2003 Guestbook
Comments and Responses

Telling corporations obvious things

This guestbook entry
is categorized as:

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Date:December 29, 2003
Location:Washington, U.S.


I read your interview in The Sun and was astounded at both your fees and the scope of your work. Essentially, as with many consultants in other areas, you’re called in when company employees, CEOS primarily, aren’t doing their jobs. I have no issue with you making a grand living due to such absurdity, but it’s hardly a challenge, or shouldn’t be, for corporations to figure out a communication strategy, sincere or otherwise. Instead of giving these guys the boot for mishandling the company affairs, hire a consultant. I suspect many problems could be resolved by listening to lower-level staff, but what do they know? Anyone with half a brain could read your Sun interview and use it as a blueprint to head off future problems, but that’s too easy and cost-effective. I see this all the time and as a shareholder in a variety of businesses, it drives me nuts. I have this quaint notion that upper-level managers and execs should be competent. This notion is proven to be increasingly quaint with every passing day.

Peter responds:

I don’t disagree with you. It has long seemed to me that what I tell my clients (at great expense) isn’t all that different from what their critics are trying to tell them (for free). And surely many of the strategies of outrage reduction are also “strategies” of decent interpersonal relations, which we all learned at our parents’ knees: be fair, share, tell the truth, see the other person’s side, compromise, try not to sound contemptuous.… I sometimes feel like one of the world’s leading experts on tic-tac-toe.

But while good outrage management may be common sense, it isn’t common practice. It flies in the face of organizational norms and individual psychology. It does battle with our own outrage, and with our self-esteem. Figuring out what ought to be done usually isn’t very difficulty; making yourself do it in the face of organizational and psychological barriers is.

Some folks get it without help, of course. Some don’t get it even with help. Some benefit from the help.

The Sun interview mentioned in the comment has now been posted on the site.

Flu: A touch of the panic

name: Susan Keady
This guestbook entry
is categorized as:

      link to Pandemic and Other Infectious Diseases index

Field:Nurse epidemiologist
Date:December 12, 2003
Location:Alaska, U.S.


I’m looking forward to your comments on flu communications. I’m already hearing the “p word” as people line up to receive flu shots they have been advised to get… How well do you think the CDC handled the transition from “plenty of flu vaccine this year” to “all gone”?

Peter responds:

This response was written jointly with Jody Lanard M.D., my wife, colleague, and medical expert, and coauthor with me of Fear of Fear: The Role of Fear in Preparedness … and Why It Terrifies Officials – which outlines our views on panic and “panic panic” in more detail.

As you are noticing, doctors, journalists, and officials are inaccurately using the “P” word the way normal people often inaccurately use the word “flu” – as in “a touch of the flu,” meaning a nasty respiratory bug, even if it’s summer when there is no actual flu around. Like the dumbing down of “flu” in people’s minds, “panic” has been dumbed down to mean feelings of anxiety and fearfulness – less than a panic attack, far short of a mass riot. Maybe we can call it “panic lite.”

  • To doctors, “panic” partly means being inundated by suddenly anxious patients who normally don’t pay much attention to medical warnings and preventive strategies.
  • To officials, “panic” partly means the hassle of dealing with public outrage at the government for not stockpiling vaccine that the public didn’t want to pay for or think about until after it was needed.
  • To reporters, “panic” seems to mean the media hype feedback loop that occurs when a huge volume of coverage is generated by – and subsequently generates – a huge amount of interest. When a similar pattern develops around stories for which the public is merely audience, not potential actors or victims (such as the Laci Peterson and Michael Jackson coverage), no one calls it panic. But people who are paying avid attention to the news in order to decide how they themselves should cope with a risk are likely to be seen as panicking.

What they’re actually doing, of course, is coping. Despite all the worried people waiting in long orderly lines for flu vaccine that sometimes runs out before they get it, not one line has yet turned into a violent outraged mob. Some people feel panicky, but even they are not panicking – as usual. And it is insulting and patronizing to imply that they are.

It may help if doctors, officials, policy-makers, and communicators find themselves a private place in the office stairwell to vent their frustration about how the public has ignored all their warnings for years, how no one wants to fund preventive programs, etc. Blow off steam privately. Then express understanding and respect for people’s anxious efforts to protect their families and themselves, and validate that this is a natural, resilient response. Officials might even ruefully apologize for sometimes sounding frustrated with the public’s fears.

And it would help to seize on the teachable moment. This is a wonderful time to talk about hand-washing, as many experts are doing – but the hygiene lessons need to be more sympathetic, less chastising. This is a wonderful time to suggest that people might want to get their shots early next year – but to point out also that next year could as easily see an unusually mild flu season as a bad one. And this is a wonderful time to discuss the vaccine supply dilemma: Should we have too much most years or too little in the occasional bad year? Again, the dilemma needs to be framed as a policy toughie, not as a reproach to the public for not wanting to spend tax dollars on surge capacity vaccine doses that most years will go to waste. In fact there’s nothing wrong with being slightly apologetic: “We wish we had been able to guess that this would be the year we’d need more vaccine than usual.” Leave the public to add to itself, “There’s no way you could have known.”

The second part of your question relates to the CDC’s August 25, 2003 announcement that “sufficient supplies of flu vaccine should be available during the coming influenza season. The Centers for Disease Control and Prevention (CDC) predicts that everyone wanting to get a flu shot to avoid influenza, regardless of age or health status, should be able to get vaccinated as soon as vaccine becomes available in October.”

This prediction was based on a guess that demand for vaccine would be the same as in recent years. Doctors around the country made the same prediction, as manifest in their orders for quantities of vaccine they thought they could sell. But the prediction flies in the face of another, more emphatic CDC prediction, that some time soon a more severe influenza season will inevitably occur. It was entirely predictable that in such a situation vaccine demand would rise, and would exceed a supply that was calibrated to the average annual demand. This isn’t a se cret, but the CDC could have said it more aggressively last summer.

How might this have sounded? “Based on previous demand, sufficient supplies of vaccine should be available during the coming season. But if this is the year a more severe influenza appears, we will certainly be caught short when demand increases. We hope we will have another mild flu season this year. That will give us another year to think through the difficult problem of providing extra capacity for the bad years we know will come but we can never know when.”

Root/risk philosophies

Field:Corporate public affairs
Date:December 17, 2003


We are reviewing some past materials that include reference to your ‘root/risk’ philosophies? Could you describe that? I don’t see anything on the website that relates to ‘root/risk’. Thank you.

Peter responds:

This phrase rings a very vague bell for me. I think maybe I’ve seen it used in discussions of risk assessment, maybe in connection with “fault trees” and similar methodologies. If it’s been used about risk communication or about my work, I don’t remember it. I don’t think I’ve used it myself, and I don’t know what it means. Sorry

Interview in The Sun

Name:Katy Brooks
Field:Environmental communications consultant
Date:December 17, 2003
Location:Oregon, U.S.


What a wonderful article in the Sun Magazine this month. It has been a few years since we've talked (my former name was Katy Tobie and used to be at the Port of Portland). I've been consulting for almost two years now and focusing mostly on environmental remediation and permitting projects for a variety of public and private clients in the northwest. I thoroughly enjoy it and credit you for much of my success and certainly for inspiration.

Reading the Sun article was very useful for me. I have two clients (two different public agencies) who want to do the right thing, but are in denial of the issues they “own” and that people are assigning blame to them, regardless of whether these agencies feel responsible or not. It’s still hard work getting noses close enough to the coffee to take a whiff. But I sure enjoy my work.

By the way, this website is very useful.

Peter responds:

It’s wonderful to hear from you!

For other readers, Katy’s reference to The Sun is a long interview with me by Gillian Kendall, published in the December 2003 issue. The interview can now be found on this site.

Appearance of mobile telephone base stations

Field:Site assessor/negotiator
Date:December 7, 2003


I am convinced through my work assisting telcos to establish mobile phone base stations and other radio towers, that the roots of many objections are based in the ugliness of the actual structure proposed and/or the proposed siting of an individual structure in a location that would have an adverse affect on the visual amenity of the locality. However, the mass of objection tends to focus on 1) the EME (electro-magnetic emissions) debate and 2) proliferation, i.e., communities don’t understand the need for so many towers and don’t trust the telcos in this regard. In my experience, explanation of the technology and risk communication satisfies many objectors about EME and proliferation. However, others are just as concerned about visual impacts or simply would rather not see any change. I have often felt that many objectors cling to the EME argument even after they have truly become satisfied about these issues because:

  • a) the argument better leverages emotional support from media and other potential objectors,
  • b) there is significant published material and other support available from organised non-local, anti-phone tower groups which focus on EME concerns and
  • c) it is known or perceived, in this country, that this anti EME strategy has been the effective tool to stop telco’s mobile phone proposals.

I do not mean, in any way, to demean or diminish people’s concerns about EME or their right to hold any views they chose. My concern is that it has become an unfortunate by-product of the EME debate, that visual amenity concerns are largely obscured and that, as a consequence, little is done by the telcos about the appearance of the structures, particularly not pro-actively. I think there is great scope for improvement here. The key to having telcos accept the time, consultation and development costs of better structures, is not only the gaining of community acceptance of an individual proposal but perhaps also in that the EME debate generally will come to better reflect a real level of community concern about the EME issue. The level of debate often seems so out of proportion with the inherent level of risk that could or should be associated with relatively low power, non-ionising radiation compared with other risks that communities accept. I believe that there is also a potential flow on benefit. If the industry or an individual company demonstrates the will to improve the visual environment and amenity impacts of its physical infrastructure, then the perception of its general integrity and credibility should improve. This, in turn, will benefit its community consultation efforts with improved credibility in technical explanation and risk communication.

