flu, as distinct from pandemic flu, and what I think industry spokespeople are doing wrong. I didn’t know the interview was actually published until a colleague sent me a copy in late April. Here it is. It’s a little incoherent. (I’d like to blame that on Carole’s note-taking, but it’s probably my burbling.) But the main points are clear enough, I think.
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Bird flu’s potential toll warrants alerts
Published in the Atlanta Journal-Constitution, March 17, 2006
This op-ed by the former director of the U.S. Centers for Disease Control and Prevention argues that alerting people to the pandemic threat requires good risk communication. As his gold standard for good risk communication he cites principles I tried to urge on CDC during the anthrax attacks of 2001 (when he was its head) – pretty much the same principles covered in the crisis communication CD/DVD Jody Lanard and I produced a few years later. (The CD/DVD handouts are available on this site.) I had a couple of reactions to the op-ed that I sent to Jeff, and have posted excerpts from my email and his response.
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The Bird Flu: How Much Fear Is Healthy?
Posted on TIME.com, March 15, 2006
Christine Gorman of Time has covered H5N1 since it appeared in Hong Kong in 1997. I figured our 15-minute telephone interview might turn into a paragraph in a roundup on the week’s bird flu news. Instead, she devoted this article to my views on the importance of warning people, of accepting that fear (not panic – that was her word) is the price of preparedness, of non-medical preparedness, of using survivors as volunteers, etc. It’s a short article that doesn’t say anything I haven’t said before. But it’s nice to see it on the Time website.
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Fear can play role in pandemic readiness, speaker says
Posted on the website of the Center for Infectious Disease Research & Policy (CIDRAP), University of Minnesota, February 17, 2006
This article summarizes a speech I gave at CIDRAP’s groundbreaking Minneapolis conference, “Business Planning for Pandemic Influenza: A National Summit.” It focuses on two of the main points I made: that if you want to persuade people to take precautions you need to be willing to frighten them; and that frightening people shouldn’t mean claiming that a severe 1918-like pandemic is inevitable. (The probability is extremely high of a pandemic of unknown magnitude, I said; the probability is unknown of a pandemic of extremely high magnitude.)
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Worst Case Scenarios, Bird Flu, and Risk Perception – Interview with Peter Sandman (Part 2)
Published in safety AT WORK, January 2006, pp. 4–10
In November 2005 I did a two-hour interview in Melbourne with Kevin Jones, editor of Safety at Work, a monthly electronic magazine published out of Australia but distributed worldwide. We covered an extremely wide range of topics – from whether the mining industry is serious about safety (and why it so often sounds like it isn’t) to how to talk about worst case scenarios like a severe influenza pandemic to why I put everything I can on my website and don’t trademark anything. I imagined that Kevin would edit out the boring parts and organize the nuggets. But instead he used the whole two hours verbatim.
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Broadcast on “Morning Edition,” NPR (National Public Radio), January 10, 2006
This is the second “Morning Edition” story by NPR’s Jon Hamilton that draws on his two-hour December 2005 interview with me and my wife and colleague Jody Lanard. This one uses other sources as well, and focuses on what governments should do to avoid fostering panic in (or before) a pandemic. Hamilton makes good use of our concept of “panic panic” – official fear that the public may be panicking when there is no evidence that it is doing so.
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Broadcast on “Morning Edition,” NPR (National Public Radio), December 28, 2005
NPR’s Jon Hamilton came to New Jersey with a dozen audio clips of top U.S. officials talking about bird flu, and spent two hours going over the clips with me and my wife and colleague Jody Lanard. He put a little of what he got into an eight-minute story on what they’re doing right and what’s not so right in bird flu and pandemic risk communication. Jody and I think Hamilton did an excellent job of getting to some of the big issues: the need to find a balance between excessive fear and insufficient fear, the importance of getting the public involved rather than pretending the government will do it all, etc. The link gets you to a written summary of Hamilton’s story, and to a link to the audio.
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Published in the Yale Journal of Biology and Medicine, vol. 78, December 2005, pp. 369–376
This article was adapted from a presentation my wife and colleague Jody Lanard gave at an October 21, 2005 symposium on “Ethical Aspects of Avian Influenza Pandemic Preparedness” at Yale University. It focuses chiefly on official opposition to Tamiflu stockpiling, official enthusiasm for vaccines and antivirals, and official reluctance to involve the public in pandemic planning.
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Are you a sitting duck for bird flu?
Published in USA Today [posted online at USATODAY.com December 6, 2005]
This story on the flu pandemic precautions people are taking is more respectful than journalists usually are of the people on one end of the bell curve – those who are preparing strenuously for the worst case scenario, stockpiling medications, food, and even weapons. The story quotes me on the wisdom of taking at least some precautions, of not being on the opposite end of the bell curve – and then getting on with life. It also quotes me on the value of thinking through what a serious pandemic might be like, so as to be psychologically prepared as well.
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Published in U.S. News and World Report, November 21, 2005; online November 13, 2005
This is an excellent summary of the dilemma authorities face when trying to alert the public to the risk of pandemic flu – a risk that could be severe or mild, imminent or far into the future. Despite its title, the article does point out that the risk of inciting panic isn’t a major problem, although the (unjustified) fear of inciting panic is. It offers justified praise to the U.S. government and the World Health Organization for their increasing willingness to sound the alarm.
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Risk Communication Before and During Epidemics
Presentation at “Bulls, Bears, and Birds: Preparing the Financial Industry for a Pandemic,” a September 23, 2005 New York City conference sponsored by the Center for Biosecurity of UPMC, Deutsche Bank, and Contingency Planning Exchange, Inc.
