Less than a month ago, we published a piece suggesting that H5N1 bird flu could pose an even thornier health communications challenge than COVID-19. We offered a three-point prescription for how the U.S. government agencies most responsible for overseeing the response to this public health challenge — FDA, CDC, and the U.S. Department of Agriculture (USDA) — might collaborate to speak about H5N1 with one voice, be transparent about how and when they would address the issue, and balance the paradoxical challenge of allaying fears while providing a realistic assessment of the risk to human health.
But the underlying truth of this situation is that even with the best of communications plans and perfect interagency cooperation, the only real certainty about this situation is its uncertainty. This means our federal agencies must communicate what they don’t know as clearly as what they do know. And they need to invest in working with communications scientists to achieve a better understanding of how people process and understand scientific uncertainty, especially in light of a possible human outbreak.
The Current H5N1 Situation
On May 10, HHS Secretary Xavier Becerra and USDA Secretary Tom Vilsack jointly announced nearly $200 million worth of new initiatives to address bird flu. Yet, in the weeks since, uncertainty surrounding the situation has only increased and things are not going too smoothly on the ground.
For one, farmers and farm state political leaders have resisted what they see as federal encroachment, and dairy farmers have rejected the offer of personal protective equipment even if the government is footing the bill for it. On May 22, as resistance to control efforts rose, we learned of a second reported case of bird flu in a dairy worker in Michigan. When they announced this “second” case of H5N1, the CDC continued to reassure Americans that their health risk remained low. Shortly afterwards, news surfaced that H5N1 had been detected in beef from the meat of a sickened dairy cow, which thankfully was not allowed to enter the food supply. And just last week, reports showed that a third human case had been detected.
The increasing number of H5N1 cases in humans, coupled with news that agricultural authorities in Iowa are sacrificing 4 million potentially bird flu-infected chickens and that HHS is moving forward with production of 4.8 million doses of H5N1 vaccine for pandemic preparedness, should all raise red flags. It certainly concerns those of us who specialize in health communications.
An Uncoordinated Response
New funding notwithstanding, the CDC, FDA, and USDA have not succeeded in coordinating their response, much less their communication goals, either with each other or with state and local health departments.
For example, CDC agents rushed to get involved at the local farm level, while farmers pushed back on a response they thought should have been local, or at least driven by the USDA. Even though CDC and USDA insist they are working “hand in glove,” many dairy farmers have been resistant.
Another issue stems from the fact that USDA and FDA sometimes have turf battles due to their overlapping jurisdictions but different missions. While USDA both regulates and promotes agriculture, FDA regulates food to protect human health. This turf battle becomes evident when Scott Gottlieb, MD, a former FDA commissioner, says things like: “I think [USDA] should be doing more [with regard to the H5N1 outbreak].” Public displays of interagency warfare undoubtedly reduce public confidence in the government’s response to an outbreak.
At the same time, there is still so much we don’t know, like whether the virus could be transmitted through ingestion (as would happen with consumption of tainted milk or beef, particularly if not pasteurized or cooked to a proper temperature). We don’t know much about what symptoms this version of the virus is likely to cause in humans, how virulent it is, or, most importantly, how widespread it is. Sure, there have been three reported cases, but is that really the whole story?
We remain in the dark, and recent reports of H5N1 human outbreaks in southeast Asia should disquiet us further.
Taking Lessons From COVID
As the COVID pandemic slowed down, many of us touted transparent communication about medical and health-related uncertainty as a possible panacea for growing distrust of public health and medicine. But if we are honest with ourselves, we don’t really know exactly how we should be communicating about uncertainty.
Right now, we have no idea if H5N1 will become a truly serious threat to human health requiring significant interventions, including potential mass culling of cattle. What is clear, however, is that the CDC — the agency that should be taking the lead on communicating risk to the public — needs to state bluntly: “We will not hesitate to share what we know with the public and coordinate what federal law tasks us to do: disease control and prevention.”
It is also worth pointing out that good health communication should be based on good health communication research. In this context, health communicators are not comforted by the Fall 2023 decision of the NIH to “pause” (which ultimately meant cancel) what would have become its first dedicated health communication science and practice research program. The Biden administration should reconsider this unfortunate decision. We need to invest real money in health communication research and evaluation now, with an emphasis on testing strategies that build bridges and help people make appropriate health decisions based on information that is inevitably in flux.
Even if the present H5N1 outbreak is not a harbinger of the next pandemic, we need to make a conscious effort to communicate about it more efficiently and effectively. If we wait until we truly are on the cusp of a new pandemic, it will be too late.
Sara Gorman, PhD, MPH, is CEO of Critica and author of the forthcoming book, The Anatomy of Deception: Conspiracy Theories, Distrust, and Public Health in America. Kenneth H. Rabin, PhD, MA, is a senior scholar at the City University of New York Graduate School of Public Health and Health Policy, and a co-author of Informing the People: A Public Affairs Handbook. Scott C. Ratzan, MD, MPA, MA, is the founding editor of the Journal of Health Communication, distinguished lecturer at CUNY Graduate School of Public Health and Health Policy, and author of Mad Cow Crisis: Health and the Public Good. Gorman, Rabin, and Ratzan are all founding members of the Council for Quality Health Communication.
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