Risk and Crisis Communication For Disasters: Manila, Philippines, February 12-15, 2007

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 Involuntary
Controlled by self Controlled by others
Trustworthy sources Untrustworthy sources
Responsive process Unresponsive process
Familiar Unfamiliar
Not memorable Memorable
No moral relevance Moral relevance
Not dreaded Dreaded
Chronic 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
Risk
Hazard
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
*
HAZARD
Copyright  2003 Peter Sandman
FourFour
kindsKinds
of riskof Risk Communication
communication
1. When people are ignoring a serious hazard
O
U
T
R
A
PUBLIC
G RELATIONS
E
HEALTH & SAFETY
EDUCATION
ACTIVISM
HAZARD
Fourare
1. When people Kinds of Risk
ignoring Communication
a serious hazard, contin.
O
U
T
R
A
G
E “Precaution
Advocacy”
HAZARD
1. When Four
peopleKinds
are ignoring a serious
of Risk hazard, contin.
Communication
Warning: next comes a concept that
generates enormous resistance:
O
U
T
R
A
G
E “Precaution
Advocacy”
HAZARD
First, inform people – andofmobilize
Four Kinds Risk Communication
their
O concern to a level of fear or worry
U proportionate to the hazard.
T
R
A
G
(Officials hate the second half of this
E recommendation!!)
Or
F
E
A
R
“Precaution
Advocacy”
HAZARD
O
U
Then, help them
Fourmanage
Kinds ofthe hazard
Risk (“things
Communication
T they can do”), or else they will try to
R manage their fear (by way of denial, apathy,
A scoffing).
G
E
Or
F
E
A
R
“Precaution
Advocacy”
HAZARD
Fear Appeal Documentation

In other words…
O
U
T
R
A
G
E
Or
F
E “Precaution
A Advocacy”
R
HAZARD
Lower right hand circle, arrow
O
U
T
R
OUTRAGE
A MANAGEMENT
G
E
Or
F “Precaution
E
A Advocacy”
R
HAZARD
Upper Left Hand Circle

O
U Your Job: Inform people
T AND use outrage/fear
R
OUTRAGE
A MANAGEMENT management strategies to
G reduce their outrage or fear.
E
Or
F
E
A
R
HAZARD
In other words...
O or
U OUTRAGE
MANAGEMENT
T F
R E
A A
G R
E
HAZARDUpper Left Hand Circle, Arrow

O
OUTRAGE
U MANAGEMENT
T
R
A
G
E “Precaution
Advocacy”
HAZARD
Smiley Face
O
OUTRAGE
U MANAGEMENT
T
R
A
G
E “Precaution
Advocacy”
HAZARD
Two Arrows
Three circles (adds crisis)
O
OUTRAGE CRISIS
U MANAGEMENT COMMUNICATION
T
R
A
G
E “Precaution
Advocacy”
HAZARD
O Crisis
U Communication
T
R
A “We’ll get through this together”
G
E
HAZARD
Get through this together

(No way to make a living in this corner…
… but do communication surveillance

Outrage to look for undiagnosed concerns, fear, or
or outrage)
Fear
Hazard
© Peter Sandman 2004
www.psandman.com Low Hazard Low Outrage
Guidelines
 Trust
 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 “People are a little scared
Trade Center site and and seem on edge. I
still having the 9/11 don't hear the word
jitters I thought the terrorism, but the air is
worst… 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 Answer:
“…as of this
moment…”
What words did CNN run as a
CNN crawl?
caption, while the Mayor spoke?
“???????”
For about ten minutes, CNN ran
100% sure
the words:
“100% sure”
See Saw
2. Put reassuring information
in subordinate clauses.
Subordinate Clause
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."
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

"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
Guidelines
2. Put reassuring information
in subordinate clauses.
3. 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
Guidelines
 Trust
 Transparency
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.
5. 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
5. Share dilemmas.
6. 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…
5. Share dilemmas.
6. Acknowledge opinion
diversity.
7. 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.
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."
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 !!

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.
overplan for panic.
9. Don't aim for zero fear.
Zero Fear
What is the “right” level of fear?
PANIC DENIAL
TERROR
FEAR
CONCERN
INTEREST
APATHY
PANIC DENIAL
TERROR
FEAR
“HIGH CONCERN” ???
CONCERN
INTEREST
APATHY
PANIC DENIAL
TERROR
Sometimes, a
degree of FEAR
rational fear is CONCERN

appropriate!
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.”
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. Fear
2. Empathy/Misery
3. Anger
4. Hurt
5. Guilt
6. Resilience!
List other emotions

11. Don't ridicule the public's

emotions.
Don’t ridicule emotions


emotions.
12. 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 about it too soon?
 Waiting 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

emotions.
12. Legitimize people's fears.
13. Tolerate early over-
reactions.
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:
Culling:
Culling:
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
Guidelines
 Trust
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 Min-
istry 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
16 Offer people things to do.
Offer people things to do


17. 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).

17. Let people choose their own
actions.
18. 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
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
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."
and Half-truths
19. Acknowledge errors,

20. Apologize often for errors,
Apologize for Errors

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
and Half-truths
21. Be explicit about "anchoring

frames."
22. 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
and Half-truths
23. Don't lie, and don't tell half-

truths.
Don’t Lie…
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
The case is a 89-year-old Malay male….

18 Oct 2004

 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….
and Half-truths
23. Don't lie, and don't tell half-

truths.
24. Aim for total candor and
transparency.
Aim for total…

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.

Risk and Crisis Communication For Disasters: Manila, Philippines, February 12-15, 2007

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Risk and Crisis Communication

Jody Lanard M.D.

 We’ll get through this together.

"The interactive process of exchanging

-- The National Research Council

 “Educating the public”

 Talking to people who have no

 Information you give out after you

How likely to happen?

How bad if it happens?

(Peter Sandman’s formula!)

Fear Appeal Documentation

Upper Left Hand Circle

HAZARDUpper Left Hand Circle, Arrow

Get through this together

… but do communication surveillance

Christie Todd is pleased

“for reassuring Manhattan residents soon

Blasting Christie Todd Whitman

“The EPA's internal watchdog found the

“The first radio reports

“I can tell you 100

Bloomberg example don’t over-reassure

 What words “protect” him if he turns out

caption, while the Mayor spoke?

“The WHO said the peak is over in

But he added: health authorities were doing extra

"Even though there is no sign of

“Although this virus appears to be of

Photo from: http://pardonbakarmisiniz.wordpress.com/files/2006/08/meteor-shower.jpg

"Even though there is no evidence

-- Dr. Julie Gerberding, U.S. CDC

Err Alarming Side

“One might think we are overreacting to the

“We will learn things in the coming weeks

This became the U.S. CDC’s mantra after its

In the middle of the SARS crisis, the

13 February, 2007, Philippine Star-News:

Investigating the cause of death of an egret, a

“There are many causes of death and not

People fled the fire.

“Foreigners were seen helping mostly local

"no one was reported injured or killed."

"no one was reported injured or killed,"

but the same reporter said the fire sent

And said that the incident

In the next sentence, the author notes

49 injuries, no deaths – out of 15,100 !!

The residents knew their way around the alleys

Undoubtedly it looked chaotic to the firefighters.

“HIGH CONCERN” ???

rational fear is CONCERN

Don’t forget other emotions

List other emotions

11. Don't ridicule the public's

Don’t ridicule emotions

11. Don't ridicule the public's

“We saw this courage in our doctors, nurses and

"We need to involve our community in all aspects of

'So we must expect other countries to advise their

Closing the schools during SARS

Open respectful expert disagreement