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The single most important thing I want to say to you is, don't worry so much about scaring people. People can take it," Sandman told the group of over 300 business leaders and others at the Minneapolis Convention Center on Feb 15. He made no apologies to Franklin W. ("The only thing we have to fear is fear itself") Roosevelt.

Leaders are often reluctant to tell the truth about dangers because they fear causing panic, Sandman said. "The notion that we will panic people if we frighten them is outright false," he said.

The mistaken fear of panic is compounded by other errors that get in the way of telling people the truth about threats, he said. These errors include "the failure to realize the positive value of fear" for stimulating appropriate action and "the mistaken judgment that fear can be avoided."

"There's no way to get people to take precautions without frightening them," Sandman said.

What is likely to lead to panic is giving false reassurance, he said. "When you mislead people, when you overreassure people, they feel abandoned—because they are," he said. That's what happened in the United States during the flu pandemic of 1918 and during the SARS (severe acute respiratory syndrome) outbreak in China in 2003, he added.
"People panicked because the government was telling them there was no SARS," he said.

"People are much better able to handle a crisis when they are told the truth" and "treated as adults."
However, there is danger in overplaying a threat as well as in false reassurance, Sandman said. He zeroed in on the oft-repeated statement, "A pandemic is not a matter of if, it's a matter of when."

"That's true of a pandemic; it's not true of a severe 1918-like pandemic," he said. "In that case, it's if."

He added, "Just as overreassuring people backfires, alarming people in ways that won't last, that won't stand up to investigation, backfires. There's an unknown probability of a pandemic of very high magnitude."

To say that a severe pandemic is inevitable is "dishonest," and it gives ammunition to those who argue that the threat is trivial, Sandman said.

In a similar vein, Sandman urged his audience to be frank about uncertainty. "People love certainty, but people punish fake certainty. The public is extremely capable of tolerating high levels of uncertainty."

When you are uncertain about a risk, he advised, "You need to be visibly, vividly, confidently uncertain."

But his primary message was that in the presence of a real threat that demands precautions, leaders should not be afraid of causing some fear.
Calling fear a "fungible" emotion, he said, "When you [preparedness advocates] frighten people, you are not making them more fearful people. You are competing for their fear with other interest groups. You are working to get your share of their fear. You only have so much fearfulness to go around. If you allocate more to terrorism, you have to allocate less to other things."

"We have to overcome our fear of fear, our 'panic panic,' so that we can do the job," he concluded.

Sandman was asked how to maintain the level of concern about pandemic flu long enough to ensure that preparations are adequate. Part of the answer, he said, is not to try to maintain exactly the same level of concern all the time, but rather to use opportune moments to boost concern.

"You pivot on the event," he said. For example, every time the H5N1 virus infects birds in another country, concern about a potential pandemic increases. The event doesn't necessarily mean much in relation to the actual threat of a pandemic, he said. "It is, however, a teachable moment."