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Manuale del Dr. Marc van Ranst in 15 punti per creare e gestire una psico-pandemia, vi ricorda nulla?
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Manuale del Dr. Marc van Ranst in 15 punti per creare e gestire una psico-pandemia, vi ricorda nulla?
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00:07Grazie a tutti, grazie per l'invitation.
00:10I was asked to tell you about my experiences
00:12being the crisis manager, the flu commissioner
00:15for Belgium, and highlighting
00:17the communication aspects there.
00:20These are some of my conflicts of interest
00:22over the past 20 years, I guess.
00:26It all started for me at that time,
00:28well, actually in 2006 when I was appointed,
00:30this is an unpaid hobby, so it's not a profession
00:33or a function, whatever, it's really a hobby,
00:36that flu commissioner thing.
00:39On April 24, 2009, that was when WHO said,
00:45okay, there will be a pandemic,
00:46and that's when the thing started.
00:48And then you have one opportunity to do it right.
00:51I mean, day one is so important.
00:54In day one, you start your communication
00:56with the press, with the people,
00:58and you have to do it right.
01:01I mean, you have to go for one voice, one message.
01:03In Belgium, they chose to appoint
01:06a non-politician to do that.
01:08I mean, I have no party affiliations,
01:11and that makes things a little bit,
01:12at that time at least, a little bit easier,
01:14because you're not attacked politically.
01:17Majority, minority, that doesn't come into play,
01:20and that was a huge advantage.
01:22The second advantage is that you can play in Brussels
01:25the complete naive guy and get a lot more done
01:28than you would otherwise be able to do.
01:30So one voice, one message,
01:32that's the tone that you set on day one,
01:34and you have to be very transparent in that.
01:39My name is the Interministerial Commissary
01:41for Pandemic Influenza Preparedness Planning.
01:43That, of course, is too long.
01:45That became the flu commissary,
01:46and that was a lot easier.
01:49You have to be omnipresent that first day or the first days
01:52so that you attract the media attention.
01:55You make an agreement with them
01:57that you will tell them all,
01:58and if they call, you will pick up the phone.
02:00When you do that, then you can profit from these early days
02:03to get complete carpet coverage of the field,
02:07and they're not going to search for alternative voices there.
02:11And if you do that, that makes things a lot easier.
02:14And then you convey the message,
02:16and you can do that if you do it that way,
02:17that our country is ready for a pandemic.
02:20That is a gross overestimation for sure,
02:24but it is crucial to go into that pandemic.
02:31First of all, what's in the name?
02:33If you talk about the pandemic, it's quite important.
02:35People are talking about the swine flu,
02:37the pandemic H1N1, 0-9 virus,
02:40novel influenza, 2009 AH1N1 flu.
02:44At some point, it was called the North American influenza,
02:46the novel flu virus.
02:48That was way too difficult,
02:49so we called it the Mexican flu.
02:51That got me into huge trouble
02:53with the ambassador of Mexico at that time,
02:57and she was furious.
02:59Afterwards, we became good friends.
03:01I still get invited to their New Year's reception every year.
03:05But people were making fun of it,
03:06and okay, that's probably unavoidable,
03:09but the fact to have a clear and recognizable name
03:12which was easy for the lay public to understand and use
03:16was actually quite important.
03:18It also worked.
03:19This is the word of the year of 2009.
03:22Defriending on Facebook became number one.
03:25To my big disappointment,
03:27Mexican flu was second,
03:28and flu commissary was number six.
03:30So the term works,
03:32and that makes things a lot easier.
03:34These first weeks,
03:36that's easy street.
03:37When you have no opposition,
03:39and everybody needs news,
03:41and they can come to you for news,
03:43you can bring quite a lot of neutral information,
03:46and it is picked up,
03:48and it is,
03:50well, the news is brought the way you bring it,
03:53and that is,
03:53you can only do that
03:54in the first couple of weeks or months.
03:57One of the problems that we have,
03:59or that we had,
04:00is that we did not have a media budget.
04:02That was really zero euros that we could spend.
04:05That means that you have to use every opportunity.
04:08You can get to,
04:10well, it's not Britannia rules the waves,
04:12but rule the airwaves
04:13to bring out your message,
04:17and that's something that you can do for free
04:19on radio, on TV.
04:21If you have good pre-existing relationships with the media,
04:25you can try something else.
04:26We tried the following thing.
04:28We asked all of the anchors
04:29of the different TV stations,
04:32are you willing for free
04:34to participate in a sort of infomercial
04:38that you would pay for, all of you?
04:41And they said, yes, we'll do that.
04:43And that was hugely influential,
04:45and, well, we would never be able,
04:47nobody would ever be able to pay
04:49for something like this.