Despite the title, this brief speech focused mostly on pre-pandemic communication, and especially on the need to overcome official “fear of fear” and scare people into pandemic preparedness. (Please note that the article is located on the source page.)
In addition to the speech transcript (which I edited a little for clarity and grammar), a video of the speech itself is available. -
Most Canadians have taken note of the threat of a flu pandemic
Distributed by Canadian Press, March 30, 2005
Helen Branswell initially wrote to me for my comments on a survey of Canadian awareness of avian influenza, which showed higher awareness than I’d expected but also more skepticism. My complete response is on this site.
Guestbook Entries
(Influenza Pandemics other than Swine Flu)
2015
2014
2013
Estimating uncertain probabilities quantitatively (of a pandemic or anything else) (July 2013)
Pandemic preparedness and pandemic stages re H5N1, H7N9, and MERS (July 2013)
2012
Risk communication aspects of the debate over H5N1 transmission studies (May 2012)
Bird flu risk perception: bioterrorist attack, lab accident, natural pandemic (January 2012)
2008
The dangers of excessive warnings … and of over-reassurance (July 2008)
Risk communication is a type; outbreak communication is a subtype (July 2008)
You can’t hector people into pandemic preparedness (February 2008)
2007
Panflu risk communication to foreign-born populations (August 2007)
Corporate Tamiflu stockpiling (April 2007)
Pandemic preparedness and the poor: Are we urging people to do more than they can? (January 2007)
2006
Talking about animal culls (December 2006)
Pandemic flu good communication example file (October 2006)
Pandemic flu misinformation “Hall of Shame” (October 2006)
Talking about “high-path” and “low-path” avian flu (September 2006)
How much should we trust what WHO says about pandemic phase? (September 2006)
“Mild” versus severe pandemics – public health versus emergency response (May 2006)
Preparing for a severe pandemic (May 2006)
Talking to wildlife rescuers about their bird flu risk (April 2006)
Coming out of the closet about pandemic preparedness (April 2006)
Measuring pandemic fear, panic, denial, and apathy (April 2006)
More on Tamiflu stockpiling ethics and psychology (March 2006)
Message points for a pandemic flu school flyer for parents (March 2006)
Surgical masks: Another pandemic risk communication controversy (February 2006)
Pandemic risk and the U.S. poultry industry (January 2006)
2005
Likelihood of a severe pandemic – the hunger for a number (December 2005)
The flu pandemic issue-attention cycle – where does skepticism fit? (December 2005)
Talking to a local government official about pandemic flu (November 2005)
Talking to healthcare workers about pandemic risks (November 2005)
Trusting in your government’s pandemic planning (November 2005)
Pandemic preparedness: the individual, the government, and the world of finance (November 2005)
Some flu pandemic adjustment reactions (October 2005)
Pandemic preparedness – what’s a doctor to do? (October 2005)
The ethics of Tamiflu (October 2005)
Myanmar takes note of bird flu (September 2005)
Giving children frightening bird flu information (August 2005)
Homeland Security’s color coding as an excuse not to warn people about bird flu (July 2005)
People getting themselves ready for a flu pandemic (July 2005)
The math behind the U.S. Tamiflu supply (June 2005)
Magnitude of the communication problem during a flu pandemic (May 2005)
What can individuals do to prepare for a bird flu pandemic? (May 2005)
WHO’s new pandemic influenza phases (May 2005)
Communication plans for flu pandemics (March 2005)
People’s need for health emergency information (February 2005)
SARS, “Ordinary” Flu,
and Other Infectious Diseases
Subsections
Articles
(SARS, “Ordinary” Flu, and Other Infectious Diseases)
Sharing Dilemmas about Monkeypox Containment
Op-ed rejected by the New York Times, July 25, 2022 – and also rejected (with some editing) in the following week by four other mainstream U.S. newspapers
On July 25, 2022, infectious diseases expert Michael Osterholm sent the New York Times an op-ed he and I had written together about monkeypox messaging. The column listed eight monkeypox dilemmas we thought public health officials should be more honest about: allocating Jynneos, dose-sparing, the smallpox vaccine, TPOXX, sex, stigma, how little we know, and preparedness. The Times turned us down – as did four other mainstream newspapers in quick succession. It was clear they didn’t like what we had to say about sex and stigma. We thought public health officials should focus on gay men with multiple partners, prioritizing health over stigma. The editors thought saying so was itself stigmatizing. There has been some progress in the weeks since our op-ed was universally rejected; that progress is briefly discussed in my italics introduction.
