Riding the many pandemic seesaws

(CIDRAP Source Weekly Briefing) – Because most people feel ambivalent about possible future pandemics, communicating effectively with them requires skillful balance on a wide range of communication 'seesaws.'

What I call the "seesaw" is a fundamental aspect of pandemic risk communication. People who are ambivalent—that is, people who are torn between two competing opinions—tend to resolve their ambivalence by favoring the viewpoint everyone else seems to be ignoring.

The pandemic seesaw I discussed in my last column is the alarm-versus-reassurance seesaw. Here's a brief summary: Some audiences for your risk communication are profoundly ambivalent about whether to shrug off the possibility of a pandemic or to worry about it and take precautions. Not all audiences are like that. Some are uninformed and uninterested and have no strong opinion. Some have already decided they're taking pandemic risks seriously or they're not. But some are ambivalent. And those ambivalent audiences will tend to worry all the more if your communications strike them as overly reassuring, while they'll be inclined to shrug off the risk if your communications seem excessively alarmist.

Effective risk communicators therefore try to adjust the level of alarm or reassurance in their pandemic messages on the basis of two factors: how alarmed or reassured they believe their audience currently is, and how alarmed or reassured they think it should be. You choose your seat on the seesaw with care, depending on which seat you want to entice your audience to choose.

Alarm versus reassurance isn't the only pandemic-related seesaw. There are many, including the following four.

1. Confidence versus tentativeness

If you keep insisting you know what you're doing and the situation is under control, stakeholders will start thinking you don't and it isn't. We'll feel paradoxically more confident about your leadership when you point out (confidently) that influenza is always unpredictable, that managing a pandemic requires a lot of guesswork, and that there are bound to be some mistakes.

As David Heymann (currently the World Health Organization's executive director of communicable diseases) said during the SARS crisis: "We are building our boat and sailing it at the same time." People tended to have a lot of confidence in Heymann. They had confidence not despite his acknowledgments of uncertainty but because of them. (Heymann is also very competent—but not all competent leaders generate confidence.)

2. Your fault versus somebody else's

Blame is yet another seesaw. When things go wrong, there are almost always ways in which the trouble is genuinely your fault—and ways in which the fault lies elsewhere. If you blame yourself more, people blame you less. If you're too quick to say it's not your fault, people decide it is.

This is one of the things Johnson & Johnson (J&J) got right during the 1982 Tylenol poisonings. The company blamed itself for having insufficiently tamper-proof packaging. So the ambivalent public decided the poisonings weren't J&J's fault, and the brand quickly recovered.

3. Prepared versus unprepared

As every business continuity manager knows, preparedness isn't a toggle switch. You're never fully prepared. You just keep trying to get more prepared. You always have a list of additional steps you could take. Some of them are low on your priority list; others you really expect to get to when you find the time and the budget.

Have you prepared enough? Not enough? Too much? That's the preparedness seesaw. If you tell ambivalent people you're ready to cope with a pandemic, expect them to reproach you with everything on your list that you haven't done. If you tell people you need a lot more resources to get ready, expect them to look hard at all the money you've already spent. Continuity managers would do well to think about this seesaw before heading into a budget meeting.

Ironically, emergency preparedness experts have spent decades haranguing anyone who will listen that "We're not prepared enough!" Usually the public and the money people aren't listening. Once in a while, though, the whole society starts wondering if maybe we're not prepared enough. That happened after Katrina, and it happened when people first woke up to the risk of pandemic flu. And that's exactly when many emergency preparedness experts started feeling defensive—and found themselves claiming that they were really quite well prepared already. Instead of managing the seesaw, they let themselves get seesawed.

4. Low frequency versus high magnitude

A severe pandemic is a low-frequency, high-magnitude risk—horrific but unlikely in any given year. Since "horrific" and "unlikely" lead to opposite conclusions about the importance of precautions, people are torn. You need your management, employees, and other stakeholders to keep both halves of this ambivalence in mind. If they forget it's horrific, they'll consider precautions a waste of time. If they forget it's unlikely, they'll blame you when it doesn't happen soon.

People new to the pandemic issue have no opinion. You need to teach them that a severe pandemic would be horrific, and you need to teach them that it's unlikely in any given year. Then they'll start to feel some ambivalence.

Presumably, you want them to resolve their ambivalence in the end by putting more stress on "horrific" than on "unlikely." You want them to think, "Yeah, a severe pandemic probably won't happen soon, but look how bad it could get." So you need to locate yourself on the seesaw's other seat. Your core message to your ambivalent audiences: "Yeah, a severe pandemic could get really bad, but it probably won't happen soon."

You still need to explain why you believe it is important to prepare for that low-frequency, high-magnitude worst-case pandemic. But you need to ground the explanation in an accurate (and vivid) depiction of how horrific a worst case might be, not in a misleading claim that it's likely.

And you need to stay firmly on the low-probability side of the seesaw. Give people the information they need to reach their own judgment that not preparing would be unconscionably irresponsible. Tell people you agree with this judgment—but come closer to "admitting" your agreement than to "proclaiming" it. Keep reminding everyone that a severe pandemic will probably never materialize anytime soon, that many pandemic precautions, though absolutely essential, will very likely be wasted.

A playground of seesaws

These four are the tip of the iceberg. Once you start looking for seesaws, you'll find a lot of them. Is everything a seesaw, then? Nope. When people are uninterested and uninformed, they're unlikely to have two conflicting opinions. They probably have no opinion at all. Then the game is follow-the-leader, not seesaw. You can offer up your opinion without getting a paradoxical response.

But as people start paying closer attention to pandemic issues, they are likely to acquire some ambivalence. And as soon as you sense ambivalence rather than apathy, start playing seesaw.

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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