When public relations defeated the Bubonic Plague


Photo by Hukuzatuna

Last night I finished Plague Ports, a history of the third Bubonic Plague epidemic as it swept the globe a hundred years ago. It was a fascinating story, but one thing that really struck me was the role of public relations in saving lives. Geek culture has a negative view of marketing, something that was shared with the 'progressive' technocrats in charge of medicine at the turn of the century.

Medical officers in places like Cape Town, Honolulu, San Francisco and Rio were given sweeping emergency powers to do whatever they considered necessary to stop the plague. They had firm ideas based on the science of the time, some solid, like the use of vaccines, and others that have been proven false, such as the use of quarantine to prevent person-to-person contagion. With good intentions, they used their authority to impose these ideas on the local population, drafting squads to keep people from leaving their neighborhoods, forcibly disinfecting their belongings and demolishing houses.

Predictably the racist views that were common meant that much of the blame was heaped on low-status groups like the blacks in Brazil and South Africa, and the Chinese in the US. In Honolulu this culminated in the burning of the entire Chinatown district, and in South Africa it was the impetus behind the first formal apartheid segregation of groups into different residential areas.

Equally predictably, all the policies provoked resistance from the general population, especially those most affected by the measures. In Brazil, the Vaccination Revolt grew out of the popular resistance to enforced vaccination, and almost toppled the government. Less spectacular but more deadly was the widespread concealment of plague cases from the authorities, for fear of the imprisonment of anybody who knew them, and the defilement of their corpses by autopsies and quicklime burials. In San Francisco, 100% of the nearly 400 cases were fatal, a strong indication that many more were concealed by the Chinese community, and only the dead were revealed.

This all meant the plague's spread was effectively unchecked, and spread to far more victims than it would have if the best procedures known at the time had been followed. The big exception to this pattern of failure was in Sydney, Australia. J. Ashburton Thompson was in charge, and despite relying on almost exactly the same tactics as the other cities, was able to successfully implement them and so save hundreds of lives. What was his secret? He effectively communicated with everyone involved!

For example, when he'd implemented a quarantine, he went into the area, heard that people were clamoring for food, and arranged for the restaurants to serve everyone. He then hired the people from within the affected district for a good wage to disinfect their own neighborhood, rather than trucking in squads from outside. He organized a rat eradication program, explaining why it was necessary. His vaccination clinic was over-subscribed, to the extent that there was a near-riot by enthusiastic would-be patients. Unlike most of the other efforts, his was voluntary, but he sold people on it being a good idea. When some politicians balked at the price of his rat program, he organized a media campaign through the newspapers, and successfully pressured the government into agreeing.

I think as a community, we engineers are a lot like those technocrats, with deep knowledge in niches which most people don't understand at all. That makes impatience with their ignorance extremely tempting. It's obvious to us what needs doing, why should we have to spend precious time explaining it to those dolts? Let's just implement it!

User-adoption failure is the inevitable result. The users will sabotage any plan they don't buy into, guaranteed. A well-communicated message on how your product helps them is the first and most vital part of your user interface. Thompson shows us how rare and powerful having that real dialog with your stakeholders is.

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