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Laurie Garrett DR. INGLESBY: Our last speaker this morning is Laurie Garrett, also well known to many of you. She is the only writer ever to have been awarded the three big Ps of journalism -- the Peabody, the Polk, and the Pulitzer. She studied biology as an undergraduate at Santa Cruz, and then as a graduate student at U.C. Berkeley. Began her media career on radio, and then produced documentaries which began to win many awards. She quickly moved on to NPR, where she also won numerous awards. Has been at Newsday for more than a decade, interrupted briefly for a stint at the Harvard School of Public Health, and she has written a number of books on infectious disease and public health, including her most recent book "Betrayal of Trust: The Collapse of Global Public Health." Her talk is entitled "Understanding Media's Response to Epidemics." MS. GARRETT: Well, I would say -- I would do the trick of saying stand up and stretch, but then we'd really be in a mess, and we're so far over at this point. So, instead, I'll just try to be really fast. And I think I wanted to say thanks to Tom and Tara for bringing me here, but I don't know if I should say thanks, because I think I have the thankless task of this entire meeting -- meaning defending the media. (Laughter.) MS. GARRETT: And I think, first, what makes that hard is what you folks seem to think the media is. Let me provide a few quotes from the last 24 hours. (Laughter.) MS. GARRETT: Jerry Hauer said, "The whole issue of dealing with the media when it comes to bioterrorism is something that has really been ignored. The media is either going to be an ally in getting information out or a foe in increasing panic." George Poste, "Dealing with the issue of how media responds to imposition of quarantine barely merits consideration." (Laughter.) MS. GARRETT: CSIS, the Center for Strategic and International Studies, released a report just about a month ago called "Contagion and Conflict," and in it they say -- and I think this is something you should all think about very carefully. They are speaking in the international context, but I think it would apply to any locality. "Good information is the foundation of good policy, and addressing problems at the intersection of health and security must include efforts toward bolstering both the quality of and the transmission mechanisms for health-related information that may have security implications." Amy Smithson spoke to you yesterday, and she wrote a report that I had hoped was actually going to be the subject of her talk because it's something I hope all of you get a chance to read, "Ataxia." But there are a couple of quotes I need to lift from that report. She said, "Promptly establishing a perimeter is important to hold the number of victims to a minimum and enable rescuers to do their jobs without undue interference. News crews monitor the emergency communications frequencies and could quickly get to the scene, sometimes even before key response squads. "Continuous live television broadcasts of the Murrah Building in Oklahoma City began 12 minutes after the April 1995 bombing. Some reporters would view such a disaster as a career-making story, and might be willing to do practically anything to obtain spectacular images or insider interviews for live reports. "The media's behavior could jeopardize their own health and also impede rescue operations in the early moments critical to victims' survival. Citizens who believe that family members or friends could be victims would also have to be kept at a safe distance." Also, in the report she states, "A well-coordinated media game plan will be essential to reassure the public and attempt to manage the crisis. Even with careful media relations, public health and emergency response officials anticipate a widespread panic of the kind inspired by Orson Welles' 1938 War of the Worlds radio broadcast, except much, much worse." Marcie Layton told us, in commenting on the West Nile Virus outbreak, that, in fact, on balance most of media coverage had not been bad in New York. She did say that, "There were some attempts to politicize the outbreak by the media." Martin Hugh Jones told us regarding PROMED that much of PROMED's information actually comes from the media. And when they have done an accuracy test, they found that 1.7 percent of the official reports from governments were retracted, and 2.6 percent of news accounts proved incorrect. That implies that more than 97 percent were, in fact, correct. He also said, "If you get it out first, you are then in charge of that news stream. If journalists get it out first, you're not." Dr. Rodier told us that 25 percent of the information that reaches WHO in a timely fashion comes from government sources and field laboratories. The remainder of timely information comes from the media. And he said, "I think it's almost impossible to beat the media." So, what's the bottom line here? Well, from the point of view of public health, it seems your bottom line is that the media is either an enemy or a troublesome fool that needs to be coddled into dispersing helpful information against its better wisdom. It also seems that, from your perspective, media relations are at the bottom of your list. It seems to be the last thing you give serious consideration to in your planning. And as you noted, it was not really part of the Top Off report. It's not been part of most of the exercises I have viewed that any of you have staged. It's also interesting that, as a group, public health practitioners and national security people think very, very differently about media when they speak in international terms versus domestic. In international terms, you think media is very good. You think they are part of transparency. You think that they promote democracy and that the presence of a strong media means you may be working in a country or with a country that will be more cooperative and interested in the needs of the general public. But, domestically, you see media as pests, liars, sensationalizers. So Dr. Glass gave us some very interesting comments. I want to comment them 100 percent. I don't know how many of you have quite this track record, but I have personally been in the middle of several epidemics, in the middle of three major earthquakes, in the middle of one major volcanic eruption, a victim of the largest fire in the history of New York City. And I will attest to, yes, there is an eerie calm. And I will also attest to, in most cases I have observed, media response has actually been excellent. I