Whose pandemic fatigue?

(CIDRAP Source Weekly Briefing) – Far from being fatigued by pandemic warnings, the public is just beginning to hear the message. As planners, we're the ones at risk of pandemic fatigue, as we slog our way forward.

At CIDRAP's "Business Preparedness for Pandemic Influenza Second National Summit" in Orlando this February, Editor-in-Chief Michael Osterholm used the term "pandemic fatigue." Some in the audience understood him to mean that the public is getting tired of hearing about a possible future pandemic. But as Mike well knows, the public's fatigue isn't a significant problem yet. Our fatigue may be.

Of course, the media suffer from periodic pandemic fatigue. If you don't believe it, look at this graph of LexisNexis data showing general media coverage of H5N1.

This isn't an unusual-looking graph. Journalists are novelty junkies; they get bored fast. For a while, the risk of a pandemic was novelty enough for them. Then, inevitably, reporters started longing for a new angle. The one they found was: "Whatever happened to the risk of a pandemic?" That fueled some year-end stories. And it helped reporters gin up interest in otherwise run-of-the-mill January and February outbreaks, enabling them to report "Bird flu is back!" as if it had ever left.

It's a mistake to interpret the media's cyclic boredom as the public's fatigue.

But those of us who are trying to arouse the public's concern—and management's concern—may be experiencing a bit of fatigue. I won't speak for Mike, but I know I wouldn't mind moving on to a different issue—if only we were further along on this one. I've talked to more than one health department planner and business continuity manager who expressed the same wish. It is a truism of mass communication that the source typically feels the message is getting old when the audience has barely begun to hear it. We should be careful not to project our own exhaustion onto the public.

Which public are you addressing?

The public, though, is really a lot of different publics. Here's a quick-and-dirty audience segmentation analysis:

  1. Some are completely unaware. Far from being fatigued, they have yet to be reached at all.
  2. Some are aware, but haven't really become interested yet. We just barely engaged them; we've got a toehold, nothing more.
  3. Some have given the issue real consideration, and now they're digesting what they have learned. They may not be paying much attention at the moment, but when something new happens on the pandemic front, they'll be interested again.
  4. Some are suffering from pandemic fatigue. They were interested; now they're not.
  5. Some looked at the issue and decided we were wrong. They think H5N1 is a foolish distraction from more serious risks.
  6. Some have decided we're right. They've even taken some pandemic preparedness steps. They're converts and allies, and they're hungry for more information.
  7. Some are active pandemic preppers and key information sources themselves for their neighbors and coworkers. They may see us as the laggards.

We should be tracking the relative size of these groups much more carefully than we are. But my bet is that groups 2 and 3 are the biggies.

It's important to note that many in these two groups don't understand the distinction between bird flu and pandemic flu. Some don't know the word "pandemic" yet at all. Some who have learned the word think that the pandemic risk will come to them from birds. They are predisposed to overreact to diseased poultry and to underreact until diseased poultry are found nearby. And when news stories about bird flu outbreaks disappear for a while, it feels to them like the risk is gone. Some of what they've learned so far, in other words, is badly misleading.

This pandemic audience segmentation, by the way, is grounded in Neil Weinstein's precaution adoption process model, which lays out the stages any new risk goes through from ignorance to precaution taking. Weinstein's main point is that the messages that work for people at one stage in the model are likely to be completely different from the messages that work for people at a different stage. As we try to figure out what people in groups 2 and 3 need to hear, it's important not to confuse them with those in groups 4 and 5.

Or even with each other. People in group 2, for example, almost certainly need to hear more about how bad a severe pandemic could be. People in group 3 may have heard as much of that as they need right now. Messages about what to do and why it can help might be a lot more useful in persuading them to bypass groups 4 and 5 and progress to 6.

This audience segmentation is also consistent with what Anthony Downs has called the issue-attention cycle. When something happens that raises a new concern, people pay attention for a while. Their attention grows, peaks, and then falters. But it doesn't retreat back to where it started. It settles into "the new normal," a baseline level of awareness and attention higher than the previous baseline. The next time something happens, the public's interest rises again, peaks again, and falters again.

What follows is a series of peaks and valleys. The shape of this mountain range varies. It takes work and skill (and luck) to make sure the peaks keep getting higher, to build the public's interest, concern, and willingness to act. What doesn't vary is this: There are always valleys along the way.

Slogging between teachable moments

I see four lessons here.

Prepandemic communication—that is, pandemic precaution advocacy—happens most effectively in teachable moments. Sometimes you can create a teachable moment. Other times you need to wait, poised to strike, for the teachable moment.

Between teachable moments, we have better things to do than bang our heads against the brick wall of public inattention. Keep up some baseline level of communication, so the issue doesn't fall off the radar screen entirely. Other than that, focus on working with your fellow fanatics, the people who share your pandemic preoccupation (including those you successfully recruited during the last teachable moment). And focus on planning for the next teachable moment. What's your plan for when H5N1 is found in North America? It will be a big teachable moment. Are you ready? And I don't mean ready to reassure people about eating chicken. I mean ready to tell them about the real public health risk: a future pandemic.

The pandemic audience is worth segmenting. Sometimes, like it or not, we're stuck talking to everybody at once. But it's often feasible to address different messages to the different audience segments. Knowing what each segment most needs to hear is a huge advantage.

Pandemic preparedness is a slog. As Julie Gerberding, director of the Centers for Disease Control and Prevention, said at CIDRAP's Orlando conference, it isn't a sprint, it's a marathon. When the public's attention periodically falters, we need to sustain our own. It normally takes about a generation to get a new risk or a new precaution firmly onto the public's agenda: Think about seat belts, smoke alarms, and radon. Think about smoking. Think about global warming! In fact, a lot of activists on other risk issues are frankly envious of the fast progress made by pandemic preparedness advocacy since H5N1 came roaring back in late 2003.

Stay on guard

We rightly think the progress isn't nearly fast enough. We rightly worry that we may not have a generation to prepare. We should do everything we can to hurry the process along. And we should remember that it's a slog, moderate our expectations, pace ourselves, and stay on guard against our own pandemic fatigue.

An internationally renowned expert in risk communication and crisis communication, Peter Sandman speaks and consults widely on communication aspects of pandemic preparedness. Dr. Sandman, Deputy Editor, contributes an original column to CIDRAP Source Weekly Briefing every other week. Most of his risk communication writing is available without charge at the Peter Sandman Risk Communication Web Site, which includes an index of pandemic-related writing on the site.

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