Major US cities report new monkeypox cases
Published in CIDRAP News, June 3, 2022
Avoiding Stigmatization Shouldn’t Be the Top Priority in Monkeypox Risk Communication
Two emails from Peter M. Sandman to Stephanie Soucheray of CIDRAP News, June 2 and June 3, 2022
On June 2, 2022, CIDRAP News reporter Stephanie Soucheray emailed me for my views on monkeypox risk communication, “specifically the challenges public health officials may have in messaging around this risk to the MSM/gay community.” My answer later that day included some of my other thoughts on how monkeypox risk was getting communicated, especially re overconfidence and over-optimism. In a follow-up, Stephanie asked me what I thought about “Interim advice on Risk Communication and Community Engagement during the monkeypox outbreak in Europe, 2022,”
a just-published joint report of the World Health Organization and the European Centre for Disease Prevention and Control. So I sent her a list of my reactions to that report. Her June 3 article on the day’s monkeypox developments included some points from my emails.-
Posted: October 19, 2018
The fundamental question this column poses is whether to post informational “warnings” about a risk that many people consider serious but most experts don’t. The column focuses on a specific example: labeling foods that contain genetically modified ingredients. The column concedes that GM food labels have a “hazard salience” effect that leads to increased concern. But the labels also have an “outrage reduction” effect – a product of control, voluntariness, familiarity, trust, and cognitive dissonance – that leads to decreased concern. Usually the outrage reduction effect is stronger and longer-lasting than the hazard salience effect. And the available evidence suggests that this is indeed the case for GM food labels, which turn out more calming than alarming. The column then broadens the discussion to informed consent more generally. Relying in part on the example of the Dengvaxia vaccine, it builds a case that it is wiser to provide potentially scary information about small risks than to withhold this information. Even when people overreact – that is, even when the hazard salience effect overwhelms the outrage reduction effect – the crucial need to build and sustain trust makes honesty nonetheless the best policy.
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Posted: May 25, 2018
For decades I have maintained a file of articles in which experts claimed some precaution they disapproved of could give people a “false sense of security.” But until recently I didn’t focus enough on false sense of security as a genuine risk communication and risk management problem. Every precaution is also a communication; it tells people that they’re safer than they were previously, and thus implies that alternative precautions may be superfluous. Sometimes a precaution does a better job of making people feel safer than it does of making them actually safer – thus inculcating a false sense of security and potentially undermining other precautions. This column looks at both intentional and unintentional inculcation of a false sense of security. It tries to make a case for not overselling precautions. It also addresses some related phenomena: false sense of insecurity (precautions that work better than they seem); risk homeostasis and compensation; etc. The column makes substantial use of flu vaccination as an example, so I’ve indexed it under Infectious Diseases as well as Precaution Advocacy.
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U.S. Public Health Professionals Routinely Mislead the Public about Infectious Diseases: True or False? Dishonest or Self-Deceptive? Harmful or Benign?
Presented to the Leadership Forum, University of Minnesota Center for Infectious Disease Research & Policy, Minneapolis MN, October 5, 2016
This is the uncut video – 101 minutes long – of an October 5, 2016 presentation I gave to the CIDRAP Leadership Forum. It continues and updates an argument I have been making for years: that the public health profession is far too willing to say or imply untrue things in its communications with the public.
In my introductory comments I discuss the dishonesty of public health professionals generically: why they do it; why they get away with it (compared to corporate leaders who are far likelier to be caught and crucified); how they feel about it; whether it undermines their credibility; whether they’re intentionally dishonest or self-deceptive or deceived by their leaders; the relationship between dishonesty and disrespect; etc.
Then comes the meat of the presentation. I intended to focus on four detailed examples:
- The oral polio vaccine (see also this 2012 discussion)
- The measles-mumps-rubella vaccine (see also this 2011 discussion)
- Ebola quarantine (see also this 2014 discussion)
- Zika funding (see also this June 2016 discussion, especially endnote 14)
But I ran out of time toward the end and had to settle for a very short summary of my views about Zika funding.
Throughout the presentation, my position wasn’t that public health professionals are wrong about these four controversies, but rather that they are too often dishonest and disrespectful in the way they make their case.
The text of my speech notes contains a lot of detail that I skipped in the actual presentation – both additional points and additional proof (with links) for the points I actually made in Minneapolis. It also has a Foreword written later. And it covers Zika funding; by the time I got to Zika funding in Minneapolis, I was nearly out of time.
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Posted: June 16, 2016
On May 27, 2016, Elizabeth Whitman of International Business Times emailed me to request a telephone interview with both me and my wife and colleague Jody Lanard about “how public health officials juggle the need to educate the public and convey a sense of urgency about the Zika virus without sending people into unnecessary panic.” We did the interview the same day.
But instead of focusing on education/urgency versus panic, we focused on our judgment that public health messaging about Zika risk in the continental U.S. had become much more alarmist starting around the beginning of April. That was when White House officials preempted one of the CDC’s key Zika messages: that domestic Zika outbreaks were very likely (but not guaranteed) to be small and local. Instead of preparing Americans to take limited domestic Zika outbreaks in stride, we told Elizabeth, the White House started preparing Americans to expect epidemic-level domestic Zika outbreaks; to see even small limited domestic Zika outbreaks as widespred aand catastrophic; and to blame them on Republicans for failing to pass Zika funding.
Elizabeth’s June 9 story made only a little use of our interview. She ignored our main point about the hijacked message. Instead, her main point was how hard it is for public health officials to communicate nuance to a frightened population. And she wrongly attributed to us the view that there was a “media frenzy” to cover Zika that made “crucial nuances disappear.” We taped the interview. Since we didn’t have Elizabeth’s permission to record and publish her side of the conversation, a transcript of our side only is posted here, very slightly edited for clarity but not content. We have also added boldface headings, bracketed clarifications, links, and endnotes documenting a few of the many sources that led to our analysis. By the time we got done adding all that, we decided to post the resulting document as a column as well as posting it in “Peter M. Sandman in the News.“
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Three Kinds of Zika Risk Communication
Posted: May 16, 2016
In February 2016 I participated in a panel discussion on “Stakeholder Engagement Meets Outrage Management,” sponsored by the GHD consultancy (which had brought me to Sydney for several weeks of work with its clients). Near the end of the hour-long discussion, I was asked about the risk communication challenges of the Zika epidemic. I spoke for six minutes on how Zika requires all three kinds of risk communication: precaution advocacy, outrage management, and crisis communication.
