H1N1: Spreading the Message

Jan. 1, 2010
As EHS professionals, what steps should you take to deal with the H1N1 virus, and what should you be doing to plan for future pandemics?

In April of 2009, an outbreak of what was originally called “swine flu” began in Mexico City. (The name H1N1 was later adopted as it more accurately describes the flu strain.) Its rapid spread and the potential for a global pandemic dominated the news for several weeks at its peak in late April and early May.

Eventually, on June 11, 2009, WHO declared that the outbreak had reached a pandemic level due to its spread to over 70 countries. As the pandemic progressed, however, the severity of the virus was minimal, with a low mortality rate and symptoms that generally were mild, treated most often by infected persons in their own homes.

During the outbreak, numerous experts, bureaucrats and politicians delivered crisis messages designed to both inform the public and motivate action that would reduce the spread as well as efficiently utilize medical resources. This article examines the effectiveness of those messages as well as steps EHS professionals can and should be taking to deal with the secondary outbreak that is occurring now, as well as encourage long-range planning for future pandemics that may not be so mild.

In the United States, the primary expert messengers were the Centers for Disease Control and Prevention (CDC) and HHS Secretary Kathleen Sebelius, who early on delivered messages that were both designed to inform the public about virus transmission and simple methods to halt its spread through personal hygiene and “social distancing,” a new term in most of our vocabularies.

In part due to these messages, hand sanitizers proliferated in public venues and private workspaces. Posters that both taught and reminded us about the proper way to sneeze into an elbow appeared in paychecks and during weekly tool box talks. The effectiveness of these short-term mitigation methods never will be completely quantified, but it can be argued that the broadness and consistency of the message educated a large part of the public and reduced the spread both in the initial outbreak as well s the one that is occurring now.

However, it is this author's opinion that the CDC missed an excellent opportunity to use its bully pulpit to educate the public on long-term mitigation methods that are critical now, as the virus resurfaces, or later, when a future pandemic of significantly higher virulence strikes — something that most epidemiologists believe is inevitable. Reminders to businesses and the public of the importance of putting together a “survival kit” and developing plans for existing nearly completely on their own for as much as 2 weeks at the height of a pandemic were then, and are now, very nearly absent.

As we are experiencing the secondary wave, EHS professionals should be certain to reinforce habits of good personal hygiene and social distancing when ill. It is through the conversion of these short-term habits into long-term ones among our work forces that will help us be better prepared to deal with this current wave as well future pandemics.

In addition to messages reinforcing good hygiene and social distancing habits, public health officials also have been cajoling the public to participate in a large-scale vaccination program, focusing first on selected high-risk groups and, eventually, for everyone. Since the discussions about vaccinations began, numerous conflicting messages have had the unfortunate side effect of reducing the public's willingness to get vaccinated and understand the importance of doing so. Early pronouncements by the CDC and Sebelius of 120 million doses being available by late October was slowly whittled down over time to the approximate 25 million doses that were released in the late fall.

These unfortunate and overconfident predictions, as well as distribution snafus, created very public controversies: whether or not detainees at Guantanamo were going to receive vaccinations, whether the children of President Obama did or didn't get vaccinated and whether Goldman Sachs and Citibank received preferential treatment in receiving their orders of vaccination for their employees in the priority groups.


It could be argued that, prior to the H1N1 pandemic, a majority of the public was not familiar with the term, despite attempts in the past several years to raise the awareness level concerning the much-anticipated avian flu pandemic. Even now, a “man in the street interview” would likely provide definitions that mostly miss the mark.

The inaugural use of the WHO pandemic scale in the spring succeeded in part by simplifying fairly complex immunology terms and spread patterns, but the drum of criticism that the scale does not address the virulence is earnestly beating and apparently efforts already are underway to modify it in some manner. In addition, CDC's own document that addresses the virulence issue, the Pandemic Severity Index, received limited coverage and messaging.

In the end, it is the “Chicken Little” perceptions by various stakeholder groups that have the greatest potential to set crisis communications back. In the early days of the outbreak, many of the crisis communication messages focused on the notion that a full-blown pandemic of significant virulence would result in substantial deaths, overtax the medical system and create a breakdown of public services and societal mores.

Unfortunately, the accuracy of those predictions when speaking of a pandemic of significant virulence was lost in the talk show jokes, social networking pages, blogs and water cooler conversations as the current pandemic rapidly showed itself to be minimally disruptive or deadly. Now that we are well into the second wave with continued limited disruption and virulence, it will be vitally important that we continue to help the public understand that not all pandemics are created equal.


