Dupras and Williams-Jones Respond

In his letter, Card argues that “it is not the word ‘pandemic’ that needs improvement, but rather our plans and our communication about what the word means—and doesn’t.” We totally agree with and support this statement. We did not aim to critique the formal definition of the word “pandemic.” Instead, we argued that improving communication should not only mean spreading the true definition of technical medical words, but also the recognition that definitions of risk and assessment of what risks are acceptable vary greatly across peoples and contexts. Thus, we argued for a bidirectional transparency—that is, paying greater attention to public perception—to improve risk communication between the experts and the lay public. Building on Doshi’s article,1 Card suggests that the word “pandemic” has never been (formally) associated with levels of severity, and thus “a pandemic is simply an epidemic writ large.” Although this may be (formally) correct, it is also only half true because it does not account for the kind of risk perception engendered by the World Health Organization (WHO) 2009 declaration of a Phase 6 pandemic, which was aimed at both the lay public and the medical community. To say that “pandemicity and severity are separate constructs” ignores the clear variability in risk perception. It also promotes a utopian view of formal definitions that unreasonably minimizes the impact that changing the description of the characteristics of a pandemic (by the WHO on their official Web site in Spring 2009)2 might have had on the development of the influenza A (H1N1) crisis. Severity was implicit in the use of the word “pandemic” by public health authorities. Ignoring this reality—combined with risk amplification by the media—resulted in a worldwide panic that might have been prevented with a more cautious communication of the facts of the case, including open discussions of the scientific uncertainty associated with H1N1 incidence and severity. Now, if “a pandemic is simply an epidemic writ large,” why does the WHO still include in its description of the characteristics of an influenza pandemic the criteria “against which the human population has no immunity”?1 Is this not in fact an aspect of severity?

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