Second in a two-part series examining the numbers and epidemiologic factors surrounding the virus that many experts believe could lead to the next pandemic. Part 1 explored why the apparently lower number of human H5N1 cases in early 2007 does not mean the pandemic threat is receding.
May 17, 2007 (CIDRAP Source Weekly Briefing) – Before this week, it might have been easy—albeit wrong—to draw the conclusion that the pandemic threat was lessening. But when the World Health Organization (WHO) on May 16 confirmed 15 human H5N1 cases and 13 deaths in Indonesia, dating back to January, official WHO data now show that this year's tally of avian influenza in humans is at least keeping pace with 2005, when media coverage of H5N1 reached its zenith. (See the sidebar, "Keeping tabs on H5N1 media coverage.")
The WHO confirmation may produce a spike in news coverage, which might help correct the misimpression given by greatly diminishing news coverage that H5N1 is a fading risk and put the issue back on the radar screen of top executives. "If it's not in the media, for the average American it's out of sight, out of mind," says Penny Turnbull, senior director of crisis management and business continuity planning at Washington, DC–based Marriott International, Inc.
From Jan 1 to May 16 of this year, 43 official human cases of H5N1 were reported, with 27 deaths. This compares with 98 cases and 43 deaths for all of 2005. Even with the newly confirmed Indonesian cases, 2007 numbers still appear to be off 2006's pace of 115 cases and 79 deaths for the entire year. Although the pandemic threat isn't fading, it could look that way to those not fully informed.
Pandemic preparedness planners, say Turnbull and other experts, need to frame the situation to more accurately reflect the reality that the pandemic threat is, ultimately, not about case numbers.
This is a difficult task, given that many in the field may have given the impression that it was about numbers, says Peter Sandman, risk communicator and Weekly Briefing deputy editor. "We need to take some of the blame for the misimpression, because we put too much emphasis on the number of human cases and human deaths," he says.
Pandemic preparedness planners can help correct that misimpression by communicating to senior executives that the real threat to business lies not in numbers but in failing to use this time to fortify their business.
Striking a balance
Keeping up the pandemic preparedness momentum relies on identifying "teachable moments" rather than reporting on each new human H5N1 case, Turnbull says. "It's finding a very judicious balance between providing good, valuable information and getting the timing right," she says. "You don't just want to keep on issuing reports and updates when there's nothing of much value to report on."
For example, she says, the Centers for Disease Control and Prevention's (CDC's) release of its "Community Strategy for Pandemic Influenza Mitigation" report in February and its recent guidance on masks were good opportunities to present new, concrete information to senior executives. National Emergency Preparedness Month, in September, will provide another chance to drive home the importance of being ready.
Strategies that you want the company to adopt don't necessarily have to be couched in terms of pandemic preparedness; indeed, Turnbull says some strategies may be better received by pandemic-weary executives if presented under the general heading of seasonal flu mitigation or disaster preparedness."You want to use these opportunities to reinforce the behaviors that you want to see happening during a pandemic," she says.
Another teachable moment might be the Apr 26 announcement that Roche was cutting back on production of the antiviral Tamiflu because governments were not buying as much as predicted, Sandman says. While a senior executive who does not want to invest in a stash of Tamiflu that may expire before a pandemic occurs may view that news as proof that the need to prepare is not as urgent, a planner can use this as an opportunity to argue that now the company could buy a supply without worrying that the purchase might be taking it away from emergency workers.
"Of course, you should admit that Roche has found a smaller pandemic preparedness market for Tamiflu than it—and preparedness experts—hoped," Sandman adds. "But your company isn't planning to sell Tamiflu; it's planning to use it. Roche's sales problems have very little to do with whether the XYZ Corporation needs an antiviral stockpile to keep operating in a pandemic."
Working with numbers
Because people in the pandemic preparedness field have always pointed to the growing number of human H5N1 cases and bird outbreaks as an indicator of the pandemic threat, they're in a weak position to turn around and say the numbers aren't important, according to Sandman. "The number of people that caught the disease is absolutely irrelevant," he says. "The disease that causes a pandemic is one nobody's caught yet. We should have been saying so all along."
Now, the people who never wanted to spend money on preparedness can use those very numbers to try to prove their point. "I bet the numbers are giving very valuable ammunition to people who want to argue that this issue isn't worth their company's time and investment," Sandman says.
Likewise, the strategy of giving the public the impression that a pandemic was imminent (because otherwise no one would prepare) has also backfired. "Nobody says we know it's imminent, but we certainly have given the impression that it's imminent," Sandman says. While that strategy seemed to mobilize the public for about a year, by now many Americans, feeling misled, have shrugged off the threat.
Reframing pandemic preparedness
Rather than backing off from communicating about pandemic issues, reframe them, Sandman says.
- Focus on the potential destruction. "Good pandemic preparedness warnings are about the potential magnitude of the risk—not the probability of the pandemic," he says.
- Use the insurance industry analogy. You can say, Sandman says, "It's not like hedging is unknown in our business. We spend a lot of money in our business on getting ready for things that may or may not happen. If there is a pandemic and if it's severe, the impact on our company can be huge."
- Emphasize that the world is fragile because of our just-in-time economy. Many people mistakenly believe that the world is much better prepared to handle the effects of a pandemic now than it was in 1918. "We're more vulnerable to pandemics than we ever were before," he says.
- Point out that business continuity isn't about media popularity. "Companies are supposed to make a business judgment about which issues deserve sustained attention," Sandman says. "I would tell my management that, now that the media focus is elsewhere, companies are the only force capable of preparing their employees."
Individualizing the plan
Stephen Redd, MD, director of the CDC's Influenza Coordination Unit, says that the slightly lower numbers of human H5N1 cases in 2007 haven't produced pandemic fatigue in the government sector. "There's no evidence that we're at reduced risk of a pandemic, so we understand that we need to continue all the work that we've been doing for the past several years," he says.
To keep up the pandemic preparedness momentum during the past year, Redd and his team conducted a 24-hour tabletop exercise followed by a 48-hour exercise. "Those experiences have helped us realize that there are a lot of challenges and a lot of things we still need to do," he notes.
Redd recommends that businesses conduct these drills as a continuing cycle of activity. "The cycle is to develop a plan, exercise the plan, and then, based on the results of those exercises, revise the plan," he says.
Another process that keeps preparedness planning in the forefront is to charge employees with getting themselves and their families ready for a pandemic. According to Redd, "I think it does help reduce the risk of complacency for people to need to do something for themselves."
