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Scenarios for the Future of Technology and International Development - Rockefeller & GBN-2010-F Flipbook PDF
Scenarios for the Future of Technology and International Development - Rockefeller & GBN-2010-F
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Scenarios for the Future of Technology and International Development
This report was produced by The Rockefeller Foundation and Global Business Network. May 2010
Contents Letter from Judith Rodin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Letter from Peter Schwartz.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 WHY SCENARIOS?.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 WHY TECHNOLOGY?.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 THE FOCAL QUESTION.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 ENGAGING YOUR IMAGINATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
The Scenario Framework.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 CHOOSING THE CRITICAL UNCERTAINTIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 GLOBAL POLITICAL AND ECONOMIC ALIGNMENT. . . . . . . . . . . . . . . . . . . . . 15 ADAPTIVE CAPACITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 THE SCENARIO NARRATIVES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Lock Step. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Clever Together. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Hack Attack.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Smart Scramble.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Concluding Thoughts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Appendix.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Letter from Judith Rodin President of the Rockefeller Foundation
The Rockefeller Foundation supports work that expands opportunity and strengthens resilience to social, economic, health, and environmental challenges — affirming
Scenarios for the Future of Technology and International Development
its pioneering philanthropic mission, since 1913, to “promote the well-being” of humanity. We take a synergistic, strategic approach that places a high value on innovative processes and encourages new ways of seeking ideas, to break down silos and encourage interdisciplinary thinking.
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One important — and novel — component of our strategy toolkit is scenario planning, a process of creating narratives about the future based on factors likely to affect a particular set of challenges and opportunities. We believe that scenario planning has great potential for use in philanthropy to identify unique interventions, simulate and rehearse important decisions that could have profound implications, and highlight previously undiscovered areas of connection and intersection. Most important, by providing a methodological structure that helps us focus on what we don’t know — instead of what we already know — scenario planning allows us to achieve impact more effectively. The results of our first scenario planning exercise demonstrate a provocative and engaging exploration of the role of technology and the future of globalization, as you will see in the following pages. This report is crucial reading for anyone interested in creatively considering the multiple, divergent ways in which our world could evolve. The sparks of insight inspiring these narratives — along with their implications for philanthropy as a whole — were generated through the invaluable collaboration of grantee representatives, external experts, and Rockefeller Foundation staff. I offer a special thanks to Peter Schwartz, Andrew Blau, and the entire team at Global Business Network, who have helped guide us through this stimulating and energizing process.
Leading this effort at the Rockefeller Foundation is our Research Unit, which analyzes emerging risks and opportunities and thinks imaginatively about how to respond to the complex, rapidly changing world around us. This outward-looking intelligence function adopts a cross-cutting mindset that synthesizes and integrates knowledge that accelerates our ability to act more quickly and effectively. It has also helped to shape and build the notion of “pro-poor foresight” that is committed to applying forward-looking tools and techniques to improve the lives of poor and vulnerable populations around the world.
Judith Rodin President The Rockefeller Foundation
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I hope this publication makes clear exactly why my colleagues and I are so excited about the promise of using scenario planning to develop robust strategies and offer a refreshing viewpoint on the possibilities that lie ahead. We welcome your feedback.
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Letter from Peter Schwartz
Cofounder and Chairman of Global Business Network
We are at a moment in history that is full of opportunity. Technology is poised to transform the lives of millions of people throughout the world, especially those who
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have had little or no access to the tools that can deliver sustainable improvements for their families and communities. From farmers using mobile phones to buy and sell crops to doctors remotely monitoring and treating influenza outbreaks in rural villages, technology is rapidly becoming more and more integral to the pace and progress of development.
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Philanthropy has a unique and critical role to play in this process. By focusing its patience, capital, and attention on the links between technology and international development, philanthropy will change not just lives but the very context in which the field of philanthropy operates. This report represents an initial step in that direction. It explores four very different — yet very possible — scenarios for the future of technology and development in order to illuminate the challenges and opportunities that may lie ahead. It promotes a deeper understanding of the complex forces and dynamics that will accelerate or inhibit the use of technology to spur growth, opportunity, and resilience especially in the developing world. Finally, it will seed a new strategic conversation among the key public, private, and philanthropic stakeholders about technology and development at the policy, program, and human levels. The Rockefeller Foundation’s use of scenario planning to explore technology and international development has been both inspired and ambitious. Throughout my 40-plus-year career as a scenario planner, I have worked with many of the world’s leading companies, governments, foundations, and nonprofits — and I know firsthand the power of the approach. Scenario planning is a powerful tool precisely because the future is unpredictable and shaped by many interacting variables. Scenarios enable us to think creatively and rigorously about the different ways these forces may interact, while forcing us to challenge our own assumptions about what we
believe or hope the future will be. Scenarios embrace and weave together multiple perspectives and provide an ongoing framework for spotting and making sense of
The Rockefeller Foundation has already used this project as an opportunity to clarify and advance the relationship between technology and development. Through interviews and the scenario workshops, they have engaged a diverse set of people — from different geographies, disciplines, and sectors — to identify the key forces driving change, to explore the most critical uncertainties, and to develop challenging yet plausible scenarios and implications. They have stretched their thinking far beyond theoretical models of technology innovation and diffusion in order to imagine how technology could actually change the lives of people from many walks of life. This is only the start of an important conversation that will continue to shape the potential of technology and international development going forward. I look forward to staying a part of that conversation and to the better future it will bring.
Peter Schwartz Cofounder and Chairman Global Business Network
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important changes as they emerge. Perhaps most importantly, scenarios give us a new, shared language that deepens our conversations about the future and how we can help to shape it.
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Introduction For decades, technology has been dramatically changing not just the lives of individuals in developed countries, but increasingly the lives and livelihoods of people throughout the developing world. Whether it is a community mobile phone, a solar panel, a new farming practice, or a cuttingedge medical device, technology is altering the landscape of
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possibility in places where possibilities used to be scarce.
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And yet looking out to the future, there is no single story to be told about how technology will continue to help shape — or even revolutionize — life in developing countries. There are many possibilities, some good and some less so, some known and some unknowable. Indeed, for everything we think we can anticipate about how technology and international development will interact and intertwine in the next 20 years and beyond, there is so much more that we cannot yet even imagine. For philanthropies as well as for other organizations, this presents a unique challenge: given the uncertainty about how the future will play out, how can we best position ourselves not just to identify technologies that improve the
lives of poor communities but also to help scale and spread those that emerge? And how will the social, technological, economic, environmental, and political conditions of the future enable or inhibit our ability to do so? The Rockefeller Foundation believes that in order to understand the many ways in which technology will impact international development in the future, we must first broaden and deepen our individual and collective understanding of the range of possibilities. This report, and the project upon which it is based, is one attempt to do that. In it, we share the outputs and insights from a year-long project, undertaken by the Rockefeller Foundation and Global Business Network (GBN), designed to
This report builds on the Rockefeller Foundation’s growing body of work in the emerging field of pro-poor foresight. In 2009, the Institute for Alternative Futures published the report Foresight for Smart Globalization: Accelerating and Enhancing Pro-Poor Development Opportunities, with support from the Rockefeller Foundation. That effort was a reflection of the Foundation’s strong commitment to exploring innovative processes and embracing new pathways for insight aimed at helping the world’s poor. With this report, the Foundation takes a further step in advancing the field of pro-poor foresight, this time through the lens of scenario planning.
WHY SCENARIOS? The goal of this project was not to affirm what is already known and knowable about what is happening right now at the intersections of technology and development. Rather, it was to explore the many ways in which technology and development could co-evolve — could both push and inhibit each other — in the future, and
then to begin to examine what those possible alternative paths may imply for the world’s poor and vulnerable populations. Such an exercise required project participants to push their thinking far beyond the status quo, into uncharted territory. Scenario planning is a methodology designed to help guide groups and individuals through exactly this creative process. The process begins by identifying forces of change in the world, then combining those forces in different ways to create a set of diverse stories — or scenarios — about how the future could evolve. Scenarios are designed to stretch our thinking about both the opportunities and obstacles that the future might hold; they explore, through narrative, events and dynamics that might alter, inhibit, or enhance current trends, often in surprising ways. Together, a set of scenarios captures a range of future possibilities, good and bad, expected and surprising — but always plausible. Importantly, scenarios are not predictions. Rather, they are thoughtful hypotheses that allow us to imagine, and then to rehearse, different strategies for how to be more prepared for the future — or more ambitiously, how to help shape better futures ourselves.
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explore the role of technology in international development through scenario planning, a methodology in which GBN is a long-time leader.
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Scenarios for the Future of Technology and International Development
WHY TECHNOLOGY?
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Technology was chosen as a focal point of this project because of its potentially transformative role — both in a positive and negative way — in addressing a wide range of development challenges, from climate change, healthcare, and agriculture to housing, transportation, and education. Yet while there is little doubt that technology will continue to be a driver of change across the developing world in the future, the precise trajectory along which technological innovation will travel is highly uncertain. For example, will critical technological advances come from the developed world, or will innovators and their innovations be more geographically dispersed? Or, how might the global economic and political environment affect the pace of technology development? It is important to state that in focusing on technology, this project did not set out to identify a set of exact, yet-to-be-invented technologies that will help shape and change the future. Rather, the goal was to gain a broader and richer understanding of different paths along which technology could develop — paths that will be strongly influenced by the overall global environment in which the inventors and adopters of those technologies will find themselves working and dwelling. Technology,
as a category, cannot be divorced from the context in which it develops. The scenarios shared in this report explore four such contexts, each of which, as you’ll see, suggests very different landscapes for technology and its potential impacts in the developing world. Finally, a note about what we mean by “technology.” In this report, we use the term to refer to a broad spectrum of tools and methods of organization. Technologies can range from tools for basic survival, such as a treadle pump and basic filtration technologies, to more advanced innovations, such as methods of collecting and utilizing data in health informatics and novel building materials with real-time environmental sensing capabilities. This report focuses on themes associated with the widespread scalability, adoption, and assessment of technology in the developing world. While the scenarios themselves are narratives about the global environment, we have paid particular attention to how events might transpire in subSaharan Africa, Southeast Asia, and India.
Every scenario project has a focal question — a broad yet strategic query that serves as an anchor for the scenarios. For this project, the focal question was:
How might technology affect barriers to building resilience and equitable growth in the developing world over the next 15 to 20 years? In other words, what new or existing technologies could be leveraged to improve the capacity of individuals, communities, and systems to respond to major changes, or what technologies could improve the lives of vulnerable populations around the world? A 15- to 20-year timeframe was chosen on the assumption that it is both sufficiently long
A Note on Terminology The Foundation’s work promotes “resilience and equitable growth.” Resilience refers to the capacity of individuals, communities, and systems to survive, adapt, and grow in the face of changes, even catastrophic incidents. Equitable growth involves enabling individuals, communities, and institutions to access new tools, practices, resources, services, and products.
enough that significant technological change is plausible and sufficiently short enough that we can imagine some possibilities for the kinds of technologies that could be developed and applied. Focusing on how to overcome a set of obstacles associated with the application of technology to the challenges of development helped to both bound the inquiry and promote a problem-solving approach that seeks to identify potential, systematic intervention opportunities.
ENGAGING YOUR IMAGINATION It is our hope that these scenarios help inspire the same future-orientation in other initiatives that are broadly concerned with technology and international development. Of course, there is no hard data about the future — nobody yet knows precisely what technologies will be successful at addressing new and evolving development needs. Rather, as you read the scenarios, think of them as a journey — four journeys — into a future that is relevant, thought-provoking, and possible. Imagine how the world will function and how it will be organized to tackle the challenges it faces. Who will be responsible for driving local and global development initiatives and what would that require? And what is your own role in leading your organization, community, or region to a preferred future?
Scenarios for the Future of Technology and International Development
THE FOCAL QUESTION
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Scenarios are a medium through which great change can be not just envisioned but also actualized. The more closely you read them, the more likely it becomes that you will recognize their important but less obvious implications to you, your work, and your community. We strongly encourage you to share and discuss this report widely, use it as a springboard for further creative thinking about how technology
could shape development, and test and adjust your strategies or personal actions accordingly. It is also our hope that these scenarios help to identify potential areas of future work for governments, philanthropies, corporations, and nonprofits, and that they illuminate choices and commitments that a wide range of organizations may want to make in these areas in the future.
FURTHER READING ON TECHNOLOGY AND DEVELOPMENT
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This report adds to a growing body of literature focusing on the relationship between technology, development, and social systems. While not a comprehensive list, the following readings offer additional insights on this topic. • Caroline Wagner, The New Invisible College: Science for Development, 2008. • Institute for the Future, Science and Technology Outlook: 2005-2055, 2006. • RAND Corporation, The Global Technology Revolution 2020, In-Depth Analyses, 2006. • World Bank, Science, Technology, and Innovation: Capacity Building for Sustainable Growth and Poverty Reduction, 2008. • UN Millennium Project, Task Force on Science, Technology, and Innovation, Innovation: Applying Knowledge in Development, 2006. • W. Brian Arthur, The Nature of Technology: What It Is and How It Evolves, 2009.
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• STEPS Centre Working Papers, Innovation, Sustainability, Development: A New Manifesto, 2009.
The Scenario Framework The Rockefeller Foundation and GBN began the scenario process by surfacing a host of driving forces that would affect the future of technology and international development. These forces were generated through both secondary research and in-depth interviews with Foundation staff, Foundation grantees, and external experts. from renewable resources and may succeed, but there will likely still be a significant level of global interdependence on energy. Predetermined elements are important to any scenario story, but they are not the foundation on which these stories are built. Rather, scenarios are formed around “critical uncertainties” — driving forces that are considered both highly important to the focal issue and highly uncertain in terms of their future resolution. Whereas predetermined elements are predictable driving forces, uncertainties are by their nature unpredictable: their outcome can be guessed at but not known.
Scenarios for the Future of Technology and International Development
Next, all these constituents came together in several exploratory workshops to further brainstorm the content of these forces, which could be divided into two categories: predetermined elements and critical uncertainties. A good starting point for any set of scenarios is to understand those driving forces that we can be reasonably certain will shape the worlds we are describing, also known as “predetermined elements.” For example, it is a near geopolitical certainty that — with the rise of China, India, and other nations — a multi-polar global system is emerging. One demographic certainty is that global population growth will continue and will put pressure on energy, food, and water resources — especially in the developing world. Another related certainty: that the world will strive to source more of its energy
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While any single uncertainty could challenge our thinking, the future will be shaped by multiple forces playing out over time. The scenario framework provides a structured way to consider how these critical uncertainties might
for example, the pervasiveness of conflict in the developing world; the frequency and severity of shocks like economic and political crises, disease, and natural disasters; and the locus of innovation for crucial technologies
unfold and evolve in combination. Identifying the two most important uncertainties guarantees that the resulting scenarios will differ in ways that have been judged to be critical to the focal question.
for development. (A full list of the critical uncertainties identified during the project, as well as a list of project participants, can be found in the Appendix.)
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CHOOSING THE CRITICAL UNCERTAINTIES
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During this project’s scenario creation workshop, participants — who represented a range of regional and international perspectives — selected the two critical uncertainties that would form the basis of the scenario framework. They chose these two uncertainties from a longer list of potential uncertainties that might shape the broader contextual environment of the scenarios, including social, technology, economic, environmental, and political trends. The uncertainties that were considered included,
The two chosen uncertainties, introduced below, together define a set of four scenarios for the future of technology and international development that are divergent, challenging, internally consistent, and plausible. Each of the two uncertainties is expressed as an axis that represents a continuum of possibilities ranging between two endpoints.
STRONG
LOW
POLITICAL AND ECONOMIC ALIGNMENT
WEAK
ADAPTIVE CAPACITY
HIGH
This uncertainty refers to both the amount of economic integration — the flow of goods, capital, people, and ideas — as well as the extent to which enduring and effective political structures enable the world to deal with many of the global challenges it faces. On one end of the axis, we would see a more integrated global economy with high trade volumes, which enables access to a wider range of goods and services through imports and exports, and the increasing specialization of exports. We would also see more cooperation at the supra-national level, fostering increased collaboration, strengthened global institutions, and the formation of effective international problem-solving networks. At the other axis endpoint, the potential for economic development in the developing world would be reduced by the fragility of the overall global economy — coupled with protectionism and fragmentation of trade — along with a weakening of governance regimes that raise barriers to cooperation, thereby hindering agreement on and implementation of largescale, interconnected solutions to pressing global challenges.
ADAPTIVE CAPACITY This uncertainty refers to the capacity at different levels of society to cope with change and to adapt effectively. This ability to adapt can mean proactively managing existing systems and structures to ensure their resilience against external forces, as well as the ability to transform those systems and structures when a changed context means they are no longer suitable. Adaptive capacity is generally associated with higher levels of education in a society, as well as the availability of outlets for those who have educations to further their individual and societal well-being. High levels of adaptive capacity are typically achieved through the existence of trust in society; the presence and tolerance of novelty and diversity; the strength, variety, and overlap of human institutions; and the free flow of communication and ideas, especially between and across different levels, e.g., bottom-up and top-down. Lower levels of adaptive capacity emerge in the absence of these characteristics and leave populations particularly vulnerable to the disruptive effects of unanticipated shocks.
Scenarios for the Future of Technology and International Development
GLOBAL POLITICAL AND ECONOMIC ALIGNMENT
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Scenarios for the Future of Technology and International Development
Once crossed, these axes create a matrix of four very different futures:
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LOCK STEP – A world of tighter top-down
HACK ATTACK – An economically
government control and more authoritarian eadership, with limited innovation and growing citizen pushback
unstable and shock-prone world in which governments weaken, criminals thrive, and dangerous innovations emerge
CLEVER TOGETHER – A world in which
SMART SCRAMBLE – An economically
highly coordinated and successful strategies emerge for addressing both urgent and entrenched worldwide issues
depressed world in which individuals and communities develop localized, makeshift solutions to a growing set of problems
The scenarios that follow are not meant to be exhaustive — rather, they are designed to be both plausible and provocative, to engage your imagination while also raising new questions for you about what that future might look and feel like. Each scenario tells a story of how the world, and in particular the developing world, might progress over the next 15 to 20 years, with an emphasis on those elements relating to the use of different technologies and the interaction of these technologies with the lives of the poor and vulnerable. Accompanying each scenario is a range of elements that aspire to further illuminate life, technology, and philanthropy in that world. These include: • A timeline of possible headlines and emblematic events unfolding during the period of the scenario • Short descriptions of what technologies and technology trends we might see • Initial observations on the changing role of philanthropy in that world, highlighting opportunities and challenges that philanthropic organizations would face and what their operating environment might be like • A “day in the life” sketch of a person living and working in that world
Please keep in mind that the scenarios in this report are stories, not forecasts, and the plausibility of a scenario does not hinge on the occurrence of any particular detail. In the scenario titled “Clever Together,” for example, “a consortium of nations, NGOs [nongovernmental organizations], and companies establish the Global Technology Assessment Office” — a detail meant to symbolize how a high degree of international coordination and adaptation might lead to the formation of a body that anticipates technology’s potential societal implications. That detail, along with dozens of others in each scenario, is there to give you a more tangible “feel” for the world described in the scenario. Please consider names, dates, and other such specifics in each scenario as proxies for types of events, not as necessary conditions for any particular scenario to unfold. We now invite you to immerse yourself in each future world and consider four different visions for the evolution of technology and international development to 2030.
Scenarios for the Future of Technology and International Development
THE SCENARIO NARRATIVES
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This uncertainty refers to both the amount of economic integration — the flow of goods, capital, people, and ideas — as well as the extent to which enduring and effective political structures enable the world to deal with many of the global challenges it faces. On one end of the axis, we would see a more integrated global economy with high trade volumes, which enables access to a wider range of goods and services through imports and exports, and the increasing specialization of exports. We would also see more cooperation at the supra-national level, fostering increased collaboration, strengthened global institutions, and the formation of effective international problem-solving networks. At the other axis endpoint, the potential for economic development in the developing world would be reduced by the fragility of the overall global economy — coupled with protectionism and fragmentation of trade — along with a weakening of governance regimes that raise barriers to cooperation, thereby hindering agreement on and implementation of largescale, interconnected solutions to pressing global challenges.
ADAPTIVE CAPACITY This uncertainty refers to the capacity at different levels of society to cope with change and to adapt effectively. This ability to adapt can mean proactively managing existing systems and structures to ensure their resilience against external forces, as well as the ability to transform those systems and structures when a changed context means they are no longer suitable. Adaptive capacity is generally associated with higher levels of education in a society, as well as the availability of outlets for those who have educations to further their individual and societal well-being. High levels of adaptive capacity are typically achieved through the existence of trust in society; the presence and tolerance of novelty and diversity; the strength, variety, and overlap of human institutions; and the free flow of communication and ideas, especially between and across different levels, e.g., bottom-up and top-down. Lower levels of adaptive capacity emerge in the absence of these characteristics and leave populations particularly vulnerable to the disruptive effects of unanticipated shocks.