I suppose my theory is essentially that, the better looking or the better a structure is visually accepted in a particular environment, the less objection there tends to be on EME grounds also. Simply stated this way, I realise this would be inflammatory and insulting to many objectors. Never-the-less I have had considerable experience in the field and can’t help feel there may be an important truth in the argument. My problem is that I can only support my argument with my own experiential and other anecdotal evidence. This experience includes, in the last couple of years, improvements in antenna technology that allows a cellular base station to be established with as few as two antennas, if the radio engineer is willing to accept minor performance compromises. This antenna technology allows a cell to be established using what might be called a “candlestick” design. A simple, clean-lined steel or concrete pole up to 30 metres tall with two, basically hemispherical 2 to 3 metre long antennas sitting back to back and close together on top of the pole. Even in densely populated urban areas these installations have been very well accepted with relatively little or no EME based, community objection.

Occasionally, an argument arises from an objector that BECAUSE a telco is trying to hide, disguise or improve the appearance of a base station, the telco must know there are EME risks and that the telco doesn’t want the community to know that the base station is there, or that it is trying to conjure a design that is suggestively benign. I do not think that risk of this sort of objection is reason enough for not trying to achieve the best possible visual outcome.

I’d very much appreciate any comment or advice you may give. I would also appreciate it if you could refer me to any other discussion or papers on similar argument, including anything that may be even vaguely relevant to the industry about the psychological effects and acceptance of different approaches to design. I suspect that human beings of this time and society tend to accept more readily smooth, clean or “organic” forms over those that might be considered mechanical, busy, spikey or even “futuristic”, e.g., there is certainly something about a lattice tower topped with angular forms and a dozen protruding antennas or high voltage insulators, that says “War of the Worlds” to me.

Peter responds:

I agree with everything you say about mobile phone towers. That is, I agree that attractive or unobtrusive towers are less likely to provoke objections than ugly or scary-looking ones; and I agree that some people who raise health-related objections are turned off chiefly by the appearance of the tower; and I agree that a company that alters the appearance of its towers without altering anything else opens itself up to charges of hiding the problem instead of fixing it; and I agree that despite this problem visual improvements are worth the effort, both for their own sake and for their likely beneficial impact on overall outrage.

I know of no evidence of any of this, though there may be some. My impressions, like yours, are grounded only in experience and anecdote.

A few additional points:

Some years ago, a woman who lived near a client’s base station told me that the tower overlooked her bedroom window and she often felt that it was almost literally looking into her bedroom. She suggested, half-humorously, that painting closed eyes on the tower might significantly reduce her objections. This anecdote suggests to me that appearance has some fairly deep dimensions. It would be fun, and useful, to research what sorts of tower designs strike most people as benign.
My own favorite mobile phone base station looks like a futuristic, slightly abstract tree. It isn’t a soft, organic form exactly, but it’s derived from one. It occupies a nice middle ground, actually – part nature, part art, part technology. It doesn’t look to me like it’s trying to hide, more like it’s trying to be friendly. Once again, this suggests that appearance is a complicated variable.
I remember a water company client that was battling with a neighborhood about its plans to install a water storage tank. The appearance of the tank – really a tower of sorts – was definitely an issue. My client decided to ask the opponents to collaborate on the design. This sharing of control significantly reduced the outrage, and the neighborhood ended up proud of its water tower.
Bear in mind that people usually end up believing deeply what they started out saying for merely strategic reasons. That’s true on both sides of a risk controversy. One side may be motivated by ideology and the other by profit, but before long both are convinced their arguments about risk are central to their views – and by then they are. So people who are actually offended by a tower’s appearance but “claiming” to be worried about EMEs morph into people who are genuinely worried about EMEs. Even so, their worry about EMEs may diminish if the tower’s appearance improves, especially if they have a hand in improving it. But it almost never pays to accuse them of pretense about their motives. Address both the motives they are claiming and the ones you think may lie beneath … without accusations of hypocrisy.
Whatever you do about appearance, I’m very sure it’s important to do it with candor. Be clear that you are hoping that a better appearance will make it easier for some people to reconcile themselves to the tower, but that you understand that improving the tower’s appearance does absolutely nothing to make it safer. People who are worried about EMEs, you should say explicitly, will of course remain worried, as they should. But you figure the least you can do is solve the part of the problem that is easiest to solve, the intrusiveness and ugliness of so many tower designs.

Some knotty dilemmas of public consultation

name: Trevor
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is categorized as:

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Field:Community relations manager for government road
Date:November 25, 2003


I’m interested in any reasoned opinions on what constitutes an effective representative of a locality based community group. For infrastructure projects it is common for the proponent or their contactor to call for nominees or volunteers to represent a suburb, street or locality.

Quite often the volume of paperwork that comes past the community reps for review and comment surprises them. Many are working people who give up their time for their community but there is little reward, nor arguably should there be, but I am open to suggestions on this point as well. I’d like to hear any comments on one or more of the following questions.

Do you support the truly local volunteer representatives following a selection process? This method has achieved many good results for communities of late regarding some high profile infrastructure projects.
What would be a reasonable level of assistance to provide community reps to ensure they have the means to receive and provide adequate feedback to their community?
Should there be financial or in-kind rewards for their efforts, eg paid reimbursement for baby-sitting, fares, theatre tickets, gift vouchers etc.
Is there merit in seeking/inviting local people from a community-based background on an affordable payment basis, eg retired/transient school teachers, ex-councillors, public servants, academics, professionals etc.
Should noted activists involved in a specific project-related campaign be included or excluded from community-based committees.
Should community groups have input into the selection of the committee chair or should this be the responsibility of the determining authority or proponent.

Peter responds:

Thorough answers to your six excellent questions require more space than I can devote here. And even thorough answers would ultimately prove unsatisfactory. The dilemmas you raise are knotty ones, and there are no magic solutions.

Much depends, also, on whether your community panel is making decisions and negotiating agreements, or just providing input. Decision-making and agreement-signing groups need legitimacy and consistency; the members normally need to be chosen by their constituencies, and all relevant constituencies need to be represented. Groups that “merely” consult, on the other hand, can be more haphazard; what matters is that the people with the strongest feelings get a chance to be heard, not that they come to every meeting or fairly represent the views of those who choose not to come at all.

With those qualifiers, some quick answers:

I certainly agree that local volunteers are crucial participants in the public involvement process. Note, however, that this is not a reason for excluding nonlocal interest groups. My clients often try to confine their consultation group to their “real” neighbors, freezing out the organized advocacy groups from out of town. I have never seen this work out well.
The only downsides of compensating local representatives are:
  • It may undermine the credibility and legitimacy of people’s contribution, giving the impression that you bought their opinion rather than just their presence;
  • It may foment conflict among community members – between those involved in the process and those not, between those offered money for their involvement and those not, or between those who accepted the offer and those who didn’t; and
  • It’s an expense, of course.

On the other hand, as you note, participation can be an awful lot of work. Not offering compensation can cost you potential participants who can’t afford to volunteer their time, or it might get you participants whose contributions are halfhearted or resentful. I would usually recommend raising the question of compensation, discussing the pros and cons, and staying out of the decision. If the group members (or the constituencies they represent) want to be compensated, I’d compensate them; if they don’t, I wouldn’t; if they disagree with each other, I’d let them work it out.

Compensation other than cash-for-time may well be the solution the group comes up with. As you mention, this can mean providing non-cash “payments” such as theater tickets, and/or reimbursing expenses like babysitters. It may also mean making a cash contribution but allowing each individual to specify whether it goes to him or her directly, or to the organization he or she represents, or to a favorite charity. Or there may be a decision that individual citizens should be compensated, but representatives of organized constituencies shouldn't. Or some may accept compensation while others decline it.
There’s nothing wrong with seeking out people who can afford to volunteer their time. But I’d be very leery of making this a condition for getting involved. You don’t want to exclude key people or key viewpoints merely because they require compensation. And you don’t want to pay wealthy participants merely because you’re paying less wealthy ones. Unless the group thinks otherwise, evenhandedness isn’t the key here.
Organized activists should definitely be included, unless they exclude themselves. If the rest of the group wants to exclude them, I’d work hard to persuade them to change their minds. If I failed to persuade them, I’d explain that my only alternative is to meet with the activists separately and report back to each group on my meetings with the other. If even that didn’t change their minds, I’d move forward with parallel meetings. It is almost never in your interest to refuse to meet with anybody who claims to be a stakeholder.
Advisory groups normally choose their own chair. Sometimes, if they want one, you might offer to pay for a professional facilitator, who actually runs the meeting logistics, makes sure everyone gets heard, drafts agendas and minutes, etc. Even so, the group should still choose a chair from among its members, who works with and oversees the facilitator. Even if asked, I would decline to choose or even to recommend a chair. The group is there for you to consult with, but it’s not your group, and the less power you exercise over its functioning, the better.

“Be first, be right, and be credible”

Field:Health communications
Date:November 21, 2003
Location:Georgia, U.S.


My question concerns a buzz phrase which seems to have gained traction in government public affairs offices: “Be first, be right, and be credible.” I haven’t quite figured out why, but there is something about that phrase that I find troubling or a little off in terms of what I’ve observed, learned, and experienced in various settings where I felt I was (successfully) using risk communication principles. I’m curious – if you’re willing to share – whether you have an opinion or any comments about whether the phrase is an effective approach to risk communication?

Peter responds:

Like you, I have a negative reaction to this phrase. And like you, I’m not sure exactly why.

There’s nothing wrong with being first – and sometimes it’s really important to take the initiative before other sources have framed the story their way. Still, making that the top priority feels just a little off-base. I'd be happier with “be fast,” I think; it focuses on meeting people’s communication needs quickly, rather than on scooping the competition.

Being right is obviously important; it sure beats being wrong. My concern here is that so often you don't know enough to be sure you're right, especially if you're working hard to be first or fast. And the command to “be right” may strike some inside the agency as meaning “sound like you’re sure you’re right” – which would be a serious (and common) mistake. CDC Director Julie Gerberding has done a superb job not just being right most of the time, but insisting endlessly that she might not be right, that she is working from an incomplete data base, that her explanations and recommendations must be seen as preliminary and tentative. Saying you might be wrong is nearly as important as trying to be right.