Is It Really GMOs or Insecticides? What's Behind the Bogus Zika Rumors
Posted on the NBC website, February 25, 2016
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Email in response to a query from Maggie Fox, February 22, 2016
On February 22, NBC Reporter Maggie Fox emailed me and my wife and colleague Jody Lanard for help with a story she wanted to write “shooting down the Zika rumors that won’t die.” She asked: “Why do people love, love, love to blame ‘toxic chemicals’ – in this case, larvicides? Why do people love to be scared of GMOs? Why are the conspiracy theorists ALWAYS the first ones to comment, and in ALL CAPS, on our stories?” Jody and I emailed her a quick response, some of which tried to answer her questions and some of which riffed on other aspects of Zika rumors. Maggie used parts of what we wrote in her story. Here is the whole email. It includes some points she probably didn’t expect us to make, including a defense of rumors in general and Zika rumors in particular, and a claim that experts and officials sometimes spread rumors too.
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Some Additional Zika Risk Communication Notes
Posted: February 16, 2016
On January 31, 2016, Jody Lanard and I sent reporter Faye Flam answers to some questions she had asked about risk communication aspects of the Zika crisis in Latin America and its possible implications for the U.S. By the time we posted our responses on February 3, under the title “Zika Risk Communication: WHO and CDC Are Doing a Mostly Excellent Job So Far,” we had added four “boxes” with updated commentary. In the days that followed, we found more points we considered worth making about Zika risk communication – partly to illustrate generic principles and strategies of risk communication, and partly to shed additional light on Zika communication in particular. Rather than add ever more boxes, we decided to post a second document. So far this second shot has five sections: on Zika test prioritization and the role of abortion; on the importance of acknowledging that Zika may turn out less dangerous than it initially looked; on sexual transmission versus mosquito transmission; on the bias against even considering a Zika quarantine; and on whether anybody is panicking over Zika. We may or may not add additional topics in the weeks ahead.
Squeezed Between Zika Panic and Complacency
Posted on Bloomberg View, February 1, 2016
Zika Risk Communication: WHO and CDC Are Doing a Mostly Excellent Job So Far
Email in response to a query from Faye Flam, January 31, 2016
Reporter Faye Flam of Bloomberg View emailed me on January 29, asking to interview me on “the risk communication side of things” regarding the Zika epidemic in Latin America. I said I’d rather write answers to her written questions, so she sent me five of them. Jointly with my wife and colleague Jody Lanard, I wound up answering three. We focused largely on Faye’s sense that the World Health Organization (WHO) was being too alarmist about Zika while the U.S. Centers for Disease Control and Prevention (CDC) was being too reassuring. While we pointed to some flaws in both organizations’ Zika communications – especially CDC’s unwillingness to mention abortion in its discussion of what Zika-infected pregnant women might want to consider – we said we thought both were doing a mostly excellent job so far. We were particularly impressed with CDC’s insistence on the high level of Zika uncertainty. Faye used only a little of our email in her story. We’re posting the whole email, plus a few boxes we added afterwards.
Tamiflu report comes under fire
Posted on the Nature website, April 22, 2014; published in the print edition of Nature, vol. 508, pp. 439–440 (April 24, 2014).
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Email to Declan Butler, April 15, 2014
In early April 2014, BMJ (British Medical Journal) published two articles reporting a research review by the Cochrane Collaboration, arguing that antiviral drugs are of minimal use against influenza. When reporter Declan Butler of Nature emailed me and my wife and colleague Jody Lanard asking for comment on how the Cochrane Review was communicated, we quickly sent back a response summarizing two key criticisms of the Cochrane researchers: that they ignored the downsides of the Cochrane methodology, which considers only randomized controlled trials; and that they massaged and cherry-picked their own results to make them look worse for antivirals. Declan’s article addressed many aspects of this complicated story, and he had room for only a little of what we had sent him. Meanwhile, we had written a more comprehensive assessment, which we are posting on this website as an introduction to what we originally sent Declan.
Is MERS an emergency? Language of IHR boxes WHO into a messaging dilemma
Distributed by Canadian Press, July 16, 2013
MERS Isn’t an “Emergency” … Yet
Email to Helen Branswell, July 16, 2013
On July 15, 2013, Canadian Press medical reporter Helen Branswell asked for an interview about how the World Health Organization was setting itself up by convening an “Emergency Committee” to decide whether to recommend declaring the MERS coronavirus a “Public Health Emergency of International Concern” (PHEIC). With MERS infecting only small numbers of people, nearly all of them in Saudi Arabia, wouldn’t such a declaration invite claims that WHO was once again hyping an infectious disease risk? We scheduled an interview for the morning of the 16th. I sent Helen this email beforehand. In both the email and the interview, I stressed that the word “emergency” implies urgency. But a MERS pandemic isn’t imminent, I said; what WHO really needs to do is alert people that a MERS pandemic (someday) could be horrific. Despite the unfortunate nomenclature – including the awkward pronunciation of the “PHEIC” acronym as “fake” – WHO could do a lot more than it’s doing to clarify the distinction.
