“The key is trust. It is when people feel totally alienated and isolated that the society breaks down. Telling the truth is what held society together.”
Those words were voiced sixteen years ago in Washington, D.C. It was October 17, 2006. The HHS/CDC sponsored workshop that day was titled “Pandemic Influenza – Past, Present, Future: Communicating Today Based on the Lessons from the 1918-1919 Influenza Pandemic.”
The speaker responsible for the quote above was writer/historian and Johns Hopkins School of Public Health adviser, John M. Barry. His opening quote from George Bernard Shaw set a somewhat pessimistic (and as we would learn 14 years later, justified) tone for the day:
“What we learn from history is that we do not learn anything from history.”
This was two years after the close of the 2002-2004 SARS epidemic with 8,469 cases and an 11% case fatality, and six years before MERS jumped from Egyptian camels to humans, infecting over 2,500 humans with a kill rate of 35% (858 known deaths.)
Specifically, John Barry was there that day in 2006 to share lessons learned from another epidemic, the 1918 Flu Epidemic which is now estimated to have killed roughly 700,000 Americans among a population that was roughly 1/4 our current size, with 2/3 of the deaths occurring over just a 14 week period from September through December, 1918.
The main point that Barry was trying to make that day focused on public communication during an epidemic, namely that “The truth shall set you free.”
Here were some of his 2006 reflections on 1918, a public health catastrophe at a time when the U.S. was focused on promoting strength not weakness during WW I.
“At best, they communicated half-truths, or even out-right lies. As terrifying as the disease was, the officials made it more terrifying by making little of it, and they often underplayed it. Local officials said things like ‘if normal precautions are taken, there is nothing to fear’…”
“Communication was rarely honest, because honesty would hurt morale.”
“There was a lot of cognitive dissonance. People heard from authorities and newspapers that everything was going fine, but at the same time, bodies were piling up.”
“Many times public health officials knew the truth but did not tell it. ..In many cases they were just plain lying.”
“The attitude of authorities was: ‘This isn’t happening, don’t worry about it.’”
Barry’s primary message that day was that communication breeds trust, and without trust, society breaks down. His words:
“The key is trust. It is when people feel totally alienated and isolated that the society breaks down. Telling the truth is what held society together.”
“The fear was so great that people were afraid to leave home or talk to one another. Everyone was holding their breath, almost afraid to breathe, for fear of getting sick.”
“False reassurance is the worst thing you can do. Don’t withhold information, because people will think you know more. Tell the truth— don’t manage the truth. If you don’t know something, say why you don’t know, and say what you need to do to know. Drown people with the truth, rather than withhold it.”
“The final lesson of 1918, a simple one yet one most difficult to execute, is that…those in authority must retain the public’s trust.”
But clearly that day, there was also a bit of a self-congratulatory air as well, an arrogance that today rings naive. John Barry says, “Today, I think, as opposed to back in 1918, we don’t have as much of a problem with misinformation…I want to emphasize that it is not likely that public health officials would tell outright lies.”
Twelve years later, on the 100th Anniversary of the 1918 Flu Epidemic, Barry re-released his New York Times best seller, “The Great Influenza: The Story of the Deadliest Pandemic in History”, a title that may not hold up as long as Covid-19 stubbornly holds on.
With Covid came Trump and his sycophants, and Barry’s theory (that mistrust can destroy societal order) was put to the test. In a 2020 interview at the University of Rochester, Barry holds strong to his messaging. “Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one.”
It is perhaps too easy to lay our current problems all on poor leadership at the top. Would that have been enough to deny the threat initially for months, and then spread false claims on fake cures, and then declare victory again and again prematurely? Was the public not somehow primed to accept such nonsense?
In the world I lived in for many decades, a profit driven world with vast rewards for scientific entrepreneurs, a world where progress up an integrated career ladder required cooperation, support for medical marketing on steroids, and bending the truth while turning a blind eye to errors of omission, truth was negotiable and trust was for the uninitiated.
Mike Magee M.D. is a Medical Historian and the author of “CODE BLUE: Inside the Medical-Industrial Complex”
