title
Risk and Crisis Communication
For Disasters
Manila, Philippines, February 12-15, 2007
Jody Lanard M.D.
Please feel free to adapt and use these slides, with proper credit to the
source:
“From material developed by Peter Sandman and Jody Lanard for the U.S.
CDC, the World Health Organization, Health Canada, the Government of
Singapore, the American Hygiene Association, and others.”
Risk Communication Paradigms

Watch out!!
(precaution advocacy)

Calm down!!
(outrage and fear management)

We’ll get through this together.
(crisis communication)
One definition of risk
communication:
"The interactive process of exchanging
information and opinion among individuals,
groups, and institutions involving multiple
messages about the nature of risk...“*
-- The National Research Council
*(Note the emphasis on multi-directional communication!)
What “risk communication” is not:

“Educating the public”

One-way communication

Talking to people who have no
pre-existing views

Information you give out after you
have made all your plans.
Who Outbreak Communication
Guidelines
Trust
 Announcing early
 Transparency
 The public
 Planning

Risk: a traditional definition
(one among many)
The multiplication of
Magnitude x Probability.
How likely to happen?
How bad if it happens?
Outrage Factors
(How normal people estimate most hazards)
“safe”
“risky”
Voluntary
Controlled by self
Trustworthy sources
Responsive process
Familiar
Not memorable
No moral relevance
Not dreaded
Chronic
Involuntary
Controlled by others
Untrustworthy sources
Unresponsive process
Unfamiliar
Memorable
Moral relevance
Dreaded
Catastrophic
© Peter Sandman 1987, 2006 (Based on the risk perception work of Paul Slovic)
A new definition of risk:
(for the purpose of communication planning)
Risk
A new definition of risk:
Risk
Hazard
A new definition of risk:
Risk
Hazard
Outrage
(Please note: “outrage” can also stand for fear; shame; loss of
face. It has different implications and expressions between
and within different cultures. The concept we call
“outrage” does not always mean the direct feeling and
expression of indignation. It would be useful to find the
right word to describe the part of the public’s perception of
“risk” that does not relate to the technical hazard.)
A new “definition” of risk:
Risk =
Hazard + Outrage
(Peter Sandman’s formula!)
For technical people:
Risk = f( H, O )
Four Kinds of Risk Communication
First communication planning task:
Diagnose which “communication
environments” are relevant.
O
U
T
R
A
G
E
*
Copyright  2003 Peter Sandman
HAZARD
Risk Communication
FourFour
kindsKinds
of riskof
communication
1. When people are ignoring a serious hazard
O
U
T
R
A
G
E
PUBLIC
RELATIONS
HEALTH & SAFETY
EDUCATION
ACTIVISM
Copyright  2003 Peter Sandman
HAZARD
Fourare
Kinds
of Risk
Communication
1. When people
ignoring
a serious
hazard, contin.
O
U
T
R
A
G
E
Copyright  2003 Peter Sandman
“Precaution
Advocacy”
HAZARD
1. When Four
peopleKinds
are ignoring
a serious
hazard, contin.
of Risk
Communication
Warning: next comes a concept that
generates enormous resistance:
O
U
T
R
A
G
E
Copyright  2003 Peter Sandman
“Precaution
Advocacy”
HAZARD
O
U
T
R
A
G
E
Four Kinds
Risk Communication
First, inform people
– andofmobilize
their
concern to a level of fear or worry
proportionate to the hazard.
(Officials hate the second half of this
recommendation!!)
Or
F
E
A
R
Copyright  2003 Peter Sandman
“Precaution
Advocacy”
HAZARD
O
U
T
R
A
G
E
Then, help them
hazard
(“things
Fourmanage
Kinds ofthe
Risk
Communication
they can do”), or else they will try to
manage their fear (by way of denial, apathy,
scoffing).
Or
F
E
A
R
“Precaution
Advocacy”
Copyright  2003 Peter Sandman
HAZARD
Fear Appeal Documentation
Four Kinds of Risk Communication
In other words…
O
U
T
R
A
G
E
Or
F
E
A
R
“Precaution
Advocacy”
HAZARD
Lower right hand circle, arrow
Copyright  2003 Peter Sandman
Four Kinds of Risk Communication
O
U
T
R
A
G
E
OUTRAGE
MANAGEMENT
Or
“Precaution
Advocacy”
F
E
A
R
Copyright  2003 Peter Sandman
HAZARD
Upper Left Hand Circle
Four Kinds of Risk Communication
O
U
T
R
A
G
E
OUTRAGE
MANAGEMENT
Your Job: Inform people
AND use outrage/fear
management strategies to
reduce their outrage or fear.
Or
F
E
A
R
Copyright  2003 Peter Sandman
HAZARD
Four Kinds of Risk Communication
In other words...
O or
U
T F
R E
A A
G R
E
OUTRAGE
MANAGEMENT
HAZARD
Upper Left Hand Circle, Arrow
Copyright  2003 Peter Sandman
Four Kinds of Risk Communication
O
U
T
R
A
G
E
OUTRAGE
MANAGEMENT
“Precaution
Advocacy”
HAZARD
Copyright  2003 Peter Sandman
Smiley Face
Four Kinds of Risk Communication
O
U
T
R
A
G
E
OUTRAGE
MANAGEMENT
“Precaution
Advocacy”
Copyright  2003 Peter Sandman
Two Arrows
HAZARD
Three circles (adds crisis)
O
U
T
R
A
G
E
Copyright  2003 Peter Sandman
CRISIS
COMMUNICATION
OUTRAGE
MANAGEMENT
“Precaution
Advocacy”
HAZARD
Four Kinds of Risk Communication
O
U
T
R
A
G
E
Copyright  2003 Peter Sandman
Crisis
Communication
“We’ll get through this together”
HAZARD
Get through this together
(No way to make a living in this corner…
Outrage
or
Fear
… but do communication surveillance
to look for undiagnosed concerns, fear, or
outrage)
Hazard
©
Peter Sandman 2004
www.psandman.com
Low Hazard Low Outrage
Who Outbreak Communication
Guidelines
Trust
 Announcing early
 Transparency