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Postscript: The CDC Is Up to Its Old Tricks Again re Flu Vaccine Effectiveness
Posted: February 24 , 2013
On February 1, 2013 I posted “The CDC Tells More of the Truth than Usual about Flu Vaccine Effectiveness,” praising the U.S. Centers for Disease Control and Prevention (CDC) for unusual candor about some disappointing flu vaccine effectiveness data. Sadly, the CDC’s new spirit of candor about flu vaccine effectiveness didn’t last. The research the agency was so candid about in January 2013 continued. By February, with a larger sample, it was possible to analyze effectiveness separately for different age groups – and the data for people 65 and older turned out very disappointing. The updated study showed only 9% vaccine effectiveness for seniors against H3N2 – that is, virtually no protection for the most vulnerable age group against the most dangerous flu strain now circulating in humans. To its credit, the CDC didn’t suppress this discouraging new evidence. It published it. But it did everything it could to spin it in a more positive direction.
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The CDC Tells More of the Truth than Usual about Flu Vaccine Effectiveness
Posted: February 1, 2013
Though far better than nothing, the influenza vaccine is surprisingly ineffective, working only 50–70% of the time in healthy young adults and significantly less than that in the people who need it most, the sick and the elderly. For years the CDC and other public health agencies have hyped flu vaccine effectiveness. And for years Jody Lanard and I have criticized the hype, fearful that it could ultimately undermine the credibility of flu vaccination, vaccination generally, the CDC, and public health itself. So we were surprised and delighted at the tenor of the CDC’s January 11, 2013 flu press briefing, which showcased a preliminary CDC finding that the 2012–2013 flu vaccine was only about 62% effective. It remains to be seen whether the CDC’s unprecedented candor is a one-off or the start of a new era. Either way, this column annotates the press briefing, finding much to praise and, inevitably, some things to criticize as well.
Report: Complacency, misperception stymie quest for better flu vaccines
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), October 15, 2012
A game-changing approach to investigating flu vaccines
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), October 15, 2012
Email to Lisa Schnirring, October 14, 2012
On October 15, 2012, a University of Minnesota research organization issued a report on “The Compelling Need for Game-Changing Influenza Vaccines,”
arguing that the current flu vaccine is sorely inadequate, that a key barrier to developing a better vaccine is the widespread judgment that the current one is fine, and that the main reason the vaccine’s effectiveness is so consistently overestimated is that public health officials keep saying it is better than it is. I served on an Expert Advisory Group that helped with the research. A few days before the report was released, Lisa Schnirring of CIDRAP News emailed me three questions. Bits of my response were included in two October 15 articles that Lisa coauthored with Robert Roos. But neither article addressed a key point I made in my answers: that public health officials aren’t just accidently mistaken about flu vaccine effectiveness; in their zeal to encourage people to get vaccinated, they are sometimes intentionally dishonest. Both CIDRAP News articles and my email to Lisa are linked above. -
Misoversimplification: The Communicative Accuracy Standard Distinguishes Simplifying from Misleading
Posted: June 5, 2012
The need to simplify technical content is not an acceptable excuse for “simplifying out” information that is essential to credibility – especially information that seems to contradict your message, and that will therefore undermine your credibility if you leave it out and your audience learns it elsewhere. The obligation to include that sort of information is called the communicative accuracy standard; the failure to include it might appropriately be called “misoversimplification.” The column distinguishes three levels of misoversimplification, depending partly on how controversial the issue is and partly on whether you’re on the warning (precaution advocacy) or reassuring (outrage management) side. The three levels are illustrated with infectious disease examples: whooping cough, bird flu, and polio.
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Flu Vaccination of Healthcare Workers: Two Risk Communication Issues
Comments on draft recommendations
of the Healthcare Personnel Influenza Vaccination Subgroup, National Vaccine Program Office, U.S. Department of Health and Human Services, submitted January 14, 2012The public health establishment in the U.S. is pushing hard for mandatory flu vaccination of healthcare workers (HCWs), chiefly on the grounds that vaccinated HCWs are less likely to give patients the flu. A committee of the National Vaccine Program Office of the U.S. Department of Health and Human Services issued draft recommendations
that included mandatory vaccination if organizations fail to vaccinate at least 90% of HCWs voluntarily. Comments on the draft were solicited, so on January 14, 2012 my wife and colleague Jody Lanard and I submitted some. We focused on two risk communication issues: the dangers of overstating flu vaccination benefits, and the dangers of requiring reluctant HCWs to get vaccinated. Flu vaccine efficacy: Time to revise public messages?
Posted on the website of CIDRAP News (Center for Infectious Disease Research & Policy, University of Minnesota), November 4, 2011
Overselling Flu Vaccine Effectiveness Risks Undermining Public Health Credibility
Email to Robert Roos, October 27, 2011
On October 25, 2011, a team led by Michael Osterholm of the University of Minnesota published a meta-analysis of prior research on the effectiveness of the flu vaccine, showing it to be less effective than public health officials and experts have usually claimed. In the resulting media coverage, many in public health said the Osterholm paper wasn’t really surprising and denied that flu vaccine effectiveness has been routinely oversold. So Jody Lanard and I made a case that it was still being oversold, focusing particularly on two very recent updates on the CDC website, and emailed it to Robert Roos of CIDRAP News. Bob interviewed public health professionals about what we said and put together a November 4 story called “Flu vaccine efficacy: Time to revise public messages?” There’s no question mark in the title we’re giving our email: “Overselling Flu Vaccine Effectiveness Risks Undermining Public Health Credibility.”
