The warnings are clear, from H5N1 to COVID-19, but how can a firm prepare for a new type of threat?
Outbreaks involving lower respiratory diseases provided an unpleasant wake up call in 1997, 2004-5, 2009 and 2011, and they will return in the future. Through COVID-19, they represent a profound threat that governments around the World are struggling to contain. Let us not forget pandemic influenza, which is described by US Centers for Disease Control (CDC) as a certainty. This year, the World Health Organisation (WHO) predicts between 290–650,000 deaths through influenza globally (2019 circa 400,000 deaths). Combine all of these lower repository infections together and they add up to 3 million deaths a year (2016 data, see WHO Top Ten Causes of Death).
Together COVID-19 and influenza are a double cause for concern particularly for the elderly. And yet, public reaction to them has been very different. The new virus, with attendant concerns about its control and treatment, sensational media reporting and graphical images of lockdowns have all led to greater public anxiety. Past experiences with SARS, avian flu, and swine flu may provide some perspective and familiarity to moderate feelings of dread or even helplessness.
As with all risks, there is a perception and reality, and both must be taken seriously. How comparable influenza and COVID-19 will be in terms of number of infections and mortality rate is unknown at this time. Given the preventative measures in place, it is likely that infections and mortality rates can be controlled given the unprecedented efforts being made by governments to limit the spread. We will not have influenza type numbers.
There are many different angles this insight piece could take and the risk perception angle is one, particularly the initial reaction to a new, disturbing threat, which is not fully understood. The concerns about modes of transmission and available treatments have certainly amplified the public’s perception of COVID-19 risk. That being said, it is also interesting to observe the return to a ‘new’ normal. An “adjustment reaction” by publics to emotions and processes of cognition. The advice to public from WHO was helpful in this regard. “Wash hands frequently.” This simple act of self-efficacy provides all you need to know about limiting transmission. When people have something to do to protect themselves a great deal of the initial feelings of danger and “worst-case” scenarios can be averted. In many situations of pending danger this is the case—a single rule works best. Walking slowly to the exit in the case of fire has saved more lives than any complicated escape plan.
This adjustment reaction is important in many areas of risk, particularly when warnings are given on labels and signs. Over time, these warnings have little or no meaning. Keep trying to warn people and you get a case of what I call “Cry Wolf Syndrome.” It’s a sort of fatigue, particularly for risks that are well known and under our control. Warnings on food, gas pumps, in parks and other pretty benign places. The initial reaction wanes as the repeated interaction/exposure change the public’s perception and ultimately behaviour.
This leads me to the focus of this insight piece, preparing for an outbreak or pandemic from a business perspective. The “Cry Wolf Syndrome” also comes into play here. Is it realistic to expect firms to have sensing and response capabilities continually prepared for a pandemic? Some writers advocated such in 2006 post-SARS and now again in the midst of COVID-19.
I think the simple answer is “yes” and consists of elements of organisational design and simple principles that any firm can put in place.
The unfortunate reality of course is that most firms will not have any plans whatsoever in place, since risk mitigation is often last on the list of priorities. Even firms with catastrophic potential have been shown to have little effective mitigation or response plans. In the case of a pandemic, the warning signs are there, the “prodromes” are glaring with regard to new diseases originating in animal hosts. If the previous and on-going outbreak weren’t sign enough, then the warnings of UN Food & Agriculture Organisation (FAO) in 2013 should be now ringing in our ears:
“Seventy percent of the new diseases that have emerged in humans over recent decades are of animal origin and, in part, directly related to the human quest for more animal-sourced food.”World Livestock Report (2013)
Population growth, agricultural expansion, and the rise of globe-spanning food supply chains have dramatically altered how diseases emerge, jump species boundaries, and spread.
At the launch of the publication in Rome:
“The ongoing expansion of agricultural lands into wild areas, coupled with a worldwide boom in livestock production, means that “livestock and wildlife are more in contact with each other, and we ourselves are more in contact with animals than ever before. What this means is that we cannot deal with human health, animal health, and ecosystem health in isolation from each other – we have to look at them together, and address the drivers of disease emergence, persistence and spread, rather than simply fighting back against diseases after they emerge.”Ren Wang, FAO Assistant Director-General for Agriculture and Consumer Protection.
FAO’s 2013 report provided a number of compelling reasons for taking disease emergence as a priority threat. Developing countries face a burden of human, zoonotic and livestock diseases, it says, creating a major impediment to development and food safety. Recurrent epidemics in livestock affect food security, livelihoods, and national and local economies in poor and rich countries alike. Meanwhile, food safety hazards and antibiotic resistance are on the increase worldwide.
Globalisation and climate change are redistributing pathogens, vectors, and hosts, and pandemic risks to humans caused by pathogens of animal origin present a major concern.
Such warnings are real, and erring on the alarming side is justified in this case. The entire area of pandemic zoonoses is a realistic potential hazard that requires people’s attention, they need to be motivated to take some action.
The Cry Wolf element is still valid in the broader context of society’s disposition towards ‘risk’ because we are faced with so many warnings that we struggle to know which one to act upon. From the organisational perspective, we cannot prepare for each in the detail many planners want. When a predicted disaster fails to materialise, the those that “Cried Wolf” are vilified and lose some of their credibility, and thus some of their ability to arouse public concern the next time. If a threat emerges and the consequences are exaggerated, a similar backlash can ensue. This happened to WHO when it talked about the mild 2009–10 swine flu pandemic as if it were moderate or severe. In Europe, WHO was widely accused of hyping a “fake pandemic” in order to enrich Big Pharma.
In the face of mounting evidence it makes sense to do something within an organisation to prepare for the next outbreak or pandemic. Basic questions like:
- How to we preserve the integrity of our supply chains?
- How do we respond if one component goes down or maybe two?
- What about the redundancy of our computer systems?
- How can we coordinate our response and be adaptive in the face of the uncertain and unpredictable?
Preparing for the novel, complex, uncertain, serious threat has proven exceptionally difficult. Even national disaster and disease control agencies have been brought to their knees by what US CDC calls, “Critical incidents.” These are scenarios defined by:
- General novelty of threat. The risk may not have been realised in this form before;
- Poor (initial) understanding of actual causes, causative organisms or means of transmission and hence avoidance;
- Dynamic nature—a risk that changes and evolves, perhaps warranting different information and prevention strategies later in the crisis;
- Threats that are severe in magnitude, with the potential to be life-threatening;
- Uncertainties about causes, actions, who is responsible or who to seek information from, how uncertainty can and should be communicated;
- Restricted response times;
- Need for coordinated, multi-agency/stakeholder actions.
COVID-19 checks all the boxes of a critical incident and in reality, it is likely that only a few national response systems or disease control agencies globally could respond according to WHO guidelines developed post-SARS in 2005. US CDC, via its Crisis and Emergency Risk Communication (CERC) Framework is one, and its experiences post-9/11 were a wake up call to the organisation, particular CDC’s response to the anthrax episode.
Returning to the firm, what steps can be taken from the organisational standpoint? A combination of preparations, sensing and organisational design. Organisations that are networked, with distributed leadership, adaptive and able to deal with uncertainty are far better placed to deal with crisis. Such qualities are a challenge to hierarchical organisations in Asia that are averse to uncertainty and often guided by strict policies and procedures. For preparedness, CDC has developed guidelines for businesses that are useful and can provide impetus for action.
Ultimately, the firm needs an overarching approach to risk, a risk policy embedded within the organisation that deals not just with global pandemics but other threats that will be realised from time to time.