How bad is it? How sure are you?
1.
Don't over-reassure.
9/11 dust chasing people
9/11 overview dust
Bad example: Premature overconfident over-reassurance:
"We are very encouraged that the results from our monitoring
of air quality and drinking water conditions in both New
York and near the Pentagon show that the public in these
areas is not being exposed to excessive levels of asbestos or
other harmful substances… I am glad to reassure the people
of New York and Washington, D.C. that their air is safe to
breath and their water is safe to drink"
– U.S.Environmental Protection
Agency Director Whitman,
September 18, 2001
Christie Todd is pleased
Judge Blasts Ex-EPA Chief For
'Conscience-Shocking' Actions After 9/11
“for reassuring Manhattan residents soon
after the 2001 terrorist attacks that the
environment was safe to return to homes
and offices while toxic dust was polluting
the neighborhood.”
--NBC News, February 2006
Blasting Christie Todd Whitman
“The EPA's Office of the Inspector General
eventually criticized the agency's response,
saying it did not have available data and
information to support the Sept. 18, 2001,
statement that the air was safe to breathe.
“The EPA's internal watchdog found the
agency, at the urging of White House
officials, gave misleading assurances there
was no health risk from the dust in the air
after the towers' collapse.”
Blasting Christie, continued
Normal view of U.S. at night,
from outer space
B
l
a
c
k
o
u
t
P
h
o
t
o
9/11 jitters
New York Blackout, 2003
“Living close to the World
Trade Center site and
still having the 9/11
jitters I thought the
worst…
“People are a little scared
and seem on edge. I
don't hear the word
terrorism, but the air is
thick with the thought.”
-- Jason Kottke, blogger
“The first radio reports
reassured everyone that
it was not an act of
terrorism.”
-- Leah Singer, blogger
Don’t over-reassure – bad example:
Mayor Bloomberg, early in the NY blackout of 2003
“I can tell you 100
percent sure that there
is no evidence as of
this moment
whatsoever of any
terrorism.”
NY Mayor Michael Bloomberg talking to CNN anchor
Kyra Phillips, 7:41 p.m., August 14, 2003
Bloomberg example don’t over-reassure
Bloomberg weasal words