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Broadcast on Minnesota Public Radio, October 25, 2011
In October 2011, Lancet Infectious Diseases published a new statistical analysis of the literature on flu vaccine effectiveness, showing that the vaccine is less effective than most patients, most doctors, and even many state and local health departments have believed. Lorna Benson of Minnesota Public Radio included some comments from me in her story on the new study. I emphasized that flu vaccine experts have known for some years that the vaccine doesn’t work as well as they wish, but have been reluctant to say so very publicly, fearing that candor about the vaccine’s low efficacy might dissuade some people from getting vaccinated or getting their kids vaccinated. (Lorna reported that some actual flu vaccine experts told her the same thing, but refused to be named.) I argued that the bigger risk was that people who discovered that flu vaccine effectiveness had been systematically hyped might start to worry – logically but I think mistakenly – that perhaps public health officials can’t be trusted on vaccine safety either. That may be why the CDC recently snuck in a downward revision of the assessment of flu vaccine efficacy on its own website, belatedly acknowledging the truth about the vaccine – but still not acknowledging the truth about its prior hype.
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Vaccine Risk Communication: Dishonesty Makes Things Worse
Posted October, 7, 2011
My 40-minute speech is basically a distillation of points I made at greater length in my three-part interview on “Vaccine Safety Skepticism: Public Health’s Self-Inflicted Wound.” But there are a few new points.
The presentation was part of a panel on “Research Integrity Issues with Vaccines and Public Trust,” chaired by Michael Yudell of Drexel University. The other panelists were Virginia Caine and Steve Ostroff. Our joint Q&A is only partly about vaccine risk communication, of course.
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Posted: May 7, 2011
This 14-minute audio clip identifies some risk communication strategies appropriate for four specific healthcare scenarios. Three of them – persuading healthcare workers to get their flu shots, to wash their hands often, and to use patient ceiling lifts – involve varying mixes of precaution advocacy and outrage management. The fourth – SARS – is a crisis communication scenario. The discussion of ceiling lifts gets into the “tranches” in thinking through employee safety communication. The discussion of SARS emphasizes the need to acknowledge uncertainty about an emerging crisis that might be horrific and might fizzle. This is one of four podcasts on “Risk Communication in Healthcare Settings,” aimed at healthcare managers, produced from a 50-minute telephone interview.
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Posted: May 7, 2011
This 14-minute audio clip focuses on two challenges that healthcare communicators face often: confidentiality and uncertainty. The discussion of confidentiality emphasizes the difference between confidentiality as an excuse and real confidentiality problems, and offers some guidelines for handling the latter. The discussion of uncertainty argues for matter-of-factly acknowledging not just uncertainty but also differences of opinion within your organization. The podcast closes with a brief wrap-up on three key characteristics of good risk communication: honesty, empathy, and strategy. This is one of four podcasts on “Risk Communication in Healthcare Settings,” aimed at healthcare managers, produced from a 50-minute telephone interview.
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Broadcast on Minnesota Public Radio, April 27, 2011
Talking about the Vaccination-Autism Connection … to Somali Parents of Autistic Children(Note: This link launches the MP3 audio file on this site.)Lorna Benson of Minnesota Public Radio asked if she could interview me about a long-brewing controversy between the Somali community in Minnesota and state health officials over the high rate of autism among Somali children in Minnesota and the resurgence of measles in the Somali community because many Somali parents suspect a connection and choose not to vaccinate their kids. The 35-minute radio interview took place on April 27. It focused on ways I though the Minnesota Department of Health might deal more empathically with Somali concerns – and, more generally, on my criticism of the public health establishment for sometimes sounding more deeply committed to defending the safety of the MMR vaccine than to vaccinating kids against measles or seeking an answer to the riddle of autism. Lorna's story ended up focusing mostly on a Minnesota “vaccination awareness forum” that had also taken place on April 27; toward the end of the story she linked some of my interview comments to some of what she had heard at the forum.
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Vaccine Safety Skepticism: Public Health’s Self-Inflicted Wound
Posted: January 30, 2011
When I was asked to do an interview for a documentary on vaccines and vaccine safety, I agreed on condition that I be allowed to post the entire interview online. I focused my comments on public skepticism about vaccine safety – and especially on what vaccination proponents do that exacerbates the skepticism and what they can do to ameliorate it. The interviewer’s questions have been edited out, but the rest is here, uncut, in three parts.
- Part 1 (37 min.)
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Part One discusses: the kinds of vaccination audiences – apathetic versus hostile; suppressing the other side’s 5% of the truth; being empathic and being accountable; and other risk communication aspects of vaccination safety skepticism.
- Part 2 (29 min.)
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Part Two discusses: vaccination/autism controversies; who’s in charge of vaccine safety research; what’s left out of flu vaccination messaging; and other risk communication aspects of vaccination safety skepticism.
- Part 3 (36 min.)
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Part Three discusses: lying about polio; different messaging for different audiences; why “good guys” mislead more; and other risk communication aspects of vaccination safety skepticism.
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Trust the Public with More of the Truth: What I Learned in 40 Years of Risk Communication
Written speechAudio (they’re pretty different)
(Note: This link launches an MP3 audio file (62MB, 1 hr, 6 min.) from this site.)Link off-site to the video
(Note: This link goes to a page off-site where you may watch this video.)The National Public Health Information Coalition is an organization of federal, state, and local health department communicators. NPHIC asked me to give its 2009 “Berreth Lecture” at its annual conference in Miami Beach – and specified that the presentation should be about myself and my career, not the substance of risk communication. But as I walked the group through my 40 years in risk communication, a substantive theme emerged: that public health communicators are at least as untrustworthy as corporate communicators, that nobody has the courage to trust the public with those parts of the truth that conflict with the message, and that public health agencies need to learn how to cope better with mistrust and outrage. I illustrated my thesis with a lot of flu and other infectious diseases examples. I had written the speech out in advance – something I almost never do – but I departed from my text more than a little, so both versions are here.