was personally on the air live on a radio station in northern California when a large earthquake hit, and the epicenter was almost directly under the radio station. We went on the air and for three straight hours we said over and over and over again, "Remain calm. This is Richter scale whatever." We kept calling the scientific station to get the latest Richter scale numbers. "Do not call 911." We said that every five minutes minimally, "Do not call 911." We said, "If you're okay, go outside immediately and check on your neighbors. Check on everybody in your family. Help your neighbors." And we said, "If any part of your home or structure appears weakened by this earthquake, go outside and find an open area with no large structures or trees nearby and remain there with an AM radio or a transistor radio listening for further messages. Hopefully, at some point government officials will tell us that it's safe to return to our structures." We then called government officials, every imaginable government office, for three straight hours, never getting anyone to agree to give us information, to go on the air, or to provide any consolation to our listeners. News today is a 24-hour cycle. You all know that, and you all know that it has increased pressure on everyone, regardless of what your occupation may be, to respond or interact with media in some way. Information points now compete against each other. So it's not about media competing against each other; it's about actual points of information competing. We are all here today competing with Bush versus Gore in Florida, and every single news event and news cycle is competing against that as the dominant data point of our time. That will always be true. And, indeed, we currently have an ebola epidemic underway in East Africa getting almost no attention, particularly when compared to the level of attention Kikwit, Zaire, in '95, received. What's the difference? Competing data points. Competing information points. It is occurring at a time when the international attention, not just of media but of the public generally, is focused elsewhere. Most real journalists care very deeply about their jobs. I'm not going to defend the scoundrels, and there are scoundrels in every profession. But most of us actually think accuracy is the most important thing. To be told that we've made a mistake in accuracy is like having a physician be told they left a scalpel inside the patient. It is of vital importance to us that we have accurate information. We try our best. We also have families. And just as health care workers and health care providers are likely to be thinking about their own children and their own families in a crisis, so are we. And that is likely to also affect how we feel about the information we disseminate. In a crisis, media will also be thinking, am I going to unduly panic my own children? The school teachers that are taking care of them right now? I find it grossly unfair to characterize journalists as award hungry, prestige hungry monsters, any more so than the scientists I have met who think of nothing but winning a Nobel Prize. And I think every profession has its scoundrels, its greedy, and its headline-grabbing jerks, but I don't think ours is particularly worse than many of yours. We are ruled, however, and there's been a fundamental change that many of you have not perhaps taken note of. We are now ruled by corporate masters. It was not long ago, in the early days of my career, when almost all newspapers in this country were family-owned, when most radio networks were very small and were owned by, again, small family companies, when ABC, NBC, CBS were all owned by ABC Company, CBS Company. Every single media organization to speak of has been swallowed up by corporate monsters, and we now have been swallowed, and then that one swallowed, and that one swallowed, to the point where I'm now through -- my newspaper is now in its, what, quaternary stage of being swallowed by the ever bigger fish. What that means is now our media information is publicly traded on the New York Stock Exchange and NASDAQ. And the pressures on all of our bosses are enormous. Newspapers traditionally in the United States turn a two to three percent annual profit. We are now being commanded to turn profits in excess of 15 percent annually; in some cases, more than 20 percent. It's almost impossible to do without sacrificing absolutely everything that news is supposed to be about. The same is true in broadcasting. They've trimmed and cut. I know all of you complain about what managed care has done to the trimming, cutting, and downsizing of the health care industry. The exact same is true in the media industry as well. And now we're competing against a new media that is a frontier, lawless zone, that is largely self-regulated and does not try to meet the same standards as we, and that's the internet. And that is now the 24-hour cycle, which is most observed by people under 30 years of age. In fact, the average young adult in this country no longer reads a newspaper. Surveys show they see no reason to subscribe to them, nor do they watch ABC, NBC, and CBS, which they consider old fogy news. Indeed, ABC, CBS, and NBC, as you will note, now have hemorrhoid ads more than almost anything else, and that's because -- (Laughter.) MS. GARRETT: -- their viewers demographically are over 65 years of age. Overseas, my colleagues face a different set of challenges, particularly in the kinds of countries that you folks are all most concerned about as likely perpetrators of bioweapons use. I was just a couple of nights ago at the annual honors banquet of the Committee to Protect Journalists, at which each year we select a handful of extraordinary reporters and editors from around the world who have stood up to jails, to imprisonment, to beatings, and to threats, in order to manage to tell the truth. In some cases, they have not survived, and we honor them posthumously. This year, Kofi Annan and Ambassador Holbrooke both attended, with a very strong presence from United Nations contingent -- I think a strong recognition that, in the absence of a free press, you cannot possibly have appropriate communications and any hope of a democracy. So let's start by respecting one another. Let's begin by having no self-fulfilling prophecies. If you assume we will be evil-doers, probably we will. If you assume that we have a real profession with real standards that we try to meet, and you appeal to that level of professionalism, it's likely that that will be the plane on which we will work together.