04:50But if you have pretty good
04:51pre-existing relationships with them,
04:54then you can ask for a return favor,
04:57and they will, or they might do that.
04:59One of the things that we tried,
05:01but it's 10 years ago,
05:03was using Facebook and Twitter,
05:05but, well, there were not enough people
05:07on Facebook and Twitter at that time
05:08to really have an impact.
05:10If we would do that now,
05:11that would be a prime channel to communicate.
05:13However, that works both ways.
05:16I mean, also the fake news
05:18would be transmitted much more readily
05:20through Facebook, through Twitter,
05:22than it did 10 years ago.
05:26Answering the question of the day,
05:28no matter what the journalist's question is,
05:32is quite important.
05:33So we had a call center
05:34which was gradually becoming
05:36more and more populated,
05:37and every, almost hour to hour,
05:41and later day to day,
05:43you have to get an idea
05:44what are the questions
05:45that the people are asking.
05:47And every day,
05:48these questions were delivered
05:49multiple times
05:50so that I could work them in
05:52into the interviews,
05:53no matter what the question was.
05:55The first questions,
05:56that was the first peak,
05:58and that peak was about 900 calls
06:00per day at the moment,
06:03per week at the first peak.
06:06The first questions were travel-related.
06:09Can I still go to Mexico?
06:11I have planned a vacation.
06:13Can I get my money back?
06:14If you solve that problem
06:15by declaring an emergency,
06:16you help quite a lot of people,
06:18and that first peak goes away.
06:23And then you have to predict the future.
06:25That's hard because the future
06:26has not happened yet.
06:27Predicting the past is a lot easier,
06:29but you have to predict the future
06:31in order to prepare the public
06:34and not have an over-and-over exaggeration
06:38or an exaggeration of the information
06:40in the press.
06:41So I said, okay,
06:42Belgium, small country,
06:43we will also have H1N1 cases.
06:46When you bring that,
06:47it is front-page news.
06:48When then, a couple of days later,
06:50the first H1N1 case arrives in the country,
06:54it is the second time
06:55that they have to bring that news,
06:56so they bring it in a more muted
06:58and, I think, appropriate way,
06:59but you can only do that
07:01when you prepare the scene for that.
07:04That was the second wave of questions.
07:07People were asking more questions
07:08about what do I do when I get sick
07:10and so on,
07:11and that gives you the opportunity
07:12to work with that.
07:14And then you have to say,
07:15okay, well,
07:16we will have H1N1 deaths.
07:19Of course, that would be unavoidable.
07:21I used there Sir Donaldson's quote
07:23where he said that in the UK,
07:26by the peak of the epidemic,
07:2740 people would die per day
07:30at the end of the summer.
07:32So 62 at that time,
07:34million people in the UK,
07:3540 deaths a day.
07:36I worked that out for Belgium.
07:37That would be seven deaths a day
07:39at the peak of the epidemic.
07:40I used that in the media.
07:42Seven Belgian flu deaths per day
07:45at the peak of the epidemic
07:46would be realistic.
07:48That is true in every year,
07:50even interpandemically.
07:52That is very, very conservative.
07:54However, talking about fatalities
07:56is important
07:57because when you say that,
07:58people say, wow,
07:59what do you mean?
07:59People die because of influenza?
08:02And that was a necessary step
08:03to take.
08:05And then, of course,
08:06a couple of days later,
08:07you had the first H1N1 death
08:09in the country,
08:10and the scene was set
08:12and it was already talked about.
08:13That was the third peak
08:15of questions where that were,
08:18well, the first death,
08:19it had an impact
08:19and you have to deal with that.
08:22I went to the first couple of funerals.
08:24You have to be very quiet,
08:25sit in the back,
08:26but it shows that you care
08:29and I think that was,
08:30at that time,
08:31quite important.
08:32So, all in all,
08:34at that time,
08:34the overall feeling
08:35in the population,
08:36in the press,
08:37was the Belgian approach
08:38is reasonable.
08:40In fact,
08:40we wanted to be calm,
08:41cool, and collected
08:42and our mantra was,
08:44and that was from day one
08:45at this moment,
08:46it is comparable,
08:48more or less,
08:49to seasonal influenza
08:50in terms of outcome,
08:52but we have to prepare
08:53for severe scenarios.
08:55Like in 1918,
08:56the first wave
08:57was rather mild
08:58and you could not predict
08:59that the second wave
09:00would carry high mortality.
09:03We focused on low-cost,
09:05basic hygiene measures.
09:06We did not do
09:07any school closures.
09:08We used antivirals
09:10for high-risk groups.
09:11Actually,
09:12we used antivirals
09:13in the beginning
09:13for people who were ill.
