I’ve been monitoring the coverage of our Good Book of Badvocacy since we released it last May. We didn’t do a press release for it – just put it on the Weber Shandwick Web site, shared it with clients and the Weber Shandwick network, and discussed it in events and social media forums (including, of course, this blog). Needless to say, we’re more than pleased that a book about the power of word-of-mouth has made its way around purely on the power of word-of-mouth. In fact, as Leslie Gaines-Ross blogged, the Book was presented in an IT meeting at a company that is not in anyway affiliated with Weber Shandwick. The review was glowing. One of the meeting attendees was my husband so you can imagine his surprise when the book appeared (in case you’re wondering, he had not discussed it at work nor does he carry it around with him but I think he should).
And who can forget when “badvocate” became Addictionary’s Word of the Day! Or when Forbes.com interviewed Jack Leslie, chairman of Weber Shandwick, about badvocacy. Certainly I don’t want to overlook the many bloggers and Tweeters who kept the discussion rolling along. Many thanks to these folks for being badvote advocates:
Wishing all our badvocate followers a new year filled with nothing but advocates on your side!
True, the H1N1 influenza is now receding. True, it has not proven to be the population threatening pandemic strain the hyperventilating media made it out to be. True, that is, until we look at kids. Here the picture is different.
The swine flu has had a tragic impact on the young.
Despite it being December, well past the prime of the flu season, the number of pediatric deaths due to H1N1 remains alarmingly high. According to the CDC, the total number of pediatric deaths since the end of August is 204; since the end of April, 267. There are usually less than 100 pediatric deaths from the seasonal flu every year.
Reports show that complications brought on from the swine flu are the major cause of these deaths among our youngest citizens, such as from pneumonia and staph. So while conditions like asthma and diabetes can certainly increase a child’s risk, it doesn’t take a pre-existing health condition for a kid to be vulnerable.
It’s with these unsettling stats in mind that I was further unsettled to read a recent article in the New England Journal of Medicine by Danielle Ofri, M.D., Ph.D. about why, at least from one physician’s standpoint, parents have been choosing not to follow the recommendations of the medical community to inoculate their children against H1N1.
As someone who looks at both advocacy and badvocacy, I found her description of the emotional epidemiology of H1N1, particularly of parents who say they “don’t do flu,” of great interest (my personal judgments and feelings about vaccination aside). It makes it clear just how badvocacy, not advocacy, is what can take root in a hyped-up health crisis. How, as she says, “suspicion has its own contagion.” And how unless there is an aggressive public health/public relations effort to counter it demand will not meet even the readiest supply of vaccine. And we wind up with the worst kind of results: too many sick kids and worse.
Below is the article for those who just want to read it here and now. We welcome your thoughts and comments about the public relations aspects of responding to H1N1. Please refrain from sharing views on what you think about vaccination or the H1N1 vaccine itself. Let’s just not go there.
Last spring, when 2009 H1N1 influenza first came to our attention, my patients were in a panic. Our clinic was flooded with calls and walk-in patients, all with the same question: “When will there be a vaccine?”
It was all so new then, and we didn’t have an answer. That lack of answer seemed to fuel anxiety to a fever pitch. A substantial cohort of my patients continued calling, almost on a weekly basis, to ask about the vaccine.
These, of course, were the same patients who routinely refused the seasonal flu vaccine. Each year we’d go through the same drill: I’d offer them the flu shot. I’d explain the clinical reasoning behind this recommendation. I’d strongly encourage vaccination.
“No, thanks,” they’d say. “The vaccine makes me sick.” Or “My brother had a bad reaction.” Or, simply, “I don’t do flu shots.”
The irony was painful. No matter how often I trotted out the statistics of 30,000 to 40,000 annual deaths from influenza, the patients would not be moved. So when they demanded the H1N1 vaccine last spring, I reminded them of their reluctance over the seasonal flu shot. “Oh, that’s different,” they said.
Six months have passed. Flu season is now here. After repeated delays, H1N1 vaccine finally arrived in our clinic earlier this month to the uniform relief of the medical staff. But my formerly desperate patients were now leery. “It’s not tested,” they said. “Everyone knows there are problems with the vaccine.” “I’m not putting that in my body.”
I was unprepared for this response, but maybe I shouldn’t have been. For weeks now, in the schoolyard of my children’s elementary school, other parents had been sidling up to me, seemingly in need of validation. “You’re not giving your kids that swine flu shot, are you?” they’d say, their tone nervous, if a bit derisive.