As for being credible, once again it’s obviously good advice, and still it feels slightly off. It smacks a little too much of manipulating or “managing” the audience, rather than telling people what’s up and letting the chips fall where they may. Like most risk communication consultants, I am often accused of teaching my clients how to manipulate or manage the audience. My usual response is to insist that paying attention to what makes you credible and what undermines your credibility is a win-win for source and audience alike, that it is more respectful to try to convince people of things than not to care whether they believe you or not. Even so, credibility should be the hand servant of candor. It isn’t a substitute.

Maybe what’s bothering us both is what isn’t here. Be humble and tentative. Be candid, even about your uncertainties and your mistakes. Be compassionate, recognizing that risk communicators are talking about things that are really scary, and sometimes really dangerous. Be collaborative, initiating a dialogue with your audience and offering them ways to get involved. Be emotionally present, acknowledging that risk communication is as much about feelings as it is about data.

Of course none of that fits into a seven-word slogan. I’m not sure I can come up with a seven- word slogan I like any better than the one you’re hearing around the office. But maybe risk communication doesn’t need a seven-word slogan.

Taking responsibility for the 2003 blackout

Name:Paul Ritterhoff
Field:Utility analyst
Date:November 20, 2003
Location:Maryland, U.S.


Yesterday a US/Canadian task force published their interim report on the causes of the August 14 Northeast Blackout. The report castigates FirstEnergy for numerous operating and procedural failures, including their failure to trim trees under three of their transmission lines.

The formal FirstEnergy response, consistent with previous responses, was defensive. In their press release “FirstEnergy Believes Interim Report Fails To Adequately Address Root Causes” issued yesterday, FirstEnergy President and Chief Operating Officer Anthony J. Alexander said “We remain convinced that the outage cannot be explained by events on any one utility system.”

What perspectives would you offer beleaguered FirstEnergy officals, and those of us who seek to learn from their experience?

Peter responds:

I haven’t made a close study of the blackout, the task force interim report, or FirstEnergy’s actual role.

But the principle here is straightforward. Unless the company has nothing – nothing – to be sorry for, apologizing for its share of the responsibility would be a lot wiser than quibbling over whether others are also at fault and it is getting more of the blame than it deserves.

It probably is getting more of the blame than it deserves. Among the obvious questions to be addressed: Are lots of power companies similarly behind in their tree-trimming and inadequately prepared for big trouble (in which case FirstEnergy was uniquely unlucky, not uniquely incompetent)? If FirstEnergy was in fact uniquely incompetent, where were the laws and regulatory standards and inspection protocols that could have deterred it or exposed it? Why on earth is the continental power grid so vulnerable to the screw-ups of one unlucky or incompetent utility? And if that sort of vulnerability is hard to prevent, then how much do we want to spend preventing it, as opposed to learning to live with a bad night every few decades?

But these are not questions FirstEnergy should be asking, except very indirectly. I can imagine a FirstEnergy executive saying something like “We had no idea that we could topple the whole system with a few local mistakes!” – which comes as close as FirstEnergy should come to suggesting that that’s a weird way to run a power grid. But mostly FirstEnergy should be focusing on its local mistakes. It should be saying how sorry it is that millions were inconvenienced, how much it now wishes that it had kept its tree-trimming up-to-date and trained its operators more in emergency procedures. Of course FirstEnergy also needs to tell us what lessons it has learned, what it is doing to bring its operations up to snuff. But even that is less important than apologetically owning its share of the blame.

The seesaw of risk communication tells us something important about the dynamics of blame: We blame you less when you blame yourself more – and we blame you the most when you are busy wriggling out from under your share of the blame, desperately trying to scapegoat others instead. A few years ago there was a major outbreak of E. coli food poisoning at some Jack-in-the-Box restaurants. Two things went wrong: The meat supplier delivered badly contaminated meat, and the restaurants failed to cook the meat thoroughly enough to kill the bacteria. The more Jack-in-the-Box blamed the supplier, the more the public blamed Jack-in-the-Box. Parents react the same way when their children try to shift the blame to each other.

For more on apologizing effectively, and on why companies find it so hard (lawyers are only one reason!), see my column on “Saying You're Sorry.”

One final point: Nothing I’ve said here is meant to imply that you should ever apologize for things that aren’t your fault. What I’m saying is that if the problem is partly your fault and partly not, you should focus on the part that’s your fault – and let the rest of us ride the you’re-not-the-only-one or the you-didn’t-do-so-bad seat on the seesaw. It’s possible that FirstEnergy did nothing wrong, that it is an innocent victim of the search for scapegoats, that it has absolutely nothing to apologize for. Paradoxically, that would make its risk communication task harder. Odds are, though, that it has plenty to apologize for, and that’s where its communication focus should be.

Improving safety by firing employees

Field:Union safety
Date:November 9, 2003


I would be very interested in your opinion on my situation. The company that I work for has a very serious safety problem (due to the high accident rate). Their way of solving the problem is to introduce new technology to reduce the workforce (reduce the workforce, reduce the accidents). The company decided to put this new technology into play without consulting the work force or give the proper training. Now add the loss of jobs to the scenario.

The workforce is pretty outraged

The community is now starting to ask questions about the safety of the environment, their not getting the answers they would like. Personnally I can see a blowout coming. Your point of view would be greatly appreciated.

Peter responds:

Your situation reminds me of the long-standing argument over whether coal mining has gotten safer or more dangerous in recent decades. Measured in terms of accidents per thousand tons of coal mined, the industry has gotten safer; measured in terms of accidents per thousand hours worked, it has gotten more dangerous. How is that possible? The coal mining industry mechanized as many jobs as it could – but some of the most dangerous jobs couldn’t be mechanized. That improved the industry’s overall safety record while simultaneously making the average coal miner’s work more dangerous.

Risk assessment specialists sometimes call this the “risk denominator” problem: deaths or accidents or other bad outcomes per what?

The effects of outrage can only make the denominator problem worse. Some jobs are eliminated, in part to improve the company’s safety record. The remaining jobs may or may not become more dangerous, as they did in coal mining; if the new technology is introduced without adequate training, increased risk will be one of the expected results. The work force isn’t consulted. Understandably, both the employees who were let go and the employees who were left behind (perhaps to be let go in the next wave) are going to experience some increased outrage. Especially in a small town, the impact on the surrounding community will also include considerable outrage.

And one of the effects of increased outrage is an increased accident rate. This is extremely well established. Angry, depressed, or demoralized workers hurt themselves and their coworkers more often than those who like their jobs and their employers. Outraged employees are also less productive, by the way.

Despite all of the above, companies still need to lay people off sometimes. Automation is a legitimate way to cut costs … and accidents. The battle over the extent to which layoffs should be regulated by government (or by labor contracts) is complicated. Left to themselves, companies don’t necessarily act in the interests of their employees or the society as a whole – but too much meddling from the rest of us can sometimes produce an industry that can’t compete and ends up employing nobody.

Even in an unregulated situation, outrage is a real cost of doing business. Laying people off produces outrage; outrage damages morale, safety, and productivity, not to mention corporate reputation. In deciding whether to lay people off, and how to lay people off, even the most self-interested of employers shouldn’t neglect to count this cost.

Philanthropy, Bribery, Blackmail, Reparations, and Penance

This guestbook entry
is categorized as:

      link to Outrage Management index

Field:Community relations manager
Date:July 18, 2003


Thanks so much for the very useful information you presented. I wish we would have talked to you several years ago! I do have a question about what your experience has been regarding the role of corporate community outreach programs (donations and volunteerism), particularly from the perspective of the activitists of an affected community during their high-outrage stage. Any insight you can provide on that would be appreciated.

Peter responds:

Thanks for your note. A few reactions:

It is well established that corporate philanthropy and community involvement help build good will. But they do not diminish ill-will very effectively. That is, when we are focused on your bad behavior in one venue (emitting carcinogens), we are not inclined to give credit for good behavior in another venue (supporting Little League). Corporate philanthropy does not diminish outrage at corporate misbehavior (or what is seen as misbehavior).
This doesn’t mean you should diminish philanthropy in the middle of a controversy. That might well be seen as a sort of blackmail (“back off or we'll stop giving”), and open up another branch of the controversy. Keep giving what you’ve normally given. Keep publicizing your giving as you’ve normally done. But don’t connect it to the controversy! When we’re talking about your emissions, talk about your emissions; don’t change the subject to your philanthropy.
Money that IS connected to the controversy can do you either great good or great harm, depending on how it’s framed … and whose will it embodies. Thus:
  • If the company offers benefits in return for community acceptance of risks, it is likely to be seen as a bribe: “If you let us endanger your children we’ll build you a park.” This is likely to exacerbate outrage, not reduce it. (Greedy stakeholders, as opposed to outraged ones, are perfectly willing to be bribed; they call it commerce. But outraged stakeholders will insist belligerently that “My children’s health is not for sale!”)
  • If outraged stakeholders demand benefits in return for acceptance of risks, on the other hand, then outrage is greatly reduced. This is a crucial distinction. If you “bribe” them, they feel all the more outraged and you feel virtuous. If they “blackmail” you, they feel vindicated and efficacious (“we made the bastards give us a park”) and you feel outraged. It’s the same park, with the same tax status.
  • If the company frames the contribution as reparations or penance instead of philanthropy (or even compensation), then it can reduce outrage even if offered rather than demanded: “We’re so generous we’re going to give you a park” versus “we’ll give you a park if you let us keep polluting” versus “we feel really bad about those emissions, and the least we can do to make it up to you is give you a park.” There is even a meaningful distinction between reparations (righting the wrong, making the victim whole again) and penance (which has more to do with humiliation and contrition, symbolizing your awareness that you have sinned and need to be punished).

Hope this helps.

Media censorship

Name:Andrea Gouveia
Field:Chemical engineer
Date:July 10, 2003
Location:Virginia, U.S.


I found it really interesting the work that you have done in the past years. I am originally from Brazil and always thought that the press in US is much more controlled than in any other countries I have already visited. Does it have anything to do with controlling the spread of bad news that would cause population outrage?

Peter responds:

I don’t know what other countries you’ve visited, but in terms of government censorship the U.S. media are less controlled than most countries’ media. The print media are less regulated than the broadcast media, and even the broadcast media aren’t heavily regulated.

