THROW OUT THE PLAYBOOK: A NEW PLAN ARRIVES
Sherri Tenpenny, DO
Every winter, it is reported that millions of people in the world get the flu. Coworkers and classmates are home, sick and miserable, for about a week. A few � mostly the elderly and infirm � die. We�re told the annual death toll exceeds 36,000 in the United States and a few hundred thousand around the globe. This computer-generated number has gaping holes in its credibility, however, because medical authorities don't separate and verify those who actually died of influenza from those who died of a "flu-like illness� or of flu-complications, such as pneumonia. 
As a general rule, people think of the flu season as a nuisance. Even major controversies � like last year�s contaminated vaccine supply that cut the number of doses by 50 percent � barely made a blip on the radar screen. For a few weeks, the media hyped the shortages with images of people standing in line to be vaccinated. But by January, a vaccine shortage turned into a vaccine glut. Authorities abandoned the rationing and started to urge everyone once again to get in line. After all that hoopla, we ended up with a very mild flu season.
In addition, the CDC (Centers for Disease Control and Prevention) has a media plan in place. Referred to as a �Seven-Step Recipe for Generating Interest in, and Demand for, Flu (or any other) Vaccination,� it was engineered to ensure the economic success of the season�s flu vaccine campaign. The program is designed to methodically manipulate the general public through the use of major media (newswires, television). The scheduled, fear-based messages are aimed at convincing the unsuspecting public that not only is the flu shot necessary, but people should be demanding it. This results in millions of dollars of free advertising for vaccine manufacturers. 
The �recipe� is ramping up all over again with the approach of fall: The annual flu vaccine push is about to begin. �Make a plan, then work the plan,� comes to mind. But the plan may be wearing thin. The general public has come to understand that the flu isn�t a catastrophic illness. Like the sparrows to Capistrano, it arrives at about the same time every year. Most people are showing the same ho-hum attitude to the frenzied reports of the avian flu virus, H5N1, also referred to as �bird flu.�
Predictably, officials don�t like it one bit. They are finding it difficult to get people really worried about avian influenza no matter how many articles of �catastrophic concern� they have published. But this time, they need to walk a tight line. They saw the economic consequences caused by �epidemic hype� in 2003, when the world was focused on the SARS (severe acute respiratory syndrome) outbreak.
The SARS virus was thought to spread from humans after infected animals were sold and slaughtered in unsanitary and crowded markets in China's Guangdong province. Over a period of five months, 8,049 people were reported to be infected by what turned out to be a novel human coronavirus. The vast majority of those (7,248) were in China, Hong Kong and Taiwan. Even though there were 774 deaths, or close to 10 percent of known cases, SARS didn�t become �the new pandemic,� killing millions as feared. 
The SARS experience, however, taught officials a critically important lesson about overestimating the staying power of an infection. The economic impact on the Asia-Pacific region of the six-month SARS outbreak was nearly $40 billion.
In Canada, 251 people were infected and 43 died.  The Canadian Tourism Board estimated that the epidemic cost the nation's economy $419 million. The Ontario health minister estimated that the cost to the province's health-care system, including money spent on special SARS clinics and supplies to protect healthcare workers, was about $763 million. That�s more than $1.18 billion spent on one disease during one season in just one country.
The SARS outbreak also had a substantial impact on the global airline industry. Flights to Asia and the Pacific Rim decreased by 45 percent and the number of flights between Hong Kong and the United States fell 69 percent. 
Undeniably, there is a genuine downside to issuing warnings that turn out to be unnecessary hype. Unfortunately, the way that the H5N1 avian flu infection is being handled is starting to inflict a similar economic impact. Since 2003, more than 160 million domestic ducks, chickens and geese have been killed in eight countries. The cost to various local economies is already estimated in the tens of millions. And based on information freely available on the Internet, bird flu is predicted to cause the �Great Global Depression,� 40 percent of the world�s population to be infected, an unimaginable number of deaths and, in Western civilization, �the end of life, as we know it.� , 
But, if the apocalypse is coming, the general public does not seem overly concerned. The old playbook isn�t working this time. No one seems to be paying much attention to the scenarios being portrayed by the CDC and the World Health Organization (WHO). Officials need a new plan.
Enter risk communication.
The field of risk communication is relatively new. Dating from the early 1980s, it evolved from several different fields of study: health education, public relations, psychology, risk perception and risk assessment. The CDC needed a new plan to get people to take bird flu seriously and to move government health officials to earmark massive amounts of money for the planning process.
Here�s the �new and improved� version of the �Seven-Step Recipe� for the flu shot:
Step 1: Start where your audience is
Fair enough. For most educational processes, this is a good place to begin. Officials are advised to start with empathy. Instead of �berating� people for their lack of concern about bird flu, make �common cause with the public� � and then talk about how �horrific the next flu pandemic may be compared with the annual flu.� Don�t tell them the answer; lead them to the conclusion.
Step 2: Don�t be afraid to frighten people
That�s right, the new plan advocates the use of fear. �Fear appeals have had a bad press, but the research evidence that they work is overwhelming�. We can't scare people enough about H5N1. WHO has been trying for over a year, with evermore-dramatic appeals to the media, the public and member states.�
This is the reason the �same old recipe� isn�t working: fear is an over-played card. At every turn is a doomsday message about something coming from the CDC and the WHO. The �Chicken Little� approach has played itself out, even though the press and the government seem to push that same button over and over again.