Quiz:
What words “protect” him if he turns out
wrong?
Bloomberg as of this moment
“…as of this
moment…”
Answer:
What words did CNN run as a
caption, while the Mayor spoke?
CNN crawl?
“???????”
For about ten minutes, CNN ran
the words:
100% sure
“100% sure”
See Saw
How bad is it? How sure are you?
1.
2.
Subordinate Clause
Don't over-reassure.
Put reassuring information
in subordinate clauses.
Singapore “subordinates” the
good news
When WHO said that the sars situation
seemed to be improving in Singapore,
the Minister of Health spokeswoman,
Eunice Teo, passed on this encouraging
information as follows:
“The WHO said the peak is over in
Singapore, but our minister has said it
is too early to tell."
See Saw
Malaysia “subordinates”
the good news:
Veterinary Services DG Datuk Dr. Hawari Hussein:
Malaysia was eligible to be declared "bird flu
free," after no new cases were detected for 21
days.
But he added: health authorities were doing extra
tests "to be absolutely sure... The threat is still
there, from neighbouring countries. The tests
are part of our own initiative to be sure."
(adapted from the Star on line, November 16 2004: Malaysia set to be declared
free of bird flu)
U.S. CDC Director Julie Gerberding
“subordinates” the good news
When asked if there was community
transmission of SARS, Dr. Gerberding said:
"Even though there is no sign of
community spread, we are continuing
intense surveillance and we're not out
of the woods yet."
U.S. CDC Director Julie Gerberding
“subordinates” the good news
When asked if SARS could possibly be due to
terrorism, Dr. Gerberding said:
“Although this virus appears to be of
entirely natural origin, we are being
vigilant about all possibilities."
One day, when there was very little
important SARS news …
“Is SARS From Outer Space?”
–CNN headline, May 23, 2003
Photo from: http://pardonbakarmisiniz.wordpress.com/files/2006/08/meteor-shower.jpg
U.S. CDC Director Julie Gerberding
“subordinates” the good news
"Even though there is no evidence
that SARS comes from outer
space, we're keeping an open
mind.”
-- Dr. Julie Gerberding, U.S. CDC
copyright Peter Sandman and Jody Lanard 2006
Who Outbreak Communication
Guidelines

Announcing early
How bad is it? How sure are you?
1.
2.
3.
Don't over-reassure.
Put reassuring information
in subordinate clauses.
Err on the alarming side.
Err Alarming Side
Early on in SARS, Dick Thompson errs on
the alarming side.
“One might think we are overreacting to the
cases. But when you do not know the cause,
when it strikes hospital staff, ands it certainly
is moving at the speed of a jet, we are taking
this very seriously.”
– WHO’s Dick Thompson
--From the risk communication Good Example file. (Don't aim
for zero fear; err on the alarming side; acknowledge people's
"anchoring frames.“)
.
See Saw 3
Who Outbreak Communication
Guidelines
Trust
 Announcing early
 Transparency