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GLOBAL POLITICAL AND ECONOMIC ALIGNMENT
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restrictions, from the mandatory wearing of face masks to body-temperature checks at the entries to communal spaces like train stations and supermarkets. Even after the pandemic faded, this more authoritarian control and oversight of citizens and their activities stuck and even intensified. In order to protect themselves from the spread of increasingly global problems — from pandemics and transnational terrorism to environmental crises and rising poverty — leaders around the world took a firmer grip on power. At first, the notion of a more controlled world gained wide acceptance and approval. Citizens willingly gave up some of their sovereignty — and their privacy — to more paternalistic states in exchange for greater safety and stability. Citizens were more tolerant, and even eager, for top-down direction and oversight, and national leaders had more latitude to impose order in the ways they saw fit. In developed countries, this heightened oversight took many forms: biometric IDs for all citizens, for example, and tighter regulation of key industries whose stability
was deemed vital to national interests. In many developed countries, enforced cooperation with a suite of new regulations and agreements slowly but steadily restored both order and, importantly, economic growth. Across the developing world, however, the story was different — and much more variable. Top-down authority took different forms in different countries, hinging largely on the capacity, caliber, and intentions of their leaders. In countries with strong and thoughtful leaders, citizens’ overall economic status and quality of life increased. In India, for example, air quality drastically improved after 2016, when the government outlawed highemitting vehicles. In Ghana, the introduction of ambitious government programs to improve basic infrastructure and ensure the availability of clean water for all her people led to a sharp decline in water-borne diseases. But more authoritarian leadership worked less well — and in some cases tragically — in countries run by irresponsible elites who used their increased power to pursue their own interests at the expense of their citizens. There were other downsides, as the rise of virulent nationalism created new hazards: spectators at the 2018 World Cup, for example,
Scenarios for the Future of Technology and International Development
China’s government was not the only one that took extreme measures to protect its citizens from risk and exposure. During the pandemic, national leaders around the world flexed their authority and imposed airtight rules and
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Scenario Narratives LOCK STEP
wore bulletproof vests that sported a patch of their national flag. Strong technology regulations stifled innovation, kept costs high, and curbed adoption. In the developing world, access to “approved” technologies increased
Meanwhile, in the developed world, the presence of so many top-down rules and norms greatly inhibited entrepreneurial activity. Scientists and innovators were often told by governments what research lines to pursue and were guided
but beyond that remained limited: the locus of technology innovation was largely in the developed world, leaving many developing countries on the receiving end of technologies that others consider “best” for them. Some
mostly toward projects that would make money (e.g., market-driven product development) or were “sure bets” (e.g., fundamental research), leaving more risky or innovative research areas largely untapped. Well-off countries and monopolistic companies with big research and development budgets still made significant advances, but the IP behind their breakthroughs remained locked behind strict national or corporate protection. Russia and India imposed stringent domestic standards for supervising and certifying encryption-related products and their suppliers — a category that in reality meant all IT innovations. The U.S. and EU struck back with retaliatory national standards, throwing a wrench in the development and diffusion of technology globally.
“IT IS POSSIBLE TO DISCIPLINE AND CONTROL SOME SOCIETIES FOR SOME TIME, BUT NOT THE WHOLE WORLD ALL THE TIME.”
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– GK Bhat, TARU Leading Edge, India
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governments found this patronizing and refused to distribute computers and other technologies that they scoffed at as “second hand.” Meanwhile, developing countries with more resources and better capacity began to innovate internally to fill these gaps on their own.
Especially in the developing world, acting in one’s national self-interest often meant seeking practical alliances that fit with those
interests — whether it was gaining access to needed resources or banding together in order to achieve economic growth. In South America and Africa, regional and sub-regional alliances became more structured. Kenya doubled its
Wherever national interests clashed with individual interests, there was conflict. Sporadic pushback became increasingly organized and coordinated, as disaffected youth and people who had seen their status and opportunities slip
trade with southern and eastern Africa, as new partnerships grew within the continent. China’s investment in Africa expanded as the bargain of new jobs and infrastructure in exchange for access to key minerals or food exports proved agreeable to many governments. Cross-border ties proliferated in the form of official security aid. While the deployment of foreign security teams was welcomed in some of the most dire failed states, one-size-fits-all solutions yielded few positive results.
away — largely in developing countries — incited civil unrest. In 2026, protestors in Nigeria brought down the government, fed up with the entrenched cronyism and corruption. Even those who liked the greater stability and predictability of this world began to grow uncomfortable and constrained by so many tight rules and by the strictness of national boundaries. The feeling lingered that sooner or later, something would inevitably upset the neat order that the world’s governments had worked so hard to establish. •
By 2025, people seemed to be growing weary of so much top-down control and letting leaders and authorities make choices for them.
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Scenario Narratives LOCK STEP
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Scenario Narratives LOCK STEP
HEADLINES
IN LOCK STEP
Quarantine Restricts In-Person Contact; Cellular Networks Overloaded (2013)
2010
Italy Addresses 'Immigrant Caregiver' Gap with Robots (2017)
2015 Intercontinental Trade Hit by Strict Pathogen Controls (2015)
Vietnam to Require ‘A Solar Panel on Every Home’ (2022)
2020 Will Africa’s Embrace of Authoritarian Capitalism a la China Continue? (2018)
2025
Scenarios for the Future of Technology and International Development
2030
Proliferating Trade Networks in Eastern and Southern Africa Strengthen Regional Ties (2023)
ROLE OF PHILANTHROPY
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African Leaders Fear Repeat of Nigeria's 2026 Government Collapse (2028)
IN LOCK STEP
Philanthropic organizations will face hard choices in this world. Given the strong role of governments, doing philanthropy will require heightened diplomacy skills and the ability to operate effectively in extremely divergent environments. Philanthropy grantee and civil society relationships will be strongly moderated by government, and some foundations might choose to align themselves more closely with national official development assistance (ODA) strategies and government objectives. Larger philanthropies will retain an outsized share of influence, and many smaller philanthropies may find value in merging financial, human, and operational resources. Philanthropic organizations interested in promoting universal rights and freedoms will get blocked at many nations’ borders. Developing smart, flexible, and wide-ranging relationships in this world will be key; some philanthropies may choose to work only in places where their skills and services don’t meet resistance. Many governments will place severe restrictions on the program areas and geographies that international philanthropies can work in, leading to a narrower and stronger geographic focus or grant-making in their home country only.
Scenario Narratives LOCK STEP
TECHNOLOGY
IN LOCK STEP
While there is no way of accurately predicting what the important technological advancements will be in the future, the scenario narratives point to areas where conditions may enable or accelerate the development of certain kinds of technologies. Thus for each scenario we offer a sense of the context for technological innovation, taking into consideration the pace, geography, and key creators. We also suggest a few technology trends and applications that could flourish in each scenario. Technological innovation in “Lock Step” is largely driven by government and is focused on issues of national security and health and safety. Most technological improvements are created by and for developed countries, shaped by governments’ dual desire to control and to monitor their citizens. In states with poor governance, large-scale projects that fail to progress abound.
• Scanners using advanced functional magnetic resonance imaging (fMRI) technology become the norm at airports and other public areas to detect abnormal behavior that may indicate “antisocial intent.” • In the aftermath of pandemic scares, smarter packaging for food and beverages is applied first by big companies and producers in a business-to-business environment, and then adopted for individual products and consumers. • New diagnostics are developed to detect communicable diseases. The application of health screening also changes; screening becomes a prerequisite for release from a hospital or prison, successfully slowing the spread of many diseases. • Tele-presence technologies respond to the demand for less expensive, lowerbandwidth, sophisticated communications systems for populations whose travel is restricted. • Driven by protectionism and national security concerns, nations create their own independent, regionally defined IT networks, mimicking China’s firewalls. Governments have varying degrees of success in policing internet traffic, but these efforts nevertheless fracture the “World Wide” Web.
Scenarios for the Future of Technology and International Development
Technology trends and applications we might see:
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Scenario Narratives LOCK STEP
LIFE
IN LOCK STEP
Manisha gazed out on the Ganges River, mesmerized by what she saw. Back in 2010, when she was 12 years old, her parents had brought her to this river so that she
Scenarios for the Future of Technology and International Development
could bathe in its holy waters. But standing at the edge, Manisha had been afraid. It wasn’t the depth of the river or its currents that had scared her, but the water itself: it was murky and brown and smelled pungently of trash and dead things. Manisha had balked, but her mother had pushed her forward, shouting that this river flowed from the lotus feet of Vishnu and she should be honored to enter it. Along with millions of Hindus, her mother believed the Ganges’s water could cleanse a person’s soul of all sins and even cure the sick. So Manisha had grudgingly dunked herself in the river, accidentally swallowing water in the process and receiving a bad case of giardia, and months of diarrhea, as a result.
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Remembering that experience is what made today so remarkable. It was now 2025. Manisha was 27 years old and a manager for the Indian government’s Ganges Purification Initiative (GPI). Until recently, the Ganges was still one of the most polluted rivers in the world, its coliform bacteria levels astronomical due to the frequent disposal of human and animal corpses and of sewage (back in 2010, 89 million liters per day) directly into the river. Dozens of organized attempts to clean the Ganges over the years had failed. In 2009, the World Bank even loaned India $1 billion to support the government’s multi-billion dollar cleanup initiative. But then the pandemic hit, and that funding dried up. But what didn’t dry up was the government’s commitment to cleaning the Ganges — now not just an issue of public health but increasingly one of national pride. Manisha had joined the GPI in 2020, in part because she was so impressed by the government’s strong stance on restoring the ecological health of India’s most treasured resource. Many lives in her home city of Jaipur had been saved by the government’s quarantines during the pandemic, and that experience, thought Manisha, had given the government the confidence to be so strict about river usage
Scenario Narratives LOCK STEP
now: how else could they get millions of Indian citizens to completely shift their
Manisha watched as an engineering team began unloading equipment on the banks. Many top Indian scientists and engineers had been recruited by the government to develop tools and strategies for cleaning the Ganges in more high-tech ways. Her favorite were the submersible bots that continuously “swam” the river to detect, through sensors, the presence of chemical pathogens. New riverside filtration systems that sucked in dirty river water and spit out far cleaner water were also impressive — especially because on the outside they were designed to look like mini-temples. In fact, that’s why Manisha was at the river today, to oversee the installation of a filtration system located not even 100 feet from where she first stepped into the Ganges as a girl. The water looked so much cleaner now, and recent tests suggested that it might even meet drinkability standards by 2035. Manisha was tempted to kick off her shoe and dip her toe in, but this was a restricted area now — and she, of all people, would never break that law.
Scenarios for the Future of Technology and International Development
cultural practices in relationship to a holy site? Discarding ritually burned bodies in the Ganges was now illegal, punishable by years of jail time. Companies found to be dumping waste of any kind in the river were immediately shut down by the government. There were also severe restrictions on where people could bathe and where they could wash clothing. Every 20 meters along the river was marked by a sign outlining the repercussions of “disrespecting India’s most treasured natural resource.” Of course, not everyone liked it; protests flared every so often. But no one could deny that the Ganges was looking more beautiful and healthier than ever.
25
CLEVER TOGETHER A world in which highly coordinated and successful strategies emerge for addressing both urgent and entrenched
Scenarios for the Future of Technology and International Development
worldwide issues
26
The recession of 2008-10 did not turn into the decades-long global economic slide that many had feared. In fact, quite the opposite: strong global growth returned in force, with the world headed once again toward the demographic and economic projections forecasted before the downturn. India and China were on track to see their middle classes explode to 1 billion by 2020. Mega-cities like Sao Paulo and Jakarta expanded at a blistering pace as millions poured in from rural areas. Countries raced to industrialize by whatever means necessary; the global marketplace bustled. But two big problems loomed. First, not all people and places benefited equally from this return to globalized growth: all boats were rising, but some were clearly rising more. Second, those hell-bent on development
and expansion largely ignored the very real environmental consequences of their unrestricted growth. Undeniably, the planet’s climate was becoming increasingly unstable. Sea levels were rising fast, even as countries continued to build-out coastal mega-cities. In 2014, the Hudson River overflowed into New York City during a storm surge, turning the World Trade Center site into a three-foot-deep lake. The image of motorboats navigating through lower Manhattan jarred the world’s most powerful nations into realizing that climate change was not just a developing-world problem. That same year, new measurements showing that atmospheric carbon dioxide levels were climbing precipitously created new urgency and pressure for governments (really, for everyone) to do something fast.
capture processes that would best support the global ecosystem. A functioning global cap and trade system was also established. Worldwide, the pressure to reduce waste and increase efficiency in planet-friendly ways was
there, would not be enough to stave off a climate disaster — or, for that matter, to effectively address a host of other planetary-scale problems. But highly coordinated worldwide strategies for addressing such urgent issues just might. What was needed was systems thinking — and systems acting — on a global scale.
enormous. New globally coordinated systems for monitoring energy use capacity — including smart grids and bottom-up pattern recognition technologies — were rolled out. These efforts produced real results: by 2022, new projections showed a significant slowing in the rise of atmospheric carbon levels.
International coordination started slowly, then accelerated faster than anyone had imagined. In 2015, a critical mass of middle income and developed countries with strong economic growth publicly committed to leveraging their resources against global-scale problems, beginning with climate change. Together, their governments hashed out plans for monitoring and reducing greenhouse gas emissions in the short term and improving the absorptive capacity of the natural environment over the long term. In 2017, an international agreement was reached on carbon sequestration (by then, most multinational corporations had a chief carbon officer) and intellectual and financial resources were pooled to build out carbon
Inspired by the success of this experiment in collective global action, large-scale coordinated initiatives intensified. Centralized global oversight and governance structures sprang up, not just for energy use but also for disease and technology standards. Such systems and structures required far greater levels of transparency, which in turn required more tech-enabled data collection, processing, and feedback. Enormous, benign “sousveillance” systems allowed citizens to access data — all publically available — in real time and react. Nation-states lost some of their power and importance as global architecture strengthened and regional governance structures emerged. International oversight entities like the UN
Scenarios for the Future of Technology and International Development
In such an interconnected world, where the behaviors of one country, company, or individual had potentially high-impact effects on all others, piecemeal attempts by one nation here, one small collective of environmental organizations
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Scenario Narratives
CLEVER TOGETHER
took on new levels of authority, as did regional systems like the Association of Southeast Asian Nations (ASEAN), the New Partnership for Africa’s Development (NEPAD), and the Asian Development Bank (ADB). The worldwide spirit
“WHAT IS OFTEN SURPRISING ABOUT NEW TECHNOLOGIES IS COLLATERAL DAMAGE: THE EXTENT OF THE PROBLEM THAT YOU CAN CREATE BY SOLVING ANOTHER PROBLEM IS ALWAYS A BIT OF A SURPRISE.”
Scenarios for the Future of Technology and International Development
– Michael Free, Program for Appropriate Technology in Health (PATH)
28
of collaboration also fostered new alliances and alignments among corporations, NGOs, and communities. These strong alliances laid the groundwork for more global and participatory attempts to solve big problems and raise the standard of living of everyone. Coordinated efforts to tackle longentrenched problems like hunger, disease, and access to basic needs took hold. New inexpensive technologies like better medical diagnostics and more effective vaccines improved healthcare
delivery and health outcomes. Companies, NGOs, and governments — often acting together — launched pilot programs and learning labs to figure out how to best meet the needs of particular communities, increasing the knowledge base of what worked and what didn’t. Pharmaceuticals giants released thousands of drug compounds shown to be effective against diseases like malaria into the public domain as part of an “open innovation” agenda; they also opened their archives of R&D on neglected diseases deemed not commercially viable, offering seed funding to scientists who wanted to carry the research forward. There was a push for major innovations in energy and water for the developing world, as those areas were thought to be the key to improving equity. Better food distribution was also high on the agenda, and more open markets and south-south trade helped make this a reality. In 2022, a consortium of nations, NGOs, and companies established the Global Technology Assessment Office, providing easily accessible, real-time information about the costs and benefits of various technology applications to developing and developed countries alike. All of these efforts translated into real progress on real problems, opening up new opportunities
CLEVER TOGETHER
to address the needs of the bottom billion — and enabling developing countries to become engines of growth in their own right. In many parts of the developing world, economic growth rates increased due to a host of factors. Improved infrastructure accelerated the greater mobility of both people and goods, and urban and rural areas got better connected. In Africa, growth that started on the coasts spread inward along new transportation corridors. Increased trade drove the specialization of individual firms and the overall diversification of economies. In many places, traditional social barriers to overcoming poverty grew less relevant as more people gained access to a spectrum of useful technologies — from disposable computers to doit-yourself (DIY) windmills. Given the circumstances that forced these new heights of global cooperation and responsibility, it was no surprise that much of the growth in the developing world was achieved more cleanly and more “greenly.” In Africa, there was a big push for solar energy, as the physical geography and low population density of much of the continent enabled the proliferation of solar farms. The Desertec initiative to create massive thermal electricity plants to supply both North Africa and, via undersea cable lines, Southern Europe was a huge success. By 2025, a majority of electricity in the Maghreb was coming from solar, with exports of that power earning valuable foreign currency. The switch
to solar created new “sun” jobs, drastically cut CO2 emissions, and earned governments billions annually. India exploited its geography to create similar “solar valleys” while decentralized solarpowered drip irrigation systems became popular in sub-Saharan Africa. Reduced energy dependency enabled all of these countries and regions to better control and manage their own resources. In Africa, political architecture above the nation-state level, like the African Union, strengthened and contributed to a “good governance” drive. Regional integration through COMESA (the Common Market for Eastern and Southern Africa) and other institutions allowed member nations to better organize to meet their collective needs as consumers and increasingly as producers. Over the course of two decades, enormous strides were made to make the world less wasteful, more efficient, and more inclusive. But the world was far from perfect. There were still failed states and places with few resources. Moreover, such rapid progress had created new problems. Rising consumption standards unexpectedly ushered in a new set of pressures: the improved food distribution system, for example, generated a food production crisis due to greater demand. Indeed, demand for everything was growing exponentially. By 2028, despite ongoing efforts to guide “smart growth,” it was becoming clear that the world could not support such rapid growth forever. •
Scenarios for the Future of Technology and International Development
Scenario Narratives
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Scenario Narratives
HEADLINES
CLEVER TOGETHER
IN CLEVER TOGETHER 'Info Cruncher' Is Grads' Job of Choice as Data Era Dawns (2016)
Global Economy Turns the Corner (2011)
2010
2015 Radical U.S. and China Emission Targets Signal New Era in Climate Change Negotiations (2015)
2020 Green Infrastructure Reshapes Economic Landscape (2018)
Scenarios for the Future of Technology and International Development
ROLE OF PHILANTHROPY
30
Consortium of Foundations Launches Third Green Revolution as Food Shortages Loom (2027)
A First: U.S. Solar Power Cheaper than Coal (2020)
2025
2030
Transparency International Reports 10th Consecutive Year of Improved Governance (2025)
IN CLEVER TOGETHER
In this world, philanthropic organizations focus their attention on the needs of the bottom billion, collaborating with governments, businesses, and local NGOs to improve standards of living around the globe. Operationally, this is a “virtual model” world in which philanthropies use all of the tools at their disposal to reinforce and bolster their work. With partnerships and networks increasingly key, philanthropies work in a more virtual way, characterized by lots of wikis, blogs, workspaces, video conferences, and virtual convenings. Smaller philanthropies proliferate, with a growing number of major donors emerging from the developing world. Systems thinking and knowledge management prove to be critical skills, as philanthropic organizations seek to share and spread best practices, identify leapfrog opportunities, and better spot problems in failed or weak states. There are considerable flows of talent between the for-profit and nonprofit sectors, and the lines between these types of organizations become increasingly blurred.
Scenario Narratives
CLEVER TOGETHER
TECHNOLOGY
IN CLEVER TOGETHER
In “Clever Together,” strong global cooperation on a range of issues drives technological breakthroughs that combat disease, climate change, and energy shortages. Trade and foreign direct investment spread technologies in all directions and make products cheaper for people in the developing world, thereby widening access to a range of technologies. The atmosphere of cooperation and transparency allows states and regions to glean insights from massive datasets to vastly improve the management and allocation of financial and environmental resources. Technology trends and applications we might see:
• Intelligent electricity, water distribution, and transportation systems develop in urban areas. In these “smart cities,” internet access is seen as a basic right by the late 2010s. • A malaria vaccine is developed and deployed broadly — saving millions of lives in the developing world. • Advances in low-cost mind-controlled prosthetics aid the 80 percent of global amputees who live in developing countries. • Solar power is made vastly more efficient through advances in materials, including polymers and nanoparticles. An effective combination of government subsidies and microfinance means solar is used for everything from desalination for agriculture to wi-fi networks. • Flexible and rapid mobile payment systems drive dynamic economic growth in the developing world, while the developed world is hampered by entrenched banking interests and regulation.
Scenarios for the Future of Technology and International Development
• The cost of capturing data through nanosensors and smart networks falls precipitously. In many developing countries, this leads to a proliferation of new and useful services, including “sousveillance” mechanisms that improve governance and enable more efficient use of government resources.
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Scenario Narratives
LIFE
CLEVER TOGETHER
IN CLEVER TOGETHER
Standing next to his desk at the World Meat Science Lab in Zurich, Alec took another bite of the steak that his lab assistants had just presented to him and chewed
Scenarios for the Future of Technology and International Development
it rather thoughtfully. This wasn’t just any steak. It was research. Alec and his research team had been working for months to fabricate a new meat product — one that tasted just like beef yet actually contained only 50 percent meat; the remaining half was a combination of synthetic meat, fortified grains, and nano-flavoring. Finding the “right” formula for that combo had kept the lab’s employees working around the clock in recent weeks. And judging from the look on Alec’s face, their work wasn’t over. “The flavor is still a few degrees off,” he told them. “And Kofi and Alana — see what we can do about enhancing this texture.”
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As Alec watched his team scramble back to their lab benches, he felt confident that it wouldn’t be long before they would announce the invention of an exciting new meat product that would be served at dinner tables everywhere. And, in truth, Alec’s confidence was very well founded. For one, he had the world’s best and brightest minds in food science from all over the world working together right here in his lab. He also had access to seemingly infinite amounts of data and information on everything from global taste preferences to meat distribution patterns — and just a few touches on his lab’s research screens (so much easier than the clunky computers and keyboards of the old days) gave him instant access to every piece of research ever done in meat science or related fields from the 1800s up through the present (literally the present — access to posted scientific research was nearly instantaneous, delayed by a mere 1.3 seconds). Alec also had strong motivation. There was no doubt that meat science — indeed, all science — was much more exciting, challenging, and rewarding in 2023 than it was a few decades ago. The shift from “lone wolf” science to globally coordinated and open-platform research had greatly accelerated the speed and spread of breakthrough ideas and developments in all fields. As a result, scientists were
Scenario Narratives
CLEVER TOGETHER
making real progress in addressing planet-wide problems that had previously seemed so intractable: people were no longer dying as frequently from preventable diseases, for example, and alternative fuels were now mainstream. But other trends were troubling — especially to a scientist who had spent his whole career researching food. In cities and villages around the world where children used to be hungry, access to higher-calorie meals had produced alarming increases in the incidence of obesity and diabetes. The demand for meat, in particular, was rising, but adding more animals to the planet created its own set of problems, such as more methane and spiking water demand. And that’s where Alec saw both need and opportunity: why not make the planet’s meat supply go further by creating a healthier alternative that contained less real meat?
