Pandemic Flu: Why the public needs to be involved

With the H1N1 influenza spreading and the CDC forecasting that up to 40 percent of Americans could contract it within the next two years, communities and businesses are working hard to develop plans. Health experts know what needs to be done to contain a pandemic, but one factor is missing from many plans – the human factor. 

An effective pandemic flu plan must include two elements: the wisdom of public health experts and an understanding of the values that will drive the actions of people in the community. The best-laid plans of the experts are doomed to fail if the public hasn’t had a role in developing them. And in a pandemic situation, the stakes are too high to risk failure. For businesses, the challenge is the same: soliciting employee input into any business crisis plan will strengthen the plan’s effectiveness and head off potential problems that only employees can foresee.

Many governments and businesses already have pandemic plans on the shelf, and these are valuable first steps. Our experience shows these communities will be even better prepared if they go to the next step and test the plan with stakeholders before a crisis begins.  Adding a public input component to pandemic preparation allows two-way communication between those who will have to follow the plan and those who are experts in the health issues. Only together can they develop a plan that will both save lives and be workable for those who need to follow it.

Engaging the public is especially important because the government cannot get us through a pandemic alone. Individuals must prepare if they are to survive, and communities in which individuals are knowledgeable and ready will fare better than those where individuals are passively waiting for help.  The best way to find out what people know and don’t know about pandemic flu and what barriers they face to being prepared is to ask them.

In our work with local health departments and businesses, Consensus has identified some of the reasons emergency pandemic plans might not be as effective as possible.  These include:

• Finding credible leaders to introduce emergency information in a pandemic will be essential. In some communities, having the mayor introduce health messages will be the most effective approach; in others, government leaders are mistrusted and church leaders are more credible. It’s vitally important to know in advance who will be trusted, and that "who" is different from community to community.

• The values of individuals may differ from public health values.  We’ve found that people will respond to an emergency by making sure their children and families are safe, even if that means violating public health advisories. A community that has worked with its citizens to understand their values can modify its plans based on the actions they will take, rather than the actions they should take.

• Churches, community groups and neighborhood associations can be valuable resources in they are involved in planning. In a pandemic emergency, most communities have an infrastructure of communication and assistance which can be mobilized, but the key players in that infrastructure need to be involved in planning before a crisis begins.

• The biggest barriers to compliance with a pandemic plan will be workplace issues. If the business community has not been engaged in developing plans, it may be impossible to ensure essential services remain available and people have the support they need to isolate themselves. And while many businesses have a crisis plan that  prepares them for a tornado or other short-term emergency, a pandemic could affect businesses for as long as six months and requires a different type of preparation.

• The way information is communicated must be planned and practiced in advance. Once a crisis begins, there will be no time for local authorities to map out a communications strategy and get training in how to speak to the media or to organize speakers’ bureaus or telephone hotlines.

Adding citizens to the planning process
All local governments are required to have pandemic plans in place. That’s an important first step, but in our work with communities, we’ve learned that citizen involvement can add important insights, identify valuable resources and enhance community understanding of pandemic flu preparation. Some of the most important reasons for including citizens in pandemic planning include:

• Gaining an understanding of the values that will drive people in a crisis. Health planners know what they would like people to do, but citizens will act based upon values they bring to a situation. In our work with communities, individuals have told us they will be reluctant to follow certain advisories or would not act the way health planners hope they would. Knowing in advance how the community will react is one of the most important steps in pandemic planning.

• Providing much-needed support for health departments and governments, who cannot handle a pandemic crisis alone.  When a pandemic strikes, each community will have to marshal all of its resources, from neighborhood associations to local businesses to its mayor. By having all of these critical stakeholders involved in planning ensures no potential resource is overlooked and that the people who will provide crisis services have designed the most effective system for delivering them. Citizen–based planning can also help attract financial resources.

• There will be no time to train spokespeople after a crisis begins. Crisis communications is a skill that can be learned, but the people who will be speaking to the public need to be identified and trained in advance. Health departments have spokespeople, but our work shows that public health messages will be more effective if they are endorsed by trusted community leaders like the mayor, clergy people and other community figures.

Planning pays off even if pandemic does not hit hard
If pandemic flu does not strike this year, is all this planning wasted? The Centers for Disease Control says local communities need to prepare because there is no question that a pandemic will come; it is just a matter of when. And a community that has a good emergency response plan and crisis communication training is prepared not only for a flu crisis, but for other types of emergencies that also require citizen participation in planning.

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