Self-censorship is a different story. The U.S. newspaper, television, and radio industries are increasingly dominated by a few huge corporations. These companies earn their substantial profits chiefly through advertising. They try hard to create an environment that is conducive to ad sales. And they try hard not to do things or say things that might offend– in order of importance – the mass audience whose attention they are selling, the advertisers to whom they make the sale, or the government that sets the rules. One result is pretty bland, pretty conventional, pretty homogeneous news.

Of course there is a whole universe of quirky magazines, newsletters, and web sites out there that are anything but bland, conventional, or homogeneous … and that are pretty completely uncensored. People who want access to idiosyncratic information and opinion can find more of it, more easily, than ever before. People who stick to the mainstream media, on the other hand, are distressingly unlikely to run into something they didn’t expect. But it’s hard to blame this on government control.

As a crucial source of risk information, the government does frequently try to minimize public panic, fear, and outrage by painting an over-reassuring picture of the situation at hand. In times of crisis the media tend to cooperate in this effort to keep people calm. I think this is a mistake, but it's a voluntary (though barely conscious) decision on the media's part – not censorship. And in more normal times, the media like controversy. Except in crises, in fact, media coverage of risk focuses mostly on outrage. I think high-outrage low-hazard risk controversies are legitimate news, and I don’t join my government and corporate clients in blaming the stories on media sensationalism. But it’s hard to argue that such controversies are under-covered!

Media coverage of SARS and monkeypox

name:Hank Hardesty
This guestbook entry
is categorized as:

      link to Pandemic and Other Infectious Diseases index

Field:Finance manager
Date:July 10, 2003
Location:Virginia, U.S.


I wonder if you feel that the worldwide SARS problem led to the intense, early stage media coverage of the Monkeypox case.

Also, do you feel that the government has played any part in the lack of recent media coverage on both SARS & Monkeypox? Although both of these seem like legitimate issues that the American public is concerned with, the amount of press that each has received over the last couple of weeks is minimal.

Peter responds:

I do think SARS prepared journalists to take monkeypox more seriously than they would have otherwise. So did West Nile Virus. Exotic infectious diseases are in vogue. (I think this is a good thing. My concern is that they’ll go out of vogue too soon!)

Another factor, of course, was the smallpox vaccination story, which helped make monkeypox newsworthy. That said, I am a little surprised that the media didn’t pay much attention to the smallpox-versus-monkeypox aspect of the story. Did any hospital or health department worry, even for a minute, that they might be looking at a sentinel case of smallpox instead of a small outbreak of monkeypox? If they did, how close did we come to a serious smallpox false alarm – complete with quarantines and ring vaccination programs? If they didn’t, what does that tell us about the likelihood that a real sentinel case of smallpox might go unrecognized until it was too late for useful quarantines and ring vaccination programs?

When I ask these questions of infectious disease experts, some tell me that smallpox and monkeypox look pretty different. Others tell me they’re good questions. Either way, the media haven’t asked them very aggressively.

I have no reason to think the government took steps to discourage media coverage of SARS or monkeypox. SARS was inadequately covered in the U.S. during the war in Iraq, I think; then it was extensively covered until there were no more new cases (for now). Monkeypox was extensively covered for the few days when it looked like it might become a big deal. In both cases I thought the coverage was less thoughtful, less well-informed, and less investigative than I’d have liked. But I can’t say it was skimpy. And I can’t say the government tried to dampen it.

Informing the public versus informing terrorists and criminals

name:Bob Bolster
This guestbook entry
is categorized as:

      link to Crisis Communication index

Field:Director of Coalitions, House Financial Services
Date:July 9, 2003
Location:Virginia, U.S.


A couple years ago, EPA floated a proposal to require chemical companies to publicize what types of toxic materials were in close proximity to residential neighborhoods. The proposal encountered congressional resistance because such information could potentially be used by terrorists for nefarious means.

My question is how much information should the public be entitled to know if the information could potentially be used to facilitate criminal activities?

Peter responds:

Two things are both true, in my judgment.

First, sometimes public information can help terrorists or criminals in their work. When a specific piece of information is enormously valuable to the bad guys and only marginally interesting to the public, it should be a no-brainer to withhold it.

Second, the vast majority of the time when authorities claim that information must be withheld for this reason, the claim is itself pretty marginal. This is nothing new. Governments have always used “national security” as a reason for withholding information that might prove embarrassing or controversial. What is new, or at least much stronger than it used to be, is the fear of being accused of inadvertently helping terrorists. Many government agencies have purged their web sites not just of content they thought might actually prove valuable to terrorists, but also of content they thought critics might claim could prove valuable to terrorists. And as always they have taken full advantage of a new rationale for getting rid of content they never really wanted to acknowledge anyway.

An analogy may prove instructive. A decade ago, when the EPA started talking about requiring chemical companies to disclose their toxic waste emissions, hundreds of companies opposed the new regulations on the grounds that the disclosures would reveal valuable proprietary commercial information to competitors. The draft rules weren’t defeated, just amended to provide a narrow exemption for such information. The exemption has had relatively little use … and the requirement has embarrassed thousands of facilities into reducing their emissions.

There are tough cases, of course – and making companies disclose what toxic chemicals they store on site is a good example. The neighborhood’s right to know such information seems clear to me – as does the desirable effect on the company’s toxics storage policies of knowing the neighborhood knows. But the information really could have value to terrorists. On balance, I would still require companies to disclose how much of which chemicals they have sitting around. Many employees (and disaffected ex-employees) already know or can guesstimate the answers; the last thing you want is a situation where terrorists can find out easily enough but ordinary neighbors can’t. But I wouldn’t make companies disclose exactly where on site their storage tanks are located, or exactly where the pipes and valves are, or exactly what precautions they have taken to safeguard their stockpiles.

Scaring people about terrorism

name: Amber
This guestbook entry
is categorized as:

      link to Crisis Communication index

Location:Virginia, US
Date:July 8, 2003


I think this article (Duct Tape Risk Communication) is very thought provoking. My comments may or may not be directly related to what you wrote, but came up as I read the article. I feel that all Americans want is to feel in control. With the government telling us that we can go out and buy some random stuff to help us in case there is an attack, we are made to feel a little more in control. But like you said, we need to be asked to do more. At this lower level of involvement, we are informed of the potential danger while also knowing what may (or may not) help us in dealing with another terrorist attack. Only time will tell how useful this preparedness information is, but I think its good that the government is at least acknowledging to the public that it is worried. Still, there is more of a need for the government to be direct, honest and trusting of the American people. We are human and assume that those people who are working for us in Washington are human as well…we’d like to see that side of them. It would probably makes us laugh a little less at duct tape.

Peter responds:

I agree with everything you say. But it’s important to add that gathering emergency supplies is more than “buying random stuff” in order to feel more in control; it does help us feel more in control – but it may also help us survive a terrorist attack!

I am coming to believe that one of the biggest barriers to good communication about the risks of terrorism is an official reluctance to scare people. In seminars on terrorism risk communication, I often draw a “fear continuum”: apathy / interest / concern / high concern / fear / terror / panic / denial. I then ask my audience where on the continuum they want the American public to be right now. The most common answer is concern. My answer is fear. (The terrorists’ answer, of course, is terror – better yet, panic.) People are concerned about many things, from West Nile Virus to the economy. Do we really want merely to add terrorism to the list? Or do we see terrorism as a unique risk requiring a higher level of vigilance, preparedness, and yes, fear?

Of course official “fear of fear” has a valid rationale – two rationales, in fact. One is the genuinely high cost (psychological, social, and economic) of a frightened population. The other is the difficulty of sustaining fear, of keeping it credible over a significant lull between attacks. (I believe we are in such a lull now.) On the other hand, you can make a good case that humans are used to living in fear … even to having fun and earning a living despite a substantial, ever-present, background level of fear. Throughout most of history, and still in most parts of the world today, people are afraid of disease, of famine, of war. When there’s nothing clear to be afraid of, we lapse into free-floating anxiety instead.

Well, now there is something clear for Americans to be afraid of. The authorities are reluctant to frighten us – but without frightening us they probably cannot persuade us to get prepared and stay vigilant.

Checklists for emergency communications

Name:Edward Norman
Field:WMD coordinator, DHS sponsored agency
Date:June 24, 2003

What I would add to this site:

More purchaseable resources and programs available.


I’m looking for resources, that I thought might be found on your site as templates scripts or sample checklists for Incident Press Briefings?

Peter responds:

You’re right that I’m weak in the checklists-for-sale department. I tend to focus on what to say (rather than what supplies to stock, for example), and what to say tends to lend itself to essays more than checklists. And I’m long-winded. I keep getting asked for shorter, checklist-like materials on what to say. Partly in response to that, I am posting my seminar handouts, so readers of my web site can use them as checklists if they like. I’d still rather you read the essays….

But the very best source of checklist materials on emergency communications is a CD-ROM called “Emergency Risk Communication,” part of the “CDCynergy” series produced by the U.S. Centers for Disease Control and Prevention. It has both checklists and essays. So far there isn’t an order form on line, but if you want a copy, send an email to Judith E. Courtney (zsx6@cdc.gov) and ask; they’re free.

Talking about dioxin

This guestbook entry
is categorized as:

      link to Outrage Management index

Field:Communications manager
Date:June 16, 2003
Location:Michigan, U.S.


I am writing to seek your consultation on an escalating dioxin debate in our community. As I’ve researched, I’ve learned that this is nothing new – dioxin has been an historical, national ‘hot button’ issue surrounded by environmental, industrial, and political controversies. Locally, the dioxin issue dates back to the ‘70s and ‘80s with Dow Chemical and the Midland/Saginaw areas.

Recently, the dioxin issue has re-emerged with new vigor and local environmentalists putting immense public pressure on Dow. Within the scientific uncertainty of health risks, state and county agencies and leaders are struggling to identify their roles and responsibilities. I see a major component as education & community dialogue, but more of your “Two-Way Environmental Education” than the traditional approach. The conversation currently revolves around fighting over the measurement and magnitude of ‘hazard’, WITHOUT addressing any of the ‘outrage’ aspects (though they seem to be the largest factors). Implicated stakeholders (other than Dow & environmentalist groups) are struggling with the decision of whether/how to get involved or let this run its course.