Scenarios for the Future of Technology and International Development
“Alec, we have a new version for you to try,” yelled Kofi from across the lab. That was fast, thought Alec, as he searched around his desk for the fork.
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Scenario Narratives
CLEVER TOGETHER
took on new levels of authority, as did regional systems like the Association of Southeast Asian Nations (ASEAN), the New Partnership for Africa’s Development (NEPAD), and the Asian Development Bank (ADB). The worldwide spirit
“WHAT IS OFTEN SURPRISING ABOUT NEW TECHNOLOGIES IS COLLATERAL DAMAGE: THE EXTENT OF THE PROBLEM THAT YOU CAN CREATE BY SOLVING ANOTHER PROBLEM IS ALWAYS A BIT OF A SURPRISE.”
Scenarios for the Future of Technology and International Development
– Michael Free, Program for Appropriate Technology in Health (PATH)
28
of collaboration also fostered new alliances and alignments among corporations, NGOs, and communities. These strong alliances laid the groundwork for more global and participatory attempts to solve big problems and raise the standard of living of everyone. Coordinated efforts to tackle longentrenched problems like hunger, disease, and access to basic needs took hold. New inexpensive technologies like better medical diagnostics and more effective vaccines improved healthcare
delivery and health outcomes. Companies, NGOs, and governments — often acting together — launched pilot programs and learning labs to figure out how to best meet the needs of particular communities, increasing the knowledge base of what worked and what didn’t. Pharmaceuticals giants released thousands of drug compounds shown to be effective against diseases like malaria into the public domain as part of an “open innovation” agenda; they also opened their archives of R&D on neglected diseases deemed not commercially viable, offering seed funding to scientists who wanted to carry the research forward. There was a push for major innovations in energy and water for the developing world, as those areas were thought to be the key to improving equity. Better food distribution was also high on the agenda, and more open markets and south-south trade helped make this a reality. In 2022, a consortium of nations, NGOs, and companies established the Global Technology Assessment Office, providing easily accessible, real-time information about the costs and benefits of various technology applications to developing and developed countries alike. All of these efforts translated into real progress on real problems, opening up new opportunities
and networked criminal enterprises exploited both the weakness of states and the desperation of individuals. With increasing ease, these “global guerillas” moved illicit products through underground channels from poor producer
also sparked proxy wars and low-level conflict in resource-rich parts of the developing world. Nations raised trade barriers in order to protect their domestic sectors against imports and — in the face of global food and resource shortages — to reduce exports of agricultural produce and other commodities. By 2016, the global coordination and interconnectedness that had marked the post-Berlin Wall world was tenuous at best.
countries to markets in the developed world. Using retired 727s and other rogue aircraft, they crisscrossed the Atlantic, from South America to Africa, transporting cocaine, weapons, and operatives. Drug and gun money became a common recruiting tool for the desperately poor.
With government power weakened, order rapidly disintegrating, and safety nets evaporating, violence and crime grew more rampant. Countries with ethnic, religious, or class divisions saw especially sharp spikes in hostility: Naxalite separatists dramatically expanded their guerrilla campaign in East India; IsraeliPalestinian bloodshed escalated; and across Africa, fights over resources erupted along ethnic or tribal lines. Meanwhile, overtaxed militaries and police forces could do little to stop growing communities of criminals and terrorists from gaining power. Technology-enabled gangs
Criminal networks also grew highly skilled at counterfeiting licit goods through reverse engineering. Many of these “rip-offs” and copycats were of poor quality or downright dangerous. In the context of weak health systems, corruption, and inattention to standards — either within countries or from global bodies like the World Health Organization — tainted vaccines entered the public health systems of several African countries. In 2021, 600 children in Cote d’Ivoire died from a bogus Hepatitis B vaccine, which paled in comparison to the scandal sparked by mass deaths from a tainted anti-malarial drug years later. The deaths and resulting scandals sharply affected public confidence in vaccine delivery; parents not just in Africa but elsewhere
Scenarios for the Future of Technology and International Development
with the capacity to help their citizens and retain stability and order. Resource scarcities and trade disputes, together with severe economic and climate stresses, pushed many alliances and partnerships to the breaking point; they
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Scenario Narratives HACK ATTACK
“WE HAVE THIS LOVE AFFAIR WITH STRONG CENTRAL STATES, BUT THAT’S NOT THE ONLY POSSIBILITY. TECHNOLOGY IS GOING TO MAKE THIS EVEN MORE REAL FOR AFRICA. THERE IS THE SAME CELLPHONE PENETRATION RATE IN SOMALIA AS IN RWANDA. IN THAT RESPECT, SOMALIA WORKS.”
Scenarios for the Future of Technology and International Development
– Aidan Eyakuze, Society for International Development, Tanzania
36
began to avoid vaccinating their children, and it wasn’t long before infant and child mortality rates rose to levels not seen since the 1970s. Technology hackers were also hard at work. Internet scams and pyramid schemes plagued inboxes. Meanwhile, more sophisticated hackers attempted to take down corporations, government systems, and banks via phishing scams and database information heists, and their many successes generated billions of dollars in losses. Desperate to protect themselves and their intellectual property, the few multinationals
still thriving enacted strong, increasingly complex defensive measures. Patent applications skyrocketed and patent thickets proliferated, as companies fought to claim and control even the tiniest innovations. Security measures and screenings tightened. This “wild west” environment had a profound impact on innovation. The threat of being hacked and the presence of so many thefts and fakes lowered the incentives to create “me first” rather than “me too” technologies. And so many patent thickets made the cross-pollination of ideas and research difficult at best. Blockbuster pharmaceuticals quickly became artifacts of the past, replaced by increased production of generics. Breakthrough innovations still happened in various industries, but they were focused more on technologies that could not be easily replicated or re-engineered. And once created, they were vigorously guarded by their inventors — or even by their nations. In 2022, a biofuel breakthrough in Brazil was protected as a national treasure and used as a bargaining chip in trade with other countries. Verifying the authenticity of anything was increasingly difficult. The heroic efforts of several companies and NGOs to create
Scenario Narratives
LIFE
CLEVER TOGETHER
IN CLEVER TOGETHER
Standing next to his desk at the World Meat Science Lab in Zurich, Alec took another bite of the steak that his lab assistants had just presented to him and chewed
Scenarios for the Future of Technology and International Development
it rather thoughtfully. This wasn’t just any steak. It was research. Alec and his research team had been working for months to fabricate a new meat product — one that tasted just like beef yet actually contained only 50 percent meat; the remaining half was a combination of synthetic meat, fortified grains, and nano-flavoring. Finding the “right” formula for that combo had kept the lab’s employees working around the clock in recent weeks. And judging from the look on Alec’s face, their work wasn’t over. “The flavor is still a few degrees off,” he told them. “And Kofi and Alana — see what we can do about enhancing this texture.”
32
As Alec watched his team scramble back to their lab benches, he felt confident that it wouldn’t be long before they would announce the invention of an exciting new meat product that would be served at dinner tables everywhere. And, in truth, Alec’s confidence was very well founded. For one, he had the world’s best and brightest minds in food science from all over the world working together right here in his lab. He also had access to seemingly infinite amounts of data and information on everything from global taste preferences to meat distribution patterns — and just a few touches on his lab’s research screens (so much easier than the clunky computers and keyboards of the old days) gave him instant access to every piece of research ever done in meat science or related fields from the 1800s up through the present (literally the present — access to posted scientific research was nearly instantaneous, delayed by a mere 1.3 seconds). Alec also had strong motivation. There was no doubt that meat science — indeed, all science — was much more exciting, challenging, and rewarding in 2023 than it was a few decades ago. The shift from “lone wolf” science to globally coordinated and open-platform research had greatly accelerated the speed and spread of breakthrough ideas and developments in all fields. As a result, scientists were
Scenario Narratives HACK ATTACK
HEADLINES Millennium Development Goals Pushed Back to 2020 (2012)
2010
Scenarios for the Future of Technology and International Development
Islamic Terror Networks Thrive in Latin America (2016)
2015
Violence Against Minorities and Immigrants Spikes Across Asia (2014)
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IN HACK ATTACK
Congo Death Toll Hits 10,000 in Malaria Drug Scandal (2018)
Warlords Dispense Vital Medicines to Southeast Asian Communities (2028)
Doctors Without Borders Confined Within Borders (2020)
2020
2025 Nations Struggling with Resource Constraints Race to Scale Synthetic Biology (2021)
ROLE OF PHILANTHROPY
2030 India-Pakistan Water War Rages (2027)
IN HACK ATTACK
Philanthropy is less about affecting change than about promoting stability and addressing basic survival needs. Philanthropic organizations move to support urgent humanitarian efforts at the grassroots level, doing “guerrilla philanthropy” by identifying the “hackers” and innovators who are catalysts of change in local settings. Yet identifying pro-social entrepreneurs is a challenge, because verification is difficult amid so much scamming and deception. The operational model in this world is a “fortress model” in which philanthropic organizations coalesce into a strong, single unit to combat fraud and lack of trust. Philanthropies’ biggest assets are their reputation, brand, and legal/financial capacity to ward off threats and attempts at destabilization. They also pursue a less global approach, retreating to doing work in their home countries or a few countries that they know well and perceive as being safe.
Scenario Narratives HACK ATTACK
TECHNOLOGY
IN HACK ATTACK
Mounting obstacles to market access and to knowledge creation and sharing slow the pace of technological innovation. Creative repurposing of existing technologies — for good and bad — is widespread, as counterfeiting and IP theft lower incentives for original innovation. In a world of trade disputes and resource scarcities, much effort focuses on finding replacements for what is no longer available. Pervasive insecurity means that tools of aggression and protection — virtual as well as corporeal — are in high demand, as are technologies that will allow hedonistic escapes from the stresses of life. Technology trends and applications we might see:
• New threats like weaponized biological pathogens and destructive botnets dominate public attention, but enduring technologies, like the AK-47, also remain weapons of choice for global guerrillas. • The internet is overrun with spam and security threats and becomes strongly associated with illicit activity — especially on “dark webs” where no government can monitor, identify, or restrict activities. • Identity-verification technologies become a staple of daily life, with some hitches — a database of retina recordings stolen by hackers in 2017 is used to create numerous false identities still “at large” in the mid-2020s. • With the cost of cosmetic surgery dropping, procedures like the lunchtime facelift become routine among emerging middle classes.
Scenarios for the Future of Technology and International Development
• Echoing the rise of synthetic chemicals in the nineteenth century, synthetic biology, often state-funded, is used to “grow” resources and foodstuffs that have become scarce.
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Scenario Narratives HACK ATTACK
LIFE
IN HACK ATTACK
Trent never thought that his past experience as a government intelligence officer would convert into something…philanthropic. But in a world full of deceit and
Scenarios for the Future of Technology and International Development
scamming, his skills at discerning fact from fiction and developing quick yet deep local knowledge were highly prized. For three months now he had been working for a development organization, hired to find out what was happening in the “grey” areas in Botswana — a country that was once praised for its good governance but whose laws and institutions had begun to falter in the last few years, with corruption on the rise. His instructions were simple: focus not on the dysfunctional (which, Trent could see, was everywhere) but rather look through the chaos to see what was actually working. Find local innovations and practices that were smart and good and might be adopted or implemented elsewhere. “Guerrilla philanthropy” was what they called it, a turn of phrase that he liked quite a bit.
40
His trip into Botswana had been eventful — to put it mildly. On-time flights were rare these days, and the plane got diverted three times because of landing authorization snafus. At the Gaborone airport, it took Trent six hours to clear customs and immigration. The airport was bereft of personnel, and those on duty took their time scrutinizing and re-scrutinizing his visa. Botswana had none of the high-tech biometric scanning checkpoints — technology that could literally see right through you — that most developed nations had in abundance in their airports, along their borders, and in government buildings. Once out of the airport Trent was shocked by how many guns he saw — not just slung on the shoulders of police, but carried by regular people. He even saw a mother with a baby in one arm and an AK-47 in the other. This wasn’t the Botswana he remembered way back when he was stationed here 20 years ago as an embassy employee. The organization that hired him was probably more right than it realized in calling it guerrilla philanthropy. After many weeks spent chasing down leads in Gaborone, then an unfortunate stint that had him hiking for miles alone through the Kalahari
Scenario Narratives HACK ATTACK
Desert, Trent found himself traveling deep into the Chobe Forest (a nice reprieve,
Scenarios for the Future of Technology and International Development
he thought, from inhaling all that sand). One of his informants had told him about a group of smart youngsters who had set up their own biotechnology lab on the banks of the Chobe River, which ran along the forest’s northern boundary. He’d been outfitted with ample funds for grant-making, not the forest bribes he had heard so much about; regardless of what was taking place in the world around him, he was under strict orders to behave ethically. Trent was also careful to cover his tracks to avoid being kidnapped by international crime syndicates — including the Russian mafia and the Chinese triads — that had become very active and influential in Botswana. But he’d made it through, finally, to the lab, which he later learned was under the protection of the local gun lord. As expected, counterfeit vaccines were being manufactured. But so were GMO seeds. And synthetic proteins. And a host of other innovations that the people who hired him would love to know about.
41
SMART SCRAMBLE An economically depressed world in which individuals and communities develop localized, makeshift solutions to a
Scenarios for the Future of Technology and International Development
growing set of problems
42
The global recession that started in 2008 did not trail off in 2010 but dragged onward. Vigorous attempts to jumpstart markets and economies didn’t work, or at least not fast enough to reverse the steady downward pull. The combined private and public debt burden hanging over the developed world continued to depress economic activity, both there and in developing countries with economies dependent on exporting to (formerly) rich markets. Without the ability to boost economic activity, many countries saw their debts deepen and civil unrest and crime rates climb. The United States, too, lost much of its presence and credibility on the international stage due to deepening debt, debilitated markets, and a distracted government. This, in turn, led to the fracturing or decoupling of many
international collaborations started by or reliant on the U.S.’s continued strength. Also in trouble was China, where social stability grew more precarious. Depressed economic activity, combined with the ecological consequences of China’s rapid growth, started to take their toll, causing the shaky balance that had held since 1989 to finally break down. With their focus trained on managing the serious political and economic instability at home, the Chinese sharply curtailed their investments in Africa and other parts of the developing world. Indeed, nearly all foreign investment in Africa — as well as formal, institutional flows of aid and other support for the poorest countries — was cut back except in the gravest humanitarian emergencies. Overall, economic
Not that anyone had time to think about the future — present challenges were too pressing. In the developed world, unemployment rates skyrocketed. So did xenophobia, as companies and industries gave the few available jobs to native-born citizens, shunning foreign-born applicants. Great numbers of immigrants who had resettled in the developed world suddenly found that the economic opportunities that had drawn them were now paltry at best. By 2018, London had been drained of immigrants, as they headed back to their home countries, taking their education and skills with them. Reverse migration left holes in the communities of departure — both socially and literally — as stores formerly owned by immigrants stood empty. And their homelands needed them. Across the developing world and especially in Africa, economic survival was now firmly in local hands. With little help or aid coming through “official” and organized channels — and in the absence of strong trade and foreign currency earnings — most people and communities had no
choice but to help themselves and, increasingly, one another. Yet “survival” and “success” varied greatly by location — not just by country, but by city and by community. Communities inside failed states suffered the most, their poor growing still poorer. In many places, the failures of political leadership and the stresses of economic weakness and social conflict stifled the ability of people to rise above their dire circumstances. Not surprisingly, across much of the developing world the rural-urban divide gaped wider, as more limited availability and access to resources like IT and trade made survival and self-sufficiency much more challenging for non-urban dwellers. Communications and interactions that formerly served to bridge one family or one village or one student with their counterparts in other places — from emailing to phone calls to web postings — became less reliable. Internet access had not progressed far beyond its 2010 status, in part because the investment dollars needed to build out the necessary infrastructure simply weren’t there. When cellphone towers or fiber optic cables broke down, repairs were often delayed by months or even years. As a result, only people in certain geographies had access to the latest
Scenarios for the Future of Technology and International Development
stability felt so shaky that the occurrence of a sudden climate shock or other disaster would likely send the world into a tailspin. Luckily, those big shocks didn’t occur, though there was a lingering concern that they could in the future.
43
Scenario Narratives SMART SCRAMBLE
“THE SPREADING OF IDEAS DEPENDS ON ACCESS TO COMMUNICATION, PEER GROUPS, AND COMMUNITIES OF PRACTICE. EVEN IF SOMEONE HAS BLUEPRINTS TO MAKE SOMETHING, THEY MAY NOT HAVE THE MATERIALS OR KNOWHOW. IN A WORLD SUCH AS THIS, HOW DO YOU CREATE AN ECOSYSTEM OF RESEARCH AMONG THESE COMMUNITIES?”
Scenarios for the Future of Technology and International Development
– Jose Gomez-Marquez, Program Director for the Innovations in International Health initiative (IIH), MIT
44
communication and internet gadgets, while others became more isolated for lack of such connections. But there were silver linings. Government capacity improved in more advanced parts of the developing world where economies had already begun to generate a self-sustaining dynamic before the 2008-2010 crisis, such as Indonesia, Rwanda, Turkey, and Vietnam. Areas with good access to natural resources, diverse skill sets,
and a stronger set of overlapping institutions did far better than others; so did cities and communities where large numbers of “returnees” helped drive change and improvement. Most innovation in these better-off places involved modifying existing devices and technologies to be more adaptive to a specific context. But people also found or invented new ways — technological and non-technological — to improve their capacity to survive and, in some cases, to raise their overall living standards. In Accra, a returning Ghanaian MIT professor, working with resettled pharma researchers, helped invent a cheap edible vaccine against tuberculosis that dramatically reduced childhood mortality across the continent. In Nairobi, returnees launched a local “vocational education for all” project that proved wildly successful and was soon replicated in other parts of sub-Saharan Africa. Makeshift, “good enough” technology solutions — addressing everything from water purification and harnessing energy to improved crop yield and disease control — emerged to fill the gaps. Communities grew tighter. Micromanufacturing, communal gardens, and patchwork energy grids were created at the local level for local purposes. Many communities took on the aura of co-ops, some even launching
currencies designed to boost local trade and bring communities closer together. Nowhere was this more true than in India, where localized experiments proliferated, and succeeded or failed, with little connection to or impact on
or philanthropic support — did help, enabling students in isolated pockets in the developing world to access knowledge and instruction through the written word and other media like video. But the development of tangible devices,
other parts of the country — or the world.
products, and innovations continued to lag in places where local manufacturing skills and capacities had not yet scaled. More complex engineering solutions proved even more difficult to develop and diffuse.
These developments were encouraging, but also frustrating. In the absence of enduring trade and FDI channels, local experiments and innovations could neither scale nor boost overall growth. For those looking, it was difficult to find or access creative solutions. Scaling was further inhibited by the lack of compatible technology standards, making innovations difficult to replicate. Apps developed in rural China simply didn’t work in urban India. High-speed internet access — which gradually emerged in some areas despite weak government
By 2025, collaboration was finally improving, with ecosystems of research and sharing — many of them “virtual” — beginning to emerge. Yet without major progress in global economic integration and collaboration, many worried that good ideas would stay isolated, and survival and success would remain a local — not a global or national — phenomenon. •
Scenarios for the Future of Technology and International Development
Scenario Narratives SMART SCRAMBLE
45
Scenario Narratives SMART SCRAMBLE
HEADLINES
IN SMART SCRAMBLE
National Medical Labs in Southeast Asia Herald New Diagnostics for Native Diseases (2013)
2010
2015 Low-Cost Water Purification Device Halves Diarrhea Deaths in India (2015)
Chinese Government Pressured as Protests Spread to 250 Cities (2017)
2020
Scenarios for the Future of Technology and International Development
2025
'Returnee' Innovators Struggle to Expand Sales Beyond Home Markets (2020)
ROLE OF PHILANTHROPY
46
Maker Faire Ghana Partners with ‘Idol’ Franchise to Spotlight Young Innovators (2027)
Famine Haunts Ethiopia—Again (2022)
2030
VC Spending Within Sub-Saharan Africa Triples (2025)
IN SMART SCRAMBLE
Philanthropic organizations look to fund at the grassroots level, in order to reach people more quickly and solve short-term problems. The meta-goal in this world is to scale up: to identify and build capacity from the individual through the institutional, because without global coordination, innovation cannot scale on its own. Philanthropy requires a keen screening capacity to identify highly localized solutions, with specialized pockets of expertise that make partnerships more challenging and transitions between sectors and issues harder to achieve. Philanthropy operations are decentralized; headquarters are less important, and the ability to quickly access different parts of the world and reconfigure teams on short notice is key. Office space is rented by the day or week, not the month or year, because more people are in the field — testing, evaluating, and reporting on myriad pilot projects.
Scenario Narratives SMART SCRAMBLE
TECHNOLOGY
IN SMART SCRAMBLE
Economic and political instability fracture societies in the developed world, resources for technology development diminish, and talented immigrants are forced to return to their countries of origin. As a result, capacity and knowledge are distributed more widely, allowing many small pockets of do-it-yourself innovation to emerge. Low-tech, “good enough” solutions abound, cobbled together with whatever materials and designs can be found. However, the transfer of cutting-edge technology through foreign direct investment is rare. Structural deficiencies in the broader innovation ecosystem — i n accessing capital, markets, and a stable internet — and in the proliferation of local standards limit wider growth and development. Technology trends and applications we might see:
• Breakdowns in the global medicine supply chain accelerate the emergence of locally bioengineered super-strength homeopathic remedies, which replace antibiotics in the dispensaries of many developing-world hospitals. • Widespread micro-manufacturing, using 3D printers, enables the fabrication of replacement components for engines and machines, allowing “perpetual maintenance” to compensate for broken trade links. • Garden allotments proliferate in mega-cities as new urban-dwellers seek to supplement a scarce food supply and maintain their agricultural heritage. • Technically advanced communities use mesh networks to ensure high-speed internet access, but most rural poor remain cut off from access.