And don't be fools. If panic occurs, it will not be of media's making. If I could have the first slide, please. I don't know. Yes, okay. I don't know if you can read this, and if it can be focused. I can't see it at all from here. But I think a little reminder is in order. I went through for my new book "Betrayal of Trust," and I went through the historical records of outbreaks in New York City, before the understanding of germ theory. And so this is starting when it was New Amsterdam and up through being New York City, through the colonial period and post Civil War. And the key thing to look at is the percentage killed. Now, you don't have to say the word "media" to imagine massive panic if you wake up one morning and realize that eight percent of the population of your city died in the last two months of yellow fever or of smallpox. And, indeed, most of these epidemics that took these huge tolls were quite short and took place during the summer months because New York City was built on a swampy area with no fresh flushing water supply of any kind, and was prone to both outbreaks of malaria and yellow fever. I also don't think it's going to take any amount of media attention to have public panic respond from quarantine efforts. As soon as quarantine signs go up, or any indication of isolation and quarantine, many, many people will indeed respond negatively. And it's not going to be because media made them respond negatively; it's going to be because Americans have very strong feelings about commanding other citizens to be sequestered. And because the mere notion that we, as a social grouping, have decided that we need to sequester a certain membership amongst us signals a higher level of threat and cause for concern. As has been mentioned, in 1947, we did have a small pox concern in New York City, and at that time New York City managed in less than 30 days to vaccinate more than six million people, and that included rapid manufacture of additional supplementary vaccine supplies done by the New York City Department of Health itself. There was no mass level or even minor level of objection to the effort. The media wholly collaborated; and, in fact, the editorial boards of all of the major newspapers in New York sat down and met with the Commissioner of Health and mapped out strategies for convincing the populous to voluntarily undergo what became a very smooth mass vaccination campaign. Of course, there was a time when all of you, and anyone in public health, garnered a great deal more respect and was seen a bit more heroically than you are today. And we could spend a lot of time talking about why that change has occurred, but that's another story. You would find actually, if you looked back into the records of 1960s, 1970s, there was a time when many elements of the media acted like cheerleaders for public health; really, waving the banner, seeing you as great crusaders. But I think that as soon as we face a situation where the public sees an image like this, this is a child with small pox -- when members of the public simply see the image, it's not going to be about any commentary media makes, but the mere fact that the photo is presented, the video is presented. It's hard to imagine that there won't be a panic response. When I show this slide to undergraduates, usually I hear a loud outcry from the audience. Oooh, oh my God, oooh. Just seeing the picture as a hypothetical, historical photograph of small pox is enough to get most of young people quite freaked out. If it were a contemporaneous photograph of someone in their community, and this went either on television or as a still photo in the newspaper, I guarantee you there would be panic, and it wouldn't be because the media made the panic, but rather the media told the community what was going on and showed it to them. Now, I don't know if you can all see this, but let's step into the present for a moment and look at some real causes for concern and how the public and media are responding to them. Amy Smithson did give us an important talk yesterday on the other subject that she has written about extensively; namely, what's going on in the former Soviet Union countries with the sort of post Bio Preparat Era. And a great deal of this has now been publicized. The public, at least if they paid attention, they have the information. They know about this massive biological warfare program. Some of them may have seen our images in Newsday or other news organizations' images of what actually transpired, and they may know that small pox was being made and that very horrible viruses are stored at this site and could conceivably be in the hands of terrorists or be loosed upon them in their community at some later date from what actually now looks like a pretty primitive facility out there in Siberia. Have they responded inappropriately? Has there been panic? No. If anything, it has assisted all of you in gaining attention in Washington. When plague broke out in Surrat, India, in 1994, there was a terrible set of reactions, horrible, and I want to quickly run them down. I know time is short, but I think it's important because I've heard some misstatements.
