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Bird Flu:
Communicating the Risk

Most virologists fear an H5N1 pandemic will happen sooner or later. Many fear it will happen soon. The unprecedented and almost inconceivable worst case is a human strain as deadly as the current hard-to-transmit H5N1 strain, but as easily transmitted as the annual flu. That could literally end life as we know it. Not so dire but still worse than any pandemic in living memory: a strain that transmits easily and kills, say, 5-10 percent of its victims. (The granddaddy of flu pandemics, the Spanish flu of 1918-19, killed about 2.5 percent.) Do the math. The world population is 6.4 billion. A pandemic that struck 30 percent of the population and killed 5 percent of those it struck would cause 96 million deaths. An H5N1 vaccine could cut this number sharply-if scientists can develop one that works, if governments can license it, and if manufacturers can make enough of it. Those are big ifs, especially the last one; most of the world's poorer countries get virtually no vaccine against the annual flu now.

 Lab technician examine vials
A lab technician at Indonesia's Disease Investigation Centre checks for the avian flu virus in samples taken from poultry. (FAO photo)

Even in the experts' best-case scenario—2-7 million deaths—a flu pandemic could slow travel to a trickle, lead cities to forbid inessential gatherings, and precipitate a worldwide depression. Preparing for it could include, among other things: national governments streamlining vaccine approval procedures; school boards deciding whether and how to close the schools for extended periods; businesses planning for the twin problems of absenteeism and presenteeism (sick people bringing the virus to work with them); hospitals stockpiling antiviral medications and personal protective equipment for staff; communities figuring out how to recruit and use volunteers to keep essential services running—including the all-important survivors of the first pandemic wave, who will be the only ones immune before a vaccine becomes available.

All of this information is publicly available. Most people have already heard a little about bird flu. But people face a host of other problems, and except for public health officials and poultry farmers, few are gearing up for action about H5N1. Yet.

Enter risk communication. Although people have always tried to figure out how to communicate about risks, the field of risk communication dates back only to the 1980s, evolving from health education, public relations, psychology, risk perception, and risk assessment. There are at least three kinds of risk communication:

  • Precaution advocacy ("Watch out!"): How to alert people to serious hazards when they are unduly apathetic.
  • Outrage management ("Calm down!"): How to reassure people about minor hazards when they are unduly upset.
  • Crisis communication ("We'll get through it together!"): How to guide people through serious hazards when they are appropriately upset (or even in denial).

Bird flu risk communication is partly precaution advocacy and partly crisis communication. It's precaution advocacy if you're talking to Southeast Asian poultry farmers who haven't heard much yet about bird flu. It's crisis communication if you're talking to poultry farmers who are trying to figure out how to cope with this huge new threat to their flocks, their livelihoods, and potentially their lives. It will be crisis communication everywhere if and when the pandemic materializes.

Meanwhile, for most of us, it's precaution advocacy. Many infectious disease experts are as worried about H5N1 as they have ever been about any microorganism. They feel weirdly alienated when they try to explain their worry to spouses or friends-or the general public. They have convinced a few medical journalists, who then feel weirdly alienated when they try to explain their worry to their editors. Bird flu is way over there in Asia. H5N1 is still flu, and flu is still the sort of risk people don't take all that seriously.

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