"Fear of avian influenza is a double-edged sword"

from The Lancet 2005; 366:1751

“To fear the worst oft cures the worst.” So wrote William Shakespeare in his Homeric love story Troilus and Cressida. This sentiment must have been uppermost in the minds of the hundreds of officials who gathered in Geneva on Nov 7–9 as they acknowledged the risk to human health of pandemic influenza, and broached an unprecedented consensus on how best to prepare.

Urgency marked the proceedings. A gloomy assurance by WHO Director-General Lee Jong-wook that no society would be left unscathed by pandemic influenza confirmed H5N1's status as a global priority. International organisations spelled out a grim forecast of the “incalculable human misery” that could result from a pandemic, and warned of the ineffectiveness of current preparations. On controlling the disease in birds, delegates from countries struggling with outbreaks pleaded for help to finance urgent control efforts. And unaffected nations in the path of migrating birds described with resignation their ill-preparedness to fend off the approaching threat.

In a demonstration of the singular spirit of cooperation nurtured by such fears, the conference ended with promises of action...

But whereas fear has certainly helped focus international preparations for a worst-case scenario, Shakespeare's axiom is not so fitting when applied to the anxieties of individuals. So with international cooperation now bolstering preparedness plans, it is time for governments to tackle the prospect of inevitable civil unrest.

Even before a pandemic emerges, panic is a danger. .. worryingly, experience shows that widespread fear can lead to social and economic consequences as serious as the disease itself.

In Thailand and China, for example, avian influenza has already damaged poultry sales and put these countries' residents off their food. Cambodia, one of the four countries to have confirmed human infections with H5N1, says a “psychosis” has gripped its population. And there have been numerous reports of individuals in rich countries—including doctors—stocking up on the antiviral drug oseltamivir (Tamiflu) in an effort to protect themselves against future disease.

Previous experience of outbreaks suggests that these examples are minor compared with what is likely to come. Intensified anxiety at the start of a pandemic could mean that people avoid travel, fear going to hospitals, or start riots in the streets. Patients will be stigmatised, and confidence in governments will be damaged or lost. But just as there is time to complete preparedness plans, there is still time to stem public anxiety. However, this can only be done by winning the public's trust—and for many governments, trust comes in short supply...

It's not my experience that The Lancet engages in loose speculation or hyperbole... So let's all take a deep breath and go calmly and quietly to the nearest drugstore or medical supply shop and get ourselves a supply of disposable surgical masks for ...









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