In this article, Sandman and Lanard analyse communication strategies for encouraging public resilience when H5N1 avian influenza in birds arrives; for helping people understand that bird outbreaks closer to home do not mean that an actual future pandemic is closer; and for reducing the duration and degree of the near-inevitable drop in poultry consumption.

The authors acknowledge that food security and small farmer livelihoods in developing countries are far more serious bird flu problems than the drop in poultry consumption in developed countries. They reserve this challenge for a future article, and focus this one on bird flu communication aimed at poultry consumers.

They argue: "Effective communication about a possible future (human) flu pandemic is greatly damaged by its entanglement with communication about what is already happening to millions of birds and a tiny number of very unlucky humans. It will be extremely difficult to do a good job of telling people what kind of 'bird flu' we really need to worry about more until communicators start doing a better job of telling people what kind of bird flu most of us probably don’t need to worry about at all."

The authors write that there are "two fundamental errors that bird flu communicators keep making":

• "The first error is to confuse avian influenza (the bird disease we face already) with pandemic influenza (the human disease we may face soon ... or years from now). This starts as linguistic confusion, but it leads inexorably to confusion about facts and logic as well."
• "The second error is to talk to poultry consumers about the tiny but non-zero human risk of catching avian influenza in ways that are over-reassuring, unempathic, insulting, and in some cases simply dishonest."

With respect to the first error, the article argues that the language being used is a source of confusion when communicating to the public. For example, the term 'bird flu' is often used to describe both the current avian strain of the virus and the potential future human strain. This leads many people to be unduly afraid of birds and poultry, and insufficiently concerned about a pandemic as long as local poultry are healthy.

The authors therefore propose that experts, officials, and journalists should confine their use of "epidemic" and "pandemic" to human disease, and should stop using the confusing and misleading terms "bird flu pandemic" and "avian influenza pandemic". While the authors acknowledge that this is probably a lost cause, they strongly urge officials and journalists to accept the blame for having confused the public, instead of blaming the public for being confused.

The article offers three communication lessons for countries in which no H5N1-positive birds have been found yet.

• Don’t lean too heavily on being H5N1-free so far. Anything said to be true “because” no local birds have been found with H5N1 will seem untrue after a local bird is found with H5N1. Communicators should base their arguments for the safety of poultry consumption on facts that won’t turn on them the first time they find an H5N1-positive bird.
• Explicitly distinguish bird flu from pandemic flu. The authors write: "One crucial key to persuading people that eating chicken isn't terribly dangerous is to explain to them what experts think is terribly dangerous - the possibility that somewhere in the world H5N1 will mutate or reassort so that it can spread easily from human to human. Every time we tell people that bird flu (in birds) isn't a big deal, we need to tell them that pandemic flu (in humans) is. And every time we tell people that pandemic flu is a big deal, we need to tell them that bird flu isn't" [in public health terms].
• When talking about bird flu in birds (as opposed to human pandemic flu), distinguish explicitly where the risk is higher and where it is lower.

The authors propose that communication about bird flu in poultry should take into account the way normal people absorb shocking or scary news. The public inevitably goes through a period of adjustment to a new perceived threat, they explain. Communicators should respectfully and empathically help the public get through this "adjustment reaction." So far, most communicators just convey factual information, and many are even overtly contemptuous of the public - accusing people of hysteria, panic, and over-reactions.

The first local H5N1-positive bird can be viewed as a teachable moment - a chance to discuss the risk of a potentially catastrophic future pandemic, compared with the near-zero risk of eating chicken even in areas with poultry outbreaks of bird flu. In order to make the adjustment reaction shorter and milder, communicators can:

• Validate (or at least respectfully acknowledge) the adjustment reaction instead of ridiculing it.
• Work hard to avoid over-reassuring or misleading people - which can damage public trust.
• Explain why an outbreak in birds will present almost no risk to consumers.
• Tell people how to reduce the risk from poultry, while acknowledging that even many experts and officials don't always cook their chickens properly.
• Distinguish bird flu (the "Right Now" problem) from pandemic flu (the "Some Day" problem).

The authors explain that good risk communication can make the adjustment reaction shorter and milder - and help to reduce (but not prevent) negative impacts on the poultry industry. This involves not merely educating the public about facts, but also taking into account the anxieties being experienced, and the various stages of the adjustment reaction.