How bad is it? How sure are you?
4.
Acknowledge uncertainty.
Uncertainty
Warning people about uncertainty
“We will learn things in the coming weeks
that everyone will wish we had known
when we started.”
This became the U.S. CDC’s mantra after its
early communication mistakes during the
anthrax poisonings.
How bad is it? How sure are you?
4.
5.
Acknowledge uncertainty.
Share dilemmas.
Share Dilemmas
Minister Tony Abbott shares
pandemic planning dilemmas
“Of course, it’s impossible to say if, when and
how a pandemic might develop. The next
pandemic might be comparatively mild like
the flu outbreaks of the late 50s and 60s.
But it could also be a worldwide biological
version of the Indian Ocean Tsunami. There
are obvious limits to how much
governments can invest in preparations for
hypothetical events, however serious.”
--from a May 2005 speech by Australia Minister of Health Tony Abbott
Minister Abbott’s Dilemma (and
yours), continued
“ It’s hard to discuss potential disasters outside
people’s ordinary experience without generating
the sort of lurid headlines which make some scoff
and others panic…
“ If a deadly flu pandemic ever seems imminent, no
preparations will be enough. But if the current bird
flu outbreaks in Asia gradually subside, the
Government’s investment in a stockpile likely to
be time-expired in five years will be the health
equivalent of a redundant weapons system.”
--from a May 2005 speech by Australia Minister of Health Tony Abbott
How bad is it? How sure are you?
4.
5.
6.
Acknowledge uncertainty.
Share dilemmas.
Acknowledge opinion
diversity.
Opinion Diversity
SARS in Singapore:
To close the schools? Or not?
In the middle of the SARS crisis, the
Singapore government told the public
about internal disagreements about
whether to close the schools…
How bad is it? How sure are you?
4.
5.
6.
7.
Acknowledge uncertainty.
Share dilemmas.
Acknowledge opinion
diversity.
Be willing to speculate –
responsibly.
Speculate
Philippines says “don’t speculate”
13 February, 2007, Philippine Star-News:
Investigating the cause of death of an egret, a
senior animal official said:
“There are many causes of death and not
necessarily bird flu,” and that it would be
wrong to speculate until after the bird had
been examined and a report made.
Who Outbreak Communication
Guidelines
The public
 Planning

