Pandemic Planning's Missing Link

The Washington Post reports today that the new federal plan for handling pandemic flu "counts heavily on the public's cooperation and good sense." That's a little frightening. Not because Americans aren't capable of following directions, but because the public's idea of good sense is often quite different from that of the experts who write these plans.

Dr. Roz Lasker, a researcher at the New York Academy of Medicine, knows a few things about this. I spoke with Dr. Lasker a few weeks ago for a story on disaster preparedness in this month's issue of Governing. She recently led a yearlong study of how people might react to two kinds of terrorist attacks: a smallpox outbreak and a dirty-bomb explosion. What she found was that in both circumstances, massive numbers of citizens would likely ignore official instructions on what to do.

In the case of smallpox, emergency plans envision the public reporting to schools or clinics to get vaccinated. Lasker found that 57 percent of the public would not automatically follow that order, either because they don't trust the government, don't think smallpox is a big deal, or worry that the vaccine might make them sick.

In the dirty-bomb scenario, plans typically call for people to "shelter-in-place" because staying indoors provides protection from contaminated dust and radiation. Yet Lasker found that only 59 percent of the public would stay inside for as long as they were told to. Many would leave to pick up their kids at school or to take care of other family
members.

As Lasker sees it, the weak link in this is that the planners don't solicit much feedback from the public. Plans tend to envision how the public should respond, not how people are likely to respond in the moment. "Planning and policy making has become professionalized and technical," Lasker says. "What's missing is the experiential knowledge of regular people."

The feds' flu plan, all 396 pages of it, is surely thorough. But where the public's role is concerned, it also sounds like a Ph.D.'s view of common sense. One suggestion for riding out a pandemic is that citizens have enough food to stay at home for 10 days. Come on. I live five blocks from the White House, presumably a top terrorist target. Rationally, I know that I should have a "go" bag, a satchel with all life's necessities in it were an attack to occur. I don't. That's not because I'm stupid (though you're free to argue that if you wish). It's because I'm human.

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