Scenarios for the Future of Technology and International Development
• Energy technology improvements are geared more toward efficiency — getting more from existing sources of power — than new-generation technologies, though some local improvements in generating and distributing wind and geothermal energy do occur.
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Scenario Narratives SMART SCRAMBLE
LIFE
IN SMART SCRAMBLE
The beat-up six-seater plane in which Lidi was the lone passenger lurched suddenly. She groaned, grabbed the armrests, and held on as the plane dipped sharply before
Scenarios for the Future of Technology and International Development
finally settling into a smooth flight path. Lidi hated small planes. But with very few commercial jets crisscrossing Africa these days, she didn’t have much choice. Lidi — an Eritrean by birth — was a social entrepreneur on a mission that she deemed critical to the future of her home continent, and enduring these plane flights was an unfortunate but necessary sacrifice. Working together with a small team of technologists, Lidi’s goal was to help the good ideas and innovations that were emerging across Africa to spread faster — or, really, spread at all.
48
In this, Lidi had her work cut out for her. Accelerating and scaling the impact of local solutions developed for very local markets was far from easy — especially given the patchiness of internet access across Africa and the myopic perspective that was now, in 2025, a widespread phenomenon. She used to worry about how to scale good ideas from continent to continent; these days she’d consider it a great success to extend them 20 miles. And the creative redundancy was shocking! Just last week, in Mali, Lidi had spent time with a farmer whose co-op was developing a drought-resistant cassava. They were extremely proud of their efforts, and for good reason. Lidi didn’t have the heart to tell them that, while their work was indeed brilliant, it had already been done. Several times, in several different places. During her many flights, Lidi had spent hours looking out the window, gazing down on the villages and cities below. She wished there were an easier way to let the innovators in those places know that they might not be inventing, but rather independently reinventing, tools, goods, processes, and practices that were already in use. What Africa lacked wasn’t great ideas and talent: both were abundant. The missing piece was finding a way to connect those dots. And that’s why she was back on this rickety plane again and heading to Tunisia. She and her team were now concentrating on promoting mesh networks across Africa, so that places lacking internet access could share nodes, get connected, and maybe even share and scale their best innovations.
Concluding Thoughts As you have seen, each of the scenarios, if it were to unfold, would call for different strategies and have different implications for how a range of organizations will work and relate to changes in technology. But no matter what world might emerge, there are real choices to be made about what areas and goals to address and how to drive success toward
We hope that reading the scenario narratives and their accompanying stories about philanthropy, technology, and people has sparked your imagination, provoking new thinking about these emergent themes and their possibilities. Three key insights stood out to us as we developed these scenarios. First, the link between technology and governance is critical to consider in better understanding how technology could be developed and deployed. In some futures, the primacy of the nation-state as a unit of analysis in development was questioned as both supra- or sub-national structures proved more salient to the achievement of development goals. In other futures, the nation-state’s power strengthened and it became an even more powerful actor both to the benefit and to the detriment of
the development process, depending on the quality of governance. Technologies will affect governance, and governance in turn will play a major role in determining what technologies are developed and who those technologies are intended, and able, to benefit. A second recurring theme in the scenarios is that development work will require different levels of intervention, possibly simultaneously. In some scenarios, philanthropic organizations and other actors in development face a set of obstacles in working with large institutions, but may face a yet-unfolding set of opportunities to work with nontraditional partners — even individuals. The organization that is able to navigate between these levels and actors may be best positioned to drive success.
Scenarios for the Future of Technology and International Development
particular objectives.
49
Concluding Thoughts
Scenarios for the Future of Technology and International Development
DEVELOPMENT-LED INTERVENTIONS ARE OFTEN NOT CAREFUL ENOUGH ABOUT WHAT THE TECHNOLOGY NEEDS IN ORDER TO WORK ON A THREE, FIVE, OR SEVEN YEAR CYCLE. WHAT SCALE IS REQUIRED FOR DEPLOYMENT TO BE SUCCESSFUL? WHAT LEVEL OF EDUCATION IS NEEDED TO BE SUSTAINABLE IN TERMS OF MAINTENANCE? HOW DO THESE REQUIREMENTS EVOLVE OVER TIME?
50
– Isha Ray, Professor, University of California-Berkeley School of Information, Energy, and Resources Group
The third theme highlights the potential value of scenarios as one critical element of strategy development. These narratives have served to kick-start the idea generation process, build the future-oriented mindset of participants, and provide a guide for ongoing trend monitoring and horizon scanning activities. They also offer a useful framework that can help in tracking and making sense of early indicators and milestones that might signal the way in which the world is actually transforming. While these four scenarios vary significantly from one another, one theme is common to them all: new innovations and uses of technology will be an active and integral part of the international development story going forward. The changing nature of technologies could shape the characteristics of development and the kinds of development aid that are in demand. In a future in which technologies are effectively adopted and adapted by poor people on a broad scale, expectations about the provision of services could fundamentally shift. Developing a deeper understanding of the ways in which technology can impact development will better prepare everyone for the future, and help all of us drive it in new and positive directions.
Appendix CRITICAL UNCERTAINTIES The following is a list of the 15 critical uncertainties presented to participants during this project’s primary scenario creation workshop. These uncertainties were themselves selected from a significantly longer list generated during earlier phases of research and extensive interviewing. The uncertainties fall into three categories: technological, social and environmental, and economic and political. Each uncertainty is presented along with two polar endpoints, both representing a very different direction in which that uncertainty might develop.
technologies with the most impact on development
existing technologies
both developed and developing worlds
origin of technology innovations critical to development
developed world and some BRICs
slow the adoption of novel technologies
social and cultural norms
allow for rapid adoption of novel technologies
new innovations that substantially reduce child and infant mortality (vaccines, treatments, cures)
many
new technologies
few
SOCIAL & ENVIRONMENTAL UNCERTAINTIES
dynamic, open to the novel and nontraditional
occurrence of “shocks” like disease, famine, and natural disasters
frequent and highly disruptive
poor and worsening
quality of the local environment in the developing world (air, water, sanitation, built environment, etc.)
improved and improving
de-prioritized
global climate change awareness and action
prioritized
static, traditional restricted infrequent and manageable
community identity in the developing world educational and employment opportunities for women
expanding
Scenarios for the Future of Technology and International Development
TECHNOLOGICAL UNCERTAINTIES
51
ECONOMIC & POLITICAL UNCERTAINTIES worse than expected inhibiting static marginal and contained weak, with barriers to cooperation
Scenarios for the Future of Technology and International Development
worse and more prone to disruptions
52
global economic performance, 2010-2015 rules and norms around entrepreneurial activity education and training opportunities in the developing world conflict in the developing world international economic and strategic relationships food security in the developing world
improves significantly supportive increasing pervasive and widespread strong, with more supranational cooperation better and more secure
LIST OF PARTICIPANTS
ROCKEFELLER FOUNDATION STAFF
This report is the result of extensive effort and collaboration among Rockefeller Foundation initiative staff, Foundation grantees, and external experts. The Rockefeller Foundation and GBN would like to extend special thanks to all of the individuals who contributed their thoughtfulness and expertise throughout the scenario process. Their enthusiastic participation in interviews, workshops, and the ongoing iteration of the scenarios made this co-creative process more stimulating and engaging that it could ever have been otherwise.
Project Leads Claudia Juech, Managing Director Evan Michelson, Senior Research Associate Core Team Karl Brown, Associate Director Robert Buckley, Managing Director Lily Dorment, Research Associate Brinda Ganguly, Associate Director Veronica Olazabal, Research Associate Gary Toenniessen, Managing Director Thank you as well to all Foundation staff who participated in the scenario creation workshop in December. A special thank you also to Laura Yousef.
ROCKEFELLER FOUNDATION GRANTEES
GLOBAL BUSINESS NETWORK
G.K. Bhat, TARU Leading Edge, India
Andrew Blau, Co-President
Le Bach Duong, Institute for Social Development Studies, Vietnam
Tara Capsuto, Senior Practice Associate Lynn Carruthers, Visual Practitioner
Aidan Eyakuze, Society for International Development, Tanzania
Michael Costigan, Practitioner
Michael Free, PATH, Seattle, WA
Jenny Johnston, Senior Editor
Namrita Kapur, Root Capital, Boston, MA
Barbara Kibbe, Vice President of Client Services, Monitor Institute
Paul Kukubo, Kenya ICT Board, Kenya Joseph Mureithi, Kenyan Agriculture Research Institute, Kenya
Brie Linkenhoker, Senior Practitioner Peter Schwartz, Chairman
EXTERNAL EXPERTS
Robert de Jongh, Managing Regional Director, SNV Latin America José Gomez-Marquez, Program Director for the Innovations in International Health initiative (IIH), Massachusetts Institute of Technology Natalie Jeremijenko, Experimental Designer and Director of xdesign Environmental Health Clinic, New York University Athar Osama, Visiting Fellow, Frederick S. Pardee Center for the Study of the Longer-Range Future, Boston University Isha Ray, Professor, School of Information (Energy and Resources Group), University of California-Berkeley Enrique Rueda-Sabater, Director of Strategy and Business Development for Emerging Markets, Cisco Caroline Wagner, Senior Analyst, SRI International and Research Scientist, Center for International Science and Technology Policy, The George Washington University
Scenarios for the Future of Technology and International Development
Stewart Brand, Cofounder of GBN and President of the Long Now Foundation
53
The Rockefeller Foundation 420 Fifth Ave New York, NY 10018 tel +1 212 869 8500 fax +1 212 764 3468
Global Business Network 101 Market Street Suite 1000 San Francisco, CA 94105
www.rockefellerfoundation.org
www.gbn.com
tel +1 415 932 5400 fax +1 415 932 5401
THE
SPARS PANDEMIC 2025 - 2028 A Futuristic Scenario for Public Health Risk Communicators
THE JOHNS HOPKINS CENTER FOR HEALTH SECURITY
Project Team Monica Schoch-Spana, PhD Senior Associate Johns Hopkins Center for Health Security
Matthew P. Shearer, MPH Senior Analyst Johns Hopkins Center for Health Security
Emily K. Brunson, PhD, MPH Associate Professor Texas State University
Sanjana Ravi, MPH Senior Analyst Johns Hopkins Center for Health Security
Tara Kirk Sell, PhD, MA Senior Associate Johns Hopkins Center for Health Security
Hannah Chandler MPH Candidate Columbia University
Gigi Kwik Gronvall, PhD Senior Associate Johns Hopkins Center for Health Security
Recommended Citation Schoch-Spana M, Brunson EK, Shearer MP, Ravi S, Sell TK, Chandler H, Gronvall GK. The SPARS Pandemic, 2025-2028: A Futuristic Scenario for Public Health Risk Communicators. Baltimore, MD: Johns Hopkins Center for Health Security; October 2017.
About the Johns Hopkins Center for Health Security
The Johns Hopkins Center for Health Security works to protect people from epidemics and disasters and build resilient communities through innovative scholarship, engagement, and research that strengthens the organizations, systems, policies, and programs essential to preventing and responding to public health crises. The Center is part of the Johns Hopkins Bloomberg School of Public Health and is located in Baltimore, MD.
Learn more at www.centerforhealthsecurity.org
Scenario Narratives SMART SCRAMBLE
LIFE
IN SMART SCRAMBLE
The beat-up six-seater plane in which Lidi was the lone passenger lurched suddenly. She groaned, grabbed the armrests, and held on as the plane dipped sharply before
Scenarios for the Future of Technology and International Development
finally settling into a smooth flight path. Lidi hated small planes. But with very few commercial jets crisscrossing Africa these days, she didn’t have much choice. Lidi — an Eritrean by birth — was a social entrepreneur on a mission that she deemed critical to the future of her home continent, and enduring these plane flights was an unfortunate but necessary sacrifice. Working together with a small team of technologists, Lidi’s goal was to help the good ideas and innovations that were emerging across Africa to spread faster — or, really, spread at all.
48
In this, Lidi had her work cut out for her. Accelerating and scaling the impact of local solutions developed for very local markets was far from easy — especially given the patchiness of internet access across Africa and the myopic perspective that was now, in 2025, a widespread phenomenon. She used to worry about how to scale good ideas from continent to continent; these days she’d consider it a great success to extend them 20 miles. And the creative redundancy was shocking! Just last week, in Mali, Lidi had spent time with a farmer whose co-op was developing a drought-resistant cassava. They were extremely proud of their efforts, and for good reason. Lidi didn’t have the heart to tell them that, while their work was indeed brilliant, it had already been done. Several times, in several different places. During her many flights, Lidi had spent hours looking out the window, gazing down on the villages and cities below. She wished there were an easier way to let the innovators in those places know that they might not be inventing, but rather independently reinventing, tools, goods, processes, and practices that were already in use. What Africa lacked wasn’t great ideas and talent: both were abundant. The missing piece was finding a way to connect those dots. And that’s why she was back on this rickety plane again and heading to Tunisia. She and her team were now concentrating on promoting mesh networks across Africa, so that places lacking internet access could share nodes, get connected, and maybe even share and scale their best innovations.
Acknowledgements
The project team is grateful to Kunal Rambhia, Meredith Li-Vollmer, Shari Veil, Brad Smith, Rita Obey, Ji Sun Lee, and the members of the Expert Working Group on Medical Countermeasure (MCM) Communication Strategies for their contributions and feedback throughout the development process for this document.
Disclaimer
This is a hypothetical scenario designed to illustrate the public health risk communication challenges that could potentially emerge during a naturally occurring infectious disease outbreak requiring development and distribution of novel and/or investigational drugs, vaccines, therapeutics, or other medical countermeasures.
The infectious pathogen, medical countermeasures, characters, news media excerpts, social media posts, and government agency responses described herein are entirely fictional.
PREFACE
P OSSIBLE F UTURE
IN
2025: T HE “E CHO C HAMBER ”
U NBRIDLED G LOBAL A CCESS TO I NFORMATION C OUPLED WITH S OCIAL F RAGMENTATION AND S ELF -A FFIRMING W ORLDVIEWS Scenario Purpose The following narrative comprises a futuristic scenario that illustrates communication dilemmas concerning medical countermeasures (MCMs) that could plausibly emerge in the not-so-distant future. Its purpose is to prompt users, both individually and in discussion with others, to imagine the dynamic and oftentimes conflicted circumstances in which communication around emergency MCM development, distribution, and uptake takes place. While engaged with a rigorous simulated health emergency, scenario readers have the opportunity to mentally “rehearse” responses while also
weighing the implications of their actions. At the same time, readers have a chance to consider what potential measures implemented in today’s environment might avert comparable communication dilemmas or classes of dilemmas in the future. Generation Purpose This prospective scenario was developed through a combination of inductive and deductive approaches delineated by Ogilvy and Schwartz.1 The timeframe for the scenario (the years 2025-2028) was selected first, and then major socioeconomic, demographic, technological, and environmental trends likely to have emerged by that period were identified. Specifically, two dominant trends likely to influence regulatory and public responses to future public health emergencies were selected: one, varying degrees of access to information technology; and two, varying levels of fragmentation among populations along social, political, religious, ideological, and cultural lines. A scenario matrix was then constructed, illustrating four possible worlds shaped by these trends, with consideration given to both constant and unpredictable
driving forces.
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The SPARS Pandemic
PREFACE
Ultimately, a world comprised of isolated and highly fragmented communities with widespread access to information technology—dubbed “the echo-chamber”—was selected as the future in which the prospective scenario would take place. From this point, scenario-specific storylines were then developed, drawing on subject matter expertise, historical accounts of past medical countermeasure crises, contemporary media reports, and scholarly literature in sociology, emergency preparedness, health education, and risk and crisis communication. These sources were used to identify communication challenges likely to emerge in future public health emergencies. This prospective scenario is not intended to predict events to come; rather, it is meant to serve as a plausible narrative that illustrates a broad range of serious and frequently encountered challenges in the realm of risk and crisis communication. Scenario Environment In the year 2025, the world has become simultaneously more connected, yet more divided. Nearly universal access to wireless internet and new technology—including internet accessing technology
(IAT): thin, flexible screens that can be temporarily attached to briefcases, backpacks, or clothing and used to stream content from the internet—has provided the means for readily sharing news and information. However, many have chosen to self-restrict the sources they turn to for information, often electing to interact only with those with whom they agree. This trend has increasingly isolated cliques from one another, making communication across and between these groups more and more difficult. From a government standpoint, the current administration is led by President Randall Archer, who took office in January 2025. Archer served as Vice President under President Jaclyn Bennett (20202024), who did not seek a second term due to health concerns. The two remain close and Bennett acts as a close confidante and unofficial advisor to President Archer. The majority of President Archer’s senior staff, including Department of Health and Human Services Secretary Dr. Cindra Nagel, are carryovers from Bennett’s administration. At the time of the initial SPARS outbreak Nagel has served in this position for just over three years. In regards to MCM communication more specifically, the US Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), the Food and Drug
Administration (FDA), and other public health agencies have increasingly adopted a diverse range of
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The SPARS Pandemic
PREFACE
social media technologies, including long-existing platforms such as Facebook, Snapchat, and Twitter, as well as emerging platforms like ZapQ, a platform that enables users to aggregate and archive selected media content from other platforms and communicate with cloud-based social groups based on common interests and current events. Federal and state public health organizations have also developed agency-specific applications and ramped up efforts to maintain and update agency websites. Challenging their technological grip, however, are the diversity of new information and media platforms and the speed with which the social media community evolves. Moreover, while technologically savvy and capable, these agencies still lag in terms of their “multilingual” skills, cultural competence, and ability to be present on all forms of social media. Additionally, these agencies face considerable budget constraints, which further complicate their efforts to expand their presence across the aforementioned platforms, increase social media literacy among their communication workforces, and improve public uptake of key messages. Scenario Organization & Use
This scenario was designed to illustrate the public health risk communication challenges associated with distribution of emergency medical countermeasures during an infectious disease pandemic. The story is organized chronologically, and each chapter concludes with a treatment of key communication dilemmas and corresponding discussion questions. Some questions are targeted towards challenges faced by risk communicators representing federal agencies, while others address issues more relevant to state and local risk communicators. As such, users may find it most helpful to run the scenario as a tabletop exercise. Alternatively, if users prefer to examine select communication dilemmas rather than proceed chronologically through the entire scenario, they may refer to Appendices A-D, which contain the timelines for the response and recovery phases of the story, as well as indices of the communication dilemmas and their corresponding page numbers.
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RESPONSE
T HE SPARS O UTBREAK B EGINS C HAPTER O NE
In mid-October 2025, three deaths were reported among members of the First Baptist Church of St. Paul, Minnesota. Two of the church members had recently returned from a missionary trip to the Philippines, where they provided relief to victims of regional floods. The third was the mother of a church member who had also traveled to the Philippines with the church group but who had been only mildly sick himself. Based on the patients’ reported symptoms, healthcare providers initially guessed that they had died from seasonal influenza, which health officials predicted would be particularly
virulent and widespread that fall. However, laboratory tests were negative for influenza. Unable to identify the causative agent, officials at the Minnesota Department of Health’s Public Health Labora-
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CHAPTER ONE
tory sent the patients’ clinical specimens to the Centers for Disease Control and Prevention (CDC), where scientists confirmed that the patients did not have influenza. One CDC scientist recalled reading a recent ProMed dispatch describing the emergence of a novel coronavirus in Southeast Asia, and ran a pancoronavirus RT-PCR test. A week later, the CDC team confirmed that the three patients were, in fact, infected with a novel coronavirus, which was dubbed the St. Paul Acute Respiratory Syndrome Coronavirus (SPARS-CoV, or SPARS), after the city where the first cluster of cases had been identified. The CDC monitored the situation closely, working with partners in Southeast Asia to quickly develop a case definition for SPARS. Within four weeks of CDC publishing a working case definition on its website, nearly two hundred suspected cases of SPARS were reported across Minnesota and in six other states. Given that flu season was just getting underway and that a rapid diagnostic test for SPARS-CoV infection was not yet available, CDC officials could not be sure
if these were, in fact, true cases of SPARS. Nevertheless, on November 17, HHS Secretary Dr. Cindra Nagel notified the World Health Organization (WHO) about the US cluster of SPARS cases, concerned that the outbreak might constitute a Public Health Emergency of International Concern (PHEIC). As transmission of SPARS was determined to occur via droplet spread, the CDC initially recommended that everyone diligently maintain hand hygiene and frequently disinfect potentially contaminated surfaces. CDC officials further urged anyone with severe flulike symptoms to seek immediate medical attention. Public health officials were concerned that the upcoming Thanksgiving holiday and Black Friday
shopping activities would facilitate the spread of SPARS, but they remained confident that the aware-
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CHAPTER ONE
ness and prevention messages disseminated annually for seasonal influenza, combined with isolation procedures for suspected cases, would be effective at countering the spread of SPARS. These messages were spread via a variety of traditional and social media sources, including Facebook, Instagram, Reddit, Twitter, and ZapQ. Concern among many Americans about the severity of SPARS at this point in the outbreak was moderately high. The public’s concern was compounded by the apparent virulence of the pathogen. At the outset of the SPARS outbreak, physicians’ understanding of the disease stemmed primarily from extremely severe cases resulting in pneumonia or hypoxia that required hospitalization and extensive medical treatment. Mild cases of the disease, which produced symptoms including cough, fever, headaches, and malaise, were often perceived as the flu by the people who had them and consequently often went untreated and undiagnosed by medical personnel. As a result, early case fatality estimates were inflated. By late November, the CDC reported an initial estimated SPARS case fatality rate of 4.7% (By contrast, WHO reported that the overall case fatality rate for SARS was 14-15% and over 50% for people over the age of 64. Later in the SPARS outbreak, data that included more accurate
estimates of mild SPARS cases indicated a case fatality rate of only 0.6%). Two additional features of the SPARS virus that were not appreciated at the beginning of the pandemic, but that impacted how the outbreak played out, are also important to consider in a review of this event. First, the virus had an extended incubation period (seven to ten days) compared to its latent period (four to five days). Thus, infected persons could spread the virus for up to nearly a week before showing symptoms of the disease themselves. As a result, isolating sick SPARS patients proved to be less effective than isolating patients infected by other, better-characterized respiratory diseases. Second, morbidity and mortality from SPARS were both significantly higher in children than adults. Pregnant women and those with chronic respiratory conditions like asthma and emphysema were also at a higher risk for both disease complications and death.