Coping with the emotional side of the crisis
8.
Don't overdiagnose or
overplan for panic.
“Panic” in Boracay fire? Not.
A couple months ago, there was a fire at a
cottage resort at Boracay, a famous vacation
spot in the Philippines.
People fled the fire.
“Foreigners were seen helping mostly local
tourists carry their baggages to safe
spots.“
"no one was reported injured or killed."
“Panic” in Boracay fire? Not.
"no one was reported injured or killed,"
but the same reporter said the fire sent
"hundreds of tourists in panic.”
And said that the incident
"caused panic not only to the residents…, but
especially to local and foreign tourists. People
flee in different directions looking for a place
where they will be safe."
Panic in Baseco barangay fire?
"Residents were screaming and running
in the streets in panic to save their lives
and their families. The firefighters
arrived at the scene, but could not
immediately control the fire because of
the chaotic situation."
Panic in Baseco barangay fire?
In the next sentence, the author notes
the huge amount of physical damage to
buildings housing 15,100 people,
observing that there were also 49
injuries but no fatalities.
49 injuries, no deaths – out of 15,100 !!
Panic in Baseco barangay fire?
Almost by definition, the self-rescue was effective.
The residents knew their way around the alleys
better than the incoming firefighters, and got
everyone out with only a few injuries and no
deaths.
Undoubtedly it looked chaotic to the firefighters.
What is typical is the assumption on the part of the
officials that the behaviour was panic – despite the
fact that it was part of an effective and successful
self-organized rescue operation.
Coping with the emotional side of the crisis
8.
9.
Don't overdiagnose or
overplan for panic.
Don't aim for zero fear.
Zero Fear
What is the “right” level of fear?
PANIC
DENIAL
TERROR
FEAR
CONCERN
INTEREST
APATHY
What is the “right” level of fear?
PANIC
DENIAL
TERROR
FEAR
“HIGH CONCERN” ???
CONCERN
INTEREST
APATHY
What is the “right” level of fear?
PANIC
DENIAL
TERROR
Sometimes, a
degree of
rational fear is
appropriate!
FEAR
CONCERN
INTEREST
APATHY
WHO/PAHO Pan Flu Communication
example: draft versus final
Draft:
“To respond to rumors and
inaccuracies to minimize concern,
disruption and stigmatization.”
Final:
“It is important to proactively
address reports that will create
misplaced fear or unrealistic
expectations.”
Coping with the emotional side of the crisis
8.
Don't overdiagnose or
overplan for panic.
9.
Don't aim for zero fear.
10. Don't forget other emotions
(besides fear).
Don’t forget other emotions
Emotional Responses to Crisis
1.
2.
3.
4.
5.
6.
Fear
Empathy/Misery
Anger
Hurt
Guilt
Resilience!
List other emotions
Coping with the emotional side of the crisis
11.
Don't ridicule the public's
emotions.
Don’t ridicule emotions
Coping with the emotional side of the crisis
11.
12.
Don't ridicule the public's
emotions.
Legitimize people's fears.
Legitimize Fears
SARS: Singapore’s Prime Minister validates
fear – and courage
“Our health-care workers put their lives at risk every
day they went to work… 'They were frightened.
But they conquered their fear with courage.
Courage in tending to an infected patient. Courage
in taking respiratory fluid samples from the throat.
Courage in cleaning the wards every night.
“We saw this courage in our doctors, nurses and
other health-care professionals; in the attendants,
security officers and cleaners in our hospitals.”
--Prime Minister Goh, at SARS Memorial Ceremony, July 23, 2003. Straits Times
Dr. Jeff Engel answers a reporter about
whether he is stirring up too much fear.
"We need to involve our community in all aspects of
public health. Certainly a disease like SARS, so
new, so frightening, should instill fear. Fear is an
appropriate response ‹ for me as a public health
physician, for everyone in the community.
We need to transfer that fear into positive energy, and
keep the facts out in front of hysteria.... I think [the
media's] response is appropriate. This is a new
disease, it spreads person to person, it can kill, it has
a high case-fatality rate. That is newsworthy!"
--June 2003, when North Carolina had its first confirmed SARS case.
Singapore PM Goh legitimizing others’ fears
during SARS:
When Australia and several Asian countries warned
against travel to Singapore, Mr Goh responded:
'We can understand that, because we also give
travel advisories to Singaporeans not to go to
[other] affected places.
'So we must expect other countries to advise their
travellers not to come to Singapore... If we are
open about it and all Singaporeans cooperate by
being as careful as they can, we may be able to
break this cycle early and if we do, then of course
people outside will have confidence in Singapore
and the way we manage the problem.'
Goh involves the public and legitimizes fear:
Closing the schools during SARS
Open respectful expert disagreement
PM Goh and SARS fear
While acknowledging SARS fear - his own, as well as his
citizens' - PM Goh nearly always pivoted from the subject
of fear to action and courage.
S-A-R-S =
"Schools Are Really Shut!" … "Single And Really Sexy!"
“Singaporeans Are Really Scared”. Yes, we were really
scared. Scared for our lives and our loved ones. Scared of
taking a taxi, scared of going to the hospital. Scared that
tourists and customers would not return, and we might lose
our jobs. For the first time in our history, all Singaporeans
felt the same fear at the same time. But far from being
frozen by the fear, the entire nation sprang into action."
Talking about mass casualties:
a dilemma
 Talking
 Waiting
about it too soon?
until inaccurate information
starts spreading, and then reacting?
Share the dilemma –
to help set the agenda.
With compassion
 With acknowledgement of the taboo
 With apology for breaking the taboo

Coping with the emotional side of the crisis
11.
12.
13.
Don't ridicule the public's
emotions.
Legitimize people's fears.
Tolerate early overreactions.
Tolerate Early Reactions
Adjustment Reactions --- the Teachable Moment in crisis
communications!
You can harness and channel it,
Or you can waste the opportunity!
Copyright Lanard and Sandman 2004
or
Fear
Initial
Reaction
Start
of crisis
Time
Tolerate Early Over-reactions:
Use the “Teachable Moment”
Curve Adjustment Reaction
Acknowledge that culling is gross
Culling:
Acknowledge that culling is gross
Culling:
Acknowledge that culling is gross
Culling:
Acknowledge that culling is gross
Culling:
Are we hungry yet?
State agriculture officials staged photo opps
From http://birdflubook.com/a.php?id=79
Nigeria validates the adjustment
reaction, and tells people what to expect:
"However, we have observed that in other countries
experiencing their first human H5N1 cases, there
has been widespread fear of poultry and poultry
products, with a concomitant drop in consumption
and sales. For a short time, that may happen in
Nigeria too. It is entirely understandable that the
population may be overtly worried about all
chickens, not just sick chickens.”
Nigeria Avian Influenza Crisis Management Center, Bulletin 29, early 2007
Who Outbreak Communication
Guidelines