Step 3: Acknowledge uncertainty
Uncertainty is the name of the game � and it is the very uncertainty of this infection that feeds the fear. The plan encourages officials to admit, �There is so much that we don�t know about H5N1.�
In spite of encouraging uncertainty, there has been a noticeable change in the language surrounding the arrival of the pandemic from �if the pandemic comes� to �when the pandemic arrives.� I suspect we may see more of this �certainty� once the new pandemic vaccine becomes available worldwide.
Step 4: Share dilemmas
In crisis communication, the goal of dilemma sharing is �to humanize the organization� making the decision, �reducing the outrage if you turn out to be wrong.� In addition, this practice will let the public think that it is helping to make decisions, leading to �better buy-in� of the decisions being made.
I wonder if the farmers in Vietnam, China and Thailand are feeling any sense of �dilemma sharing� when their birds � infected or not � are confiscated by the government and killed, leading to a complete loss of income and food production for their families?
Step 5: Give people something to do
In January 2005, Canadian infectious diseases expert Richard Schabas told The Wall Street Journal, "Scaring people about avian influenza accomplishes nothing because we're not asking people to do anything about it." The authors of the new playbook recommend that we start planning how to handle catastrophic business disruptions. They even suggest �cognitive and emotional rehearsal � learning about H5N1 and thinking about what a pandemic might be like and how you�d cope.�
Nearly every religious tradition and many researchers, including Depak Chopra, Larry Dossey and Wayne Dyer, have given us a clear message: �You get what you think about.� Could global cognitive and emotional rehearsals make the situation worse? Perhaps we should visualize, instead, a safe, clean healthy world, free of viral illnesses for all, humans, birds and animals.
Step 6: Be willing to speculate � responsibly
Step 7: Don�t get caught in the numbers game
Step 8: Stress magnitude more than probability
Step 9: Guide the adjustment reaction
All four of these steps serve to accentuate Step 2: Don�t be afraid to frighten people. Get people revved up and worried. Get them motivated to fear that the pandemic is coming. Stockpile drugs, frantically push for vaccines, store water and food. We didn�t see a disaster at the millennium, but one is just around the corner. At any minute. Soon. We�re due.
Step 10: Inform the public early and aim for total candor and transparency
The American government has collaborated with its many agencies to hide so many things from its citizens � from vaccine cover-ups about thimerosal to Vioxx � that it has lost all sense of trustworthiness. Do government officials still have the ability to be �transparent�?
Now that we have seen the new playbook, start watching for the rhetoric. The bird flu vaccine to �protect� the public from the H5N1 virus is more than a year away from release. Nonetheless, watch for the 2005/06 �normal� flu season to be the launching pad for a new form of information sharing called �risk communication.� See the plays unfold, paving the way for the arrival of a new �bird flu� shot. A global mass vaccination program plan is about to unfold.
First published on RedFlagsDaily.com on September 12, 2005
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Sherri J. Tenpenny, D.O. is the President and Medical Director of OsteoMed II, a clinic located in the Cleveland area that provides conventional, alternative, and preventive medicine. OsteoMed II's staff of three osteopathic physicians, two acupuncturists and a 10-member support team focuses on four specialized areas: allergy elimination; treating acute and chronic pain problems; all areas of woman's health; and the treatment of vaccine injured children.
Dr. Tenpenny has lectured at Cleveland State University and Case Western Reserve Medical School on topics related to alternative health. Nationally, she is a regular guest on many different radio and television talk shows, including "Your Health" aired on the Family Network. She has published articles in magazines, newspapers and internet sites, including, Redflagsdaily.com, Mercola.com and Mothering.com. She has presented at the National Vaccine Information Center's annual meeting and at several international conferences on autism.
Dr. Tenpenny is respected as one of the country's most knowledgeable and outspoken physicians regarding the impact of vaccines on health. As a member of the prestigious National Speaker's Association, Dr. Tenpenny is an outspoken advocate for free choice in healthcare, including the right to refuse vaccination. As an internationally known speaker, she is highly sought after for her ability to present scientifically sound information regarding vaccination hazard and warnings that are rarely portrayed by conventional medicine. Most importantly, she offers hope through her unique treatments offered at OsteoMed II for those who have been vaccine-injured.
Dr. Tenpenny is a graduate of the University of Toledo in Toledo, Ohio. She received her medical training at Kirksville College of Osteopathic Medicine in Kirksville, Missouri. Dr. Tenpenny is Board Certified in Emergency Medicine and Osteopathic Manipulative Medicine. Prior to her career in alternative medicine, Dr. Tenpenny served as Director of the Emergency Department at Blanchard Valley Regional Hospital Center in Findlay, Ohio, from 1987 to 1995. In 1994, she and a partner opened OsteoMed, a medical practice in Findlay limited to the specialty of osteopathic manipulative medicine. In 1996, Dr. Tenpenny moved to Strongsville, Ohio, and founded OsteoMed II, expanding her practice and her vision of combining the best of conventional and alternative medicine.
Predictably, officials don�t like it one bit. They are finding it difficult to get people really worried about avian influenza no matter how many articles of �catastrophic concern� they have published.