How to explain this dramatic shift in 6 short months? It certainly isn’t related to logic or facts, since few new medical data became available during this period. It seems to reflect a sort of psychological contagion of myth and suspicion.
Just as there are patterns of infection, there seem to be patterns of emotional reaction (”emotional epidemiology”) associated with new illnesses. When 2009 H1N1 influenza was first detected, it fit a classic pattern that Priscilla Wald recently outlined in her book Contagious1: It was novel and mysterious; it emerged from a teeming third-world city, and it was now making its insidious — and seemingly unstoppable — way toward the “civilized” world.
This is the story line for most headline-grabbing illnesses — HIV, Ebola virus, SARS, typhoid. These diseases capture our imagination and ignite our fears in ways that more prosaic illnesses do not. These dramatic stakes lend themselves quite naturally to thriller books and movies; Dustin Hoffman hasn’t starred in any blockbusters about emphysema or dysentery.
When the inoculum of dramatic illness is first introduced into society, the public psyche rapidly becomes infected. Almost like an IgE-mediated histamine release, there is an immediate flooding of fear, even if the illness — like Ebola — is infinitely less likely to cause death than, say, a run-in with the Second Avenue bus. This immediate fear of the unknown was what had all my patients demanding the as-yet-unproduced H1N1 vaccine last spring.
As the novel disease establishes itself within society, a certain amount of emotional tolerance is created. H1N1 infection waxed and waned over the summer, and my patients grew less anxious. There was, of course, no medical basis for this decreased vigilance. Unusual risk groups and atypical seasonality should, in fact, have raised concern. By late summer, the perceived mysteriousness of H1N1 had receded, and the number of messages on my clinic phone followed suit.
But emotional epidemiology does not remain static. As autumn rolled around, I sensed a peeved expectation from my patients that this swine flu problem should have been solved already. The fact that it wasn’t “solved,” that the medical profession seemed somehow to be dithering, created an uneasy void. Not knowing whether to succumb to panic or to indifference, patients instead grew suspicious.
No amount of rational explanation — about the natural variety of influenza strains, about the simple issue of outbreak timing that necessitated a separate H1N1 vaccine — could allay this wariness.
Similarly, reassuring fellow parents that I was indeed vaccinating my own children did little to ease their apprehension. When the New York City public school system offered free vaccinations for both students and families, there was an abysmally poor turnout. Less than one quarter of the consent forms sent home in kids’ backpacks were returned.
The dramatic shift in public sentiment over the course of this H1N1 epidemic is both fascinating and frustrating. It is clear that there is a distinct emotional epidemiology and that it bears only a faint connection to the actual disease epidemiology of the virus.
We cannot combat H1N1 influenza merely by ensuring adequate supplies of vaccine and oseltamivir. Unless the medical profession confronts the emotional epidemiology of H1N1 with a full-court press, we run the risk of an uncontrollable epidemic.
There is no doubt that we are far behind the curve in terms of public relations. Our science has not been dithering at all, but our articulation of that science has often seemed that way, from the unfortunate initial appellation of swine flu to our inability to clarify distinctions between vaccine-production issues and clinical-risk issues. Suspicion has its own contagion, and we have not been aggressive enough in countering it.
Every practicing clinician is, to some degree, an armchair epidemiologist. We register patterns of disease as they play out among our patients. We are also keen detectives of emotional epidemiology, though we often aren’t aware of this as such. Keeping tabs on the emotional epidemiology as well as the disease epidemiology, and treating both with equal urgency, are the essential clinical tools for this influenza season.
Thought we should point out that advocates are everywhere, including the Army (client). Take a look at what Army advocates are up to. They are putting some companies to shame. They have 61 soldiers blogging and answering questions about what life in the Army is really like. They provide a genuine window into the human side of the military. Instead of the old way of walking into a recruiting station to learn what the Army does, they are going where people are today….and that is online. Some of their lessons are worth noting if you want to build advocates for your company, organization or cause.
I’ve been monitoring the coverage of our Good Book of Badvocacy since we released it last May. We didn’t do a press release for it – just put it on the Weber Shandwick Web site, shared it with clients and the Weber Shandwick network, and discussed it in events and social media forums (including, of course, this blog). Needless to say, we’re more than pleased that a book about the power of word-of-mouth has made its way around purely on the power of word-of-mouth. In fact, as Leslie Gaines-Ross blogged, the Book was presented in an IT meeting at a company that is not in anyway affiliated with Weber Shandwick. The review was glowing. One of the meeting attendees was my husband so you can imagine his surprise when the book appeared (in case you’re wondering, he had not discussed it at work nor does he carry it around with him but I think he should).
