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Accurate information about the spread of avian influenza — and the wide dissemination of that information — is essential if the spreading pandemic is to be contained. Journalists have an important role to play in ensuring that both goals are achieved.

Journalists — including science journalists — are frequently criticized for exaggerating the significance of the stories they cover. The pressures to do so are significant, ranging from a desire to catch a news editor's eye, to competition for readers. And even where a journalist strives to avoid charges of sensationalism, the damage can be done by an overzealous subeditor or headline writer.

But there are times when an important message needs to be communicated, and a certain amount of both stridency and alarm can be justified. Such is the case with bird flu — also known as avian influenza.

Here the danger is the reverse. The name of the disease sounds relatively benign. After all, for many people, influenza is an inconvenient but short-lived disease. Flu pandemics tend to be talked about as events of the past, or events that have occurred in other, usually distant, countries.

The danger is that such attitudes could undermine the urgency of tackling what a growing number of epidemiologists and public health experts are already saying could be the first global epidemic of the 21st century, with the potential of leading to the deaths of millions of people across the world.

Broad consequences

In such situations, journalists have a double responsibility, and a careful balancing act to achieve between them.

On the one hand, it is important to report accurately — and without exaggeration — on the nature of the disease, the extent of its spread within the bird population of East — and more recently Central — Asia, the small but growing number of associated human deaths, and the possible mechanisms by which the H5N1 virus could mutate into a form that is highly infectious to humans.

At the same time, the same journalists have a responsibility to communicate — equally accurately — on the potential significance of the disease in terms of public health, and the broader social and economic consequences of a global pandemic.

Such reporting needs to be based on informed knowledge about the different scenarios that could occur. The more optimistic scenarios are those in which the spread of the virus is contained geographically and is closely monitored, and the disease fails to make a significant impact on human populations (for example, if a human version of the virus turns out to be relatively benign).

The pessimistic scenarios are much more bleak. Under these, which are being taken increasingly seriously by medical experts in the World Health Organization and elsewhere, the virus could become as infectious and deadly to humans as it is to birds.

Where outbreaks are rapidly detected and the appropriate action is taken — for example, by giving anti-flu drugs to all those in an affected area — they are likely to be containable (see Bird flu pandemic 'could be avoided if —'). But if action is too slow, or containment efforts fail — an increasingly likely event in an age of international air travel — the consequences could be disastrous.

The lessons of risk communication

Public health officials face a dilemma. One the one hand, they must scare people enough to ensure that adequate preventative measures (such as stockpiling drugs) are taken.

But they must avoid overkill, which runs the risk not only of prompting inappropriate action — such as shutting down entire transportation networks — but also of generating a backlash, and thus complacency, if the predicted catastrophe fails to occur.

The increasing familiarity of this dilemma has spawned a new field: risk communication. And bird flu, for many of the reasons outlined above, has presented those engaged in the practice of risk communication with one of their biggest challenges.

To meet these challenges, two leading Australian risk communication experts, Peter Sandman and Jody Lanard, have recent produced a tip list on "how to sound the alarm" (see Bird flu: communicating the risk, below). Some of their recommendations are primarily about how health officials should interact directly with the public.

These include the advice to acknowledge uncertainty (essential if public trust is to be maintained), to avoid getting bogged down in disputes over precise numbers — while stressing the magnitude rather than probability of risks — and to help people adjust their lives and perceptions to the new risk.

Other recommendations relate more directly to relations with the media. In particular, they urge public health officials to inform the public early, and aim for total candour and transparency. The authors point out that these are two of the hardest recommendations for governments to adopt, given concerns that range from damaging the economy to looking incompetent. But the price of informing the public late, of covering up or minimising the problem, is high: diminished credibility, just when you need it most."

Responsibilities of journalists

Sandman and Lanard's recommendations could be useful to science and health journalists. Indeed, part of their role is to act as professional risk communicators: they have a responsibility to report as accurately as possible both on the underlying science, and on its various implications.

Like other risk communicators, journalists have a responsibility to avoid excessive alarmism. As has previously been argued in this column, there are a number of current topics on the international agenda — such as the growing use of genetically-modified crops — where the appropriate caution is not always exercised.

Conversely, where experts in a field are able to point to substantial evidence that a major threat is building up, but may not be getting the attention that it requires, then ringing the alarm may be the order of the day. Examples range from warnings about the environmental impact of the heavy use of chemicals in agriculture, to, more recently, worries about the effects of global warming.

Bird flu fits squarely into the second category. Like chemical pesticides and global warming, there is already enough scientific evidence to justify action. And there is also sufficient evidence to be confident that any failure fully to communicate the nature of the threat to the public could jeopardise efforts to contain it.

Experience with the AIDS epidemic in Africa already points the way forward. Countries, such as Uganda and Senegal, which have been most open not only about the disease itself but also its transmission mechanisms and effective ways of controlling them are those that have been the most successful in suffering its consequences.

Hopefully bird flu will not become as great a public health challenge. Openness, transparency and effective communication about the disease are key to ensuring it does not. Public authorities need to lead the way; but journalists, too, have an important role to play.

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