I was in the middle of this epidemic, and I witnessed it, so I would like to correct the record. First of all, what happened in that community is that every single private physician and pharmacist fled town. They just locked up the hospitals. They literally threw patients out of hospitals, private hospitals, and left town. When the public realized that all of the doctors were fleeing, they said, "Something terrible must be going on here," and an exodus began. Then, a federal government official in the Ministry of Health in Delhi misinformed the BBC, saying there was a mystery virus loose in Surrat. The BBC, which is the voice of God in India, went on the air and said, "There is a mystery fever in Surrat." Mass panic; 400,000 people fled the city. What was left behind were extraordinarily acute antibiotic shortages. They ran out of tetracycline very shortly. The pharmacists had split town and locked up their supplies, and so they couldn't even have the alternative of getting into local supplies. However, panic did not cause people to break down the doors, as most of your scenarios show, raid the pharmacies, and steal supplies. There was no lawlessness. This did not occur. All care was handled by a tiny staff in the government hospital. They were thoroughly exhausted and personally terrified. When I reached there, many of them were wearing three masks at once and could barely breathe, but they were so frightened and so exhausted, and had worked around the clock for days on end. There was little control of family members who milled about the hospitals at will. Most of the neighborhood that was -- that the patients came from, the Ved District, was the poorest part of the city, and it was the place with the highest concentration of plague. And these were the people unable to be part of the exodus and flee because they had no money.
Finally, the laboratory capacity was virtually null set. They did observe the classic safety pin structure through their light microscope but had inability to do much else. I don't have time to say any of the rest of my remarks. It appears that we have to cut at this moment. So rather than go through the ebola epidemic, lessons there, and the West Nile epidemic, lessons there, and future slides, let me just make my key summary points. If you assume the media are jerks, we will be. That was the assumption made in the ebola epidemic in 1995. Fist fights did break out between scientists and media. Some of the media did truly misbehave themselves, and some of the scientists did truly misbehave themselves. In contrast, lesson learned -- WHO now has a field media officer on-site in Uganda during that epidemic. There have been no problems to date associated with inaccurate reporting or conflicts between media and public health officials in that area. Second point. News is now a grinding job with high profit expectations. Reporters will do well if you offer help and assistance. If you build it, they will come. If you have a valid information source that is readily available and easy to get to, with openness and facilitation, it will be utilized. And they will not go for scurrilous facts elsewhere. Three, if somebody releases a small anthrax say mini-event, targeting a particular office or family, and a few people get sick, it's very doubtful to me that you will see any panic or any hyperinflated media response. You may see a lot of anger -- anger directed at the mystery person who carried this out, anger directed at any inadequacies seen in law enforcement and public health response. Number four, if a large release occurs, there will be panic -- make no mistake about it -- but it won't be media that created it. Number five, ameliorating panic is the same as showing that you are in charge, that you have a game plan, that you are in control, that you know what you're doing, that you're providing regular streams of up-to-date, valid information. And more important, perhaps the most important thing, the longer things drag out -- and I think this is a key difference between what Dr. Glass and Dr. Osterholm were presenting -- if you're looking at a very short-term level of concern, both from the media and the public, I do think a relative calm sets in. But over the long haul, as a problem continues, as it seems to be unresolved, then you will start having the accusatory fingers pointed at you, and the demands for answers, and public anger. Number six, media are people. They will be just as worried as you. They will be just as panicked about their families as you. Number seven, don't tar the whole industry with a Matt Drudge brush or a National Enquirer brush. As Martin Hugh Jones told you, nearly 98 percent of the media outbreak reports to PROMED have proven to be accurate. And, finally, public health is a trust. That's all it is. It's a trust between government and the public it's supposed to serve. The media can be that bridge, keeping that trust intact. Or you can ignore that media, or make assumptions about that media, and that bridge will not be there for you. Thank you.
(Applause.)
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