I’ve been following your work with great interest, and find your approach a refreshingly unique one. Any response would be greatly appreciated. Thank you for all that you do--and letting us learn from it!

Peter responds:

Obviously, much depends on the specifics of your local dioxin controversy (or controversies) – and on your organization’s role; it matters whether you are Dow or the Health Department, for example. But here are a few quick generalizations that might help.

Anything you say about dioxin(s) has to be in the context of saying that there is a long history of claims that dioxin is "the most toxic substance known to man." Many in the public have absorbed the impression that any exposure whatever to anything called dioxin is a death sentence. Before you say that this isn’t necessarily so, you must acknowledge that many believe it is so, and that the burden of proof is therefore on those who claim otherwise.
Anything you say about dioxin(s) must also acknowledge that many experts continue to believe that dioxins actually are extremely hazardous, while other experts are pretty convinced the hazard is modest or even smaller than modest. Aside from chloracne, there is very little solid proof of serious human health risk from small doses – but there are lots of suggestive findings. In other words, anyone who confidently asserts that dioxin is or is not a serious hazard is misinformed; the only supportable position is that we don’t know. And given how much effort has gone into finding out, it seems likely that we won’t know, for sure, for a long time to come.
Some of the hazards tentatively associated with dioxin(s), moreover, are really scary. This also needs to be acknowledged. While the possible cancer connection has preoccupied our society for decades, a newer and in some ways even more frightening issue is endocrine disruption: the possibility that dioxin (and many other chemicals) may permanently alter such fundamental and emotionally sensitive processes as sexual potency. Evidence about endocrine disruption, like evidence about cancer, is mixed and inconclusive. The threat to human health, animal welfare, and environmental stability could be huge … or tiny … or even non-existent.
So the key question, you should explain, is how to behave in the face of this sort of uncertainty. This is a values question, not a scientific question. Again, the two extremes are both insupportable – the extremely casual position that toxins are innocent until proven guilty, and the extremely rigid position that they are guilty until proven innocent. Reducing dioxin emissions where feasible makes good sense. Committing to "zero dioxin" at any cost (eliminating chlorine from the periodic table) does not make good sense. Wisdom is somewhere in the middle, but exactly where in the middle is a tough question. To what extent should we distort other priorities – other health priorities, other financial priorities, etc. – to minimize our societal exposure to dioxin?
The problem is made thornier by the reality that some dioxin sources seem more innocent than others. Dioxins are created by many chemical reactions that cannot and should not be eliminated – including barbecuing meat and driving cars. [Don’t rely on me for this; I’m not fact-checking.] Dioxins are also created by industrial processes. Understandably, opponents of industrial pollution focus on the fact that Dow once was and maybe still is the single largest dioxin emitter on the planet. Just as understandably, companies like Dow focus on the fact that non-point-source dioxin emitters are collectively a bigger problem (if dioxin is in fact a problem) and are going comparatively uncriticized. It makes sense that dioxin alarmists don’t have much to say about the emotionally least objectionable dioxin sources. But the reassurers are unwise to focus only on those sources; they should discuss the whole range, and acknowledge frankly that most people would rather go after the industrial side of the problem than its lifestyle side.
Dioxin emissions, locally and globally, have been significantly reduced in the past two decades. Every time you point this out, you should stress that this notable achievement is the result mostly of powerful pressure from activists and reluctant responsiveness from industry. Of course regulators also played a role in many cases – but the most important reductions were “voluntary,” under public pressure rather than regulatory mandate. It is often hard for regulators to require a change when they cannot provide good evidence of risk; one of the strengths of our society is the existence of less legalistic processes for motivating companies to be cautious even when the evidence is uncertain.
The greatest reductions so far have appropriately been in the industrial arena. Say this approvingly; it is easier and smarter to make a few huge emitters change their ways than to enforce such changes on millions of smaller emitters. Now that most of the easy-and-smart industrial dioxin emission reductions have been accomplished, the question is what to do next. Do we go after the ever-smaller but still substantial industrial emissions? Do we go after "lifestyle" emissions like that barbecue? Do we focus on other risks, at least until we have better evidence that the remaining dioxin emissions are a serious hazard? If you want the public to consider this a serious question, you must pose it as a serious question – not as one you have already answered and are asking rhetorically.

What are the components of hazard?

Name:Evan Smith
Field:Environmental student studing risk management
Date:June 11, 2003


What are the components of Hazard as described by Dr. Sandman?

Peter responds:

In writing about my “Risk = Hazard + Outrage” formula, I go on endlessly about meaning of outrage, but I don’t often have much to say about hazard.

There are two reasons. First, it isn’t my field. I’m a communicator and maybe some kind of psychologist, but a risk assessment expert I’m not.

Second, it’s a can of worms. The oversimplified, straightforward definition of what I call “hazard” (and most risk assessors call “risk”) is magnitude times probability. Magnitude (or consequence) is how bad something is if it happens; probability (or frequency) is how often it’s likely to happen. Multiplying these two by each other yields a measure of how serious the risk is.

The difficulty is coming up with numbers to multiply. Often there are huge measurement problems, so we end up multiplying not magnitude times probability but our guess at magnitude times our guess at probability. This of course raises more questions than it answers. Should we use our “best guess,” which is equally likely to underestimate as to overestimate the risk, or should we prefer a “conservative guess,” which intentionally overestimates the risk to make very sure not to leave people underprotected? What about those whose guesses differ from ours, sometimes by many orders of magnitude – how do we distinguish informed guesses from ignorant ones, or objective guesses from biased ones? How should we measure, and represent, the uncertainty itself, so that whatever sort of guess we use, we can bear in mind the odds that it’s a bad guess? And what on earth makes us imagine that a one-in-a-hundred chance of killing ten people is neither better nor worse than a one-in-a-million chance of killing a hundred thousand people, as the magnitude-times-probability formula suggests. Risk assessors grapple with these and dozens of similar questions, and try to develop ever more complicated formulas that take them into account.

That’s just the measurement problems. At least as daunting are the values problems. Is the death of a 30-year-old higher “magnitude” than the death of a 70-year-old? Is a war in Europe higher magnitude than a war in Africa? What’s the magnitude of the extinction of a unique species of spider? Of a disfiguring but not deadly case of chloracne? Of having to live fearfully next door to a factory that probably won’t ever explode but keeps feeling like it might? Of getting stuck with the factory in the first place only because your neighborhood is poor and black? Some of these values questions fit better into “outrage” than they do into “hazard.” But if you really want to calculate (or estimate) a single hazard number, you need numbers for these things too.

Panic (and even fear) can do real harm

Field:Epidemiologist in local health department
Date:May 9, 2003
Location:Virginia, U.S.


I just read your column Fear is Spreading Faster than SARS – and So It Should. I found it very valuable (up until this point I had not exposure to the field of risk communication) and it gave me some insights I didn’t previously have. However, I wish that you had acknowledged some of the less palatable actions that fear can lead to (or at least allow to manifest) – the vilification of and hostility toward what or who is perceived as the cause of the fear. You advocate balance in the communication of risk – acknowledging the good and the bad. I think the same approach can be taken to discussing emotional, fearful reactions – we in public health aren’t contemptuous of fear and panic only because it’s inconvenient to us; we also ‘dislike’ it because it has been responsible, at least in part, for some nasty abuses, and it can lead to significant harm and suffering.

Peter responds:

Your point is a fair one, I think. There are good reasons as well as not-so-good ones for worrying about excessive public concern, and Jody and I should have acknowledged this more than we did.

This is in fact a risk communication principle … one that we obviously violated in the column. When urging people to do X instead of Y, it is important to acknowledge the reasons why they are inclined to do Y, and the validity of those reasons. We do believe that public health officials and political leaders tend to overestimate the probability of public panic, going into a sort of “panic panic.” And we think the official behavior that too often results – withholding information, making over-reassuring claims, expressing contempt for people’s fears and their efforts at self-protection – paradoxically make public panic likelier.

But while public panic is less frequent than officials suppose, it isn’t less horrible! By definition, panic involves actions that are damaging to both the person panicking and the people nearby. When it happens, panic can be deadlier than the risk people are panicking about. Even lesser levels of fear can motivate not just healthy self-protective behavior but also behavior that can be harmful to self and others – from the side effects of unnecessary antibiotics to the emotional pain of inappropriate stigmatization.

As I write this, many organizations in the U.S. and other relatively SARS-free places are confronting the dilemma of how to deal with people who come to them from places with significant SARS problems. How does a university cope with students from affected countries? How does a conference deal with participants from affected countries? It now seems likely, but not yet quite proved, that asymptomatic people cannot transmit SARS. It’s easy to understand the caution that leads university officials and conference organizers to want to exclude or quarantine “potentially infectious” individuals even though the risk is small. But if the risk is actually very small, the damage done by the exclusion (emotional, economic, etc.) may very well exceed the value of the precaution. Wearing protective face masks does no harm, and should be accepted even when it is almost certainly unnecessary. But excluding and stigmatizing others does real harm; if it is almost certainly unnecessary, it should be respectfully discouraged.

Those who argue against excessive precautions should be respectful of people’s reasons for wanting to be hyper-cautious. But it is equally true that those who defend people’s reasons for wanting to be hyper-cautious should be respectful of the harm done by excessive precautions. Our column fell short of the second half of this prescription.

Communicating a health concern

Field:Health educator/risk communicator county government
Date:April 30, 2003
Location:New Jersey, U.S.


I am very new to the communication field, but am very comfortable with health. The community I work in is extremly rural and has a high immigration population. If you needed to communicate a health concern that was naturaly occuring in the environment and may be effecting the water how would you go about it. I have developed FAQ sheets in advance to be distributed and we will also post this information on our website. I would like to give them actions they can do at home, but many of these actions require purchasing expensive items. Any ideas?

Peter responds:

It’s hard to frame an answer without more information about the problem. But here are a few off-the-cuff thoughts.

