Posted: May 23, 2009
This page is categorized as:    link to Pandemic and Other Infectious Diseases index
Hover here for
Article SummaryFor weeks, a number of governments have been urging the World Health Organization to redefine “pandemic” so it wouldn’t have to declare H1N1 a pandemic. Their main worry: that a pandemic declaration would panic their publics, leading to demands for border closings and other such ineffective and economically damaging infection control measures. On May 22, WHO announced that it would reconsider its pandemic definition. I thought the rationale for doing so was mistaken. But I saw some merit in the decision itself, for exactly the opposite reason: that a pandemic declaration while swine flu remained mild would “teach” people that pandemics are no big deal. I wrote to reporter Helen Branswell to explain my view.

On WHO Changing
the Definition of “Pandemic”

Peter M. Sandman’s Email to Helen Branswell
Helen Branswell’s Canadian Press article is also online.

I think it is unnecessary and even foolish for WHO to change its definition of “pandemic” in order to avoid frightening people with the word. Most people won’t get frightened by the word. And those who do won’t stay frightened for long. The concern that people will overreact to a pandemic declaration and demand unwise, futile, and costly precautions (like border closings) is overwrought. It is what I call “panic panic” – unreasoning fear on the part of governments that their people won’t be able to cope.

The people of the U.S., China, and Mexico have already adjusted to the reality of swine flu. The people of Japan will do so as well, probably in the same couple of weeks it took us. So will the rest of the world, as their own case counts increase.

But there is a good reason to change the WHO phase definitions – perhaps by creating a Phase 7 (or Phases 7 and 8) for more severe pandemics. WHO has use for a way to describe what might happen – what it’s worried about and wants us to prepare for and be vigilant for. A pandemic definition that ignored severity may have been appropriate when only health officials were following WHO pronouncements. But since the spread of bird flu, journalists and parts of the public have been following its pronouncements too. WHO shouldn’t signal its highest level of concern about a virus that is still comparatively mild.

My concern over the past week has been that WHO would declare a pandemic, people would notice that nothing much had changed in their daily lives, and they’d conclude that pandemics are no big deal. That’s an outcome worth avoiding.

Of course changing the rules in the middle of the game always looks a little déclassé. But a lot is changing in the pandemic world, and consistency isn’t the highest of virtues.

To ameliorate the inconsistency, it would be better to invent new phases for worse pandemics than to redefine “pandemic” itself.

And if “pandemic” must be redefined, it would be better to be clear about what has happened – and in particular to acknowledge that the current situation fits the prior definition. I would want WHO to say something like this:

Under the previous definition, H1N1 was due (some say overdue) to be declared a pandemic. That was doubly unwise, both because it might alarm some people more than the current situation justifies and because it would leave us no higher category ready to deploy for the truly alarming pandemic that could materialize at any time. For both of these reasons, we decided changing the definition of “pandemic” would cause less confusion than adhering to the previous definition.

Experts have long understood that the disastrous pandemic of 1918 was a very different experience than the mild pandemics of 1957 and 1968. Now that millions of people are paying attention to these matters for the first time, it will be useful to have different terms for the two different situations.

Many scientists and some risk communication professionals are really distressed at WHO’s decision. I think it is doing a pretty reasonable thing … albeit for the wrong reason.

Copyright © 2009 by Peter M. Sandman

For more on infectious diseases risk communication:    link to Pandemic and Other Infectious Diseases index
      Comment or Ask      Read the comments
Contact information page:    Peter M. Sandman

Website design and management provided by SnowTao Editing Services.