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CHAPTER ONE
COMMUNICATION DILEMMA Engendering Public Trust and a S e n s e o f S e l f - E f f i c a c y Wh e n a C r i s i s i s S t i l l E v o l v i n g and Health Information is Incomplete
FOOD
FOR
THOUGHT
1) How can health authorities best meet public demands for critical information, such as, “What is the health threat?” and “What do I know about it?” when the crisis is still unfolding and not all the facts are known? 2) What benefits does monitoring trends in social media postings confer on efforts to meet people’s information needs during an evolving health crisis? 3) What medical and morale-boosting purposes does sharing information about self-protective actions (eg, infection control measures) serve for the public during an uncertain and fear-instilling situation?
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A P OSSIBLE C URE C HAPTER T WO
Distributed via the CDC Health Alert Network December 15, 2025, 13:00 ET (1:00 PM ET) CDCHAN-00528 Summary The Centers for Disease Control and Prevention (CDC) and state health departments are investigating the emergence of the St. Paul Acute Respiratory Syndrome Coronavirus (SPARS-CoV), now reported in 26 states and several other countries. The purpose of this HAN Advisory is to update public health departments and healthcare facilities about this epidemic and to provide guidance to healthcare providers. At this time, the FDA and NIH are evaluating potential treatment options. Evidence indicates that antiviral pharmaceuticals may provide benefit. Based on previous trials in other coronavirus patients, the antiviral Kalocivir is the leading candidate; however, neither the efficacy nor safety profile has been determined for SPARS cases. Further guidance regarding personal protective equipment (PPE) and clinical care protocols are delineated below.
Early in the SPARS pandemic, public health and medical professionals were hopeful that the outbreak could be contained through case identification and isolation. It quickly became clear, however, that this strategy was not as effective as initially hoped. First, challenges in identifying mild cases limited the impact of isolation programs. Because the initial symptoms of SPARS closely resembled influenza,
many who contracted SPARS did not immediately seek care, assuming they merely had the flu. Fortunately, some who thought they had the flu chose to isolate themselves at home, thereby prevent-
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About the Johns Hopkins Center for Health Security
The Johns Hopkins Center for Health Security works to protect people from epidemics and disasters and build resilient communities through innovative scholarship, engagement, and research that strengthens the organizations, systems, policies, and programs essential to preventing and responding to public health crises. The Center is part of the Johns Hopkins Bloomberg School of Public Health and is located in Baltimore, MD.
Learn more at www.centerforhealthsecurity.org
Table of Contents Preface A Possible Future in 2025: The “Echo Chamber”..................................................................................1
Response Chapter One: The SPARS Outbreak Begins............................................................................................4 Chapter Two: A Possible Cure....................................................................................................................8 Chapter Three: A Potential Vaccine........................................................................................................11 Chapter Four: Users Beware.....................................................................................................................14 Chapter Five: Going Viral..........................................................................................................................19 Chapter Six: The Grass is Always Greener...........................................................................................23 Chapter Seven: The Voice..........................................................................................................................25 Chapter Eight: Are You Talking To Me?..............................................................................................29 Chapter Nine: Changing Horses Midstream.........................................................................................31 Chapter Ten: Head of the Line Privileges..............................................................................................34 Chapter Eleven: Standing in Line, Protesting Online.........................................................................37 Chapter Twelve: Don’t Put All Your Eggs in One Basket................................................................40 Chapter Thirteen: Lovers and Haters.....................................................................................................43 Chapter Fourteen: The Grass is Always Greener, Part II.................................................................49 Chapter Fifteen: Are You Talking to Me, Part II................................................................................52 Chapter Sixteen: Antibiotics, HO!............................................................................................................55
Recovery Chapter Seventeen: Vaccine Injury..........................................................................................................59 Chapter Eighteen: Acknowledging Loss................................................................................................63 Chapter Nineteen: SPARS Aftermath.....................................................................................................66
References & Appendices References......................................................................................................................................................67 Acronyms.......................................................................................................................................................68 Appendix A: Response Scenario Timeline.............................................................................................69 Appendix B: Response Scenario Communication Dilemmas............................................................73 Appendix C: Recovery Scenario Timeline.............................................................................................75 Appendix D: Recovery Scenario Communication Dilemmas............................................................76
A P OTENTIAL V ACCINE C HAPTER T HREE
GMI TO: Gretta Smithson, Vice-President for Animal Health FROM: Dr. Marcus Thompson, Director, Vaccination Research Branch RE: Hooved Mammal Respiratory Virus Vaccine Number 14 (HMRV-vac14) Use in Human Populations DATE: December 30, 2025 ATTACHMENTS: 1. HMRV-vac14 Efficacy and Side Effects 2. Hoofed Mammal Respiratory Coronavirus Outbreak Model Estimates (2021)
PROBLEM BACKGROUND Your office requested information regarding any previous SPARS-like illness in GMI animal populations and potential immunization or treatment implications for the ongoing SPARS pandemic. SUMMARY In 2021, a coronavirus caused an outbreak in Region 7 (Southeast Asia) hoofed mammal populations. Our researchers developed and produced in-house an effective vaccine against the infection (HMRV-vac14). Its subsequent approval and use successfully ended the outbreak in the region. While largely effective in preventing infection, severe side effects—including swollen legs; severe joint pain; and encephalitis potentially resulting in seizures, seizure disorders or death— occasionally occurred (Attachment 1). Given the millions of vaccinations required for Region 7, this resulted in measurable losses to the animal population; however, these were acceptable compared to those from the respiratory infection itself (Attachment 2). Each of the severe side effects was accompanied by physical presentation such that the affected animal was removed from the population and culled to prevent processing affected animals for sale. It is unknown at this time how similar the two coronaviruses are or whether HMRV-vac14 (or a similar vaccine) would be effective in human populations. Due to its development for internal use only, HMRV-vac14 has not been tested or authorized by any governing agency for use in animals or humans.
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CHAPTER THREE
Shortly after authorizing expanded access to Kalocivir for select patients, the FDA received reports of an animal vaccine developed by GMI, a multinational livestock conglomerate operating cattle and pig farms in, among other places, Southeast Asia. Since 2021, ranchers had been using the vaccine to prevent a SPARS-like respiratory coronavirus disease in cows and pigs in the Philippines and other Southeast Asian countries. Data provided by GMI suggested that the vaccine was effective at preventing SPARS-like illnesses in cows, pigs, and other hooved mammals, but internal trials revealed several worrisome side effects, including swollen legs, severe joint pain, and encephalitis leading to seizures or death. Because any animals experiencing these side effects were immediately killed, and because animals were typically slaughtered within a year of vaccination, further information regarding the short- and long-term effects of the GMI vaccine was unavailable. Lacking a viable alternative—and considering the potentially high morbidity and mortality associated with SPARS (at the time the case fatality rate was still considered to be 4.7%)—the United States government contacted GMI in regards to the vaccine. After laboratory tests confirmed that the coronavirus affecting livestock in Southeast Asia was closely related to SPARS-CoV, the US began an
extensive review of GMI’s animal vaccine development and testing processes. Shortly thereafter, federal health authorities awarded a contract to CynBio, a US-based pharmaceutical company, to develop a SPARS vaccine based on the GMI model. The contract included requirements for safety testing, ensuring the vaccine would be safe and effective for human use. It also provided considerable funding from the National Institutes of Health (NIH) and included provisions for priority review by the FDA. Additionally, HHS Secretary Nagel agreed in principle to invoke the Public Readiness and Emergency Preparedness Act (PREP Act), thereby providing liability protection for CynBio and future vaccine providers in the event that vaccine recipients experienced any adverse effects.
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CHAPTER THREE
COMMUNICATION DILEMMA Maintaining Trust in Government Processes for Ensuring the Timely Development of Safe and Effective Vaccines Wh e n N o v e l T h r e a t s A r i s e
FOOD
FOR
THOUGHT
1) How might federal health authorities avoid people possibly seeing an expedited SPARS vaccine development and testing process as somehow “rushed” and inherently flawed, even though that process still meets the same safety and efficacy standards as any other vaccine?
2) How might federal health authorities respond to critics who propose that liability protection for SPARS vaccine manufacturers jeopardizes individual freedom and wellbeing? 3) Once the vaccine becomes broadly available (see the chapter, “Head of the Line Privileges”), how might public health communicators implement the “best practices” principle of enabling people to make their own informed decisions about whether to accept the novel SPARS vaccine? 4) What are the potential consequences of health officials overreassuring the public about the potential risks of a novel SPARS vaccine when long-term effects are not yet known?
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U SERS B EWARE C HAPTER F OUR
Following limited evidence of success in treating SPARS patients with Kalocivir, the FDA issued an Emergency Use Authorization (EUA) for this drug as a SPARS therapeutic in the United States. While Kalocivir had a positive impact against SPARS, preliminary data indicated it also caused intense stomach cramping in a statistically significant number of adult cases. Additionally, while initial hopes had been that Kalocivir would, in addition to treating the disease, prevent or reduce transmission, this was not the case. Nevertheless, due to high public demand for access to viable SPARS treatments, public health and healthcare agencies drew from existing SNS inventories of Kalocivir (several million
doses) until further production of the drug could begin.
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C HAPTER F OUR
Official announcements about the use of Kalocivir to treat SPARS were made in early January 2026. Although extensive interagency efforts were made to coordinate messages, slight differences were emphasized by the media, leading to the appearance of diverging messages. The FDA, for example, explained that Kalocivir was being authorized under emergency use protocols as a treatment for SPARS and recommended that healthcare providers and other interested persons review the FDAapproved drug insert, which included information about potential side effects. The CDC’s announcement contained similar information, but when a CDC spokesperson was asked direct questions on air, he explained the preliminary nature of the Kalocivir trials and stressed that the efficacy of the drug against SPARS remained unknown. The NIH announcement, meanwhile, also echoed the FDA announcement, but when the NIH spokesperson appeared on a widely viewed interview on a popular morning news show, the interviewer focused primarily on the possible benefits of Kalocivir for adults only. In addition to the government agencies’ official channels of communication, messages about Kalocivir were also distributed by national and local media organizations. Depending on the particular
government source(s) these news agencies used, their reports differed slightly. When these messages were, in turn, shared via social media, they continued to diverge. Some individuals on social media, citing the CDC spokesperson’s interview, claimed that Kalocivir had not been thoroughly tested and was potentially unsafe. Others, citing parts of the CDC and NIH announcements, incorrectly claimed that while Kalocivir was safe for adults, it was possibly unsafe for children. Yet others wondered why the drug was not being administered preventatively to the entire US population. Because little actual data on the safety and efficacy of Kalocivir existed at the time, government agencies had a difficult time responding to the ever-diverging public responses on social media. After Kalocivir was in public use for three months, the FDA was able to release updated information about the drug’s effectiveness and the incidence of side effects. This information came too late, however, for large portions of the general public. In Wisconsin, where many individuals were treated with Kalocivir, local citizens posted, Tweeted, chatted, and Zapped real-time impressions of the drug. While some claimed the drug was effective and even life-saving, most reported no effect and claimed that the drug had caused additional side effects, such as headaches, nausea, and body aches. The social media reports of these side effects were so ubiquitous in the Milwaukee area that local news reporters
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C HAPTER F OUR
openly questioned the FDA’s updated safety information, with one reporter even asking live on air if the FDA even knew what side effects were. In Lawrence, Kansas, on the other hand, local media— again using social media responses as a source—focused on how successful Kalocivir was at treating SPARS. By late January 2026, the WHO reported sustained transmission of SPARS in 42 countries across the globe. The disease proved to be particularly devastating in low-income countries where weak health systems, malnourishment, and co-infections greatly exacerbated the impacts of SPARS. In the United States, the situation was much less dire, but public concern about SPARS remained high. This anxiety resulted in extensive use of Kalocivir across the country and led many citizens to actively seek out medical attention for even minor SPARS-like symptoms. Though taxing for local hospitals and clinics, increased self-reporting of SPARS-like symptoms provided data that clarified certain epidemiological features of the disease. The CDC published analyses of this data, which indicated a much lower case fatality rate of 1.1%, compared to the initial 4.7% estimate. While this information was a relief to public health officials, it did little to quell public concern. In addition, not all members of the public responded to the SPARS in the same way. Small groups of individuals spread throughout the country, for example, who felt that natural cures such as garlic and vitamins would be more effective at treating SPARS than an “untested” drug, were much less likely to accept Kalocivir as a treatment option or even seek medical attention for SPARS-like symptoms. Similarly, some ethnic minorities, and particularly ethnic groups who lived close together in large, tight-knit communities, also rejected Kalocivir. Some of this resistance—particularly among select ethnic minority groups—was attributable to questionable messaging on the part of public health agencies. While news reports and press releases were provided in multiple languages, not all of the messages were culturally appropriate for the populations receiving them. One of the best examples of this occurred among the Navajo tribe in the southwestern United States. In early February 2026, the newly instated director of the Navajo Area Indian Health Service (NAIHS)
took messaging provided by the CDC and modified this so it was more fear-based. His methods
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C HAPTER F OUR
included taking the tagline from a CDC message — “See your health care provider if you experience SPARS-like symptoms”—and adding the phrase “SPARS can kill you” at the end. While the intent of the director was to increase the number of Navajo seeking treatment for SPARS, the modified message, which was widely distributed throughout tribal areas, backfired. Fewer Navajo came forward in the following weeks for treatment from the NAIHS for SPARS-like symptoms. Sensing a mistake had been made, the director reached out to tribal leadership. After intensive dialog the messaging of the NAIHS was changed to reflect Navajo beliefs in sustaining life and eschewing a focus on death. Specifically, the fear-based messaging was replaced with positive messages including “Seeing health care providers for SPARS-like symptoms can help you and your family members live long and happy lives.” Due to the variation in local responses to Kalocivir and persisting anxiety around the outbreak itself, local public health agencies actively tried to address controversies and coordinate public health outreach with local populations. While many of these local public health outreach efforts successfully increased compliance with recommended health actions, they were not effective at reaching some special interest groups, including the growing national anti-Kalocivir/natural medicine movement,
which was dispersed across the country and not concentrated in local areas.
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C HAPTER F OUR
COMMUNICATION DILEMMA Harmonizing Inconsistent Messaging Across Health Agencies Appropriately Tailoring Public Health Messages to Address the Concerns and Cultures of Specific Communities
FOOD
FOR
THOUGHT
1) How could pre-crisis partnerships and alliances have averted the potential for inconsistent messaging around Kalocivir safety and efficacy? What are the potential effects of unaligned official messages about MCM safety and efficacy? 2) How could social media have been used to supplement traditional methods of collecting data about Kalocivir’s effectiveness and side effects? 3) What is the difference between word-for-word translation and culturally competent MCM messages? What are the potential social and public health impacts of failures to deliver culturally competent MCM guidance?
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G OING V IRAL C HAPTER F IVE Reports of negative side effects associated with Kalocivir began gaining traction in February 2026. Despite the negative response, public health agencies continued to make progress until February, when a video of a three-year-old boy in North Carolina — who was hospitalized with SPARS and began projectile vomiting immediately after taking a dose of Kalocivir — went viral. In the video clip, the boy’s physician administers a pediatric dose of liquid Kalocivir; a few moments later, the boy begins vomiting profusely, chokes, and then faints while his mother shrieks in the background.
This clip was widely shared across the United States with a variety of captions including #NoKalocivir and #NaturalIsBetter. The hashtags, in turn, provided a way for people sharing these views to find one another and band together on social media. They formed ZapQ and other online discussion groups, which allowed them to receive any messages from group members via smart phones and internet accessing technology (IAT) instantaneously as they were posted. Some members of these ZapQ groups even began to use full-sized (12”x12”) IAT screens on backs of their jackets, coats, and backpacks to loop the vomiting video for all in their immediate vicinity to see.
The social media groundswell quickly overwhelmed the capacity of local, state, and federal agencies to respond, and compliance with public health and medical recommendations dropped considerably. The
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C HAPTER F IVE
FDA and other government agencies quickly attempted to remind the public that correlation does not equate to causation, and that vomiting was not a known side effect of Kalocivir. This message, while scientifically accurate, lacked appropriate empathy and failed to assuage the public’s mounting fears. As a result, it was largely ignored, and public concern continued to grow. In the following weeks, officials from the FDA, CDC, and other government organizations attempted to promote positive, accurate information about Kalocivir on several traditional and social media platforms in order to quell public fear. This messaging, however, was less than optimal both in terms of timing and dissemination. While the government took several days to provide an emotionally appropriate message, the spread of the viral video on social media was exponentially faster. By the time the government responded, most people across the
country had already seen the vomiting video and formed their own conclusions. Additionally, in their responses, governmental organizations were not able to effectively access all social media platforms. ZapQ groups, for example, had closed memberships and typically could only be accessed via invitations from group members. Both of these issues prompted government organizations to improve the timing and impact of their social media responses. While most government agencies including the CDC and HHS had longestablished offices that were directed to coordinate social media and other communication efforts, the protocols of individual agencies and different agency cultures led to delayed and sometimes uncoordinated messages. Compounding this situation was the social media outreach conducted by individual members of the government. Several members of Congress were very active on sites like Twitter where they could leverage their office to spread their own personal beliefs under the guise of public positions. In late May, one of these individuals, a former doctor and current Senator from Iowa, responded to a
second vomiting video by tweeting, “Don’t be buffoons! Kalocivir is 100% safe and 100% effective. Correlation does NOT equal Causation!” After being shared tens of thousands of times, the tweet was
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C HAPTER F IVE
picked up by traditional media outlets. This led to multiple awkward news interviews with FDA and CDC officials who had to clarify that while the sentiment of the message was correct, Kalocivir did have potential side effects and was not completely effective at treating SPARS. Despite the many outreach efforts by various government officials and entities, the government was ultimately unable to develop a suitable response to the initial vomiting video. By early June 2026, the video had become the most shared Zap clip among junior high and high school students across the country who appreciated the shock factor of the video. As a result, the public was continually reexposed to the anti-Kalocivir message for several months after the initial incident and subsequent responses.
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CHAPTER ONE
ness and prevention messages disseminated annually for seasonal influenza, combined with isolation procedures for suspected cases, would be effective at countering the spread of SPARS. These messages were spread via a variety of traditional and social media sources, including Facebook, Instagram, Reddit, Twitter, and ZapQ. Concern among many Americans about the severity of SPARS at this point in the outbreak was moderately high. The public’s concern was compounded by the apparent virulence of the pathogen. At the outset of the SPARS outbreak, physicians’ understanding of the disease stemmed primarily from extremely severe cases resulting in pneumonia or hypoxia that required hospitalization and extensive medical treatment. Mild cases of the disease, which produced symptoms including cough, fever, headaches, and malaise, were often perceived as the flu by the people who had them and consequently often went untreated and undiagnosed by medical personnel. As a result, early case fatality estimates were inflated. By late November, the CDC reported an initial estimated SPARS case fatality rate of 4.7% (By contrast, WHO reported that the overall case fatality rate for SARS was 14-15% and over 50% for people over the age of 64. Later in the SPARS outbreak, data that included more accurate
estimates of mild SPARS cases indicated a case fatality rate of only 0.6%). Two additional features of the SPARS virus that were not appreciated at the beginning of the pandemic, but that impacted how the outbreak played out, are also important to consider in a review of this event. First, the virus had an extended incubation period (seven to ten days) compared to its latent period (four to five days). Thus, infected persons could spread the virus for up to nearly a week before showing symptoms of the disease themselves. As a result, isolating sick SPARS patients proved to be less effective than isolating patients infected by other, better-characterized respiratory diseases. Second, morbidity and mortality from SPARS were both significantly higher in children than adults. Pregnant women and those with chronic respiratory conditions like asthma and emphysema were also at a higher risk for both disease complications and death.
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CHAPTER ONE
COMMUNICATION DILEMMA Engendering Public Trust and a S e n s e o f S e l f - E f f i c a c y Wh e n a C r i s i s i s S t i l l E v o l v i n g and Health Information is Incomplete
FOOD
FOR
THOUGHT
1) How can health authorities best meet public demands for critical information, such as, “What is the health threat?” and “What do I know about it?” when the crisis is still unfolding and not all the facts are known? 2) What benefits does monitoring trends in social media postings confer on efforts to meet people’s information needs during an evolving health crisis? 3) What medical and morale-boosting purposes does sharing information about self-protective actions (eg, infection control measures) serve for the public during an uncertain and fear-instilling situation?
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C HAPTER S IX
COMMUNICATION DILEMMA Responding to Demand for an Alternative Drug Not Available in the United States
FOOD
FOR
THOUGHT
1) How might pre-tested messages comparing US and foreign MCM review processes have enabled the US FDA and US CDC to support the USG decision to promote Kalocivir as the antiviral of choice? 2) What responsibility, if any, does the FDA have to advise Americans to avoid using VMax? How can the FDA and other public health entities best support the public when making informed MCM choices to protect their health? 4) How should local public health and healthcare providers address patients’ questions about the risks and benefits of foreign MCMs?