Trust
Coping with the emotional side of the crisis
14.
Establish your own humanity.
Establish Humanity
WHO's David Heymann shows his humanity,
after issuing a global alert about SARS:
"[It] was a pretty radical decision, and I
didn't sleep that night because I knew
that what we were doing was going
to have a lot of different repercussions.“
Involving the public
15.
Tell people what to expect.
Good example: Thai candor, and
telling people what to expect
Thailand tells people what to expect,
and does not over-reassure:
“We are now about 80% ready to deal with
a bird flu outbreak should it happen
today.”
--Thai Deputy Prime Minister Chaturon Chaisaeng,
9 February, 2005, Bangkok Post
Thailand tells people what to expect, does not
over-reassure, and acknowledges uncertainty:
“The first wave of bird flu outbreak
has passed ... but we don’t know when the
second wave will come, and we don’t trust
the situation.... So the Public Health Ministry is being as careful as possible.”
Bulgaria “tells people what to expect:”
Agriculture Minister Nihat Kabil said that…
he expected the latest Bulgarian samples to
test positive for this strain.
"We suppose, after all samples sent to
Weybridge from southeast Europe tested
positive for H5N1, the other samples (from
Bulgaria) that will be sent tomorrow will,
with very high probability, also test positive
for H5N1.".
....
Bulgaria tell people what to expect
Bulgaria, continued:
Kabil said he feared it was only a matter of time
before H5N1 appeared in domestic poultry.
"It is not necessary to start culling domestic birds ...
(but) we have to accept the thought that in the
coming days we might have the first outbreak.
The probability of that is very high and we have to be
ready for pictures of veterinarians going into those
areas with special suits to cull birds.“ (Reuters)
Selangor outbreak: Singapore tells its
people that Malaysia can be trusted

HPAI in Selangor / Effectiveness of DFZs

The Highly Pathogenic Avian Influenza (HPAI) or
Bird Flu is currently the most threatening disease
to our food supply.

Its worldwide spread and recent detection in
Selangor have raised concerns in Singapore.

In accordance with protocols established between
the veterinary authorities of Singapore and
Malaysia, AVA suspended poultry and egg imports
from Selangor.
From a speech by the Singapore Minister of State for National
Development, 6 March 2006
Singapore tells its people that Malaysia can
be trusted, continued

Over the last two years, AVA has been working
with its Malaysian counterpart to establish Disease
Free Zones.

Poultry can be imported from these zones even if
isolated cases of HPAI are detected in other areas.

We hence did not suspend all poultry imports from
Malaysia, unlike the outbreak in Kelantan in 2004.

