The problem facing South Korean Health Minister Moon Hyung-pyo was painfully obvious and played out during his May 31 press conference in Seoul regarding MERS CoV.
As MERS CoV cases continued to climb and fear of the disease threatened to envelop the nation, the Minister explained that the key to managing the threat would be in preventing new infections. The Minister made a direct plea: “In order to do this, we need cooperation from all health care workers and citizens”.
But the questions from the media and others focused on which health facilities were implicated; Ministry officials had previously explained that established protocols prevented identifying the affected facilities in order to avoid social stigmatization and undue financial loss.
The stunning inconsistency in message: on the one hand calling for everyone to pull together to manage the risk, and on the other, concealing the very information which would help them do so, had the predictable impact producing frustration, rumours and accusations of cover-up. As it struggled to maintain trust through the outbreak, the Government had not just dropped the ball, but — one fears — they may have dropped it off a cliff.
The criticism of South Korean officials was justified at one level, but let’s be clear, the stigma dilemma is hardly theirs alone.
Stigma is real. The kind of anti-social, mean-spirited and more often counter-productive behaviour associated with Ebola in Western Africa and the United States, is only the most recent and intense example of stigma during high risk events. It’s endemic in situations serious enough to produce real fear.
But at the same time, if the situation is serious enough, the key to its management lies in achieving the risk management ideal — everyone working together towards a common goal. But that comes with one crucial condition: open sharing of information – what is known, what is unknown, and on what basis decisions are being made. This kind of real time transparency is the key to a sense of response ownership, coordination and positive behavioural change.
So authorities have a duty to try and avoid threat related stigma through information disclosure, but they also have a response imperative to ensure open and transparent communication. The dilemma, which takes priority? Like so many aspects of the practical challenge of communicating risk, it depends.
It depends on the assessed level of risk, it depends on the assessed level of risk perception, but ultimately it depends on the adaptive skills of organization leaders, knowing when the transparency imperative supersedes the threat of stigma. When the need to protect the many overrides the need to protect the few. No mean feat.
When the social, economic and political stakes are high and circumstances rapidly evolving, these decision points can be incredibly challenging. One simple preparedness step is to adopt a basic risk communication algorithm to help guide decision-making groups.
In the event of high risk or high risk perception scenario, in deciding whether or not to release a given piece of information, decision makers should ask themselves:
1. Is the information needed to allow people to protect themselves?
If the answer is yes, that information must be released.
If the answer is no, then ask:
2. Is the information needed to maintain trust, for example, explaining the basis for decision making?
If the answer is yes, that information should be released.
If the answer is no, then ask:
3. Is there a compelling reason – such as potential stigmatization or to maintain the integrity of a criminal investigation — to withhold this information?
If the answer is yes, then there may be justification for withholding the information, but if at any point circumstances change, ensuring people can protect themselves and maintaining trust has to take priority.
In the world of emergency and other high risk event preparedness, dominated by a culture searching for ways to minimize indecision, “it depends” doesn’t offer much. But if success in managing the stigma dilemma ultimately rests on the judgement of risk communication decision makers, adopting a basic risk communication algorithm doesn’t provide the right risk communication answers, but at least forces a consideration of the right risk communication questions.