Framing risk in pandemic influenza policy and control

Abstract

This article explores differing understandings of ‘risk’ in relation to pandemic influenza policy and control. After a preliminary overview of methodological and practical problems in risk analysis, ways in which risk was framed and managed in three historical cases were examined. The interdependence between scientific empiricism and political decision-making led to the mismanagement of the 1976 swine influenza scare in the USA. The 2004 H5N1 avian influenza outbreak in Thailand, on the other hand, was undermined by questions of national economic interest and concerns over global health security. Finally, the recent global emergency of pandemic influenza H1N1 in 2009 demonstrated the difficulties of risk management under a context of pre-established perceptions about the characteristics and inevitability of a pandemic. Following the analysis of these cases, a conceptual framework is presented to illustrate ways in which changing relationships between risk assessment, risk perception and risk management can result in differing policy strategies.

Keywords:

• risk
• risk assessment
• risk management
• risk perception
• pandemic influenza policy

Acknowledgements

The authors are grateful for the London School of Hygiene and Tropical Medicine (LSHTM) School Trust Funds sponsorship.

Notes

1. In this study, we take the word ‘frame’ to mean how public health policies are determined by its actors, context, content, decision-making processes and the interrelations among these factors (Walt and Gilson 1994).

2. Examples of grey literature include technical reports and articles from governments and international organisations, and working papers from research groups.

3. A quantitative presentation of the literature reviewed, such as a systematic meta-analysis, could have been useful if the research involved a numerical synthesis of statistical risk estimates. However, for the purpose of this research, which involves the development of a conceptual abstraction on risk based on the concept and practice of risk in pandemic influenza policy, quantitative analysis is inadequate and inappropriate in capturing the rich conceptual explanations on risk. A qualitative analysis, on the other hand, aids the reviewer in elucidating and contextualising the concept of risk (Patton 2002, Green and Thorogood 2004) with inference to recurring themes (Cooper 1982) based on the information reviewed.

4. Reliability, applicability and parsimony were considered in the design of the conceptual framework. Reliability involves the use of multiple sources to cross-reference evidence (Patton 2002), such as the consultation of a variety of sources in the decision to include specific components in the conceptual framework. Applicability refers to how widely the conceptual framework can be generalised, and this leads to the development of a framework based on broad but applicable factors. Parsimony involves limiting the components essential for the framework on risk such that the number of components in the framework is kept sufficiently small.