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T HE V OICE C HAPTER S EVEN By May 2026, public interest in SPARS had begun to wane. In late April the CDC had publicized an updated case fatality rate estimate, suggesting the SPARS was only fatal in 0.6% of cases in the United States (where access to medical treatment was available). This figure matched public sentiment, widely expressed on social media, that SPARS was not as dangerous as initially thought. Combined with persisting doubts about Kalocivir and the lack of a commercially available SPARS vaccine, the new, lower case fatality rate estimate led the public to grow increasingly hostile toward continued SPARS messaging.
In order to overcome the public’s disinterest, the CDC and FDA, in concert with other government agencies and their social media experts, began developing a new public health messaging campaign about SPARS, Kalocivir, and the forthcoming vaccine, Corovax. The purpose of this campaign was to create a core set of messages that could be shared by all public health and government agencies over the next several months during which time the SPARS vaccine would be introduced. Even though the disease was less fatal than initially thought, it remained expensive to treat in its severe form and even mild cases had substantial impacts on economic productivity across the country. In late May, three messages were approved by the cross-agency committee established to produce the messaging campaign: one addressing the nature and risks of SPARS, one regarding the effectiveness of Kalocivir, and one about the anticipated release of Corovax. These messages were broadly shared via all relevant government agencies’ internet and social media accounts. In an effort to further reach certain population subgroups, agency officials enlisted the help of well-known scientists, celebrities, and government officials to make short videos and Zap clips and, in a few cases, give interviews to major media outlets. Among those chosen were former President Jaclyn Bennett; BZee, a popular hip-
hop star; and Paul Farmer, co-founder of Partners in Health and a renowned global health expert.
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C HAPTER S EVEN
The campaign produced mixed results. Common messaging did reduce public confusion, evinced by a
15-23% increase in the public’s correct understanding of SPARS and Kalocivir in national polls. While common messaging resulted in more cohesive traditional media coverage, the celebrity outreach campaign was more problematic. BZee’s original Zap clip was widely shared, particularly among African American and urban populations; however, in an interview aired on Access Hollywood during which he was asked about the accelerated clinical trials for Corovax, BZee noted his admiration for those who volunteered to participate in the trials, and then compared these recent volunteers to volunteers in previous healthrelated studies “including the men who volunteered at Tuskegee.” The resulting backlash, particularly from African Americans, undermined the effectiveness of BZee’s efforts. Not long after, 60 Minutes aired a live, nationally broadcast interview with former President Bennett. When asked if she would want her new grandson to receive Kalocivir, Bennett, caught off-guard, paused and eventually gave a hesitant, somewhat contradictory response: “Well, I – experts say the drug is safe. And it’s not easy, but I think…Everyone should make the decision that’s best for their family.” Video clips from this interview were shared widely on social media and by traditional media outlets, leading many healthcare professionals and members of the public to criticize Bennett for not taking a strong stance in support of Kalocivir.
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C HAPTER S EVEN
The aftermath of the interview, however, did galvanize many House and Senate Republicans to
support Kalocivir use in earnest in an effort to demonstrate their opposition to from the former Democratic President.
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C HAPTER S EVEN
COMMUNICATION DILEMMA Responding to Misinformation or Doubt about an MCM Generated by a Prominent Public Figure
FOOD
FOR
THOUGHT
Given the ability of powerful, popular figures to reinforce or to undermine public health messages, what steps might health authorities—at either national or local levels—take to reverse the negative effects of BZee’s unintended linkage of Tuskegee and Corovax, or Bennett’s tepid, uncertain support for Kalocivir?
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A RE Y OU T ALKING
TO
ME?
C HAPTER E IGHT While government agencies were spreading the newly tooled public health messages about SPARS, Kalocivir, and Corovax through a variety of traditional and social media outlets, several popular platforms were overlooked. A notable example was UNEQL, a social media interface used at the time almost exclusively by college students. UNEQL was designed and first used at the University of California Berkeley in 2023. The initial purpose of the interface was to provide undergraduate college students with a common forum to collectively critique local, national, and international social and economic policies such as anti-immigration laws and drug policies. By 2026, the interface still
maintained a critical focus but had expanded to include an underground news reporting system, led by seven primary “reporters” across the country; a satirical news feed that could be streamed as a caption on any program running on IAT; and special interest message boards accessible to anyone. While UNEQL was the primary news source of many college students on the east and west coasts, its existence and particularly its prominence was largely unknown outside of college communities and completely ignored by most public health agencies. The SPARS pandemic and concerns about the disease prompted a sizeable response on UNEQL. While information shared about SPARS closely followed the information provided by the CDC, FDA, and other agencies, information about Kalocivir was often incorrect. Multiple message board threads questioned, in detail, the accelerated clinical trial process; others examined alternative treatments for SPARS, including VMax; and the second most popular “reporter,” StanfordGY, led discussions on and organized protests against how Kalocivir was being administered, particularly focusing on how a lack of access to primary care could result in unequal access to the drug. By late May, opinion polls on UNEQL showed that 68 percent of the interface’s two million users felt that equal access to medical care for SPARS was a serious issue. In an effort to galvanize political will around this issue, students
began using UNEQL forums to organize and promote protests outside the offices of state and local political leaders.
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C HAPTER EIGHT
COMMUNICATION DILEMMA Overlooking Communication Platforms Used by Specific Groups; Quickly Gaining Fluency and Effectively Engaging the Public Using a New Media Platform Responding to Public Criticism About Potential Unequal Access to MCMs Like Kalocivir
FOOD
FOR
THOUGHT
1) What are the roles of a media-literate staff and organizational capacity to communicate via both social and traditional media platforms critical to understanding and influencing public debates about an MCM like Kalocivir? 2) Why is it important to listen to the public during the emergency to find out what they think or want done about equity in access to a MCM like Kalocivir? How might the public’s desire for fairness in allocating Kalocivir ultimately influence public health outcomes? 3) How could authorities—at national and local levels—craft an effective response to public criticism and concern about unequal access to Kalocivir? How might the emergency communication principles of speaking honestly and openly and acknowledging the human dimension of the problem be applied in this instance?
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C HAPTER T WO
ing the spread of SPARS outside their households. Over the Thanksgiving holiday and Black Friday, however, fewer infected persons remained home, thereby enabling the spread of SPARS beyond the Midwest. Second, SPARS transmission was accelerated by infectious individuals who had not yet become symptomatic. Together, these factors led to significant spikes in the number of reported cases. By mid-December, SPARS cases were reported in 26 states, and the Ministries of Health in Mexico, Canada, Brazil, Japan, and several European countries had notified the WHO of dozens of imported cases. There was widespread concern in public health circles that travel over the Christmas and New Year’s holidays would spark a global pandemic. The WHO, which had declared the SPARS epidemic to be a PHEIC on November 25, was actively engaged in preventing further spread of the disease internationally. However, the WHO’s efforts promoted interventions originally designed for influenza and other similar respiratory pathogens, such as hygiene, social distancing, and isolation of suspected cases, all of which were less effective against SPARS. The CDC initially followed a similar strategy. The spike in cases in November and December,
however, led to increasing public concern about the disease. By late December, public concern about SPARS in the United States was extremely high, and there was intense public pressure to identify treatments for the disease. At that time, no treatment or vaccine for SPARS was approved for use in humans. The antiviral Kalocivir, which was initially developed as a therapeutic for Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), was one of several antiviral drugs authorized in the United States by the FDA to treat a handful of severe SPARS cases under its Expanded Access protocol. Kalocivir had shown some evidence of efficacy against other coronaviruses, and a small inventory of the drug was already a part of the Strategic National Stockpile (SNS) in anticipation of FDA approval, despite some concerns about potential adverse side effects. The lack of concrete information regarding potential treatments in the face of the increasingly rapid spread of SPARS prompted demands from the media, the public, and political leaders for the FDA to be more forthcoming with information on potential treatment options.
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healthcare providers continue to provide palliative care to SPARS patients and that, if necessary, patients with more mild cases could use over-the-counter medications to alleviate symptoms. Ultimately, this left providers to address patient concerns and demands on their own, which proved frustrating for them and many of their patients. On a positive note, however, the new data also suggested that the side effects associated with Kalocivir were milder than initially reported. Among adults and children receiving pediatric does, only mild stomach irritation was now associated with Kalocivir use. Immediately following the release of the RCT data, current US President Archer, HHS Secretary Nagel, officials from other government organizations, and scientists across the country publicly praised the FDA and CDC for their responses and updated guidelines. The response on social media, however, was largely negative. Citing the vomiting video, reports about VMax from Europe, and the communication blunders made by President Bennett and BZee, citizens across the country took to Twitter, Facebook, Tumblr, Vine, and ZapQ to assert that the changing messages merely proved that
scientists knew very little about how to deal with SPARS. Common social media messages shared during this time included #FakeScience and #GoNatural. The response was particularly vitriolic from the burgeoning natural medicine movement. This negative response, in turn, was covered extensively by traditional media sources. The Los Angeles Tribune, for example, ran a front-page editorial responding to local social media posts that questioned the government’s response to SPARS in light of the new revelations about Kalocivir. The editorial accused the government of shoddy science and wasting tens of millions of dollars to advertise and supply an ineffective treatment. It ended by questioning the government’s other SPARS-related endeavors, particularly the production and promotion of Corovax. The resulting media storm was especially problematic, as Corovax was due to be released in the coming weeks.
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COMMUNICATION DILEMMA Maintaining Public Support After Changing Positions on MCM Safety and Efficacy
FOOD
FOR
THOUGHT
1) In the time leading up to the newly revealed data about antiviral safety and efficacy, how might health communicators have better prepared the public for uncertainty and fluidity of crisis response and the need to act in the absence of complete information? 2) In light of waning public confidence in official statements about antiviral risks and benefits, how should health authorities best lay the groundwork for the release of the novel Corovax vaccine? 3) How can health authorities reestablish public confidence in MCM recommendations while also speaking truthfully about the state of knowledge about Corovax’s safety and efficacy profile?
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H EAD
OF THE
L INE P RIVILEGES
C HAPTER T EN In late June 2026, Corovax entered the final stage of its expedited review in the United States. After passing FDA safety reviews, production of the completed vaccine had begun and was on schedule. Ten million doses were expected to be available by mid-July, with another twenty million doses due by the end of August. With SPARS continuing to spread both within the United States and around the world, demand for a vaccine was still moderately high in spite of recent social media debacles, and every effort was made to increase domestic production capacity. Given the demonstrated morbidity and mortality of SPARS, and in anticipation of initial vaccine shortages, the CDC Advisory Committee on Immunization Practice (ACIP) identified the following priority groups for immunization: children aged
1-18, young adults 19-22 with chronic respiratory conditions, and pregnant women.
This plan was met with skepticism among certain groups. Doctors and nurses, for example, expressed concerns that they were not included as a priority group. In Milwaukee, healthcare providers even protested their lack of inclusion by refusing to report for work, which, in turn, prompted the Wisconsin Department of Health Services to promise that healthcare providers would be vaccinated as soon as more vaccine became available. In Republican ZapQ groups across the rest of the state, however, these protests and particularly the response from the Wisconsin Department of Health were widely reported across social media platforms as yet another example of liberal politics at work,
regardless of the absence of politics or the actual content of the policy. Many Wisconsinite Republicans subsequently stopped following the news feeds and Twitter accounts of their state and local public health departments.
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CHAPTER TEN
Other groups harboring concerns about ACIP’s vaccine prioritization plan included parents of children under the age of one, adults over the age of 22 with chronic medical conditions, and people across the country who opposed vaccination generally. During the initial stages of the SPARS vaccine campaign, all of these groups (with the exception of the anti-vaccinators) were sparsely organized and had limited contact with one another, reducing the need for any type of formal response from the public health community.
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CHAPTER TEN
COMMUNICATION DILEMMA Communicating the Need for and Reasoning Behind the Prioritization of Scarce Resources
FOOD
FOR
THOUGHT
1) When responding to public concerns about priority access to scarce supplies of the Corovax vaccine, what solutions might result from authorities putting themselves in the place of outraged groups? How might authorities then adapt their messages? 2) How might health authorities balance scientific explanations for the allocation framework with a humanistic acknowledgement of the public’s distress at them or their family being left out of the initial vaccine priority groups? 3) How can health authorities best set public expectations about the fluidity of priority groups, as determined by the nature of the outbreak, the vaccine supply, and the emergence of new knowledge about risks and benefits? 4) How might timely outreach to, and potential partnerships with, intermediary organizations such as healthcare professional societies figure into strategies to address the outrage of lower priority vaccination groups?
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S TANDING
IN
L INE , P ROTESTING O NLINE C HAPTER E LEVEN
To determine how to best distribute limited doses of Corovax to members of priority groups across the country, the US government resorted to new, controversial tactics; notably, having healthcare providers access patients’ electronic health records (EHRs) to determine the number of individuals in high-risk populations receiving care in particular areas. Due to widespread increases in EHR use since 2020, this method proved to be highly effective, enabling providers to quickly tabulate the number of pregnant women and young adults 19-22 with chronic respiratory conditions. In some communities, like Los Angeles County, California, this method also identified neighborhoods with limited access to primary care. Based on this data, the Los Angeles County Department of Public Health began
intensive public vaccination campaigns in those areas. The use of EHRs was not without controversy, however. Some US citizens were upset because they believed the federal government was accessing private patient data. This stemmed from a misunderstanding on the citizens’ part: the federal government was not accessing patients’ EHRs directly, but rather was relying on healthcare organizations and providers to access patients’ EHR and then report summary information (specifically, the number of people in the targeted groups) to the CDC, FDA, and other government agencies. The US government attempted to rectify this misunderstanding by posting, tweeting, and Zapping short statements and videos explaining the vaccine distribution process. These messages successfully reached citizens who subscribed to government news feeds or relied on traditional media coverage based on government sources. Critically, however, these messages failed to reach a small but growing segment of the US population obtaining information about SPARS and SPARS treatments from other, non-government sources. During early stages of the US vaccination campaign, social media also played a key role in vaccine
distribution. In communities like Austin, Texas, Facebook Live, Snapchat, Twitter, and ZapQ helped alert members of the public when vaccine dispensing was occurring. In many cases, this led to rapid
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local responses that improved overall vaccine coverage. In some cases, however, it resulted in vaccine points of dispensing (PODs)—such as individual healthcare offices and schools—being overwhelmed, particularly with the 2026 flu season drawing closer. In Phoenix, for example, a social media campaign promoting vaccine dispensing at a closed POD (ie, not open to the public) serving a local elementary school resulted in more than two thousand parents and their children not affiliated with the school arriving at the POD and expecting to receive immunizations. The parents were informed that the POD was open only to children attending the school and were directed to obtain vaccinations for their children from their healthcare providers or a POD open to the general public. Events like this were widely covered by local and state media as well as by local social media. In some instances, like the case described above, the perceived lack of access to vaccines led some eligible individuals to give up seeking vaccinations altogether.
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COMMUNICATION DILEMMA Publicizing MCM Programs and Availability to Promote Uptake and Efficient Distribution Providing Real -Time Data on Vaccine Availability to Align MCM Supply with Public Demand
FOOD
FOR
THOUGHT
1) Why is active monitoring of the “information sea” in which the public is swimming critical to the efforts of authorities to create conditions and provide information that support recommended public health behaviors? 2) How might a strong social media presence allow the federal government—and public health officials more broadly—to anticipate potential communication issues (eg, privacy concerns over using EHR data to direct vaccination efforts) before they become full-fledged crises? 4) Given the growing trend of people building their own “situational awareness” of an event via social media (eg, tracking vaccine availability), how might health authorities capitalize on this collective information-gathering and -sharing behaviors to enhance public understanding of MCM availability and improve access to life-saving MCMs?
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D ON ’ T P UT A LL Y OUR E GGS
IN
O NE B ASKET
C HAPTER T WELVE
I M P O R T A N T H E A LT H A D V I S O R Y ! Grant County Health District and Okanogan County Public Health will provide COROVAX for the general public from 8 AM - 7 PM this Saturday, July 18 at their local offices (see below).
G E T V A C C I N A T E D A G A I N S T S PA R S !
On July 9, 2026, a week before Corovax was released for distribution in the United States, the power grid at the Grand Coulee Dam in eastern Washington State experienced a catastrophic failure. While the event did not destroy any infrastructure or result in any deaths, it did cause widespread power outages in Washington, Oregon, Idaho, Montana, and British Columbia. Though power was restored within a day of the initial outage, blackouts continued plaguing these areas over the next three weeks. Because summer temperatures in this region are typically moderate and adequate numbers of emergency generators existed for hospitals and other public facilities, there were no significant public health concerns associated with the event. Unfortunately, all communication about the vaccine rollout was published in electronic form, and consequently, many individuals in the affected areas were initially unable to access information provided by state, local, or federal health authorities regarding
Corovax dispensing.
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CHAPTER THREE
COMMUNICATION DILEMMA Maintaining Trust in Government Processes for Ensuring the Timely Development of Safe and Effective Vaccines Wh e n N o v e l T h r e a t s A r i s e
FOOD
FOR
THOUGHT
1) How might federal health authorities avoid people possibly seeing an expedited SPARS vaccine development and testing process as somehow “rushed” and inherently flawed, even though that process still meets the same safety and efficacy standards as any other vaccine?
2) How might federal health authorities respond to critics who propose that liability protection for SPARS vaccine manufacturers jeopardizes individual freedom and wellbeing? 3) Once the vaccine becomes broadly available (see the chapter, “Head of the Line Privileges”), how might public health communicators implement the “best practices” principle of enabling people to make their own informed decisions about whether to accept the novel SPARS vaccine? 4) What are the potential consequences of health officials overreassuring the public about the potential risks of a novel SPARS vaccine when long-term effects are not yet known?
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U SERS B EWARE C HAPTER F OUR
Following limited evidence of success in treating SPARS patients with Kalocivir, the FDA issued an Emergency Use Authorization (EUA) for this drug as a SPARS therapeutic in the United States. While Kalocivir had a positive impact against SPARS, preliminary data indicated it also caused intense stomach cramping in a statistically significant number of adult cases. Additionally, while initial hopes had been that Kalocivir would, in addition to treating the disease, prevent or reduce transmission, this was not the case. Nevertheless, due to high public demand for access to viable SPARS treatments, public health and healthcare agencies drew from existing SNS inventories of Kalocivir (several million
doses) until further production of the drug could begin.
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L OVERS
AND
H ATERS
C HAPTER T HIRTEEN Early on in the Corovax vaccination campaign, anti-vaccination groups began emerging on social media platforms. These groups initially came from four primary sources: Muslim groups across the country, who opposed the vaccine on the basis that the original formulation was used to treat pigs; African Americans, who refused vaccination based on continued fear of governmental experimentation on African American populations; alternative medicine proponents, who had also been active in campaigning against Kalocivir; and anti-vaccination activists, who were galvanized by the anti-antivaccination sentiment associated with the nationwide measles outbreak in 2015.
