The tiny H1N1 virus pictured above (the influenza formerly known as "Swine")* has brought me back to this blog after a long hiatus. As those of you who have read this blog for a while know, I have written quite a bit about pandemic preparedness from a social marketing perspective both here at Spare Change and as an invited blogger on the HHS Pandemic Flu Leadership Blog in 2007.

At that time, a pandemic seemed like a far-off risk, though we knew it was more a question of 'when' than 'if.' Since then, HHS and CDC have been working hard to increase preparedness at the national, state and local levels. From the rapid and effective response we've seen so far, it appears that they have done good work in that arena. Health departments and school districts in the US, and especially in Mexico City, have been quick to identify cases, isolate them and implement social distancing measures to keep people away from each other.

But I'd hoped we would have been further along prior to a pandemic in the areas of public awareness and preparedness. I'm currently involved in the social media piece of a CDC contract that is building grassroots coalitions to increase pandemic preparedness at the community level. As you can imagine, this project has been refocused to be H1N1-specific, and the timeline has been greatly accelerated. Our biggest concern, up until a week or so ago, was 'how do we get people to understand what a pandemic is and why they should care?' Suddenly, awareness is no longer an issue. But that also means that we are dealing with many other challenges that did not previously exist.

I believe that the CDC and WHO have done an excellent job of getting information out about the virus, its victims and how to prevent the spread of the flu. They are providing straightforward facts without hype and avoiding alarmism in their communications. The social media team has been especially innovative in providing online tools and maintaining an active presence on various online social media sites.

Unfortunately the 24-hour news machine, which by its nature needs to be constantly fed with new information, different angles on the same story, and attention-grabbing visuals, sank its teeth into the pandemic story and ran with it. Constant stories about new victims, pictures of people wearing masks, and ridiculous overreactions like that of Egypt, which slaughtered all of the country's 300,000 pigs, overwhelmed the public. Even Vice President Joe Biden put his foot in his mouth and said that he advised his family to stay off airplanes and subways, going far beyond any recommendations given by the government and adding to the sense of panic (he later backtracked).

A backlash has been building against the perceived hysteria, which has created its own new problems. People with the sniffles are flooding emergency rooms and demanding to be screened for H1N1. Tamiflu and Purell are flying off the shelves. People are wearing masks when going out in public, even though the masks are designed more for preventing a sick person from spreading their illness rather than protection from the other direction. The result is that many people are afraid and are growing weary of having their guard up with no perceived benefit.

Luckily, it appears that for now, this H1N1 virus may not be the Big One. It's too early to know whether it will mutate and come back in a more virulent form, as the 1918 influenza virus did. And it's impossible to know what might have happened with it had precautions not been imposed from the very beginning. Greg Dworkin of the Flu Wiki does an excellent job of explaining how seemingly drastic measures at the beginning of a pandemic can make all the difference in the outcomes. But prevention gets no respect. It's really hard to get excited about something that didn't happen. Many people don't understand that the public health system has to act on the potential threat, not waiting to see how bad it will get before intervening. Prepare for the worst and hope for the best.

Whichever way the body count goes, the government would not win with its critics. It will either be accused of overhyping the threat or it will be accused of not being prepared enough. Michael Coston captured this Catch-22 well in his post "Predicting the Unpredictable":

The more successful they are in containing this outbreak, or in mitigating its effects, the more criticism they will receive in the press for over-blowing the threat.

And when this pandemic comes and goes without too much incident, particularly in the US, people may become complacent the next time we find ourselves facing a nasty virus. The government is seen as the bureaucrats who cried wolf and important recommendations may be ignored.

So what do we need to be doing to take this situation into account as we develop our communication efforts around pandemic preparedness? I have some recommendations:

• Build on the new awareness of pandemic flu to take people to the next level. HHS and the media have both done a good job of pushing handwashing, avoiding sneezing into hands, and staying home when sick. We can now move past the "what is pandemic flu" and go directly to "how can I prevent and prepare for a pandemic?"

• We may have a window of opportunity for individuals and families to begin the process of gathering the supplies they would need in the case of an extended severe pandemic to survive at home sheltering in place. I think that HHS did a good thing by not emphasizing the need to stockpile food while we were in the thick of the beginning of the outbreak, thereby avoiding panic and shortages. But once the danger has passed, messages about slowly but steadily building up a supply of food, water and medical supplies must begin. (Here is an excellent pdf guide to pandemic preparedness and response.)

• Complacency is a real danger. Messages should make the point that a severe pandemic remains a real possibility and that prevention measures kept this H1N1 virus in check. Parallels with the 1918 influenza virus, which started out relatively mild but returned in a second wave in a more virulent form, may illustrate the possible risks. In any case, the same good hygiene habits that prevent the spread of H1N1 will benefit people by keeping away seasonal flu as well and should be continued.

• We must take care not to use fear-based messaging and imagery because this can lead to feelings of helplessness and hopelessness -- not useful emotions when trying to get people to take action. Messages should emphasize how being prepared puts you in control. During turbulent times, giving people steps they can take to prevent or mitigate problems makes them feel empowered and capable. That's what we need!

• Government agencies need to avoid any perceptions that their decisions are being made based on politics rather than science. In chatting with an acquaintance who was at NIH during the 1976 Swine flu epidemic, I learned that he strongly advised against proceeding with making the vaccine public because of safety concerns. He was overruled in favor of political considerations; 25 people died and hundreds of others were paralyzed from the faulty vaccine. While some conspiracy theorists will find nefarious motivations in any government actions, don't give reasonable people cause to doubt the basis of your policies.

• Emphasize that being prepared for a pandemic will benefit them for many other types of disasters as well. Many of the same recommendations for food, water and medical supplies apply for regional hazards like earthquakes, hurricanes, tornadoes, and floods. It never hurts to be prepared, and often helps.

• Continue to use social media to monitor what people are saying about pandemic flu-related issues. This can give you an idea of incorrect information or rumors that are being passed around, or the questions that keep coming up that need to be answered.

• The government needs to be proactive about getting its messages out, beyond the news media. Television ads, entertainment education outreach, radio and outdoor media all could be used effectively to motivate people to prepare for another pandemic episode. Social media efforts can be expanded from primarily news coverage to help people learn more about preparedness activities.

• The tone of the information needs to continue to be straightforward and factual, but emotionally appealing to various audiences. Right now the messages are very general, but they should be tailored to different key groups. If only we had a C. Everett Koop-style figure -- or at least a Surgeon General!
  

This will be a challenge. But on the bright side, we have a higher level of pandemic awareness than I ever thought possible. We need to take full advantage of this window of opportunity.


*Thanks to Michael Coston for that very cute name!

Image credit: CDC Influenza Laboratory