A Polish translation was published in December 2010 in Bezpieczeństwo i Technika Pożarnicza (Safety & Fire Technique).
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Flu Preparedness: An Even Tougher Sell than Usual
Posted: September 9, 2009
I wrote this short column in early June 2009 for The Synergist, a magazine for industrial hygienists, on some ways of communicating about flu – seasonal and pandemic – in the workplace. When I wrote it, most people had “recovered” from what they considered the spring “swine flu scare,” and they were in no mood to listen to any more influenza warnings. By the time the column was published in September 2009, some of the complacency had waned, and people were actually girding up (a bit) for another wave of mild-but-pervasive pandemic illness. So the column’s claim that flu preparedness is a tough sell needs to be modified somewhat. But its actual recommendations still stand.
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Convincing Health Care Workers to Get a Flu Shot … Without the Hype
Posted: January 10, 2009
Convincing health care workers to get a flu shot might normally be seen as a straightforward problem in precaution advocacy, but this column focuses on an aspect of the problem that’s grounded in outrage management: flu protection hype. By means of three case studies, Jody Lanard and I document that hype – misleading, one-sided messaging on behalf of vaccination and other flu precautions – does in fact characterize much of what’s produced by flu prevention campaigners. We also argue, with much less evidence, that the hype leads health care workers to mistrust what the campaigners are telling them, and that the mistrust probably reduces their willingness to get vaccinated. The column ends with a list of less tendentious recommendations for convincing health care workers to get a flu shot.
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Published in Vaccine, vol. 24, 2006, pp. 3921–3928
This article assesses the controversy over whether the MMR vaccine might cause autism in terms of my list of outrage components, and offers some outrage-based recommendations for ways public health communicators could better address the controversy. Published in 2006, it is grounded in my 1993 book “Responding to Community Outrage: Strategies for Effective Risk Communication,”
and doesn’t reference any of my more recent writing on this website (on the vaccination/autism controversy or on outrage management generally). Nor, of course, does it reference recent developments in the controversy itself. A similar analysis of the mobile telephone controversy, written by Simon Chapman and published in 1997, is also on this website. -
Posted: June 16, 2005
This column argues that western society has a blind spot for bad guys – that our vision of an actionable emergency is an accident, not an attack. It discusses several examples, from the resistance to evidence that the 1984 Bhopal “accident” was probably sabotage to the opposition of the U.S. public health profession to the possibility that smallpox might constitute a weapon of mass destruction that could justify a vaccination program. The best example – detailed in the column – happened in April 2005, when it was learned that an infectious disease testing company had mistakenly sent samples of a potentially pandemic strain of influenza to labs all over the world. So a fax went out to all the labs telling them so, and asking them to destroy the sample – thus converting a small accident risk into a much larger terrorism risk. The facts were public at the time, but a society with a blind spot for bad guys simply ignored their implications.
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Flu Vaccine Shortage: Segmenting the Audience
Posted: October 22, 2004
Because of manufacturing problems, the U.S. had less vaccine for the 2004–05 flu season than it expected to need. The shortfall actually increased the demand, as people who don’t usually get vaccinated decided that this year they would. Jody Lanard and I were critical of what officials were telling the American public about the situation. We were especially critical of the failure to segment the audience – both according to the medical importance of vaccinating each segment and according to whether members of that segment bother to get vaccinated in a normal year. Since audience segmentation is a basic principle of risk communication (and all communication), we decided to show how it’s done by developing different flu vaccination messages for each segment. This column is the result.
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SARS Exercise: What Are They Doing?
In “Crisis Communication: Guidelines for Action – Planning What to Say When Terrorists, Epidemics, or Other Emergencies Strike,” a CD/DVD produced by The American Industrial Hygiene Association, May 2004
This exercise provides quotations from SARS communications and asks the reader to decide what crisis communication principles each quotation either illustrates or violates. It was prepared to accompany a crisis communication CD/DVD produced by the American Industrial Hygiene Association.
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Practicing for The Big One: Pennsylvania’s Hepatitis A Outbreak and Risk Communication
Posted: December 4, 2003
In late 2003, an outbreak of hepatitis A in Western Pennsylvania provided a neat case study of pretty good risk communication (not perfect, but not bad) about a pretty serious problem (not huge, but not tiny). In this column, Jody Lanard and I use Pennsylvania’s hepatitis outbreak to illustrate four basic dilemmas in crisis communication – dilemmas that are sure to come up in bigger emergencies: preoccupation with panic; trust and secrecy; over-reassurance; and anticipatory guidance.
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Risk Communication Recommendations for Infectious Disease Outbreaks
Presented to the World Health Organization SARS Scientific Research Advisory Committee, Geneva Switzerland, October 20, 2003
In October 2003, the WHO included social scientists (including me) on its SARS-fighting team for the first time. This invited paper has a list of 24 risk communication principles relevant to a possible second SARS outbreak or to any infectious disease outbreak; it also lists SARS-related risk communication research needs and has a short bibliography.