09:15I had pre-positioned cars
09:17in the different provinces
09:18and they would drive
09:19antivirals to patients
09:20when they would be
09:21diagnosed by influenza
09:23in order to delay
09:24the onset of the epidemic
09:26and that worked
09:26until the end
09:28of the school year.
09:30We only purchased
09:32one dose of vaccine
09:33per person
09:33and the vaccination plan
09:36would be to vaccinate
09:37more or less
09:38the same high-risk groups
09:39as for seasonal influenza.
09:42And then the vacation came
09:44and that is communication-wise
09:46a very dangerous period.
09:48It's a dangerous period
09:49because the more untrained
09:51journalists are at the helm
09:53and you get
09:54the weirdest questions.
09:56They're understaffed
09:57so more articles
09:58from other countries
09:59will come in
10:00and contaminate your message
10:01and that was a weird period.
10:05That was a picture
10:06that my father took
10:07from the holiday
10:08with the grandchildren
10:09and I was not the most social guy
10:15I must admit
10:17and my son was born
10:18two weeks before
10:20the pandemic struck
10:21so that was not good timing.
10:23And then comes the time
10:24inevitably
10:25that they're going
10:27to talk about you.
10:28The flu commissioner
10:28is really a great guy
10:30and then you get
10:31the feel-good articles
10:33about what does he like
10:36and what music does he like,
10:37pictures from my first laboratory
10:39when I was 13 years old.
10:42And it's all feel-good
10:43but when they do that
10:45they also sharpen the axes
10:47at the same time.
10:49and then your personal life
10:54becomes a little bit compromised
10:56and so then they come
10:58to your home
10:59and you have to really limit that
11:00because if you do not limit that
11:02then you have no life.
11:05And then everything is said
11:07about the pandemic,
11:09about you,
11:10and then they search for controversy.
11:13At a certain point in time
11:14I had a controversy
11:15about the payment
11:17of the physicians
11:17for the mass vaccination
11:19that would happen
11:20in a couple of months
11:21or a couple of weeks later
11:24and the quote that I gave them
11:26in terms of how much money
11:27they would receive
11:27that was far too low
11:28and I had to be fired.
11:30You can solve that quite easily.
11:32I said,
11:33okay,
11:33you want me to be fired.
11:35I would like to win the lottery.
11:36The odds of both
11:37of these things are happening
11:38are fairly slim
11:40and that passed.
11:42and then you come
11:43to the phase
11:45where they're going
11:45to be much more critical
11:46and the first one was
11:47the government
11:48does not do enough.
11:49The H1N1 vaccine
11:51will arrive too late
11:52and there will not be
11:53enough vaccine.
11:54Get it while you can.
11:55That was the first
12:00really atmosphere
12:00that was created.
12:02So not enough vaccine.
12:04Get it while you can.
12:05So at that point
12:05I had to say,
12:06okay,
12:07I will be the last one
12:08to be vaccinated.
12:09I mean,
12:09you can all go in before me.
12:11I'll be the last one
12:13and later on
12:17I regretted that message.
12:20That vaccination campaign
12:22got a huge number of questions.
12:25That was actually
12:25the crux of the campaign
12:28was the vaccination campaign
12:30and many people
12:31had questions there.
12:33So you had to show them
12:34that you had to,
12:35I mean,
12:35the stockpiles,
12:36you had to walk there
12:37and walk in the rooms
12:39where you could show them
12:41that we have the vaccines
12:42and there they are
12:43already in the country.
12:45A lot of reassurance
12:48was necessary there.
12:49And then you had to pick
12:50who is going to be vaccinated first.
12:54And then,
12:54well,
12:54women and children first,
12:55whatever.
12:56I mean,
12:56risk groups,
12:57they were important.
12:58and then I misused
13:00the fact that
13:01the top football soccer clubs
13:04in Belgium
13:06inappropriately
13:06and against all agreements
13:09vaccinated their,
13:11they made their soccer players
13:12priority people.
13:14So I said,
13:14I can use that
13:15because if the population
13:17really believes
13:18that this vaccine
13:19is so desirable
13:20that even the soccer players
13:22would be dishonest
13:23to get their vaccine,
13:24I said,
13:26okay,
13:26I can play with that.
13:27So I made a big fuss about this.
13:29This is Van Rans
13:29that is raving mad.
13:33But it worked.
13:35And actually,
13:36these vaccination campaigns
13:37by the GPs
13:38went really,
13:39really well
13:40in a number of weeks.
13:41Everybody could be vaccinated.
13:43That's still
13:44a fairly relevant portion
13:46of the pandemic.
13:47Well,
13:47it worked fine in Flanders.
13:50So,
13:50you know,
13:51Belgium,
13:51it's a complicated country.
13:52and this is
13:54the vaccination coverage.
