Complacency, not overreaction, is the greatest
danger
Editorial
Nature 459, 9 (7 May 2009) | doi:10.1038/459009a;
Published online 6 May 2009
Between a virus
and a hard place
Abstract
Complacency,
not overreaction, is the greatest danger posed by the flu
pandemic. That's a message scientists would do well
to help get across.
[but is
there any need to go off to the other extreme, e.g. saying 'the
flu pandemic' when there is none? - RM]
Damned if you do, damned if you don't. The emergence of
a new, swine-flu-related H1N1 strain of influenza in people in North
America, with sporadic cases elsewhere in the world, has left the US
Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia,
and the World Health Organization (WHO) in Geneva in an unenviable
position.
For more than a week now, these two
agencies have been holding daily media briefings to keep the world
informed about the rapidly unfolding story. There is ample
reason for concern: a new flu virus has emerged to which humans have
no immunity, and it is spreading from person to person. That has
happened only three times in the past century. The pandemics of 1957
and 1968 were mild in most people but still killed many, and that of
1918 - which also seemed mild in its early phases - killed at
least 70 million people worldwide. As Nature went to press, the
WHO had already upped its pandemic threat level from 3 to 5, and a
final step to its highest level of 6 - a global pandemic - seemed
only a matter of time.
Yet at this early stage, the
consequences of the pandemic are so uncertain that communicating the
risks is a delicate matter. Influenza viruses evolve rapidly, making
it extremely difficult to predict what this strain might look like a
few months from now. If the agencies alert people and the pandemic
fizzles out, they will be accused of hyping the threat and causing
unnecessary disruption and angst. Indeed, just such a media backlash
is already beginning, because most cases so far have been mild. But if
the agencies downplay the threat and an unprepared world is hit by a
catastrophe on the scale of 1918, the recriminations will come as fast
as you can say 'Hurricane Katrina'.
The risk is not hyping the pandemic threat, but underplaying
it
To their credit, the WHO and the CDC have avoided the kind of
falsely reassuring officialese that has too often accompanied past
crises. As Peter Sandman, a risk-communication consultant based in
Princeton, New Jersey, aptly puts it: "Anyone who's paying
attention gets it that we just don't know if this thing is going to
fizzle, hang in abeyance for months, disappear and then reappear,
spread but stay mild, replicate or exceed the 1918 catastrophe, or
what. The reiteration of uncertainty and the insistence on what that
means - e.g., advice may change; local strategies may differ;
inconsistencies may be common - has been almost unprecedentedly
good."
Also encouraging is that many governments now have at least
some kind of pandemic plan in place, thanks to the scare over the H5N1
avian flu virus earlier this decade. Five years ago very few of them
did. But many of those plans contain an important element that has
been conspicuously absent in the current communication by governments
and public-health authorities: during a severe pandemic, there is only
so much they can do. Much of the response will depend on local
communities taking action for themselves.
Scientists can
help, by serving as credible voices to inform their communities of the
risks and uncertainties, and by pointing people to the
pandemic-planning resources on the CDC and WHO websites, the
PandemicFlu.gov site, and many others. For the moment, the risk is not
hyping the pandemic threat, but underplaying it. We know a tsunami is
coming. No one can say whether it will be just a large wave, or a
monstrous one, but it is time to start thinking about at least being
ready to move to higher ground.