The Challenge of Providing the Public with Actionable Information during a Pandemic

Journal of Law, Medicine and Ethics

Volumn 40, Issue 3, 2012, Pages 630-654

  Gerwin, Leslie E ^a,b  

^a PRINCETON UNIVERSITY   (United States)

^b YESHIVA UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

INFLUENZA VACCINE;

ARTICLE; CONSUMER HEALTH INFORMATION; HUMAN; INFLUENZA; INFLUENZA VIRUS A H1N1; INFORMATION DISSEMINATION; MASS IMMUNIZATION; MASS MEDIUM; PANDEMIC; PATIENT ATTITUDE; POLITICS; UNCERTAINTY; UNITED STATES;

CONSUMER HEALTH INFORMATION; HUMANS; INFLUENZA A VIRUS, H1N1 SUBTYPE; INFLUENZA VACCINES; INFLUENZA, HUMAN; INFORMATION DISSEMINATION; MASS MEDIA; MASS VACCINATION; PANDEMICS; PATIENT ACCEPTANCE OF HEALTH CARE; POLITICS; UNCERTAINTY; UNITED STATES;

EID: 84867617007     PISSN: 10731105     EISSN: 1748720X     Source Type: Journal    
DOI: 10.1111/j.1748-720X.2012.00695.x     Document Type: Article

References (102)

