Scaring People Scary

In February 2005 I had a chance to spend a day with many of the top pandemic people at the US Department of Health and Human Services (HHS) and the US Centers for Disease Control and Prevention (CDC). I made the strongest case I could for alerting the American public to the risk of an H5N1 pandemic—for shaking people by their collective lapels and persuading them that family and community preparedness should be a priority.

I failed. The collective wisdom of the group was that, yes, pandemic preparedness was an important government priority. But trying to make it an important public priority would require frightening people . . . and that was simply too high a price to pay. The psychological toll and the economic impact could be incalculable.

That summer US President George Bush read John Barry’s book on 1918, The Great Influenza. And a couple of months after that, Katrina led White House strategists to decide that, for a while at least, Cassandra’s doomsday predictions might provide a better role model than Pollyanna’s over-optimism. By the end of 2005, HHS and CDC were in the forefront of an orchestrated federal campaign to sound the alarm about pandemic preparedness.

Have you noticed any signs of pandemic preparedness panic? Are your friends suffering from pandemic preparedness post-traumatic stress disorder? Has a massive pandemic preparedness market selloff hurt your share price? I don’t think so.

The pandemic “fear campaign,” as its critics rightly called it, was modestly successful. It was a decent start on what will have to be a 5-year or 10-year effort to get the US public emotionally and logistically ready for a pandemic. (We hope we are given that much time.) As I write this in early December 2006, we’re in a lull. Pandemic preparedness is old news in the mainstream media. But when the story becomes newsworthy again—perhaps when the first bird with Asian H5N1 virus is found in the North America—we will start at a higher level of public awareness and concern than we started in 2005.

Much of the private sector, meanwhile, is about where HHS and CDC were nearly two years ago: convinced that pandemic preparedness is important, but reluctant to frighten customers or employees. Client after client tells me that the company is busy getting ready for a possible pandemic—but quietly. Why quietly? Because they don’t want to “unduly frighten people.”

What about duly frightening people?

During consultations and presentations on pandemic risk communication, I typically draw a diagram representing the “fear dimension” of emotional arousal.

When I ask the group where on the scale they want their stakeholders to be with respect to pandemic preparedness, the typical choice is “concern.” When I advocate for “fear” instead I get a lot of pushback. The group’s usual solution is to add another label, “high concern.”

I think my clients are imagining a cowering fear; a paralyzing fear; a swarming mass-hysteria panic-fear. But for the most part people are sturdy—responding to fearful situations with initial anxiety and riveted attention, followed quickly by resilient response, and then by integrating the new fear into their daily lives. Pretty quickly—sadly, in a way—people adapt. Many people even become too apathetic again.

On the diagram at right, the level of emotional arousal most conducive to precaution-taking is fear—proportionate fear. Concern is too low; terror is too high. Sustained fear would be optimal for preparedness (though not optimal for normal living). But fear isn’t sustainable. The best we can manage is an oscillation between fear (when something newsworthy is happening) and concern (when it isn’t).

My wife was once a university psychiatrist. Students used to say to her, “I want to break up with my boyfriend, but I don’t want to hurt his feelings.” Her answer: “That isn’t one of the choices. When you tell him hurtful news, you can’t skip the part where he feels hurt.”

Scaring people is scary. But if you want people to prepare for a possible pandemic, you can’t skip the part where they feel frightened.

Hows Your Business Discontinuity Program

Business continuity is exactly the right frame for a mild pandemic. Under conditions something like the 1957 or 1968 influenza pandemic, you can expect some impact on your supply chain and your absenteeism. It’s good business to plan to cope well with these problems so they don’t disrupt your business.

But a severe pandemic, anything like 1918 or worse, will disrupt your business. Period. Planning to prevent disruption is worse than useless; it’s likely to backfire. Even planning to minimize the disruption isn’t quite on target. The smartest companies (and government agencies), I think, are planning to manage the disruption. I mean that literally. They are planning how best to disrupt their own operations. In a sense, they’re planning how to work with the pandemic instead of struggling to work against it.

In other words, they’re developing triage plans. Wikipedia defines triage as “a system used by medical or emergency personnel to ration limited medical resources when the number of injured needing care exceeds the resources available.” You let minor problems go unaddressed. You let problems so severe you probably can’t solve them go unaddressed, too. You concentrate your effort where it will do the most good.

Think about nonmedical triage. It isn’t business continuity. It’s business discontinuity–planned discontinuity.

What normal functions of your organization are you planning to stop doing when it’s clear that you’re facing a severe pandemic? Have you compiled a list that distinguishes the dispensable tasks you’ll regretfully abandon for the duration from the core tasks you may need to ask people to risk dying in order to sustain?

Having such a list–that is, facing a possible severe pandemic with a discontinuity mindset instead of a continuity mindset–is central to pandemic preparedness. I think it’s almost a definition of taking preparedness seriously.

The risk communication aspect of all this is how you talk about your list. Some questions I am asking my clients:

  • Have you shared your triage/discontinuity plans with your key customers? They need to know where you’re planning to let them down and where you’re planning to keep going no matter how tough it gets. You may even want to talk about amending some of your contracts to match.
  • Have you asked your key suppliers what their triage/discontinuity plans are? Their plans, obviously, could have a huge impact on your plan. And if they haven’t got any such plans yet, you can do them–and yourself–a favor by insisting that they come up with some.
  • Have you invited your customers, suppliers, and other stakeholders to help you with your triage/discontinuity planning? Transparency is a virtue in risk communication, but consultation and responsiveness are better yet.

Above all, in my judgment, have you talked about pandemic business discontinuity planning with your employees? Like all your stakeholders, employees need to know your plans, and would appreciate the chance to influence your plans. But there’s an even more fundamental reason for involving employees. Absenteeism during a pandemic is likely to be closely tied to business discontinuity planning.

This factor emerged clearly in several surveys I have seen that asked employees in various sectors to predict whether they’d show up for work under pandemic conditions. It emerged also in pandemic tabletop exercises, where nonmedical personnel often decide not to come to work because they haven’t imagined that they will be needed. In a December 2004 San Diego drill, even military officers and public officials “required convincing that they had crucial roles in what they initially thought was a purely medical exercise,” according to a published report on the drill.

Would I show up to do my normal job during a pandemic? Probably not; I’d stay home, stay away from others, and take care of my family. But if I had been cross-trained for a pandemic-related job, that’s another story. There’s a far better chance I’d take a deep breath and report to my emergency duty station.

Planning for business continuity, in other words, may worsen the discontinuity, because most employees won’t endanger themselves just to keep doing their routine jobs. Planning for discontinuity, on the other hand, significantly increases your chances of sustaining the core tasks you decided you simply must sustain no matter what. But discontinuity planning can’t help much unless employees are convinced beforehand that they will have a crucial, nonroutine role to play if and when a severe pandemic hits.

The psychology of precrisis communication makes convincing them a daunting task. Despite periodic accusations of resorting to scare tactics, government and the private sector are more typically united in their profound disinclination to frighten their publics. (The accusations of scare tactics actually contribute to this disinclination.) Emergency planners are characteristically much more willing to plan for a possible disaster than they are to talk about a possible disaster. They are even willing to plan what they’ll say if and when the disaster strikes–but don’t ask them to say anything now. I’ll address this nearly universal “fear of fear” in my next column.