First, get clear on whether you are trying to alert people to a health risk or trying to reassure them about one. Even if it’s a new issue that they don’t really know about yet, the same question applies: Are you guessing the problem will be apathy or excessive concern? If you’re worried about apathy, see my March 22, 2003 Guestbook answer entitled: “When people are under-reacting to a risk.” If you’re worried about excessive concern, see the various articles and columns on this web site devoted to outrage management, and try to figure out where the over-reaction is rooted (what sorts of outrage) and what you can do about it. Resist the temptation to tell yourself you’re “simply trying to inform” your audience. The technical information won’t depend on your apathy–versus–over-reaction diagnosis, but everything else about the way you discuss the risk will.

The fact that the risk is naturally occurring suggests that you may be facing an apathy problem. If you expect people to shrug off the risk because it's natural, acknowledge that this is the natural response to a natural risk – that just about everybody tends to get more anxious about technological risks than about natural ones. Then explain that even though it tends to upset people less, this particular natural risk is actually likelier to harm our health than lots of more upsetting ones…. You stand a better chance of correcting the low-outrage response to natural risks if you concede its universality than if you ignore the issue.

It’s good that you want to offer people things they can do to reduce their risk. Try to suggest a range of actions (more and less protective, more and less expensive) so that they get to do some of their own decision-making. On the cost issue, be candid and matter-of-fact. If you think a particular remedy is costlier than the risk justifies (unless people have lots of money to spare), say so. If you think it’s costly but worth the sacrifice, say that. If you think there’s a serious social problem here – a really necessary precaution that many people cannot afford unless they get help – say that.

A largely immigrant population may mean a language problem, in which case you need to make sure your key messages are translated for the appropriate populations. There may be significant cultural differences to be addressed – things that look intuitively serious in your culture but not in theirs, or vice-versa. And there may be access issues; first-generation immigrants often have their own media, their own religious and civic institutions, their own communication patterns. But don’t get too caught up in the special problems of talking to people from another country. Responses to risk are more impressive in their similarities than in their differences.

Template for risk communication planning

Field:Academic research
Date:April 28, 2003
Location:California, U.S.


This is more a questions than a comment. Do you have a template for health departments that they could use to write a risk communication plan? If not, do you know where one could find something like this? Many Thanks.

Peter responds:

If you’re interested in developing an emergency risk communication plan (for a terrorist attack, for example, or a Toronto-like SARS outbreak), just about everything you could possibly need can be found in the CDC’s CD-Rom called “Emergency Risk Communication CDCynergy.” Check it out at http://www.cdc.gov/cdcynergy/emergency/.

If you’re interested in more conventional sorts of risk communication, I don’t know of anything comparably complete on how to plan your program. Most of the books on risk communication have at least a chapter on planning to get you started, but that’s about it. My book doesn’t even have that much – it’s focused almost exclusively on figuring out how to respond to outraged stakeholders, and offers little help on such crucial planning stages as audience identification, media selection, and evaluation. I do work with my consulting clients on developing their risk communication plans … when they ask me to. But it’s not my focus, and I haven’t written much about it.

When people are under-reacting to a risk

Date:March 22, 2003


What do you think are the best ways to make a risk seem worse? I’m sure the government is doing a lot of it in the USA but over here there isn’t much said by our government that isn’t laughable (not in the ways you mention in the duct tape article just labor said this liberal said this politics).

Peter responds:

Your question, how to make a risk seem worse, is a huge question. And it’s part of an even huger question: What to do when you think people are under-reacting. The latter question is the right one to ask, I think, because making the risk seem worse isn’t the only possible way to cope with risks you think people are under-reacting to. Without trying to cover the ground thoroughly, let me list eight key questions to ask yourself when you think people are under-reacting. The list is in chronological order. You shouldn’t focus on the questions near the bottom until you have eliminated the ones above them.

Are you sure they’re under-reacting? Might they be taking the risk more seriously than you’re giving them credit for? Might you be taking the risk more seriously than it deserves? Perhaps most important given the new focus on terrorism, might they be in denial rather than apathetic, too terrified to let themselves feel it rather than insufficiently alarmed? If the answer to any of these questions is affirmative, trying to make the risk seem worse is the wrong approach.
Can you engineer the problem away? Reducing the risk is sometimes easier and more effective than getting people to take it more seriously. Especially in situations where you are responsible for causing the risk, you have an obligation to think about whether you can eliminate it. Instead of fighting with your employees about why they should wear their respirators, stop emitting toxic fumes. If there is a feasible, cost-effective engineering answer, risk communication is a pallid (even an unethical) replacement for it.
Are they ignorant or misinformed? My clients lean far too much on this explanation, assuming that the problem is education (or re-education) when it isn’t. But sometimes it is! If there are truths people don’t know that would persuade them to take the risk more seriously, or falsehoods they think they know that are keeping them from taking it seriously, then that’s the place to start.
Do they know how to protect themselves? This is about training rather than education – and it’s about self-efficacy. One common reason for under-reacting to a risk is not knowing how to react more aggressively, or not believing it would help any to react more aggressively. Even if a risk is serious, apathy isn’t foolish if you’re powerless. So if you don’t want people to wallow in apathy, make sure they’re not powerless and know they’re not powerless. Give them things to do – a menu of things to do, so they can make their own choices. And take seriously the task of persuading them that they can implement the precautions, and that the precautions can work.
Are they paying attention? Even when people are well-informed and well-trained and full of efficacious feelings, they may still forget to stay focused on the risk you want them focused on. We’re all busy, and it’s easy to let safety issues fall off our radar screens. Industrial safety experts have obtained big improvements with programs aimed at reminding employees (and teaching them how to remind themselves) about the risks they should be worried about and the precautions they should be taking. This is much harder to do outside the workplace, but it is no less important.

And now the three that are my stock-in-trade. If the top five don’t do the trick, try these:

Is there a “motivated inattention” problem? Sometimes when people aren’t paying attention to a risk, it's not because they’re daydreaming or focusing on other problems; it’s because they don’t want to pay attention to that risk. Motivated inattention can have many sources. I have a list of 16 for employees and 24 for employers that I use in my seminars. Among the ones on the employee list: “It can’t happen”; “it can’t be prevented”; “you can’t scare me”; “I’m terrified”; “that’s not my culture”; “my friends would laugh at me”; and “my boss doesn’t mean it about safety.” These reasons for ignoring a risk can be dealt with … but only if they have been properly diagnosed.
Are they outraged at the precautions? We all spend our childhood outraged not at risk but at precaution-taking; our parents keep spoiling our fun by warning us about risks we can’t imagine might really be serious. It’s crucial to notice that this outrage at precaution-taking often survives into adulthood. How dare that safety manager make me wear those goggles! How dare the government make me wear that seat belt! Reducing outrage about recommended precautions is a powerful and much-ignored strategy for getting people to take risks more seriously.
Can you get them outraged at the risk? This is the activists’ answer to risks that people are under-reacting to: Mobilize their outrage. Depending on your issue, your employer, and your own opinions, you may or may not want to avail yourself of this powerful tool for getting people to take a risk more seriously. If you do, think through which three or four outrage components you can most effectively trigger in your particular situation. Control? Trust? Responsiveness? Dread? Then plan your campaign.

Emergency how-to warnings

name:Vanessa Musgrave
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Field:Government community relations
Date:February 26, 2003
Location:Texas, U.S.


It used to be when you went to the movies you first saw highlights of upcoming attractions. Then you got the messages to be quiet during the movie, take your trash out with you when you leave, and WHERE THE EMERGENCY EXITS WERE AND HOW TO EVACUATE.  They don’t do that anymore: maybe they should, in light of the terrorism, night club and nursing home fires, etc. Small actions such as these might help the general public deal with the uncertainties of life as we now experience it.

Peter responds:

As you can tell from the duct tape column, I agree.  We need more emergency how-to warnings in our lives.

The trick is to integrate these warnings into people’s lives – so they don’t alarm us more than they should, but they alarm us enough to get us to pay attention and learn what we need to learn.  I’ve been wondering about the mantra airline flight attendants have to recite: “In the unlikely event of a water landing….”  Frequent fliers certainly aren’t deterred or freaked out by this instruction.  Are we in fact instructed?  Do we actually learn where the emergency exits are and how to put on our life vests?

There are really three questions to consider.  What’s most worth knowing about preparing for and responding to an emergency in the movie theater?  How do we give people this information in a way that won’t frighten them out of going to the movies (or out of paying attention to the information – that’s denial)?  And how do we give people this information in a way that won’t get so boring they stop listening without having learned what they need to know (that’s apathy)?

Evacuation feasibility – the attractions of fatalism

name: Robert Duff
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Date:February 26, 2003
Location:Washington, U.S.


Interesting and thoughtful.  I have to make one point that has only a little bearing on the essence of your article.  The sign about Seabrook nuclear power plant and no possible evacuation route is more true than perhaps you are giving it credit.  While it came from a biased perspective (my guess is the Clamshell Alliance), sometimes that bias does not slant the message as much as it may seem.  On any given summer Saturday/Sunday in the Seabrook/North Hampton area, the only road out was invariable packed with cars.  In the event of an emergency, this route would have been a parking lot and could not at all be considered an evacuation route.  I don’t know if anything has changed.

Peter responds:

Point taken.  Evacuating the Seabrook area on a summer afternoon wouldn’t be quick.

On the other hand, on a brisk evening in late fall the evacuation would go swimmingly.  The point we were making in the duct tape column is that those who opposed nuclear power plants didn’t want evacuation to work, so they exaggerated their case that it wouldn’t.  Similarly, duck-and-cover and duct tape are useful sometimes but not always.  When we segue from “not always” to “not ever” the response may make emotional or political sense, but it doesn’t make homeland security sense.

