Contagious Disease Public Health

Should the CDC warn Americans about a ‘potential’ epidemic?

Although at first glance, the answer would be ‘yes’, the answer is not so straight-forward.  Consider the case of the recent H7N9 influenza outbreak in China.  Although the media gave some coverage to this issue, the risk of a pandemic was not emphasized.

The reason may be Bayesian updating.  Previous influenza threats in recent years have not had the impact expected.  A H5N1 bird flu pandemic never occurred in the U.S.; the H1N1 swine flu was serious, but not the pandemic that many individuals expected.  Another CDC ‘false alarm’ would harm the agency’s reputation; it would risk that its future announcements about pandemics would be taken less seriously.

The Peter Sandman Risk Communication Website gives the following opinion on the topic:

The CDC chose to go along with the overall mood of mild, casual interest. I’m not sure this was the wrong decision. Piercing the apathy would have been difficult and perhaps premature. If H7N9 never amounts to much, the CDC might have done some damage to its credibility by trying to pierce the apathy. On the other hand, if H7N9 does start looking like The Big One, the CDC will have passed up an early teachable moment. But on a third hand, if the situation starts to look worse, more teachable moments will come along, and the CDC can prepare for them in advance: reminding its experts not to over-reassure and not to sound overconfident about managing a pandemic; figuring out what to ask of the public; etc.

Chinese public health agencies may be more likely to give stern warnings than the CDC due to China’s recent history with infectious disease.  “China lived through SARS and H5N1 firsthand, whereas the U.S. experienced them mostly as faraway news stories and possible future threats that never materialized. And China is living through the first few H7N9 cases firsthand as well. If the public reaction in the U.S. ranges predictably from ridicule to apathy to casual interest, the reaction in China can be expected to be significantly more anxious.”

In the arena of public health, warning citizens of serious health threats is vital to the economy, health and survival of a nation.  False positive warnings, however, are not costless.


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