Thank you for the conversationI want to thank the Secretary, the Department and staff for taking the initiative to reach out to the public in this way. Blogs have a tendency to encourage informal two-way conversations, which can sometimes pose a challenge to those used to polished, one-way institutional communication. And this is a good thing! Ultimately people want to feel that they are being treated like real human beings, not just faceless citizens to whom government messages can be broadcast. We want to feel like we know our leaders, that they know us, and we want to be treated with respect. We want to be trusted with truthful information so that we can make the best decisions for ourselves, our families, and our communities. I hope the Department looks at this experiment not only as a new way to communicate with the public, but also as a way to enable real conversations with real people. The threat we face from pandemic flu is real, and I believe the best preparedness will come out of two-way conversations, not just one-way communication, when people are armed with complete and honest information. And also a big thank you to all the people who took the time to read the posts and to add their comments. Your participation made this experiment a real conversation, and I think sent a clear message that given the right information and support, private citizens are ready to take a primary role in preparing for a pandemic.
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Painting the riskIt’s difficult to communicate the urgency of preparing for an event the scale and impact of which none of us has experienced in our lifetimes. In my casual conversations with friends and colleagues, I get the sense that while they are generally concerned about this thing called “bird flu,” they’re not sure what they should be doing about it, or even if anything is to be done at all. In California, for instance, I get the feeling that the level of concern about a possible pandemic is about the same as concern for a major earthquake. You know “the big one” is going to happen someday, so you develop a few contingency plans, put them in a safe place waiting for the day you’ll need them, and then get back to “real” work. Or even worse, you say, “someone must be thinking about this issue, so I don’t have to worry about it myself. When the time comes, they’ll tell us what to do.” And getting people to think about earthquake preparedness is much easier because we seem to have a pretty serious earthquake every now and then to knock us out of our complacency. The trouble is, of course, that a severe flu pandemic would be far worse than even a devastating earthquake. People reading this blog already know that, but I don’t think my otherwise smart and thoughtful colleagues do. It’s interesting to me to hear their reactions when I first start talking about a possible pandemic. “No one knows for sure if there will really be a bird flu pandemic. We can’t prepare for every theoretical risk out there.” “They’re working on a vaccine, right? It’s just a matter of time until they get one. If there’s a pandemic, we’ll just have to get an extra flu shot and we’ll be fine.” “What if there’s not enough vaccine to go around? That’s ok, I know people and I’ll be able to get enough for me and my family.” “Prepare in advance just in case? Ok, maybe that’s a good idea. I’ll get a bunch of Tamiflu and put it in a safe, and we’ll be fine.” “Wait, you mean none of this will be enough in a really bad pandemic? In that case, what can we do? Either the government will rescue us, or if they can’t, we’re all screwed anyway.” I think it’s fascinating how quickly people seem to jump from business as usual, to token preparedness, to dependence on government, and then to complete despair. There’s clearly a step missing there, and I think part of the problem is that we don’t have good stories and texture to describe what might happen, so people can’t think about how they might react and how to prepare. When I attempt to paint a picture to my friends and colleagues, I sometimes use example scenarios like these. (I made these up, which is part of the problem — I’m sure they exist, but I haven’t yet found a good source of credible scenarios to use for planning.) “One of the first things governments may do is to close the schools, because we all know kids are little germ factories and are always getting sick at school. Sounds like a good plan, right? So, who is going to stay home with the kids and who is going to go to work? Day care will also be closed for the same reason, so that’s out. Hey, what about the doctors and nurses? If they have kids, they’ll have to stay home with them, because they’re not about to bring them to the hospitals that are full of sick people. That means there’ll be fewer hospital workers while more people are sick.” “Where do we get our food? Supermarkets don’t have farms in the parking lot… all the food is trucked in from somewhere else. What if a third of the truck drivers are too sick to drive? And at the same time, the government is telling us to stockpile two weeks of food. Is there even that much food on the shelves? Are people going to be fighting over food?” “Ok, so we try to stockpile two weeks of food in advance. Is there a two-week supply of food available if everyone decided on Monday to make a stockpile? For example, I’ve heard that Hawaii has at most a seven to eleven day supply of food at any given time, so if shipping were interrupted for two weeks, there would be no food on the shelves for one million people. It’s not as if they can drive to another state to get some food, either.” “So you were smart and prepared your stockpile. What happens if your neighbor didn’t and there is no more food or water available in your town, even for just a couple of days? Do you have enough to share? If not, you face both a moral dilemma and a very real threat. To protect and care for your own family, you have to make sure your entire neighborhood is well prepared.” The point of these scenarios is not to scare people, but to to lend some texture to the challenges we might be facing during a severe pandemic. I agree that being an alarmist is not an effective way to get people to listen to you. But we also shouldn’t avoid calmly painting the picture of the world we might be living in for several weeks, or apparently as long as 90 days at a time, during a severe pandemic. If people don’t know what to expect, they can’t prepare. In order to prepare effectively, they have to have some idea of what they are preparing for. It’s not enough to make lists of recommended preparations without the context within which those preparations will come in handy. I’m not against making lists, but I may have more faith in the ability of individuals and families everywhere to do the right thing when they have all the information they need. So the trick is to figure out a way to paint a picture of the real risk we face, without sounding alarmist or shrill. We don’t want to be in a situation where someone has to say, “no one ever thought this would happen.” With a little foresight, we can anticipate lots of problems that would occur even during a mild pandemic, and the public — not just planners — should be thinking about how those problems would affect them, ahead of time.
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Why care, why prepare?Secretary Leavitt, Michael, Greg, thank you for your posts, which I read with interest. Here is my take on the question, “Why is it critical for each of us to prepare for the threat of pandemic influenza?” For me, it’s pretty simple. Here’s the bad news: 1. There will be a pandemic eventually. The only slightly-less-bad piece of this news is actually a caveat to #1: There will be a pandemic eventually, but we can’t predict the timing or the severity. It could be a really bad one starting in March of 2008, or it could be a really mild one in September of 2012.
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