With the exception of this last group, none of the anti-vaccination movements were cohesively organized initially, existing primarily in small, isolated pockets across the country. The general antivaccination proponents, however, existed as a core, national group long before the SPARS pandemic. Following the 2015 measles outbreak in the United States, this group united online. By 2016, they had created several primary Facebook groups and numerous Twitter accounts and began using hashtags like #NoVaccines4Me and #VaccinesKill. The anti-vaccination movement migrated to ZapQ upon its emergence in 2022 due to its ability to combine feeds from across multiple platforms, including realtime text, picture, and video messages from members as well as select traditional media posts such as videos, texts, or streaming news feeds on a single interface that could be used on IAT and other mobile platforms. Additionally, through their ability to control group membership, these groups ensured that they would not be exposed to pro-vaccine “propaganda” from pharmaceutical companies, the federal government, or public health or medical authorities. By 2026, many core members of the anti-vaccine movement obtained their national news almost exclusively from anti-vaccine ZapQ sites. When Corovax distribution began, the anti-vaccination movement mobilized their resources. Citing
select quotes from the CDC, NIH, and other government agencies, anti-vaccine proponents began spreading the message that Corovax was inadequately tested and had unknown, long-term side effects
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and that natural immunity resulting from contracting the disease was a more effective means of conferring protection. Many of these messages also contained suggestions (once again drawing on carefully selected and edited quotes from CDC, NIH, and other government officials) regarding how to manage SPARS symptoms. The anti- vaccination movement’s ubiquity, motivation to prevent vaccine injury, and social media expertise meant that numerous Americans heard their message. National polls conducted in mid-August 2026, for example, showed that 68% of US citizens had seen a post or read a comment from someone expressing anti-Corovax sentiments. Concern about Corovax among American Muslims was also common, in particular Muslim immigrants to the United States. These concerns stemmed from early traditional media reports on Corovax that explained how the
vaccine was a derivative of the GMI vaccine used to treat cows and pigs in Southeast Asia. After reading and viewing these reports, several local Muslim leaders mistakenly conflated the origin of the virus with the origin of the vaccine and concluded that the vaccine itself was unclean. As such, they viewed receiving the vaccine as a violation of their faith. By posting their conclusions on social media, their views quickly spread beyond their local communities, and rumors began among Muslims across the country that the vaccine was forbidden. When federal public health officials became aware of the opposition from Muslim communities, they organized a press conference, hosted by HHS Secretary Nagel to address these misperceptions. In this press conference, Secretary Nagel explained that Corovax was designed specifically for humans and not for pigs. She invited Imam Omar Khalifa, a prominent imam in the Washington, DC area, to speak at the press conference and he reiterated the Secretary’s points. He also called on his fellow Muslims to embrace SPARS vaccination. Assuming that this press conference, which was widely publicized and shared would effectively assuage the concerns of American Muslims, the US government continued with its existing vaccination promotional campaign. In contrast to most Christian religions, however,
the Muslim faith is not at all centralized, and the statements of an imam from Washington, DC held
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little validity for many local Muslim communities. The influence of local imams continued to perpetuate anti-Corovax sentiments among many local Muslim communities well into the national vaccination campaign. Consequently, vaccination rates among Muslims generally lagged behind those of other demographic groups in the United States. Despite the failure of these federal initiatives, some local public health departments were able to effectively address concerns of local Muslim populations. In King County, Washington, for example, local public health officials became aware of the concerns of the local Somali Muslim population in early August. Acknowledging the authority held by local imams, these officials held community meetings with local Somali leaders to engage the local community and posted culturally relevant information on a website specifically designed for their Somali Muslim constituents. By enlisting the support of local Muslim leadership, these efforts ultimately led to high levels of Corovax acceptance among Somali Muslims in King County. Not all local or state public health departments, however, took this approach. Some were unaware of
the concerns of this particular subpopulation, and others felt that resources should be more appropriately allocated elsewhere. The fact that websites like the one posted by Seattle King County Public Health were publicly available, however, meant that Muslim populations in other areas of the country had access to them. In Denton, Ohio, for example, local Senegalese Muslim immigrants began sharing the link to the King County webpage. This, in turn, helped increase Muslims’ acceptance of Corovax in this area, although it also diminished their confidence and trust in local public health officials, who had not conducted targeted outreach to their community. The concerns of African Americans were very different. Distrust of new treatments, including vaccines, was not a new phenomenon among African American communities. The legacy of the Tuskegee syphilis experiments and the fact that during the 2014 Ebola outbreak, experimental therapeutics were not made available to Thomas Eric Duncan (a Liberian traveler who had died of Ebola in Dallas, Texas), nor to many West African communities struck by Ebola, meant that many African Americans — particularly those living in communities consuming media through local, traditional media platforms — feared the possibility of being subjected to scientific experimentation. These fears worsened during healthcare providers’ analysis of EHRs in Los Angeles County, which
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identified many African American communities (as well as other minority populations) as lacking access to primary care. In some areas, aggressive public health vaccination campaigns were locally interpreted as direct examples of experimentation. Repurposing hashtags like #BlackLivesMatter, some African Americans in these communities began to actively campaign against Corovax. Through August 2026, anti-vaccinators, Muslims, and African Americans remained largely isolated from one another. By early September, however, continued anger over EHR use and growing concern over Corovax’s side effects spurred these once-disparate groups to join forces with the alternative medicine proponents still campaigning against Kalocivir. Uniting their efforts, these groups began sharing common anti-vaccine messages through a variety of social media channels including Facebook, Tumblr, Snapchat, YouTube, and ZapQ forums, as well as local radio announcements. Some antivaccine groups also began crowdsourcing information about vaccine distribution sites to stage local anti-vaccination protests. These protests, along with the anti-vaccine messages shared by the supergroup, subsequently received wide, national coverage through traditional media outlets, including local and national television news channels. While the US government attempted to respond to claims raised by the anti-vaccination super-group, their messages did not reach many members of the anti-vaccination groups because they had already tailored their social media and news feeds to reflect only the opinions of those with whom they agreed. On the other hand, the government messages were effective among some segments of the general US population who had not limited their news feeds, and more importantly, they served to galvanize a burgeoning pro-vaccination campaign. During the measles outbreak of 2015, pro-vaccination groups like Mothers Against Vaccine Waivers emerged across the United States. With a few exceptions, these groups lost all momentum by 2018. Furthermore, activity among the groups that remained active was limited to a few, underused social media sites and semi-popular hashtags such as #GetVax, #VaccinesWork, and #Vaccinate. With the advent of Corovax, the pro-vaccination movement found renewed purpose. By the time Corovax distribution began in July 2026, it was clear that not only did SPARS infect children more frequently and severely, but even mild cases of the disease often gave rise to secondary bacterial pneumonia in children. These infections often occurred between four and six months after initial infection with SPARS, resulting in greater rates of pediatric morbidity and mortality from the disease.
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Concern about SPARS was quite high among many parents of young children, and when antivaccination campaigns began threatening vaccine uptake, some of these parents began to mobilize. Parents who were once active in the provaccination campaigns of 2015 began repurposing communication channels developed at that time, including Facebook pages and Twitter accounts. New local groups also began to organize on ZapQ, Snapchat, and other social media outlets. Ultimately, by November 2026, many of these groups coalesced to form a semi-cohesive national group that attempted to counter the efforts of the super-anti-vaccination group. HHS, including the CDC and FDA, and other government agencies at the federal, state, and local levels also renewed messaging efforts in support of Corovax. The common message developed about Corovax originally used in early June was re-released, and two additional messages were developed
and distributed by mid-October, just before the vaccine was made available to the entire US population. Paul Farmer, the renowned global health expert, provided the dialogue for the first of these, wherein he lauded the safety and efficacy of Corovax and underscored the dangers of SPARS. His only regret, he said, was that the vaccine could not yet be made available to everyone on the planet. In the second message, former President Bennett redeemed herself by televising her vaccination as well as the vaccination of two of her granddaughters. These pro-vaccination efforts were largely successful, and vaccination rates in many areas of the country began to climb through December 2026. The population with the highest vaccination rates in the United States, however, did not participate in this pro-vaccination rhetoric. Filipino-Americans and Filipino immigrants living in the United States—the groups most closely associated with SPARS in the news media, and at least in some circles the group often blamed for the spread of SPARS—had near-perfect vaccination rates. Though Filipinos across the United States demonstrated great solidarity throughout the SPARS pandemic, their potential as a source of pro-vaccination rhetoric remained largely untapped.
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C HAPTER F OUR
COMMUNICATION DILEMMA Harmonizing Inconsistent Messaging Across Health Agencies Appropriately Tailoring Public Health Messages to Address the Concerns and Cultures of Specific Communities
FOOD
FOR
THOUGHT
1) How could pre-crisis partnerships and alliances have averted the potential for inconsistent messaging around Kalocivir safety and efficacy? What are the potential effects of unaligned official messages about MCM safety and efficacy? 2) How could social media have been used to supplement traditional methods of collecting data about Kalocivir’s effectiveness and side effects? 3) What is the difference between word-for-word translation and culturally competent MCM messages? What are the potential social and public health impacts of failures to deliver culturally competent MCM guidance?
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G OING V IRAL C HAPTER F IVE Reports of negative side effects associated with Kalocivir began gaining traction in February 2026. Despite the negative response, public health agencies continued to make progress until February, when a video of a three-year-old boy in North Carolina — who was hospitalized with SPARS and began projectile vomiting immediately after taking a dose of Kalocivir — went viral. In the video clip, the boy’s physician administers a pediatric dose of liquid Kalocivir; a few moments later, the boy begins vomiting profusely, chokes, and then faints while his mother shrieks in the background.
This clip was widely shared across the United States with a variety of captions including #NoKalocivir and #NaturalIsBetter. The hashtags, in turn, provided a way for people sharing these views to find one another and band together on social media. They formed ZapQ and other online discussion groups, which allowed them to receive any messages from group members via smart phones and internet accessing technology (IAT) instantaneously as they were posted. Some members of these ZapQ groups even began to use full-sized (12”x12”) IAT screens on backs of their jackets, coats, and backpacks to loop the vomiting video for all in their immediate vicinity to see.
The social media groundswell quickly overwhelmed the capacity of local, state, and federal agencies to respond, and compliance with public health and medical recommendations dropped considerably. The
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also especially concerning to the US public. Compounding this concern was the general lack of a response to the Japanese decision from the US government. Although HHS Secretary Nagel released a short statement reiterating the safety of Corovax, the CDC, FDA, and other government agencies did not respond at all, a reflection of a longstanding tradition of not commenting on other countries’ internal public health decisions. From the public’s viewpoint, however, the lack of a response from trusted government agencies only exacerbated vaccine fears. The growing anti-vaccination super-group in the US also used the Japanese government’s decision as further evidence that Corovax was harmful and should be avoided. In September and early October 2026, the group continually posted video clips of Japanese news conferences and translations of Japanese reports on Corovax through their social media channels. Additionally, the group hosted realtime, public conversations with the scientists in charge of running clinical trials of Corovax in Japan. Clips from these conversations were subsequently shared through an aggressive IAT campaign in which anti-vaccine proponents streamed the clips on jackets, bags and other IAT devices for all around them to see. While many in the US government and traditional media outlets ultimately attributed
Japan’s refusal to approve Corovax to its desire for a domestically produced vaccine, this story gained little traction across social media platforms. These actions by the anti-vaccination super-group eventually led to responses from various US government agencies as well as the emerging pro-vaccination movement. Such responses, however, were not effective at reaching all groups. Many anti-vaccination proponents had previously limited their newsfeeds to exclude many state and federal agencies, and other individuals and groups, particularly those with close ties to Japan, had already begun to consider foregoing Corovax vaccination in the US and instead traveling to Japan to receive the new vaccine once it became available in 2027.
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FDA and other government agencies quickly attempted to remind the public that correlation does not equate to causation, and that vomiting was not a known side effect of Kalocivir. This message, while scientifically accurate, lacked appropriate empathy and failed to assuage the public’s mounting fears. As a result, it was largely ignored, and public concern continued to grow. In the following weeks, officials from the FDA, CDC, and other government organizations attempted to promote positive, accurate information about Kalocivir on several traditional and social media platforms in order to quell public fear. This messaging, however, was less than optimal both in terms of timing and dissemination. While the government took several days to provide an emotionally appropriate message, the spread of the viral video on social media was exponentially faster. By the time the government responded, most people across the
country had already seen the vomiting video and formed their own conclusions. Additionally, in their responses, governmental organizations were not able to effectively access all social media platforms. ZapQ groups, for example, had closed memberships and typically could only be accessed via invitations from group members. Both of these issues prompted government organizations to improve the timing and impact of their social media responses. While most government agencies including the CDC and HHS had longestablished offices that were directed to coordinate social media and other communication efforts, the protocols of individual agencies and different agency cultures led to delayed and sometimes uncoordinated messages. Compounding this situation was the social media outreach conducted by individual members of the government. Several members of Congress were very active on sites like Twitter where they could leverage their office to spread their own personal beliefs under the guise of public positions. In late May, one of these individuals, a former doctor and current Senator from Iowa, responded to a
second vomiting video by tweeting, “Don’t be buffoons! Kalocivir is 100% safe and 100% effective. Correlation does NOT equal Causation!” After being shared tens of thousands of times, the tweet was
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A RE Y OU T ALKING
TO
M E , P ART II
C HAPTER F IFTEEN
Jonathan Atwell From: Atwell, Jonathan F Sent: Thursday, October 15, 2026 4:45 PM To: Sloane, Heidi J; Rojas, Xavier M; Lukas, Andrew J Subject: UNEQL Interns, Assemble!
At the county SPARS response briefing today, the County Commissioner and Board of Administrators identified UNEQL as an untapped social messaging resource to promote county public health recommendations for SPARS. Despite everyone feigning knowledge and experience with UNEQL, the closest we came in the room to any kind of exposure to it was several Department Heads and Administrators whose college-aged kids are on it. Director of Health, Janice O’Connor, has scheduled a meeting for 10 AM Monday morning to discuss UNEQL and its potential as a means of communicating with the public. I would like to bring the three of you along to serve as resident experts on UNEQL in order to help us identify ways to establish a presence and leverage it to promote public health recommendations. Take some time tomorrow and this weekend to think through this problem. See you bright and early Monday! I’ll bring donuts. Cheers, Jon
Jonathan Atwell Cook County Department of Public Health Infectious Disease Programs Officer (444) 444-4444
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Another group that was not generally affected by the government’s Corovax promotion efforts were college students, especially those attending school on the east and west coasts. Public health officials had no explanation for the lack of vaccine uptake among this population until protests began at several college campuses including UC Berkeley, the University of Washington, Reed College, Harvard, and the University of Chicago. The focus of these protests was the lack of access to Corovax, particularly for populations in less-developed countries like Haiti, Guatemala and Cameroon. The college students involved declared that they would not accept Corovax until it was made available, in terms of both access and expense, to everyone in the world who wanted it. The impact of these protests was substantial. Protesters cited reports and statistics, used photographs and videos obtained from students studying abroad in affected countries, and re-circulated the government’s clip of Paul Farmer expressing regret over low Corovax distribution in less-developed countries to drive home their argument. The students’ views and the protests themselves were increasingly covered in local, national, and international media as well as social media across the globe. In the following months, Congressional hearings on access to the vaccine were held in response to the
protests, President Archer conducted meetings with multiple heads-of-state, and the WHO began developing an enhanced international vaccine program based on the expanded financial support of the United States and other countries. Once public health agencies and university administrators became aware of the magnitude of UNEQL’s influence among college-aged populations, they began to incorporate the platform into their communication protocols. Three of UNEQL’s reporters were asked to conduct interviews with several prominent state and federal public health officials and government offices to ensure that pro-Corovax messages were posted in public UNEQL forums. Despite these efforts, however, vaccination rates among college students continued to lag behind those of their peers not enrolled in college and the US population in general. One possible reason for this was that the messages put out by the CDC, FDA, and other government agencies on UNEQL did not adequately address the specific concerns of college students and, in the absence of a solution to the issue of global vaccine access, focused instead on the benefits of Corovax and the nationwide vaccination program.
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COMMUNICATION DILEMMA Responding to Complex Ethical Issues That are Beyond the United States Government’s Control
FOOD
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Which of the following communication measures might help health authorities successfully encourage college students to seek out vaccination while world leaders mobilize to improve equity in access to Corovax globally? How so? Engaging in direct dialogue with student leaders to understand their concerns Communicating to students with empathy and understanding with respect to their desire to advocate on the behalf of others Encouraging students to take action in their own communities, such as volunteering with local health departments, to ensure that marginalized groups have information about and access to Corovax
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A NTIBIOTICS , HO! C HAPTER S IXTEEN Corovax production continued throughout the fall and winter. By mid-December, vaccines were no longer limited to priority populations, and by January 2027, efforts to vaccinate the entire US population were actively underway. Global vaccination efforts up to this point were limited by vaccine supply, and while they had a moderate effect on SPARS incidence rates, the disease continued to spread steadily worldwide. Demographically, vaccination rates across the United States were mixed. Rates were high among Filipino-Americans, healthcare workers, families with young children, and individuals who identified
themselves as Republicans. Rates were considerably lower among African Americans, Muslims, college students, and pocketed communities in places like San Francisco and Boston, where anti-vaccine sentiment was particularly high. To reach members of these groups—which, with the exception of the pocketed communities, were largely spread throughout the country—the US government added a new, aggressive advertising campaign to its pro-vaccination efforts. This campaign provided targeted internet advertisements to individuals as they conducted web searches or visited anti-vaccination websites. If someone searched Google for “Corovax side effects,” for example, a sidebar advertisement appeared on the results page explaining the benefits of the vaccine. Likewise, if someone wished to view the Kalocivir vomiting video on YouTube, they would first have to watch either a montage of pictures illustrating the effects of SPARS or a clip of Paul Farmer’s explanation of Corovax’s benefits. This advertisement campaign required government officials to leverage relationships in the information technology industry, including the many companies involved with social media, but the impact was worth the effort. Vaccination rates eventually began increasing across all targeted demographics except the most
recalcitrant anti-vaccine activists.
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A new challenge soon emerged, however: antibiotic shortages. In late 2026, at the height of the cold and flu season, bacterial pneumonia cases were on the rise across the country. Epidemiologic evidence later indicated that thirty to forty percent of children and ten to twenty percent of adults developed secondary bacterial pneumonia approximately four to eight months after initial SPARS infections. Luckily, most of these infections were easily treated with antibiotics. By February 2027, however, antibiotic supplies in the United States were running low. In an effort to combat the shortage, HHS Secretary Nagel authorized deployments of antibiotics from the SNS to supplement health care systems across the country. The oldest lots of antibiotics in the SNS were originally scheduled to expire in 2021, but those expiration dates had been extended multiple times through the Shelf Life Extension Program (SLEP). Tests conducted in August 2026 showed continued potency of the drugs in 95% of those lots, and all viable lots were granted another two-year extension, postponing their expiration from 2027 to 2029. This was the first set of tests indicating any degradation in those lots of antibiotics, and both the Office of the Assistant Secretary for Preparedness and Response (ASPR) and the CDC recommended purchasing additional inventory to replace the expiring lots by 2030. The most recent tests (conducted
in February 2028) assessed that 94% of the remaining lots due to expire in 2029 remained sufficiently effective. Federal authorities decided to deploy these lots first to ensure adequate public uptake before the drugs expired. Despite proactive efforts to address public concern over the use of antibiotics from the SNS, rumors about the effectiveness of the drugs spread quickly. Inaccurate local news broadcasts and social media messages asserted that the government was distributing expired antibiotics, and concerned citizens, particularly parents of young children, began calling their healthcare providers, pharmacists, and local health departments to seek clarification. While many of these parents’ fears were alleviated when they learned about the distinction between shelf life extension and expiration, the effort required to convey this message to parents on an individual basis proved overwhelming for local health authorities. The FDA and CDC had not anticipated such a strong and rapid response from the public on this issue, and they were initially unprepared to combat the negative publicity. Within 48 hours, however, a coordinated response was developed that highlighted the need for the rapid deployment of antibiotics and illustrated the capability of the SNS to do just that. The decision to deploy antibiotics closest to expiring was also justified by providing concrete and consistent laboratory evidence of every test
performed on the deployed lots of antibiotics, noting consistent potency of the drugs over their entire
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shelf lives and comparable potency of the deployed lots to newer lots. Having dealt with multiple communications issues over the course of the SPARS pandemic, federal leaders successfully applied communications lessons learned from past failures and coordinated a rapid and effective response. Despite the stubborn persistence of the echo-chamber, where increasingly connected individuals persistently chose to only listen to opinions that mirrored their own, not all opinions remained static throughout the SPARS pandemic. In January 2027, Alyssa Karpowitz, one of the most outspoken antiKalocivir and anti-Corovax activists and a leader in the natural medicine movement, had an experience that changed her stance on the use of “expired” antibiotics. Her youngest son, Lennon, contracted a mild case of SPARS and experienced few complications, but several months later he developed a severe case of post-SPARS bacterial pneumonia. Alyssa attempted to treat Lennon with a variety of natural medicines, but his condition deteriorated. Desperate, she took him to her local emergency department where he was administered a dose of intravenous antibiotics deployed to the hospital from the SNS. As Alyssa later described, “The effect was almost instantaneous. Within a day I had my beautiful baby boy back!” As a result of this experience, Alyssa used all of her connections in the natural medicine and anti-
vaccine circles to share her story and her newfound belief in the safety and effectiveness of “expired” antibiotics. While her message about the antibiotics being expired was erroneous, her outreach proved extremely effective. While many people who participated in these groups were no longer listening to official or even unofficial communications about the safety and effectiveness of the recommended pharmaceuticals, they were willing to listen to Alyssa. As a result, the opposition to “expired” antibiotics in the groups to which Alyssa belonged began to dissipate. When government health authorities became aware of the impact of Alyssa’s story on her followers and others who heard about her son’s recovery, they began to expand their use of social media to gather accounts of positive experiences with Corovax and antibiotics used to treat post-SPARS pneumonia. The CDC in particular began mining data from public social media sources for positive stories they could include in their new outreach efforts. While limited to individuals who were still receiving messages from the CDC, or news outlets that reported information from the CDC, the impact of these outreach efforts was positive. National surveys conducted in the months following Alyssa’s decision to give her son antibiotics and the government’s efforts to promote Corovax showed that opposition to Corovax decreased by 23% and opposition to antibiotic use from the SNS decreased
by 61% among the general US population.
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C HAPTER S IXTEEN
COMMUNICATION DILEMMA Responding to Questions Regarding Safety and Efficacy of Drugs That Have Extended Shelf Lives
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1) Given that the term “expiration date” can trigger public misunderstanding about the safety and efficacy of SNS-stockpiled drugs, how might pre-message testing around this topic and shelf life extension have proved useful to health authorities in the SPARS context? 2) Why were partnerships between the federal government and the information technology industry, including a number of social media companies, so vital to increasing overall uptake of the Corovax vaccine? 3) What communication strategies might be effective at overcoming the “echo-chamber” effect over the course of the SPARS outbreak? What pre-crisis measures, if any, might have been useful to dampen the “echo-chamber” effect?
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RECOVERY
V ACCINE I NJURY C HAPTER S EVENTEEN In contrast to Alyssa Karpowitz’s story, not all changes in opinion were in favor of public health messaging. As time passed and more people across the United States were vaccinated, claims of adverse side effects began to emerge. Several parents claimed that their children were experiencing neurological symptoms similar to those seen among livestock exposed to the GMI vaccine. By May 2027, parental anxiety around this claim had intensified to the point of lawsuits. That month, a group of parents whose children developed mental retardation as a result of encephalitis in the wake of Corovax vaccination sued the federal government, demanding removal of the liability shield protecting
the pharmaceutical companies responsible for developing and manufacturing Corovax. The growing plaintiff cohort quickly withdrew their suit upon learning that the National Vaccine Injury Compensation Trust Fund (NVICTF) and an emergency appropriation of funds authorized by Congress under the PREP Act existed to provide financial reimbursement to those who were adversely affected by the Corovax vaccine in order to cover healthcare costs and other related expenses.2,3 Given the positive reaction to the federal government’s response and the fact that the majority of US citizens willing to be vaccinated had already been immunized, the negative publicity surrounding adverse reactions had little effect on nationwide vaccination rates. The focus on adverse side effects, however, resulted in a considerable increase in the number of compensation claims filed, and many grew concerned about the long-term effects that Corovax could have on their health. This concern was particularly high among some African American parents who continued to question the government’s motives regarding the Corovax vaccination campaign. While the FDA, CDC, and other agencies were busy researching possible connections between Corovax and the reported neurological side effects, their efforts were continually undermined by
epidemiological analyses produced by various non-governmental individuals and groups. A popular
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science blogger EpiGirl, for example, began posting interactive maps of the incidence of Corovax side effects in April 2027. To create the maps, EpiGirl collected anecdotes of adverse Corovax side effects using Facebook, Twitter and YouTube and combined them with data downloaded from the HHS Vaccine Adverse Event Reporting System (VAERS), a national vaccine safety surveillance program maintained by the CDC and FDA. EpiGirl also encouraged those among her subscribers who were Apple product users to share health data with her via Apple’s ResearchKit and HealthKit applications. EpiGirl’s maps were consequently shared widely in social media circles and even included in local and national news reports. The federal government became concerned about the validity of EpiGirl’s anecdotal data and the widespread sharing of patient information via the internet. EpiGirl’s data showed a significantly higher incidence rate of nearly every reported side effect; however, federal officials believed that this was largely due to duplicate entries resulting from compiling data from multiple sources. Additionally, EpiGirl’s data did not seek to address the cause of the reported side effects, only the incidence rate. Publication of similar results from organizations such as Patients-Like-Me, a group closely associated
with the natural medicine movement, further legitimized these independent reports. The government attempted to respond to these claims through formal press releases, but these were neither as visually appealing nor as interactive as EpiGirl’s maps and were, therefore, largely ignored. While the federal government appeared to have appropriately addressed concerns around the acute side effects of Corovax, the long-term, chronic effects of the vaccine were still largely unknown. Nearing the end of 2027, reports of new neurological symptoms began to emerge. After showing no adverse side effects for nearly a year, several vaccine recipients slowly began to experience symptoms such as blurry vision, headaches, and numbness in their extremities. Due to the small number of these cases, the significance of their association with Corovax was never determined. As of this writing in 2030, longitudinal studies initiated by the NIH at the beginning of the vaccination program have not reached the next round of data collection, so formal analysis on these symptoms has not yet been conducted. Furthermore, these cases arose from the initial cohort of vaccine recipients—those in highrisk populations, including those with other underlying health conditions—making it increasingly difficult to determine the extent to which these symptoms are associated with vaccination.