13:56And you could see
13:57Flanders did really well.
14:00I did as many interviews
14:02in French
14:03than in Dutch.
14:04However,
14:05in the Flemish part
14:07of the country,
14:08we listened to
14:08the Flemish media.
14:10In the French-speaking
14:11part of the country,
14:12they equally often listen
14:14to the,
14:14or watch
14:15the French television
14:16where all kind
14:18of other messages
14:19were coming across
14:20and that was
14:20really polluting
14:22the vaccination campaign in.
14:25And then,
14:26of course,
14:26people say,
14:27okay,
14:27the vaccine is unsafe
14:28and then you get
14:29the swine flu hoax
14:31and the vaccine
14:32could kill you,
14:33say no to the vaccine,
14:35that atmosphere starts.
14:36And then after the crisis,
14:37everybody becomes smart.
14:39And you have to accept
14:41that from the get-go.
14:43And then the overall statement
14:44was,
14:45no,
14:45well,
14:45the government
14:45did too much,
14:46of course,
14:47because the number
14:49of deaths
14:49were disappointing
14:50to some people
14:51and then all the books
14:52are written
14:53and everybody
14:54uses all the data
14:56and forgets that
14:56you had to take
14:57the decisions
14:57based on a fragment
14:59of the data
15:00that were available
15:02or that would be
15:03available later on.
15:04And then it was
15:05turned into a scam.
15:06People were really
15:07making money out of it
15:08and I think
15:09the Council of Europe
15:11played a very bad role
15:13in this.
15:14This is Wolfgang Wodarg
15:15and I want to shame him
15:17actually
15:18because he
15:18in the Council of Europe
15:20had a motion
15:21for a recommendation,
15:22faked pandemics,
15:23a threat for health.
15:24They basically said
15:24that all these
15:26virologists,
15:26vaccinologists,
15:28they all have money
15:28in their pockets.
15:29They're dishonest people.
15:31That's easy to say.
15:32This is when you Google
15:33for H1N1.
15:35Of course,
15:35there was a peak
15:35in October and November.
15:37You didn't hear
15:38Wodarg at that time.
15:39When you Google Wodarg,
15:40you see that
15:41it starts nicely
15:42after the end
15:42of the pandemic.
15:43People become very brave
15:45at the end
15:46of the pandemic.
15:46I think that's not good.
15:48Then as time goes by,
15:50I still have
15:51one minute and 51 seconds,
15:53I would like to
15:54actually issue a warning.
15:56This all started
15:57in April 2009.
16:00Many years have passed.
16:01In fact,
16:023,560 days today,
16:05508 weeks
16:06and almost 10 years
16:07have passed.
16:08That has an impact
16:09because people are forgetting
16:11about the pandemics
16:12a little bit.
16:13This is when you look
16:14for influenza
16:15and pandemic
16:15in PubMed.
16:16Until 2003,
16:182004,
16:19there wasn't much.
16:20Then H5N1 came
16:21and some interest
16:22was raised.
16:23Then the 2009 pandemic
16:25arrived
16:26and there was a lot
16:26of interest
16:27and that is what
16:28happened since.
16:29So the interest
16:30is scientifically
16:31is going down.
16:33Also,
16:34the leadership
16:34is changing.
16:35And this was
16:36a good exercise
16:37for a big pandemic.
16:39I agree.
16:41But when we're moving
16:42farther away
16:43from 2009,
16:44that experience
16:45is being lost.
16:46At that time,
16:47Margaret Chen
16:48lead at the WHO,
16:50Tom Frieden, CDC,
16:51Suzanne Jacob,
16:52the ECDC.
16:53Well,
16:54we're now one
16:55or two directors further
16:56and that experience
16:57from 2009,
16:59there have of course
16:59been other experiences,
17:01but that one
17:01is not there anymore.
17:02The same for the leadership,
17:04the political leadership.
17:05At that time,
17:06Obama, Brown, Sarkozy
17:07in Belgium,
17:08Van Rompuy were there
17:09and well,
17:10there were two
17:10or three political leaders
17:13further down the road
17:14and a lot of what
17:15was learned in 2009
17:17has been sort of unlearned
17:20and would have to be
17:21invented all.
17:22Well,
17:23there is still
17:24Angela Merkel
17:26and Apostelhaus.
17:28They're the mainstays.
17:34We can always count
17:35on them.
17:36So are we ready
17:38for the next pandemic?
17:39I don't think we are,
17:40but I would say
17:41that pandemics
17:41are like a box of chocolates
17:43and then I would like
17:44to invoke the words
17:45of the philosopher
17:46Forrest Gump,
17:47you never know
17:48what you're going to get.
17:50Thank you.
17:50Thank you.
17:52Thank you.
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