The impact on our egg and poultry supply this
time was negligible.
From a speech by the Singapore Minister of State for National
Development, 6 March 2006
Involving the public
16
Offer people things to do.
Offer people things to do
Involving the public
16
17.
Offer people things to do.
Let people choose their own
actions.
Let People Choose
Dr. Balaji acknowledges uncertainty, and lets
people choose their own actions: SARS masks
During a television call-in show, Minister of
State for Health Balaji Sadasivan was asked
by a caller about whether to wear masks in
public, and what kind to use.
At this point, it seemed very likely, but not yet
100% definite, that SARS was mostly
transmitted by close personal contact,
through droplets and touching contaminated
surfaces.
Dr. Balaji acknowledges uncertainty, and lets
people choose their own actions: SARS masks
Dr. Balaji told the caller that there was no
evidence that wearing a mask [in public]
helps, and no evidence that it doesn't help,
and that is why they hadn't given a definite
recommendation at that point.
But the MOH explained how to wear masks
properly, if people decided they wanted to
wear them.
The SARS mask example showed:
Acknowledging uncertainty.
Legitimizing people’s fears.
Letting people choose their own actions
(and helping them do it right).
Involving the public
16
17.
18.
Offer people things to do.
Let people choose their own
actions.
Ask more of people.
Ask more of people
Adult resilient response?
Emergency
Ambivalence
or
Regressed dependent response?
Ask More of People: Ally with Our Adult Selves!
Ally with adult side
Singapore shares emotions about SARS
SARS commemoration ceremony, Singapore, Summer 2003
“Heroes and Angels / Through Your
Eyes” – the SARS anthem, Singapore
“Heroes and Angels / Through Your
Eyes” – the SARS anthem, Singapore
“Heroes and Angels / Through Your
Eyes” – the SARS anthem, Singapore
Overwhelmed by emotion, a nurse sheds a tear as she watches a patient suffering from SARS.
http://www.wpro.who.int/sites/whd/heroes/singapore/pic10.htm
“Heroes and Angels / Through Your
Eyes” – the SARS anthem, Singapore
Acknowledge Errors, Misimpressions,
and Half-truths
19.
Acknowledge errors,
deficiencies, and misbehaviors.
Canada protests WHO travel advisory
Canadian official: “We believe this decision was
made without consulting the province – we
believe it was an over-reaction.” “The medical
evidence does not support this advisory.”
WHO’s Dick Thompson: “There was a breakdown in
communications. I think that we’re willing to
acknowledge that there was some kind of mistake,
that they didn’t receive the message. And I think
we’re ready to accept some blame here.”
Singapore acknowledges error
In mid-May, 2003, there was an unexpected potential
new outbreak of SARS at a Singapore mental
hospital. Before this turned out to be a false alarm,
the Singapore Straits Times wrote: "SARS
Combat Unit Chief Khaw Boon Wan....admitted
that the fresh batch of possible cases at the
Institute of Mental Health had caught him
unprepared. The chronic-care hospital 'was not on
my radar screen," [he] confessed, 'because we just
didn't have the time to focus on it. It was a tactical
error."
Acknowledge Errors, Misimpressions,
and Half-truths
19.
20.
Acknowledge errors,
deficiencies, and misbehaviors.
Apologize often for errors,
deficiencies, and misbehaviors.
Apologize for Errors
Acknowledge Errors, Misimpressions,
and Half-truths
21.Be explicit about "anchoring
frames*.”
*what people already know and believe;
their “mental models.”
Anchoring Frames
Suppose…
You want parents to use child car
seats.
You found out Hispanic parents are
particularly resistant.
Why?
From Dr. Wm. Smith, Academy for Educational Development, slides
on line at: http://www.izcoalitionsta.org/content.cfm?id=514
My child is always safest in my
arms.
God decides when to take my
baby.
From Dr. Wm. Smith, Academy for Educational Development, slides on line at:
http://www.izcoalitionsta.org/content.cfm?id=514
Have a priest bless the car seats.
From Dr. Wm. Smith, Academy for Educational Development, slides on line at:
http://www.izcoalitionsta.org/content.cfm?id=514
Acknowledge Errors, Misimpressions,
and Half-truths
21.
22.
Be explicit about "anchoring
frames."
Be explicit about changes in
official opinion, prediction, or
policy.
Changes in Policy
FAO official acknowledges error
re: best guess about AI spread, after
over-emphasizing possible role of
migratory birds:
"Many of us at the outset underestimated
the role of trade.”
-- FAO’s Sam Jutzi, director of Animal Production
and Health, February 12 2007
Acknowledge Errors, Misimpressions,
and Half-truths
23.
Don't lie, and don't tell halftruths.
Don’t Lie…
Who Outbreak Communication
Guidelines
Trust
 Transparency

Singapore’s cholera outbreak, 2004

Reported to the public immediately.

Updated the public often.

When they said the outbreak was over, there was
no apparent skepticism.