Another example: One of the best arguments against the internal combustion engine, the automobile, and a petroleum-based economy is global climate change.  Longtime opponents of Big Oil quite appropriately latched onto the global warming issue.  That’s all fine.  But one possible solution to global warming is to find chemicals that can be added to the atmosphere to neutralize the warming effects of greenhouse gases.  Another possible solution is carbon sequestration.  I have no idea if these solutions will prove promising or illusory or even dangerous.  For obvious reasons, the oil and car industries are greatly attracted to them.  The environmental movement, on the other hand, tends to oppose them – and even to oppose research on them.  Many environmentalists simply do not want global warming to be solvable unless the solution is getting rid of the internal combustion engine and various industrial sources of greenhouse gases.  A “technical fix” doesn’t just seem unlikely to them; it seems morally wrong.

Why the sudden interest in smallpox?

name: Adeline
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Field:A student
Date:February 12, 2003


Why is small pox such a big issue all of a sudden, but no one was really worried about at first so why now.What can we do about it now, how can we fix the issue?

Peter responds:

After the September 11 terrorist attacks and the anthrax attacks only a few weeks later, it was natural – and sensible – for Americans and their government to worry about bioterrorism. The question isn’t really why we worried about it after; it’s why we didn’t worry about it before.

But why smallpox in particular? Some experts think smallpox is the likeliest choice for a bioterrorist to make. Other experts think other biothreats are likelier. Smallpox is on everyone’s list of the six or eight or ten or twelve top biological agents a terrorist might pick. But the recent public and media focus on smallpox vaccination, almost to the exclusion of the other biothreats on the list (and other ways of preparing for smallpox), is unexpected and probably unwise.

Of course everything we do to prepare for a possible smallpox attack increases the likelihood that terrorists, when they do act, will have chosen something else as a weapon. (The same reasoning applies to airport security.) So if there is ultimately a bioterrorist attack on the United States and smallpox is not the weapon, it will be hard to know what to conclude: that we deterred a smallpox attack and forced the terrorists to opt for a different agent, or that we were focusing on the wrong agent in the first place.

SUVs and risk communication

Date:January 29, 2003
Location:Maryland, U.S.

What I would add to this site:

The safety of the SUV


  • who are the stakeholders in the SUV controversy?
  • what were or are their desires and interests in whether auto manufacturers continue to produce SUVs?
  • What do you think is or was driving the demands for the SUV controversy?
  • How would you resolve conflicts among the various stakeholder groups in the SUV controversy?
  • If you where a senior manager at one of the major U.S. automakers. what step would you take to resolve the controversy?

Peter responds:

I've never been asked to work on the SUV controversy (not yet, anyway), so what I know is based only on what I’ve read and on my own driving experience. Of course everyone knows that SUVs are gas guzzlers, which implicates them not just in environmental problems but also in foreign policy issues. And everyone knows they’re hazardous (not to mention irritating) to other drivers. According to what I’ve read, they are also hazardous to their own occupants, more so than other sorts of cars.

What can be said on their behalf is that they make their drivers feel invincible (even if it’s mistaken, the feeling is nice). And I suppose we should also list on the credit side that SUVs have almost single-handedly kept the U.S. auto industry in the black.

So what would I advise the SUV manufacturers to do?

In the past, the answer would have had to be “not much.” The SUV issue had never exploded into a serious controversy. Environmental activists cared, but they had trouble getting anyone else to care with them; non-SUV drivers might have muttered their way through traffic jams, but when they got home they didn’t write their Senators and Representatives about it and all too often they went SUV-shopping instead. Even environmental activists put a higher priority on other issues – issues that wouldn’t line them up so squarely against many of their members. In other words, SUVs were more a public relations issue than a stakeholder relations issue. I would have welcomed the chance to help SUV opponents mobilize anti-SUV outrage and attract more stakeholders. But in the absence of aroused stakeholders, it would have been hard to urge the industry to “respond.”

Of course there’s a strong case to be made that companies should do the right thing – and publicize that they are doing the right thing – even if there isn’t much pressure to do so. A smart company can gain a competitive advantage by anticipating and meeting a societal demand shortly before it is demanded. The key word here is “shortly.” Even then it’s a lot to expect … especially when the “demand” endangers a highly profitable product category.

Has the time come to anticipate/meet the demand for socially responsible SUVs? Maybe so. It’s still a little early to tell whether the newly visible anti-SUV activism is a trend or a blip. But that’s the ideal time for a company to make its move – to acknowledge that SUVs have serious drawbacks and to begin marketing an SUV that is safer, greener, and friendlier … and that still makes its drivers feel invincible. Among the keys to the success of any such campaign: giving anti-SUV activists the credit they deserve for forcing the change, enlisting their involvement in developing the new product, and getting them to certify that it is genuinely better.

GM foods and risk communication

name:Tom Hoban
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Field:Sociology professor
Date:January 28, 2003
Location:North Carolina, U.S.

What I would add to this site:

Perhaps some video clips from your presentations. How about some Powerpoints.


I came across your website and find it to be one of the best I have seen. Well organized, easy to navigate and complete. It is great to read your latest thinking on the risk issues. You really have made a great impression on a lot of groups. I particularly like how you got to where you are (muddling through). My story is similar. I still am with NC State University, but do a lot of my own work.

I am still working actively on the biotech (GMO) controversy. It is interesting how that has become so much more of a political and emotional issue than it was when we last spoke (about 6–7 years ago). I continue to do survey research in this area with a particular focus on global comparisons.

It would be great to get your impressions of how this issue is playing out. Also would appreciate your thoughts on what has gone right or wrong with all the industry and government communication. I have watched the Council for Biotech Information (www.whybiotech.com) try to sell the benefits while not addressing the risks or other public concerns. Their whole focus has been on plants. I have been warning the ag and food sectors for almost three years that the cloned and genetically engineered animals will lead to much greater outrage. No one is taking the lead on that (and so by default groups like PETA and the Humane Society will determine the agenda). I tried to work with the hog industry here in NC on animal waste – only to find them to be arrogant, naive, and in denial that any problems exist. They have lost much of their freedom to operate here in NC and elsewhere as a result. I have a number of publications on my website (not as nice as yours yet!!)

Hope we can talk and possibly collaborate.
Tom Hoban

Thomas J. Hoban, Ph.D.
Director, Center for Biotechnology in Global Society
Professor of Sociology and Food Science
Phone: (919) 515-1676
E-mail: tom@sa.ncsu.edu
Web: http://www4.ncsu.edu/~hobantj/

Peter responds:

It’s great to hear from you, Tom, and to have a chance to look at your web site. It has lots of good information on genetically modified (GM) foods and related controversies.

I certainly agree with you that the ag biotech industry continues to do pretty poor risk communication. There are some signs of improvement. Monsanto has admitted it was arrogant in the way it tried to get GM foods into Europe. DuPont is working on a GM code of ethics that puts strong emphasis on accountability to an advisory board. The industry generally has stopped pretending it can prevent gene migration from a bioengineered crop to its neighbor.

Individual companies (at least some of them) are doing better than the trade associations. I agree with you that the one-sided materials put out by the Council for Biotechnology Information do their cause more harm than good; the same is true, generally, of the output of the Biotechnology Industry Organization. Sadly, this is a familiar pattern. Too often industry groups appeal to the lowest common denominator within their industry, saying what their members like to hear instead of what might help convince the rest of us.

Still, the prize for the worst communication effort on behalf of GM foods has to go to the U.S. Government, and particularly U.S. trade representatives, who continue to insist that Europe’s horror at the spectre of eating genetically modified food is nothing more than an unfair trade practice, an excuse for protecting local agriculture against American competition. Protectionism really is part of the mix, of course – but anyone who has traveled at all in Europe or the U.K. knows that many European consumers who care nothing for the fortunes of Europe’s farmers are desperate to avoid exposure to GM foods.

What’s sad about all this is that genetically modified crops can bring the world enormous benefits. They haven’t brought many significant benefits yet, I think – neither for society nor for the companies that bet heavily on them. But the potential is there … and poor risk communication may well have delayed it for a generation. It makes me heartsick to see African nations choose starvation over U.S. food aid, fearing that genetic material from American GM foods might spread to local crops and cost them European acceptance of their own agricultural exports.

What would I do if I were masterminding ag biotech risk communication efforts? A lot – but here's my top three:

Treat the GM controversy as a serious issue: high-hazard, high-outrage, high-benefit. Acknowledge that the stakes are high in both directions, address ag biotech reservations seriously, and slow down. I don’t think people want to be led into a biotechnology-based universe by companies that are charging forward with too much zeal and too little caution. “Half-speed ahead” should be the watchword.
Invest in products with significant, visible public benefits. What ag biotech needs is a compelling benefits story that isn’t hype or hypothetical – ideally, a product or two that obviously benefit consumers in the West and a product or two that obviously benefit the Third World. It will still be necessary to balance the benefits story with candor about risks, problems, and objections, of course.
Take values objections seriously. GM supporters are happiest rebutting claims of consumer risk, where they are almost certainly right. They are more hesitant to address environmental concerns, because those concerns have more substance behind them. But the most serious objections to GM foods are grounded in values, in concerns about what sort of society we will be once we start viewing the whole world’s gene pool as a smorgasbord. Your comment that the ag biotech companies need to take animal cloning seriously is a good example of the more general need to take social impacts and values-based concerns seriously.

Smallpox vaccination: Can we trust the government?

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Field:Reactionary who doesn’t trust the government
Date:January 8, 2003
Location:near Atlanta, Georgia, U.S.


There are three things that I’m not sure were discussed adequately in your smallpox column (Smallpox Vaccination: Some Risk Communication Linchpins). They are:

  • misleading or just plain missing data about who and how many people will be sickened or killed by these govt vaccinations.
  • who can afford or will pay the costs for treatment of “horrific side effects”
  • the uncertainty (or is it cover-up?) of whether and how the feds intend to force us all to be vaccinated, regardless of health status (putting us at risk of death from their “efforts” to protect us from the risk of death!)


The Washington Post says:

“Official estimates of the risk of smallpox vaccine are based on the 1960s CDC studies showing one or two people die and 15 to 52 suffer serious illness for every million persons vaccinated. The most serious effects include encephalitis – brain inflammation – and several potentially deadly rashes and skin conditions.

