A pandemic of human fear and anxiety

Is a flu pandemic looming and if so should we worry? It is now 41 years since we experienced the last pandemic of flu and many think that we are overdue for the next one. But have we over-reacted to the present outbreak of swine flu?

Like Bird Flu it would seem that we are faced by not one pandemic but two. The first is an epidemiological one comprised of cases and a few deaths from a relatively mild flu virus. The second is a rapidly emerging pandemic of human fear and anxiety, largely orchestrated by the World Health Organisation (WHO), governments and the media, and one which threatens to overwhelm the epidemiological pandemic.

Certainly we are faced by a new flu virus that seems to be very contagious between people, particularly teenagers and young adults, and one that is spreading quickly around the globe. We are also in the southern hemisphere about to enter our winter flu season and given that this virus is still evolving and moving we do not really know what it might do. But did we really need to construct this all pervading environment of fear and panic?

Have we learnt nothing from our over-reaction to SARS and Bird Flu when the media's reaction totally swamped the epidemiological realities of two relatively small but significant epidemics among wildlife and transformed them into the Black Death of the 21st century?

Perhaps a certain amount of fear is useful, forcing people to consider precautionary behaviour and adopt personal avoidance strategies, but the line between what is 'reasonable' fear and something which produces widespread fear, anxiety and panic is a very blurred one and frequently over-stepped by the media.

While it is not in the media's brief to enquire into the impact that their stories have on people, there seems little doubt that the media plays a defining role in how we see swine flu. While some media stories aid awareness and place such issues on our agenda, the temptation to sensationalise through emotional headlines, images and language is often irresistible.

We saw it with SARS and Bird Flu and in many respects we are seeing it repeated with swine flu. But what are the epidemiological realities of this flu outbreak?

So far the disease has spread to 53 countries producing a little over 15,500 cases and approximately 100 deaths. Up to this point 91 per cent of all cases have been in Mexico, the USA and Canada, and 98 per cent of all deaths in Mexico and the US.

Elsewhere the virus has been fairly mild and responded well to antiviral treatment. In a globalised interconnected world where millions cross international borders by air everyday, many perhaps incubating respiratory viruses, why are we surprised by the rapid diffusion of swine flu?

One of my major criticisms of Australia's reaction to any anticipated pandemic is that there appears to be little understanding of the production and communicability of fear and how fear might be understood and 'managed' during the pre- and actual pandemic period.

To a large extent this stems from the different ways in which experts and ordinary people see risk and exposure. To experts, risk and exposure are quantifiable dimensions simply arrived at by comparing those exposed to a particular threat with those not exposed.

But to ordinary people, risk and exposure are emotional, intuitive, socially constructed things, very much influenced by the way we construct our view of our world, as well as by the reaction and opinions expressed by people around us, and by our reaction to media influences and government pronouncements.

There seems little doubt that most people harbour deep-seated fears about contagion and infection which are a mix of rational and irrational fears, and that while government pronouncements and media stories play an important role in informing and advising us, they may often play on our fears and ignite hysteria.

When we are consistently told that we are faced by an extraordinary viral threat that may strike down 25 per cent of the population, that people will be quarantined in their homes and should consider stockpiling food and antivirals, that 10 million doses of vaccine will be produced but that it may take three months, and confronted by headlines like "Killer Flu is Running Wild", rationality is very quickly thrown out the window and replaced by emotion.

Further, when we are told that there is no magic cure, confidence in medical science and the government rapidly evaporates. It would also seem that most people are highly sceptical about government claims that it will protect them if a pandemic crisis does emerge. In consequence they fall back on their own resources and place self and family first.

No one disputes that governments should not follow a policy of active caution and plan for a possible pandemic, but we need to be convinced that we haven't over-reacted, that authorities understand how people see such threats, and how government policies may impact on their lives. Critically, we also need to know more about the communicability of fear and how ordinary people react to pandemic threats both real and constructed.

One of the great ironies of 21st century life is that we seem to be more moved by the tempest than the gentle rain and what might be, rather than what is.

Swine flu is important, but where is the widespread public interest in the dengue epidemic in North Queensland that has so far produced more than 1,200 cases, or the thousands of whooping cough cases in NSW?

Peter Curson is professor of population and security at the Centre for International Security Studies, University of Sydney, and emeritus professor of medical geography at Macquarie University, Sydney.

Contact: Professor Peter Curson