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As these cases emerged, patients began filing for compensation under the PREP Act. Due to lingering uncertainties over possible links between vaccination and reported neurological symptoms, their compensation requests were placed on indefinite hold, pending further data analysis. This cohort, many of whom adamantly supported the Corovax vaccine initially, quickly took to social media to publicize their issues. Despite relatively few reports of neurological symptoms, the social media response was immense. After experiencing initial success with PREP Act compensation policies and working diligently to ensure transparency throughout the claim request and evaluation process, HHS was caught off guard by the new round of negative publicity. They were pressured by the public and media to award compensation to those claiming long-term effects from Corovax despite having no data to support these claims. Displaying a fundamental misunderstanding of scientific research, many demanded proof that the vaccines did not cause long-term effects. HHS Secretary Nagel firmly and vocally supported the decision to postpone evaluation of all claims of long-term side effects and invited an independent Congressional investigation to ensure that the PREP Act was being properly implemented. In addition to demands for immediate compensation, Congress faced public pressure to increase the PREP Act emergency appropriation. While the initial allocation of funds was sufficient to provide compensation for acute side effects, the prospect of long-term effects and potentially permanent disability gave rise to concerns that additional resources would be necessary in the near future.
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COMMUNICATION DILEMMA C o m m u n i c a t i n g Wi t h t h e P u b l i c A b o u t Trustworthy Sources of Data and Options for Legal Recourse in a Climate of Mistrust
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1) How might advance development and testing of recovery messages that specifically address the topics of adverse side effects and the NVICTF help improve health authorities’ ability to respond to public distress about medical issues emerging after a MCM campaign? What are some messages that would warrant such testing?
2) Despite the uncertain science about the link between Coravax and the reported neurological symptoms, why should health officials still communicate with compassion and genuine sympathy toward those in the vaccinated population who experience medical issues subsequent to being vaccinated?
3) Given growing interest in open data systems and the application of “crowd sourcing” to solve complex problems, how might public health officials take greater advantage of two-way communication with an interested public in the aftermath of the SPARS outbreak? For instance, how might input and analysis from members of the public help improve adverse event monitoring or assess the strengths and weaknesses of a specific MCM campaign?
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healthcare providers continue to provide palliative care to SPARS patients and that, if necessary, patients with more mild cases could use over-the-counter medications to alleviate symptoms. Ultimately, this left providers to address patient concerns and demands on their own, which proved frustrating for them and many of their patients. On a positive note, however, the new data also suggested that the side effects associated with Kalocivir were milder than initially reported. Among adults and children receiving pediatric does, only mild stomach irritation was now associated with Kalocivir use. Immediately following the release of the RCT data, current US President Archer, HHS Secretary Nagel, officials from other government organizations, and scientists across the country publicly praised the FDA and CDC for their responses and updated guidelines. The response on social media, however, was largely negative. Citing the vomiting video, reports about VMax from Europe, and the communication blunders made by President Bennett and BZee, citizens across the country took to Twitter, Facebook, Tumblr, Vine, and ZapQ to assert that the changing messages merely proved that
scientists knew very little about how to deal with SPARS. Common social media messages shared during this time included #FakeScience and #GoNatural. The response was particularly vitriolic from the burgeoning natural medicine movement. This negative response, in turn, was covered extensively by traditional media sources. The Los Angeles Tribune, for example, ran a front-page editorial responding to local social media posts that questioned the government’s response to SPARS in light of the new revelations about Kalocivir. The editorial accused the government of shoddy science and wasting tens of millions of dollars to advertise and supply an ineffective treatment. It ended by questioning the government’s other SPARS-related endeavors, particularly the production and promotion of Corovax. The resulting media storm was especially problematic, as Corovax was due to be released in the coming weeks.
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prescribed countermeasure that promised to end the pandemic, but whose long-term consequences were not fully understood at the time. Following the meeting, ASPR recommended to HHS Secretary Nagel that SAMHSA collaborate with stakeholders and devise behavioral health guidance for the states, tribes, and territories on how to strengthen the public’s coping skills, provide support for grieving individuals, encourage a forward direction, and meet other SPARS recovery needs. It was further recommended that Secretary Nagel consult with President Archer about the possibility of acknowledging the emotional toll of SPARS during a future public appearance. The primary message would be one of gratitude to the American people for remaining strong during the pandemic. Another key message would convey appreciation for adhering to public health recommendations, including vaccination, to hasten the end of the pandemic in the face of considerable uncertainty. President Archer agreed to address the country’s resolve and recovery in the face of SPARS. Top risk communication advisors from the CDC, FDA, NIH, and SAMHSA conferred as a group about how
best to frame the President’s remarks. The group vigorously debated whether it was appropriate for the President to acknowledge the sacrifice that vaccine recipients had made on behalf of their communities or to console them in their grief over that sacrifice.
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COMMUNICATION DILEMMA B r i n g i n g a S e n s e o f R e s o l u t i o n t o a P e r i o d o f C r i s i s Wh i l e Striking a Balance Between the Need to Affirm Collective Grief and Loss and the Need to Move Forward
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1) Given the uncertain long-term safety profile of the Corovax vaccine, why are both science and sympathy necessary when communicating about a possible correlation between vaccination and adverse events?
2) What general communication principles does the advice of Dr. Ann Flynn suggest with respect to the recovery phase of a public health emergency involving MCMs? What might pre-event planning for recovery-phase communication look like based on her guidance?
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SPARS A FTERMATH C HAPTER N INETEEN Today, nearly five years since the St. Paul Acute Respiratory Syndrome coronavirus made its global debut, there remain human cases in 14 countries across Europe, Africa, and Asia. The pandemic officially ended in August 2028, but the virus persists in domesticated animal reservoirs. WHO experts hypothesize that small, isolated outbreaks of SPARS were occurring long before the disease emerged on a global scale in 2025, and they anticipate that future outbreaks will continue to emerge unless countries maintain widespread vaccination coverage.
As the pandemic tapered off, several influential politicians and agency representatives came under fire for sensationalizing the severity of the event for perceived political gain. As with many public health interventions, successful efforts to reduce the impact of the pandemic created the illusion that the event was not nearly as serious as experts suggested it would be. President Archer’s detractors in the Republican Party seized the opportunity to publicly disparage the President and his administration’s response to the pandemic, urging voters to elect “a strong leader with the best interests of the American people at heart.” A widespread social media movement led primarily by outspoken parents of affected children, coupled with widespread distrust of “big pharma,” supported the narrative that the development of SPARS MCMs was unnecessary and driven by a few profit-seeking individuals. Conspiracy theories also proliferated across social media, suggesting that the virus had been purposely created and introduced to the population by drug companies or that it had escaped from a government lab secretly testing bioweapons. After-action reports, government hearings, and agency reviews following the pandemic were too numerous to count. Emergency funding appropriated by Congress to fight the disease became available partway through the course of the pandemic, but federal, state, and local public health agencies
struggled to manage the procedural requirements to spend it. As a result, significant amounts of
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emergency funds remained unused as the pandemic wound down. As the investigations grew in intensity, several high-ranking officials at the CDC and FDA were forced to step down and withdraw from government in order to “spend more time with their families.” Exhausted employees of these agencies, many of whom worked long hours six or seven days a week throughout the pandemic, simply wanted to put the whole response behind them. Little desire remained on the part of decision-makers or those who served in the trenches during the response to rehash the events of the past several years. The very real possibility of a future SPARS pandemic necessitates continued commitment to vaccination programs as well as accurate, culturally appropriate, and timely communication from public health agencies across the planet. While the communication experiences of the SPARS pandemic of 2025-2028 offer some examples for how this communication can and should occur, they also identify practices that should be avoided, or at least modified, for responses to future public health emergencies.
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COMMUNICATION DILEMMA Institutionalizing Communications Lessons from the 2025-2028 SPARS Pandemic
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What benefits might arise if health authorities publicly share what they have learned from MCM use during the health emergency (including response missteps and successes) and communicate how government agencies plan to evolve on the basis of that information?
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REFERENCES & APPENDICES
C HAPTER E LEVEN
COMMUNICATION DILEMMA Publicizing MCM Programs and Availability to Promote Uptake and Efficient Distribution Providing Real -Time Data on Vaccine Availability to Align MCM Supply with Public Demand
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1) Why is active monitoring of the “information sea” in which the public is swimming critical to the efforts of authorities to create conditions and provide information that support recommended public health behaviors? 2) How might a strong social media presence allow the federal government—and public health officials more broadly—to anticipate potential communication issues (eg, privacy concerns over using EHR data to direct vaccination efforts) before they become full-fledged crises? 4) Given the growing trend of people building their own “situational awareness” of an event via social media (eg, tracking vaccine availability), how might health authorities capitalize on this collective information-gathering and -sharing behaviors to enhance public understanding of MCM availability and improve access to life-saving MCMs?
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D ON ’ T P UT A LL Y OUR E GGS
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O NE B ASKET
C HAPTER T WELVE
I M P O R T A N T H E A LT H A D V I S O R Y ! Grant County Health District and Okanogan County Public Health will provide COROVAX for the general public from 8 AM - 7 PM this Saturday, July 18 at their local offices (see below).
G E T V A C C I N A T E D A G A I N S T S PA R S !
On July 9, 2026, a week before Corovax was released for distribution in the United States, the power grid at the Grand Coulee Dam in eastern Washington State experienced a catastrophic failure. While the event did not destroy any infrastructure or result in any deaths, it did cause widespread power outages in Washington, Oregon, Idaho, Montana, and British Columbia. Though power was restored within a day of the initial outage, blackouts continued plaguing these areas over the next three weeks. Because summer temperatures in this region are typically moderate and adequate numbers of emergency generators existed for hospitals and other public facilities, there were no significant public health concerns associated with the event. Unfortunately, all communication about the vaccine rollout was published in electronic form, and consequently, many individuals in the affected areas were initially unable to access information provided by state, local, or federal health authorities regarding
Corovax dispensing.
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A PPENDIX A
R ESPONSE S CENARIO T IMELINE 2025 October
November
The first US deaths occurred due to SPARS. Initially, these deaths were thought to Cases of SPARS were reported across Minnesota and in six other states. Thanksgiving holiday travel and Black Friday shopping facilitated spread of SPARS beyond the Midwest (26 states and multiple other countries by mid-December). The WHO declared the SPARS pandemic to be a Public Health Emergency of International Concern.
December
No treatment or vaccine for SPARS existed, but there was some evidence that the antiviral Kalocivir could be effective as a therapeutic. A proprietary vaccine developed and manufactured by a multinational livestock conglomerate (GMI) was proposed as a potential foundation for a human vaccine. The vaccine was developed to combat an outbreak of a similar respiratory coronavirus in hooved mammal populations in Southeast Asia, but the vaccine had not been licensed by any regulatory authority or tested in humans. There were concerns over potential
2026 January
The US government contracted CynBio to develop and produce a human SPARS vaccine based on the GMI animal vaccine. The HHS Secretary invoked the Public Readiness and Emergency Preparedness Act (PREP Act) to provide liability protection for the vaccine manufacturer and providers. Congress authorized and appropriated emergency funds under the PREP Act to provide compensation for potential adverse side effects from the vaccine. Following reports of Kalocivir’s limited success in treating patients with severe SPARS infections, the FDA issued an Emergency Use Authorization (EUA) for the antiviral. Kalocivir had been evaluated as a therapeutic for SARS and MERS, and several million doses were maintained in the SNS, which could be deployed as necessary while production capacity was established to meet demand.
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R ESPONSE S CENARIO T IMELINE 2026 January
The FDA, CDC, and NIH provided seemingly conflicting communications regarding the safety and efficacy of Kalocivir. In the United States, public anxiety around SPARS resulted in extensive use of Kalocivir, frequent self-reporting of SPARS symptoms, and a surge in demand for medical care. By late January SPARS was detected in 42 countries and all US states.
February
A lack of cultural competency in FDA and other governmental communication became apparent among various ethnic groups in the United States. A video of 3-year-old vomiting and fainting after taking a dose of Kalocivir was widely and rapidly spread via social media, strengthening opposition to the EUA.
March
The FDA released updated efficacy and side effect information for Kalocivir. Social media reports regarding Kalocivir were more ubiquitous than official releases. The UK Medicines and Healthcare Products Regulatory Agency and the European Medicines Agency jointly authorized the emergency use of a new antiviral, VMax, in the United Kingdom and throughout the Eurpoean Union. Some Americans attempted to gain access to VMax online or by traveling to Europe.
April
The CDC publicized an updated (and significantly lower) case fatality rate in the United States; the perception of lesser risk triggered a drop in public interest.
May
Production of Corovax, the SPARS vaccine produced by CynBio, was well underway. Federal agencies initiated a communications campaign using well-known public figures with mixed results. Polls indicated a 15-23% increase in SPARS and Kalocivir knowledge nationwide. Hip hop icon BZee had success promoting public health messaging with an online video clip, but he lost credibility when he compared volunteers for Corovax trials with “volunteers” from the Tuskegee syphilis study. Similarly, former President Bennett provided a non-committal response when asked if she would want Kalocivir for her new grandson.
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A PPENDIX A
R ESPONSE S CENARIO T IMELINE 2026 May
Public health agencies discovered that a relatively new social media platform, UNEQL, was being used as a primary means of communication in college-aged populations.
June
Corovax entered the final stage of its expedited review, and production capacity was increased. Ten million doses were expected to be available by July with fifty million more in August. The CDC Advisory Committee on Immunization Practice (ACIP) announced vaccine priority groups. Healthcare providers were not included as a priority, inciting protests by doctors and nurses across the country. In order to prioritize distribution of limited Corovax supply, the federal government requested that states report summary information for patient electronic health records (EHRs) to estimate the number of individuals in high-risk populations. This effort was met with resistance from the public, who protested the federal government accessing their private medical information.
July
A week prior to initiating the nationwide vaccination program, damage to a power grid in the Pacific Northwest resulted in a widespread power outage that lasted two weeks. State and local public health agencies initiated communications programs using posters and flyers to promote the vaccination program in the absence of electronic media. Social media efforts across the country promoted the vaccination campaign, and crowdsourced data helped to increase efficiency in distributing the vaccine.
August
The Corovax vaccination program met resistance from several groups: alternative medicine proponents, Muslims, African Americans, and anti-vaccination activists. Initially operating independently, these groups banded together via social media to increase their influence.
September
Japan announced that it would not approve Corovax for use in Japan in favor of developing and producing its own vaccine.
October
College students predominantly on the east and west coasts, staged protests against the unequal global availability of Corovax. Vaccination rates among these students were below average for college students in other areas of the country.
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A PPENDIX A
R ESPONSE S CENARIO T IMELINE 2026 November
The anti-anti-vaccine movement, formed in the wake of the 2015 measles outbreak in the United States, reignited their efforts to combat the anti-vaccination super-group. The FDA, CDC and other federal agencies also redoubled their communications efforts to promote the Corovax campaign. An increasing number of post-SPARS pneumonia cases were reported across the country.
December
The nationwide vaccination program was expanded beyond the initial priority populations to include the rest of the country. Federal agencies initiated a vaccination communication program involving targeted online advertisements.
2027 February
Post-SPARS pneumonia cases stressed inventories of antibiotics across the country. The HHS Secretary authorized distribution of the oldest lots of antibiotics from the SNS to supplement the antibiotic supply nationwide. Tests of antibiotics in the SNS inventory determined that 94% of the remaining antibiotics in the oldest lots maintained sufficient potency. Tests conducted in August 2026 provided the basis for extending the expiration of these lots from 2027 to 2029.
March
Rumors spread via traditional and social media that the government was dispensing expired antibiotics. Alyssa Karpowitz, a leader in the natural medicine movement, sought medical care at an emergency department after natural remedies failed to resolve her son’s bacterial pneumonia. After successful treatment with proper antibiotics from the SNS supply, she touted the benefits of “expired” antibiotics in her social media circles.
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A PPENDIX B
C OMMUNICATION D ILEMMAS R ESPONSE S CENARIO 1) Engendering public trust and a sense of self-efficacy when a crisis is still evolving and critical health information is incomplete (Page 4) 2) Responding to public and political pressure to share information about potential MCMs in the development pipeline even though information may be incomplete or proprietary (Page 8) 3) Maintaining trust in government processes for ensuring the timely development of safe and effective vaccines when novel threats arise (Page 11) 4) Harmonizing inconsistent messaging across health agencies (Page 14)
5) Appropriately tailoring public health messages to address the concerns and culture of specific communities (Page 14) 6) Responding to the power of graphic images of a child in distress: one story that is elevated to a population-level problem (Page 19) 7) Responding to demand for an alternative antiviral drug not available in the United States (Page 23) 8) Responding to misinformation or doubt about a MCM generated by a prominent public figure (Page 25) 9) Overlooking communication platforms used by specific groups; quickly gaining fluency and effectively engaging the public using a new media platform (Page 29)
10) Responding to public criticism about potential unequal access to MCMs like Kalocivir (Page 29)
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A PPENDIX B
C OMMUNICATION D ILEMMAS R ESPONSE S CENARIO 11) Maintaining public support after changing positions on MCM safety and efficacy (Page 31) 12) Communicating the need for and reasoning behind the prioritization of scarce resources (Page 34) 13) Publicizing MCM programs and availability to promote uptake and efficient distribution (Page 37) 14) Providing real-time data on vaccine availability to align MCM supply with public demand (Page 37) 15) Maintaining consistent messaging across electronic and non-electronic media and implementing a
secondary communications plan if electronic media are not available (Page 40) 16) Addressing multiple independent MCM concerns simultaneously (Page 43) 17) Meeting the information needs of citizens who come from diverse cultural, social, and demographic backgrounds and who may have varying degrees of trust in health authorities (Page 43) 18) Supporting the current MCM product in the face of opposition from a foreign regulatory agency (Page 49) 19) Responding to complex ethical issues that are beyond the United States government’s control (Page 52) 20) Responding to questions regarding safety and efficacy of drugs that have extended shelf lives (Page 55)
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A PPENDIX C
R ECOVERY S CENARIO T IMELINE 2027 April
Crowd-sourced and independent epidemiology analysis of Corovax side effects conflicted with official federal reports. The independent analyses gained popularity in traditional and social media due to visual presentation and interactive content. Government attempts to respond with data and press releases largely failed.
May
Reports of Corovax side effects began to gain traction. Several parents of children who experienced neurological symptoms after receiving the vaccination sued the federal government and CynBio. The lawsuit was dropped when they learned of compensation funds available through the PREP Act and the National Vaccine Injury Compensation Trust Fund.
November
Initial reports of long-term side effects of the Corovax vaccine emerged. These reports arose primarily from those in the initial priority (high-risk) populations and were few in number. With little available data and numerous pre-existing conditions, initial studies were unable to identify a statistically significant association with any long-term effects. Claims for compensation were placed on indefinite hold until further data could be gathered and analysis completed. In response to public demand for long-term side effect compensation, the HHS Secretary invited Congress to conduct an independent investigation of the federal compensation process to alleviate concerns of impropriety. The public and media pressured Congress to increase the funds authorized for compensation under the PREP Act.
2028 August
The SPARS pandemic was officially declared to be over; however, experts remain concerned about domestic animal reservoirs and the potential for future outbreaks.
Johns Hopkins Center for Health Security
Page 75
The SPARS Pandemic
A PPENDIX D
C OMMUNICATION D ILEMMAS R ECOVERY S CENARIO 1) Communicating with the public about trustworthy sources of data and options for legal recourse in a climate of mistrust (Page 59) 2) Bringing a sense of resolution to a period of crisis while striking a balance between the need to affirm collective grief/loss and the need to move forward (Page 63) 3) Institutionalizing communications lessons from the 2025-2028 SPARS pandemic (Page 66)
Johns Hopkins Center for Health Security
Page 76
The SPARS Pandemic
J OHNS H OPKINS C ENTER FOR H EALTH S ECURITY 621 E AST P RATT S TREET S UITE 2 1 0
B ALTIMORE, M D 2120 2 TEL: 443.573-3304 FAX: 443.573.3305 www.centerforhealthsecurity.org
The bottom line is for the people to regain their original, moral principles, which have intentionally been watered out over the past generations by our press, TV, and other media owned by the Illuminati/Bilderberger Group, corrupting our morals by making misbehavior acceptable to our society. Only in this way shall we conquer this oncoming wave of evil.
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