It made very little news, because it wasn't a
"cover-up" or "belated announcement" story.
Ministry Of Health Investigating a Cluster Of
Cholera Cases At Bedok 15 Oct 2004
1
A cluster of eight local cholera cases has been
identified in Singapore, comprising two males
and six females aged between 20 to 84 years.
2 The cases had acute onset of illness between 3
and 10 Oct 2004 and were admitted to SGH,
CGH and CDC. Three have been discharged and
the other five are recovering.
3
Investigations by the Ministry revealed that
majority had patronised hawker stalls and eating
establishments in Bedok. A total of 115 food
handlers and 25 home contacts have been referred
to CDC for medical screening.
Update on Cholera cases in Singapore
18 Oct 2004

The Ministry had reported on 16 Oct 2004 a
cluster of eight local cholera cases.... An
additional case has since been notified to the
Ministry.
Update on Cholera cases in Singapore
18 Oct 2004

The case is a 89-year-old Malay male….

Of the eight cases reported earlier, five are well
and have been discharged. The other three are still
in hospital: two at SGH and one at CDC.

Thus far, all the cases had onset of illness between
3 and 10 Oct 2004
Singapore: No More Cholera Cases
Reported, 27 Oct 2004

There have been no further cases reported
since the last confirmed case of cholera with
an onset of illness on 10 Oct 2004.

Investigations indicated that all the cases of
cholera had consumed seafood on or around
the week of 2 Oct 2004.

The Ministry would like to highlight the
importance of maintaining good personal
and food hygiene practices at all times….
Acknowledge Errors, Misimpressions,
and Half-truths
23.
24.
Don't lie, and don't tell halftruths.
Aim for total candor and
transparency.
Aim for total…
Acknowledge Errors, Misimpressions,
and Half-truths
25.
Be careful with risk
comparisons.
Risk Comparisons
Scenario for an exercise:





Ten minutes in a taxi with your Minister
The Minister has not been trained in risk
communication.
He or she is going to announce that a
gastroenteritis outbreak is actually cholera.
The facts are: The Health Department confirmed
this two weeks ago, but did not tell the public until
– ten minutes from now.
Brief the Minister on the risk communication
strategies to help make this announcement.
Announcing that it is cholera
For several weeks, officials have been
reporting increasing numbers of diarrheal
illnesses.
These are in villages near a major
international resort. Most of the workers at
this resort live in these villages.
Increasing rumors suggest that the illnesses
are really cholera. Today the Health
Minister is going to confirm this.
Feel free to adapt any of these
slides for your own purposes!
(with appropriate credit if it is due.)
.
For example ….
Crisis Communication: Guidelines for action,
a 64-page manual of handouts covering the
material in this presentation is available for free,
on line, on The Peter Sandman Risk
Communication Website,
www.psandman.com,
at:
http://psandman.com/handouts/AIHA-DVD.htm
Thank you!
Scenario: local outbreak
Work on this in breakout groups.
 Develop either a press statement, talking
points to inform the public.
 Optional: follow the issuance of the
statement with a role-play of a press
conference.

What you know:
4 patients, one family, flu-like symptoms a week
ago. Hospitalized. Two died.
Two care-givers at hospital sick with same
symptoms.
30 chickens died in family’s village 4 days before
victims got sick.
Samples have been taken. No results yet.
Table Top Scenario for doing crisis
and pre-crisis messaging



Trainer and groups: You can develop any scenario
you wish. The one which follows is about the start
of an influenza pandemic.)
The template for this exercise is not yet available
on line, but is included in the CDROM from most
WHO risk communication workshops conducted
by Jody Lanard. If you cannot obtain it, please
email me, and I will send it to you.
jody@psandman.com
WHO announces Pandemic Phase 6
At 11 a.m. today, WHO formally contacted all Member States to say:
At noon today, we are announcing that an influenza pandemic has begun. It is
caused by a novel flu strain, H7N3. It appears to be a reassortment of an avian
H7 and a human N3 strain. There have been no known outbreaks of unusual
bird disease in the affected countries.
There are large clusters of human to human transmitted cases in several border
towns in Texas and Mexico, plus several others in Argentina and Peru.
We do not know the attack rate or case fatality rate. There have been numerous
deaths. We do not have a case definition yet. It appears similar to descriptions
of the 1918 influenza, with rapid progression to pneumonia and death.
At noon, WHO announced this to the public.