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Should we use fear in our public health messages about pandemics?

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  • Should we use fear in our public health messages about pandemics?

Should we use fear in our public health messages about pandemics?

BMJ Blogs: Dr Kieran Walsh

Influenza is a dangerous infectious disease that causes significant morbidity and mortality. Seasonal influenza can cause serious illness, and in the past pandemic influenza has caused widespread deaths. Vaccination against influenza does offer protection and so public health authorities launch annual campaigns to ensure that people get vaccinated. The public health campaigns are generally educational – they offer guidance on influenza and how to prevent it through vaccination. Often education about influenza is aimed at particularly vulnerable groups. 

One such group is migrants. Hickey et al have recently conducted a fascinating study to evaluate the knowledge of pandemic influenza among vulnerable migrant groups in Thailand. (1) They found that knowledge of influenza was low among these groups. However certain subgroups within this population had better knowledge of influenza – these included those who had participated in an influenza prevention activity or who had received health information from a healthcare worker or the media. They also found that people “who were worried about influenza had a higher level of knowledge, potentially through increased information gathering and/or attention to public health messages.” The authors pondered whether this worry could be leveraged to encourage people to find out more about influenza. But in the end, they are sceptical about this approach. The use of worry and fear in public health campaigns has been attempted in the past – but the authors are concerned that this might send the wrong message to this particular vulnerable group. Migrants are often already worried about contact with authorities and so messages that use fear may make them less likely to seek healthcare when they need it. A further complicating factor is the stigma associated with infectious diseases – which may make some people even less likely to seek help. 

Other researchers in different settings have also found threatening health messages to be ineffective. (2) There is also the risk that public health authorities might “cry wolf” about dangerous infectious diseases once too often, and that their messages might not cut through when there is a serious outbreak. Trying to scare people into knowing more about influenza or into getting the vaccine will probably not work and in some circumstances might be counterproductive. Tailored education that is based on people’ needs is far more likely to be effective. A tailored message may also be more cost effective - which could help get relevant messages out to large numbers of people at a lower cost. (3) 




1. Hickey JE, Gagnon AJ, Jitthai N. Knowledge about pandemic influenza preparedness among vulnerable migrants in Thailand. Health Promot Int. 2016 Mar;31(1):124-32.
2. Ten Hoor GA, Peters GJ, Kalagi J, de Groot L, Grootjans K, Huschens A, Köhninger C, Kölgen L, Pelssers I, Schütt T, Thomas S, Ruiter RA, Kok G. Reactions to threatening health messages. BMC Public Health. 2012 Nov 21;12:1011.
3. Maloney S, Reeves S, Rivers G, Ilic D, Foo J, Walsh K. The Prato Statement on cost and value in professional and interprofessional education. J Interprof Care. 2017 Jan;31(1):1-4.

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