According to the South China Morning Post and other sources, China’s poultry industry wants China’s public health agencies to stop reporting individual cases of H7N9, to “avoid excessively detailed reports” of H7N9 infections, and to call this novel bird flu virus “H7N9 flu” or “H7N9 virus” rather than “H7N9 bird flu.” The industry’s goal is to reduce consumer concern about shopping for, purchasing, cooking, and eating poultry.
This has two main problems.
First, the industry’s goal is inappropriate. Consumer concern is justified, at least about contact with live poultry, and particularly about environmental exposure at live animal markets. (There isn’t any evidence that eating well-cooked or even poorly-cooked poultry is dangerous; the H7N9 virus is mostly found in the respiratory tract of infected poultry, unlike the more systemic distribution of the H5N1 virus in infected poultry.) The number of human cases of H7N9 in China, though not huge, is growing faster than last year and far faster than H5N1. And the available evidence strongly suggests that most victims are catching the virus from poultry or poultry environments (such as live animal markets), and at most only occasionally from other people. The U.S. government, among others, advises visitors to China to avoid contact with live poultry and live animal markets. It is not foolish for Chinese consumers to try to be as cautious as their food-purchasing and food-consumption patterns permit. This is especially true in the face of massive expert uncertainty about how this new virus behaves.
More importantly, the industry’s recommendations are bound to backfire. It is a fundamental principle of risk communication that mistrust arouses outrage. In other words, people become much more concerned about a health risk when they discover that they are not being told the whole truth about that risk. When sources cannot be trusted, small risks look big and big risks look bigger.
In their efforts to learn this lesson, China’s public health agencies have come far since the days when at least one hospital hid SARS patients in elevators and buses so visiting World Health Organization doctors wouldn’t find them. In April 2013, one week after reports of the first human H7N9 bird flu cases in China, Xinhua published an astonishing editorial: “Ten years after SARS, what has China learned?” The very last line of that editorial bears repeating: “If there is anything that SARS has taught China and its government, it’s that one cannot be too careful or too honest when it comes to deadly pandemics….” Too careful or too honest.
As far as Western observers can tell, China has been comparatively honest about H7N9, although some experts have expressed doubts about China’s animal surveillance efforts. So far, China’s H7N9 outbreak communication is perceived as vastly better than its performance during SARS. It’s wonderful to see China’s good example used as a harsh reproach to Saudi Arabia’s relative opacity about another current novel pathogen, MERS-CoV.
Any effort to suppress or understate the risk of H7N9 – or its link to poultry – would reverse this progress and undermine trust. The Chinese poultry industry is sending a pristinely clear signal that it considers industry wellbeing much more important than consumer wellbeing. How could anyone trust such an industry to seek, let alone reveal, valid information about the potential risk to humans?
China’s animal husbandry officials risk destroying the hard-earned improved reputation of China’s public health officials – they are all just “officials” in the eyes of most Chinese, and they are all just “China” to the outside world.
Even just lobbying for a cover-up will surely diminish trust and confidence, and exacerbate public and expert concern about H7N9, both domestically and worldwide.
Mistrust of Chinese agriculture and food production is already extremely high, fed by the melamine scandal and many other events. This low trust is directly relevant to the basic H7N9 problem. Live poultry and live bird markets appear to be the principal sources of human H7N9 infection. If Chinese consumers liked and trusted frozen poultry, their risk of infection would be far lower. But precisely because they assume or know that sick birds are often sold into the food chain, many Chinese consumers insist on inspecting the live bird before they buy it. This contributes to the potential spread of infection in poultry and in humans, as well as to individual consumers’ exposure – and it makes it hard to permanently close live bird markets.
It’s not just in Asia that agricultural sources of risk information tend to be less candid than public health sources, and therefore less trusted. This is true in the West as well. The food industry and the agricultural agencies of most governments have a structurally inherent conflict of interest when food threatens human health: how much to protect the food consumer versus the food producer. Public health agencies also sometimes have conflicts of interest, but those are rarely inherent in their agencies’ mandates.
During the pandemic of 2009–2010, pig farmers and agricultural government agencies in the U.S. and elsewhere pushed hard, with some success, to persuade public health agencies and even journalists to refer to the pandemic virus as “H1N1” rather than “swine flu.”
Pig farmers in 2009–2010 had a better case than Chinese poultry farmers have today. Pandemic H1N1 had already adapted to human hosts, and was already spreading in a sustained way from human to human by the time the first novel H1N1 viruses were identified in two southern California children with no pig exposure. The initial pig-to-human phase of H1N1’s emergence passed unnoticed. In April 2009, H1N1 was a swine flu virus that had not yet been found in pigs, but it was already spreading as a fully human flu virus. By contrast, this new H7N9 virus appears to be a fully avian virus. So far, it spreads to humans almost entirely from poultry or poultry-laden environments. Maddeningly, that is what the Chinese poultry industry wants to cover up.
The main thing wrong with calling H7N9 “bird flu” is that the virus has not yet been found in wild birds, only in poultry. So perhaps it is genuinely unfair to stigmatize all birds. Instead of “H7N9 bird flu,” we suggest that the virus be called “H7N9 poultry flu” or “H7N9 live animal market flu” – more accurate labels. Those names have an appropriate precautionary signal built into them. The poultry industry would not find them preferable to “H7N9 bird flu,” however.
When trying to persuade people about precautions, the primary risk communication goal is to recreate in the public’s mind the same level of worry and uncertainty that the experts and officials feel. If the Chinese public is more alarmed than experts and officials consider justified, that suggests a serious – and justified – trust problem.
There are three possibilities:
- The Chinese public is right to be as concerned as it is, the damage to poultry markets notwithstanding.
- The Chinese public is experiencing a temporary “adjustment reaction” to a new risk, and its appetite for poultry will recover most quickly if officials are patient and empathic.
- The Chinese public is overreacting in large measure because they mistrust what Chinese officials are telling them.
None of the three would justify the poultry industry’s advocacy of a cover-up.
Far from soft-peddling the H7N9 poultry connection, a risk communication-savvy approach would be to emphasize it: to share with Chinese consumers the concern and sadness that contact with live poultry is not risk-free, and to offer concrete advice for ways for consumers to minimize their risk. Then and only then would agricultural officials have any right to ask for public compassion about H7N9’s catastrophic effect on the industry they regulate and promote. But they still would not be justified in demanding that people put their compassion as citizens ahead of their concerns as consumers. And they would still not be justified in covering up crucial health-related information.
Copyright © 2014 by Jody Lanard and Peter M. Sandman