Posted: May 8, 2003
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Article SummaryAfter a rocky start, the world’s premier performer in SARS risk communication turned out to be the authoritarian city-state of Singapore! In this brief op-ed in Singapore’s biggest newspaper, my wife and colleague Dr. Jody Lanard and I tell the surprising story.

Sars communication:
What Singapore is doing right

The (Singapore) Straits Times, May 6, 2003
also in The Toronto Star (Canada), May 9, 2003
(under the headline “Canadian Response to SARS Scorned as Whiny”)

Note from Peter Sandman: The longer, unpublished version of the article is also provided on this site. On September 21, 2004, Jody told another version of this story as one of the keynote presentations at a World Health Organization conference on “outbreak communications.” The conference was scheduled in Singapore in part because of the superlative job Singapore had done communicating with its population about SARS – an accomplishment WHO wanted to help other countries emulate in other outbreaks. Entitled “WHO Expert Consultation on Outbreak Communications – Singapore’s SARS Outbreak Communications,” the speech text was on the website of the Singapore Ministry of Health for a while, but now is available only on this site.

IN COPING with Sars anxiety, Singapore’s grace under stress provides a rebuke to Canada, and an admirable model in risk communication for countries preparing for a possible outbreak.

The most important factors in managing severe acute respiratory syndrome (Sars) are medical, but risk communication matters too. For weeks now, Singapore has done state-of-the-art risk communication.

The most important risk communication recommendation during an evolving crisis is to avoid over-reassurance – in fact, to err on the alarming side rather than risk falling into over-reassurance.

Also important: acknowledging uncertainty rather than claiming to be confident; using anticipatory guidance and emotional rehearsal to help people get used to what may happen; treating emotional reactions with respect rather than contempt; sharing dilemmas so people come to understand the pros and cons of difficult pending decisions; and offering suggestions for things people can do themselves.

Taken together, these strategies amount to harnessing the public’s fear instead of trying to squelch it. Prime Minister Goh Chok Tong and his health officials have used them all superbly. We consider him the Rudy Giuliani of Sars.

Early on, 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 the 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.’

This compassionate respect for the fears of others is in stark contrast to Canada’s insistent whiny complaint that Australia and later, the World Health Organisation (WHO), were overreacting by issuing travel warnings.

Toronto Mayor Mel Lastman said: ‘I’ve never been angrier in my life.’ Toronto microbiologist Donald Low said the travel warning was ‘Bulls -- t’.

The same day the WHO lifted Canada’s travel warning, it also said the worst of Singapore’s Sars outbreak seemed to be over. Singapore Health Ministry spokesman Eunice Teo responded, masterfully, by moving to the fulcrum of the risk communication seesaw. ‘The WHO said the peak is over in Singapore,’ she noted, ‘but our minister has said it is too early to tell.’

In this and many other examples, Singapore has occupied the middle ground between people’s fears on one side and tentative medical reassurance on the other. This generates more credibility and confidence than Canada’s angry protests and premature celebrations.

Mr Goh does not mince words. Announcing a high-level task force on Sars, he said one of its missions was ‘to think in terms of worst-case scenarios. The committee will be asking a lot of ‘what if’ questions’.

He even talked openly about trying to avoid a complete quarantine of Singapore. Clearly he expects his citizens to bear such worries with him. Instead of photo-ops at Singapore food courts to show that everything is perfectly safe, Mr Goh is seen having his temperature taken before entering his office.

Introducing his Sars task force, he demonstrated the ‘namaste’ bow to reporters instead of shaking hands, recommending this Indian-style greeting for the duration of Sars. While other leaders are telling their citizens they are hysterical to worry so much, Mr Goh is helping his citizens figure out how to take action to help protect themselves and their neighbours – in essence, how to worry better.

Many people around the world feel safer from Sars if they wear a face mask. Many officials and experts around the world have mocked this precaution as foolish. Mr Goh told Singaporeans about the Japanese custom of wearing masks if they have a cold, to protect others.

Paradoxically, but not surprisingly, people become less fearful when their desire to wear masks is reframed as both wisely cautious and altruistic, rather than as foolish. The result is more esprit de corps, less panic – even if people wear masks when a strictly medical view suggests masks are probably unnecessary.

By understanding and even sharing the public’s fears, Singapore’s leaders are building trust and credibility; they are professional, but not hiding their humanity. It is easier for the public to emulate a leader who is bearing his fears than one who appears fearless.

More explicitly than any official anywhere in the world in any crisis we can remember, Mr Goh has acknowledged that neither extreme of the seesaw is ideal, that the goal is to move people towards the fulcrum.

‘We do not know enough of the disease, so it’s quite natural for people to swing to extremes,’ he said. ‘I can understand that anxiety and sense of panic in the beginning… The other extreme is… complacent Singaporeans. We have to bring both to the middle ground, to take a realistic approach.’

Right now, Singaporeans may be truly miserable, a bit frightened, and worried about the future. But when we all get through the Sars epidemic, or get used to it, Singaporeans and Singapore should recover well – without a C$25 million (S$31 million) public relations campaign like the one Canada is belatedly preparing.

Peter Sandman is a risk communication consultant. His wife, Jody Lanard, is a physician in Princeton, New Jersey.

Copyright © 2003 by Singapore Press Holdings. All rights reserved.

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