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2. Newspaper reports, including online versions, are particularly revealing because they provide more detail and often serve as the source for the shorter television and electronic news summaries by those Americans who regularly follow the news. Since most Americans get their news from the electronic sources, the potential for forming distorting perceptions is magnified.
3. D. Hamburg, "Forward, " in R. E. Neustadt and H. Fineberg, The Epidemic That Never Was: Policy-Making and the Swine Flu Scare ( New York : Vintage Books, 1983): at ix.
4. R. E. Neustadt and H. Fineberg, The Epidemic That Never Was: Policy-making and the Swine Flu Scare ( New York : Vintage Books, 1983) at 127.
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8. M. Specter, "The Fear Factor, " New Yorker, October 12, 2009, available at (last visited August 2, 2012).
9. Beginning in December as the vaccine became plentiful and the second wave peaked, news reports essentially add postscripts with no new themes.
10. UPI website, "Obama: H1N1 Preparedness Is Going Well, " September 1, 2009, available at (last visited August 2, 2012).
11. M. Beck, "Put Up Your Dukes: Fighting Disease With Soap and Water, " Wall Street Journal, May 12, 2009, available at (last visited August 2, 2012).
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15. For example, in May 2009, within a month of confirming evidence of the novel virus, the Centers for Disease Control and Prevention (CDC) held 21 open briefings or telebriefings on 19 separate dates.
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18. The web version of the story added that the government had paid "millions in damages" to those who developed GBS. R. Mackey, "Lessons from the Non-pandemic of 1976, "New York Times, April 30, 2009, available at (last visited June 26, 2012).
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24. The AP-GfK Poll, July 16-20, 2009, available at (last visited August 11, 2012).
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31. Interestingly, the New York Times blog on May 1 collected a variety of news reports under the heading "Blaming 'Media Hype' for Swine Flu Fears" noting that the media was fighting among itself over whether it was acting responsibly or sowing seeds of panic. R. Mackey, "Blaming 'Media Hype' for Swine Flu Fears, "New York Times, May 1, 2009, available at (last visited June 26, 2012).
32. The National Vaccine Advisory Committee Teleconference Meeting: 2009 H1N1 Influenza Outbreak and Response, DHHS, Meeting Minutes, July 27, 2009, available at (last visited August 14, 2012).
33. Centers for Disease Control and Prevention (CDC), Press Conference on Recommendations for Use of Vaccine Against Novel Influenza A (H1N1), Press Briefing Transcripts, July 29, 2009, available at (last visited August 3, 2012) (emphasis added).
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36. In a January 4, 2010 update on H1N1 developments, the New York Times identified Dr. Robinson as the "most overly optimistic" government official. It allowed him to explain that he had tried to be conservative by assuming a lower dose yield per egg than normal, but that he had not anticipated that "we had one of the poorest producing viruses in the last 50 years". This after-the-fact story likely had little impact on the public's perception of government mismanagement. Editorial, "Swine Flu (H1N1 Virus), "New York Times, available at (last visited June 26, 2012).
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47. The difference between need and demand did not go unnoticed by reporters even if they did not make the distinction in most stories. For example, at a CDC press briefing on October 1, as the first doses became publically available, ABC newsman Brian Hartman inquired "... anecdotally, it seems like every medical professional I talk to says everybody should be getting a flu shot and every regular person I talk to either in my neighborhood or my office or in my family has serious concerns and questions about that. Are you tracking that?" Similarly, an Associated Press reporter asked the CDC spokesperson, who announced that in the two days since the government opened its vaccine order system 25 states or major metropolitan areas had ordered vaccine: "Why just 25?" Centers for Disease Control and Prevention (CDC), Weekly 2009 H1N1 Flu Media Briefing, Press Briefing Transcripts, October 1, 2009, available at (last visited June 26, 2012).
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52. J. Medina, "City Parents Opting Out of Swine Flu Vaccine, "New York Times, October 28, 2009. available at (last visited August 15, 2012).
53. Admittedly, some people may have refrained from trying to get the vaccine given the reports of shortages. In general, most polls showed that about half of those asked intended to get vaccinated. See supra, note 51.
54. UPI.com, "Health News: Poll: Many Can't Get H1N1 Vaccine, " November 9, 2009, available at (last visited August 11, 2012).
55. Although the government would "look better" if it had tried to distinguish demand from need, to its credit, it appeared less interested in self-promotion if it meant highlighting the public's reluctance to take the vaccine. By challenging the demand narrative, the government would be acknowledging that public fear was tempering demand and thus, potentially undermining its message that the vaccine offered the best protection against getting sick and infecting others. Department of Health and Human Services, "Flu.gov Prevention and Vaccination, "available at (last visited August 13, 2012).
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61. The criticism was not limited to the issues associated with the government's handling of the vaccine. When the Wall Street Journal reported on the Government's promotion of effective non pharmacological disease-containing strategies, the online version of the story elicited many politically motivated comments from readers. See "Fighting Flu Without Big Gun, "available at (last visited August 1, 2012).
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90. Notably, without a requirement less than 40% of health care workers reportedly took the H1N1 vaccine. See Editorial, "They Should Know Better, "New York Times, April 13, 2010, available at (last visited August 1, 2012).
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95. The World Health Organization officially declared an end to the worldwide pandemic on August 10, 2010. The United States allowed its Public Health Emergency determination to expire on June 23, 2010. Department of Health and Human Services News Release, "WHO Declares End of 2009 H1N1 Influenza Pandemic, " August 10, 2010, available at (last visited August 17, 2012).
96. Centers for Disease Control and Prevention, "Updated CDC Estimates of 2009 H1N1 Influenza Cases, Hospitalizations in the United States, " April 2009-April 2010, available at (last visited August 7, 2012).
97. Estimating influenza deaths is not an exact science. The CDC has calculated a range estimate over 30 years beginning in the 1976-77 season of 3, 000-49, 000 people. This replaces an earlier and oft-cited estimate of 36, 000 annual deaths. See Centers for Disease Control and Prevention, "Estimating Seasonal Influenza-Associated Deaths in the United States: CDC Study Confirms Variability of Flu, " 2012, available at (last visited August 1, 2012)
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100. Providers were permitted to charge patients or their insurance companies a fee for administering the vaccine. CDC, "H1N1 vaccine administration Q & As, " October 20, 2009, available at (last visited August 17, 2012).
101. Harvard School of Public Health, "Nearly Half of Americans Believe H1N1 Outbreak Is Over, Poll Finds, " February 5, 2010, summarizing and linking to poll conducted January 20-24, 2010, available at (last visited August 14, 2012)
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