“But in those who have been previously vaccinated, the rates plunged to one death in every 4 million vaccinees. There were none from encephalitis, regarded as the most dangerous side effect because it cannot be predicted.”

So much of this data seems to have come from military vaccinations (in the Navy in the 70s, I remember being asked if I wanted them to vaccinate OVER my old smallpox vaccination scar or to have them create a new one: I picked the new one). But military folks are carefully selected for youth and health. So these numbers don’t seem like they will reflect our older, unhealthier, and immune-compromised populace at all.


I’m not seeing discussed at all WHO PAYS for the treatment of these adverse effects (er, that is, “horrific side effects”). I’m one of, what is it now, 45 MILLION Americans without health insurance. If the feds succeed in pushing their sneaky laws through the state legislatures making their “voluntary” federal vaccinations into mandatory state vaccinations, then who is going to foot the hospital bills (and death benefits)?


At the risk of sounding paranoid for not trusting “my” government, how can any of us protect ourselves against the denial of our own rights to our own health decisions? Are we just supposed to “believe” the government? As you so often say: who is it that says: “Trust me?”

“However, the announcement of the government’s ambiguously worded plan for voluntary smallpox inoculations provides more reason to question government motives in its support of the Model Emergency Health Powers Act (MEHPA).

“MEHPA makes it a criminal offense to refuse a state-ordered vaccination or medical procedure. In some states where it has already become law, refusing a compulsory vaccination is a felony. States have some leeway in determining the severity of the penalties, but in all cases the act permits the immediate confiscation and/or destruction of any private property without any procedural review in the event of a health emergency.”

Biowarfare: CDC Issues Plan for Mass Smallpox Vaccinations
Questions Raised on MEHPA and Microbiologist Deaths
From The Wilderness Publications, www.fromthewilderness.com

“Georgetown and Johns Hopkins’ Center for Law and the Public Health, the think tank where this state legislation model was created, reports MEHPA-like laws have been passed in 20 states, and 16 state legislatures have introduced measures dealing with public health emergencies caused by a terrorist attack.

“States where MEHPA laws have been enacted include: Arizona, Delaware, Florida, Georgia, Hawaii, Maine, Maryland, Minnesota, Missouri, New Hampshire, New Mexico, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia, and Wisconsin. Washington, D.C. has also enacted an emergency health powers law.

“State legislatures where MEHPA has been introduced include: California, Connecticut, Idaho, Illinois, Kansas, Kentucky, Massachusetts, Mississippi, Nebraska, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Washington, and Wyoming.”

MEHPA Now Law in 20 States; Homeland Security Act
Shields Vaccine Makers from Potential Litigation
From The Wilderness Publications, www.fromthewilderness.com

Peter responds:

These three smallpox vaccination questions are reactions to my column on how the government should run its smallpox vaccination communication effort. It is certainly true that the three issues were not “discussed adequately” in the column. They were hardly discussed at all! It would take a government smallpox expert to answer in detail … and of course then you’d wonder whether to trust the expert’s answers. Let me offer a few inexpert comments.

Note that much depends on whether we’re talking about a limited vaccination of medical personnel and emergency responders (about to be launched); or a voluntary vaccination of anyone who doesn’t have any of the contraindicated conditions (under discussion, hotly opposed by some and desperately wanted by others); or a universal mandatory vaccination (what vaccination opponents fear most).

How many people will be sickened or killed by the vaccination program? As your comment pretty much asserts, the bottom line is that nobody knows. There are some reasons to think the vaccination “adverse event” rate will be higher than in the past – especially that we have more immunocompromised, sick, and old people (some will slip through any screening program, and post-attack the plan is to vaccinate everyone who might have been exposed, regardless of contraindications). But there are also some reasons to think the rate of serious side effects will be lower than in the past – especially that we are better than we were decades ago at coping with the medical emergencies that serious side effects create.

Various estimates have been made of the likely mortality and morbidity that would result if this or that population group were vaccinated. (Obviously, the rate will be lower for emergency responders than for the general public, and lower for voluntary programs with medical screening than for mandatory programs without screening.) Though they vary, all the estimates are a great deal higher than the risk from any other widely used vaccine, and a great deal lower than the risk from smallpox itself. There is an effort now to “reconcile” these estimates so the conflict among them doesn’t become a source of controversy. In the column I recommend against this forced reconciliation, arguing that the public needs to understand that we don’t really have a precise estimate of vaccination side effects. I think being clear about the uncertainty is a lot wiser than faking unanimity and getting accused of coverup.

It seems inevitable to me that any extensive smallpox vaccination effort will bring some surprises. Odds are some of the surprises will be worse than we expected, and others will be better. The paranoid response will be to notice the former more than the latter and cry coverup. The solution is to tell people in advance to expect some surprises.

Who will pay the cost of vaccination side effects? This is an extremely tough question. There seem to be four main factors determining who pays:

  • The sort of patient. Soldiers will probably be better covered than first responders; first responders will probably be better covered than the general public; those required to take the vaccine will probably be better covered than those begging to get the vaccine.
  • The sort of side effect. Serious ones stand a better chance of compensation than more minor ones, and nobody really expects there will be compensation for lost pay while feeling rotten.
  • The sort of insurance. Some policies will presumably be interpreted to cover more conditions than others, and the uninsured will be, well, uninsured.
  • The assumption of risk and the assessment of fault. Did you sign something saying you’d cover your own risk? Did anyone else sign something saying they’d cover you? Did you withhold information during the screening? Was there anything wrong with the vaccine or the procedure? Do we even know if your problem actually resulted from the vaccination, or might it be a coincidence?

By the way, what looks like a compensation question to prospective vaccinees (“will I be taken care of if awful things happen?”) looks like a liability question to prospective vaccinators (“will I have to cover the costs if awful things happen?”).

There is widespread agreement that Congress needs to do something to clarify some of these compensation/liability issues. There is much less agreement on exactly what Congress should do … and on when and whether it will act. I suspect the situation will be a great deal clearer by the time the vaccine is offered to the general public on a voluntary basis (and long before voluntary vaccination morphs into mandatory vaccination, if it ever does). But medical responders may well be asked to accept the vaccine without a well-defined safety net, trusting that if things go wrong their government won’t abandon them. I assume this is an offer you would find easy to decline; I think I would too.

The toughest compensation situation will be if the government suddenly announces that it has evidence of a recent or imminent smallpox attack, and mobilizes to vaccinate all who were or might be exposed. The emergency won’t allow time to debate the fine points of compensation. But for those who suspect the emergency may have been manufactured or even faked, the government’s inability to give clear answers to compensation questions will be a strong argument.

Does the government plan to force us all to be vaccinated? This is the question serious conspiracy theorists are asking:  Is the relatively small and voluntary civilian vaccination program just a foot-in-the-door for a universal mandatory program the feds are secretly planning?

If it is, I don’t know it. But then I wouldn’t.

Clearly, the government does reserve the right to require vaccinations against infectious diseases, and it exercises that right when it believes the risk of a particular disease and the efficacy of the vaccine justify the downside: the infringement on individual freedom, the political hassles, and the prospect of side effects. There are always some dissenters with respect to particular vaccinations – people who argue that the vaccine is more dangerous, less effective, and less needed than the government claims. And there are some who argue simply that no health problem justifies forced medical treatments of any sort.

Most public health officials see mandatory vaccination as a no-brainer, as long as they are convinced that the benefits outweigh the risks; they think saving lives matters more than the concerns of libertarian opponents or risk assessment dissenters. Long-time anti-vaccination activists are accustomed to this, and may not notice that smallpox is different. But it is. As a naturally occurring disease, smallpox has been eradicated. Public health experts, the force behind other vaccination programs, tend to be exceedingly skeptical about the value of vaccinating anybody against a disease that no longer occurs – especially when the vaccine causes more pain and suffering than other vaccines in common use. The public health establishment pushed for a very, very limited vaccination program. It was the intelligence and counter-terrorism folks who wanted, and want, a more widespread program.

So if you’re worried about smallpox vaccination following in the path of measles and mumps vaccination, think again. Your usual enemies are likely to be your allies this time. Your new enemies are a different crew entirely.

It is still true that new bioterrorism concerns are provoking states to toughen their laws governing emergency health measures of various sorts, including mandatory vaccinations. If the government decides that there is an emergency requiring mass vaccinations, it wants to be able to make most of us submit and quarantine those who won’t. It isn’t all that crazy to worry that such sweeping powers could someday be abused, or even that public health types might end up using the new powers on behalf of old vaccines.

I personally find it difficult to imagine a government that wanted to vaccinate everybody without a medical rationale. But others have proposed nonmedical reasons they find credible: to weed out the dissenters, to make money for vaccine manufacturers, etc. Even I find it credible that the government may itself turn paranoid and see need for vaccination where rational people (me, in other words) see no such need. And of course if you put freedom ahead of public health anyway, then any strengthening of the government’s ability to coerce a medical treatment is an abuse, even if the emergency is real and the treatment is wise.

What about bioengineered smallpox? You didn’t raise this issue. But it is raised often by people who raise your other three, and the column neglected it, so I thought I’d address it here.

The most cogent argument against smallpox vaccination, I think, is the argument that vaccination is fruitless against a bioengineered virus. Even naturally occurring pathogens mutate; that’s why we need a different flu shot every winter, and why we worry about overuse of antibiotics. Opponents of smallpox vaccination argue that our enemies know we have the vaccine. An enemy who wants to unleash a smallpox attack would therefore bioengineer the virus first to make it immune to our vaccine. So why go through the pain, expense, and horrific side effects of a vaccination program?

Assessing this argument requires knowing how easy or difficult it is to bioengineer a vaccine-resistant smallpox virus. Is an enemy capable of launching a smallpox attack necessarily capable of developing a designer virus? I don’t know. I do know that the argument makes enough sense to deserve a careful answer. For the most part, that careful answer hasn’t been forthcoming. If vaccination proponents are ignoring the bioengineering issue in order to avoid giving it currency, I think they’re making a mistake. It’s going to gain currency. Answer it.

Copyright © 2003 by Peter M. Sandman

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