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Crisis Communications to the Public: A Missing Link
Chapter 5C.6 of Learning from SARS – Renewal of Public Health in Canada: A Report of the National Advisory Committee on SARS and Public Health (the “Naylor Report”), October 2003
One small section of the official Canadian government report on the lessons of SARS addresses public communication – and leans predominantly on the “scathing” assessment of Sandman and Lanard.
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Fear Factory: Have the Media Overblown Canada’s Health Scares?
Published in Maclean’s, June 9, 2003
When a magazine article starts by asking whether the media have overblown a story – in this case, SARS – you can bet the answer is going to be yes. But the article does quote me (and some others) saying that SARS was serious and that if anything the media were over-reassuring – which paradoxically scared people all the more.
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Published in The Toronto Star, May 30, 2003
This is an almost shockingly lighthearted piece on Toronto’s SARS epidemic. It starts out with a weird focus on the question of whether SARS is God’s punishment, but winds up making some fairly solid points.
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Sars Communication: What Singapore Is Doing Right
Published in The Straits Times (Singapore), May 6, 2003; also in The Toronto Star (Canada), May 9, 2003, under the headline “Canadian Response to SARS Scorned as Whiny”
After a rocky start, the world’s premier performer in SARS risk communication turned out to be the authoritarian city-state of Singapore! In this brief op-ed in Singapore’s biggest newspaper, my wife and colleague Dr. Jody Lanard and I tell the surprising story. A link to the longer, unpublished version of the article is provided.
On September 21, 2004, Jody told another version of this story as one of the keynote presentations at a World Health Organization conference on “outbreak communications.” The conference was scheduled in Singapore in part because of the superlative job Singapore had done communicating with its population about SARS – an accomplishment WHO wanted to help other countries emulate in other outbreaks. Entitled “WHO Expert Consultation on Outbreak Communications – Singapore's SARS Outbreak Communications,” the speech text was on the website of the Singapore Ministry of Health for a while, but now is available only on this site.
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“Fear Is Spreading Faster than SARS” – And So It Should!
Posted: April 28, 2003
Until it turned out less contagious than initially thought, SARS looked to many experts like it might very well be the devastating pandemic they had spent decades fearfully awaiting. When Jody Lanard and I wrote this column in April 2003, that was still an open question. The public’s SARS fears were entirely justifiable – yet many governments, experts, and even journalists were working overtime to dampen those fears. The column describes this “soft cover-up” of SARS over-optimism, tries to explain why so many officials were seduced by it, and offers both good examples of guiding the public’s fear and bad examples of trying to allay that fear. The column concludes with a list of 18 specific risk communication recommendations for talking about SARS.
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SARS: How Singapore outmanaged the others
Published in Asia Times (Hong Kong), April 9, 2003
I thought Singapore handled SARS risk communication a lot better than China, Hong Kong, or Canada. But I never expected to be explaining why in a Hong Kong newspaper.
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Candour, not PR, will calm virus fears
Published in The Straits Times, Singapore, March 27, 2003
Early in Singapore’s SARS epidemic, the country’s dominant English-language newspaper published this article on how two American risk communicators thought it should manage the crisis.
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Smallpox Vaccination: Some Risk Communication Linchpins
Public Health Outrage and Smallpox Vaccination: An Afterthought
Posted: December 30, 2002 and January 19, 2003
In December 2002, I was asked to help plan and run a meeting on risk communication recommendations for the U.S. program to vaccinate healthcare workers and emergency responders against smallpox. The first column is an edited version of my introductory remarks. It addresses some familiar “risk communication linchpins” – paying attention to outrage, doing anticipatory guidance, expressing wishes and feelings, tolerating uncertainty, sharing dilemmas, riding the seesaw, etc. – all customized for the controversies I thought likeliest to emerge over smallpox vaccination. What I learned from the meeting was that most of the public health professionals implementing the smallpox vaccination program were themselves outraged that it even existed. So I wrote an “afterthought” on the sources of that outrage, and the need to deal with it lest it undermine the program … which, in my judgment, it later did.
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Published in The Trenton Times, July 12, 2002
I think this is my wife and colleague Jody Lanard’s first risk communication publication, a newspaper op-ed urging that people who want to be vaccinated against smallpox get sent to “vaccination camp.”
Guestbook Entries
(SARS, “Ordinary” Flu, and Other Infectious Diseases)
2018
Dengvaxia and the vaccination crisis in the Philippines (November 2018)
2017
Flu vaccination dishonesty, 2017 edition – and why am I posting so little these days? (October 2017)
2016
Titrating warnings: a Zika example (December 2016)
2015
2013
Is “superbug” a dangerous exaggeration? (September 2013)
Estimating uncertain probabilities quantitatively (of a pandemic or anything else) (July 2013)
Pandemic preparedness and pandemic stages re H5N1, H7N9, and MERS (July 2013)
False sense of security (March 2013)
2012
2011
Scaring people into getting their flu shot (September 2011)
The risk communication in Contagion and Contagion as risk communication (September 2011)
Sarcasm isn’t an effective way to persuade parents to vaccinate their kids (August 2011)
2010
Mandatory flu vaccination for health care workers (again) (November 2010)
Making health care workers get vaccinated against the flu (March 2010)
2009
Mandatory vaccination for health care workers (October 2009)
2008
Risk communication is a type; outbreak communication is a subtype (July 2008)
Vaccination and autism: Responding to the Hannah Poling case (March 2008)
2007
Does taking the thimerosal out of vaccines reassure people or scare them? (October 2007)
2004
Flu vaccine risk communication (October 2004)
2003
Copyright © 2020 by Peter M. Sandman