Effective risk and crisis communications is a skill that EHS professionals would do well to develop as they seek to become more value-added members of their organizations. The H1N1 pandemic provides and will continue to provide an excellent case study for reviewing and understanding some of these key concepts.

The writings of Peter Sandman provide a substantial body of work in the understanding of risk and crisis communications. His paradigm “Risk = Hazard + Outrage” is much quoted and deserves further elaboration.

“Hazard” is the actual event covered by the communication, whether it is a potential future event that the message is attempting to prepare a receiver for or an actual event that is occurring or is about to occur. Therefore, hazards or hazardous events can be anywhere along the continuum from negligible to catastrophic. Getting the message receiver (usually the public or some stakeholder group) to understand the seriousness of the event is a significant determining factor of both the success of the message and the action the message receiver takes as a result of it.

“Outrage” refers to the emotions and behaviors of the message receivers in light of their perceptions of the level of hazard presented to them. Like hazards, the level of outrage exists on a continuum from high to low and varies from person to person.

Combining the concepts of hazard and outrage, Sandman poses a framework of the four most common situations.1

High Hazard/Low Outrage — This situation features a serious hazard, but an apathetic audience. The good news in these types of situations is that the audience often will not object to the message. The bad news is that, even with a skilled communicator and message, moving the audience to a desired action may be more difficult.

Low Hazard/Low Outrage — This situation features an audience that is interested but not so emotional that internalizing the message is difficult. It also is a situation where the likelihood of the risk occurring is low and the hazard potential is minimal. It allows the message sender to discuss the situation rationally and openly and likely will generate audience questions and rational concerns.

Low Hazard/High Outrage — Undoubtedly, this is the most difficult scenario for a risk communicator, as the audience often is not trusting of any message and sometimes is controlled by a small group of “fanatics” who purposely have exaggerated the situation for varying motives or who truly believe that situation is dire, when the facts say otherwise.

High Hazard/High Outrage — The audience here typically is not angry, but fearful and scared and, because the hazard is serious, their position may be valid. Without skillful management by the communicator, the outrage easily can slip into terror or depression, both of which are of limited use in getting the message receiver to take the desired action.

These models aid in the development of both risk and crisis communication messages. Central to all of them is an understanding of the audience and its stake in the process or situation at hand.

In addition, EPA has created a list of “Seven Cardinal Rules” of risk and crisis messages. Although these rules originally were designed for environmental communications, their applicability to a wide variety of hazard situations is obvious.

  • Accept and involve the public as a legitimate partner;
  • Plan carefully and evaluate your efforts;
  • Listen to the public's specific concerns;
  • Be honest, frank and open;
  • Coordinate and collaborate with other credible sources;
  • Meet the needs of the media; and
  • Speak clearly and with compassion.


The difficulties for EHS professionals who want to use this pandemic as an example to advance the importance of developing pandemic plans as well as risk and crisis communications plans in their organizations is obvious. What is the message that now needs to be crafted? Peter Sandman posted his thoughts on several occasions during the initial outbreak, and the quote below provides an excellent framework.

“And of course, if the virus recedes and the pandemic never materializes, these critics will consider themselves vindicated … as if the fact that your house didn't burn down this year proved the foolishness of last year's decision to buy fire insurance. It is dangerous nonsense to imagine that warnings are justified only if they are followed quickly enough by disasters. People who don't take precautions often escape injury. That makes them lucky, not wise.”2

It always has been true that preparing in advance of for any type of emergency is time well spent. Pandemic planning is no exception. The adage that it is a sign of poor planning to be meeting the incident commander of your local hazard materials team during a major chemical release holds true. This, then, is the message for EHS professionals to their managers: the time and resources utilized for emergency planning activities are like money spent on insurance policies.

Messages to our organization's management need to continue to educate and inform about pandemic characteristics and continue to push for long-term planning. These messages need to achieve a sometimes delicate and difficult balance between accuracy and urgency. There is nothing wrong with painting a “scary” picture, backed up with good science, to motivate and push for time and resources. Using the well-worn analogy of “dodging the bullet” in the H1N1 pandemic can be an effective use of this is situation.

Pam Ferrante, CSP, CHMM, is the President of JC Safety & Environmental Inc. in Pittsburgh. Her company services numerous industrial and construction sectors with occupational safety and health consultation services. Ferrante presents and writes widely on the subjects of emergency response and risk/crisis communications. She can be reached at 412.414.4769 or [email protected].


1Sandman, Peter M.; “Four Kinds of Risk Communications”, 2003, found online at http://www.psandman.com.

2Posted online at http://www.petersandman.com on April 29, 2009.

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