Pandemic or pandemonium? Drawing on crisis management best practice to prepare for the worst The theory’s good but the practice is not so easy The good news in dealing with pandemics, mass food scares, or the fear of them is that people crave information; the bad news is that information is often confused or sparse and that people may not be predisposed to hear, believe or act on it. As we shiver our way into the heart of this winter, the fears of Avian ‘Flu and virulent influenza epidemics are rising as the temperature falls. The UK media are reporting that over-zealous GPs and over-anxious consumers have already used up our stocks of flu jabs – and there are no signs of an avian flu diagnosis or cure being anywhere on the horizon, even though the race is well and truly on to find a vaccine. How did we get here? The government has a duty to inform, advise and reassure but very shaky ground on which to act. What should they do? What should any self-respecting public health education or advisory body do? They need to `tell it all’ but where are the accurate facts and how much are people ready to believe? Back in March 2005, the UK government told us it was stockpiling enough anti-viral drugs to treat one in four people in the country for ‘flu. And, the BBC reported, the Government might also announce pandemic-containment plans to close large venues such as schools and cinemas, in the event of a major outbreak, to prevent the disease spreading. The move followed a spring warning from the World Health Organization that a new strain of Avian ‘Flu could develop, which would allow the virus to spread from human to human. Professor Pat Troop, of the Health Protection Agency, told worried punters watching BBC Breakfast as they downed their cereal: "The general consensus is that it's not if but ‘when’ we have a pandemic. We don't know when. It could be this year, next year or beyond that. What's most important is that we have good plans in place and we are all prepared. We won't be able to stop it or completely control it but we can mitigate its effect." Brave words as an attempt to get things in a reasonable perspective – to imply authority and calm but to be telling us quite clearly, at the same time, that we have no plan (yet) and that there will always be an out-of-control aspect to the problem. No wonder our media and our minds have had a field day ever since… Perception of risk is a tricky phenomenon * The complexity of the issue at hand * The uncertainty about the actual occurrence of the presumed positive or negative effects, and * The ambiguity when these effects are assessed by oneself and others. All three components – complexity, uncertainty and ambiguity – must be applied in parallel to all four stages of the risk regulation process and the risk-benefit balancing process. The key questions to ask, in planning how and what to communicate with regard to the risk, cover four areas for action. They are: * How high is the risk? This is an issue concerning scientific risk assessment. * How acceptable is the assessed risk? Is it tolerable or not? This concerns risk evaluation. This process includes a comparison between benefits and risks; without such a balancing act risk tolerability cannot be determined. * What possibilities are there to further reduce a risk rated as being unacceptable and, if possible, to avoid or minimise risk? This concerns risk management. * How are transparency, understanding, and if at all possible, agreement to the planned risk management achieved? This concerns risk communication. Similarly, experience makes it possible to categorise four functions of risk-benefit communication that are very relevant to the steps required in preparing for a pandemic or the threat of one: * Enlightenment: Making people able to understand risks and benefits (and their interactions) * Behavioural changes: Making people aware of potential risks and benefits helps them to make the right choices * Trust building: Assisting health education bodies to generate and sustain trust * Conflict resolution: Assisting health education bodies to involve major stakeholders and affected parties to take part in the risk-benefit evaluation Professor Pat Troop, of the Health Protection Agency, had little choice but to embark, in her BBC interview, on the first tentative steps of this process. Unfortunately for her, there is a well-documented ‘trust deficit’ backdrop where she, or anyone else, has to fight back against huge apathy and mistrust before clawing their way back to the level playing field on which to convey sound information and simple, clear advice. Stepping stones towards a communications plan * Risk-benefit communication starts with an excellent record of management * Communicators need to specify in advance: - Purpose of communication (orientation, behavioural advice, involvement) * Trust and credibility cannot be “produced” or “manufactured” but only earned in terms of performance and effective communication. So what can be done – what would ‘success’ look like? So is there anyone out there who is managing to get some straightforward coping mechanisms in place? Well, our health education counterparts in New Zealand have made a decent start. Their Ministry of Health website outlines their national pandemic plan which is continually being updated in line with WHO recommendations. District Health Boards have local plans too. All other government agencies are also planning for a pandemic. An inter-sectoral group is considering non-health issues that are directly affected by a pandemic, such as school closures, border management and the maintenance of critical infrastructure, including supply of food and water and law and order resources and plans. The New Zealand Government, following the advice of the WHO, has been stockpiling anti-viral medicine (Tamiflu) suitable for use against influenza viruses. By the end of 2005, they claim, there will be enough anti-viral medicine to treat about 21 percent of the population. (Compare that with the UK aims and the current reality.) The New Zealand Ministry of Health has also set up a Pandemic Influenza Technical Advisory Group (PITAG), which advises the Ministry on the international situation and provides recommendations on the appropriate nature of New Zealand's responses. There is also a Pandemic Influenza Reference Committee (PIRC), with members from across the health sector. They are also conscious too of the essential importance of the front-line, consumer-facing advisors who will bear the brunt of communicating and caring. They rightly say: “Primary health care is a fundamental component of pandemic planning at a District Health Board (DHB) level, and DHBs are working in their communities to make sure this is achieved through their emergency plans. Many DHBs employ general practitioners to liaise with other GPs on primary care issues. “Nationally the Ministry of Health is working on pandemic planning with primary care leaders, such as the Royal New Zealand College of General Practitioners and the College of Practice Nurses. “National GP organisations have met and identified how they are will continue to contribute to the ongoing pandemic planning processes, and the College of GPs has been nominated as the lead agency for this. There are GPs and nurses on various pandemic influenza advisory groups to the Ministry.” And this still leaves the basic communication job to be done: simple messages and practical advice. In New Zealand, they are answering this need by producing information packs advising on infection control measures to minimise the spread of ‘flu among health workers and the public. These are being distributed to primary care practitioners. Of course, there is a much wider industry and business distribution that would also be necessary, but their website doesn’t tell us this is planned. Risk is a fact of life
•Date: 13th Dec 2005 • Region: UK • Type: Article •Topic: UK pandemic planning |
