COVID Communication Often Failed: How Health Policy Makers Can Do Better

COVID Communication Often Failed: How Health Policy Makers Can Do Better

When Robb Willer looks back on the early days of the COVID-19 pandemic–when leaders still had a chance to stop the virus from bringing the world to a halt–there’s a fateful moment that stands out. In February 2020, global health authorities spoke in one voice, advising the public not to wear masks to prevent infection.

“Seriously, people–STOP BUYING MASKS!”, tweeted Jerome Adams, the former US surgeon general, pointing out that masks do not protect the public from the virus. The World Health Organization (WHO), similarly, advised that masks should not be used by health-care workers and people with a fever or who have a cough.

But the message was quickly reversed. Scientists knew that masks could prevent viral infections from spreading to the air. However, early mask guidance was primarily aimed at preserving supplies for health workers. After realizing that the authorities were not acting in their best interests, resentment began.

The mask-messaging scandal “was a huge credibility mistake”, says Willer at Stanford University in California. “It hurt their response that they weren’t honest.” He says leaders should always be transparent about why pandemic-related health measures are being implemented, even if some facts can be difficult to swallow.

Although COVID-19 isn’t yet in the rear-view mirror, policymakers are already discussing how its lessons should shape our response to future pandemic threats, including the current outbreak of monkeypox. Their plans are supported by a new influx of behavioural-science research. This research provides insight into which campaigns and policies are most effective in convincing people to follow health guidance to stop the spread disease.

The messages that have the greatest influence are not always those that policymakers believe will work. Appealing to the empathy and responsibility that the public can feel, delivered by people they trust, can be more effective than imposing mandates. Rewarding vaccination with rewards might be more effective than just reminding people. Timing is crucial. What motivates people in one stage of a pandemic may not be as effective later. As the mixed messaging about masks demonstrates, honesty is a prerequisite.

The process of improving public-health outreach should begin well before the next pandemic strikes, according to Matthew Goldberg, Yale University in New Haven, Connecticut. His research focuses on persuasion. He says that “we need to be doing work now” so that people can act quickly .”

Woman speaking to an audience.
Katy Milkman is examining whether vaccination incentives are effective. Credit: Shira Yudkoff

Make it easy

To help society build a collective defense against pathogens researchers recommend that leaders enlist human-behaviour experts to play a greater role in health policy. This has been the Achilles heel of governments during the COVID-19 pandemic, says Armand Balboni, an infectious-disease researcher and chief executive of pharmaceutical firm Appili Therapeutics in Halifax, Canada. Balboni states that psychologists, anthropologists, and social scientists were not utilized enough.

It is important to find ways to not restrict people’s choices when crafting public-health messages. While mandates for health can be necessary in times of pandemics, they can cause backlash and make it more difficult to stop the spread of disease. Some businesses have protested against forced closures during the pandemic. Varun Gauri, behavioural economist at the Brookings Institution in Washington DC advocates for a nudge’ strategy that makes it easy to do the responsible thing. Gauri says, “The one thing that is almost universal in behavioural science”: “We’re all lazy.”

Placing hand-sanitizer units at more accessible locations could make it easier to do the right things. In one study1, this strategy boosted people’s compliance with hand-hygiene advice without the need for mandates. And a study2 by behavioural scientist Katy Milkman at the University of Pennsylvania, Philadelphia, suggests that repetition is a powerful nudge strategy. Researchers sent reminders to people more often than if they were in a control group. This confirms previous findings that repeating messages can get results.

Some persuasion strategies make intuitive sense but don’t seem to produce the desired result. After the first COVID-19 vaccines were rolled out in the United States, local and state officials invested millions in the idea that waving money at people would convince them to get the jabs. Leaders tried cash incentives. People were paid a fixed amount to get vaccinated and then entered into a drawing for a chance to win cash prizes.

But the concept was often rejected. One study3 that gauged the effectiveness of vaccine lotteries found that vaccination rates were not significantly higher in lottery states than in non-lottery ones. Guaranteed cash payouts were somewhat more likely to encourage vaccination, a meta-analysis showed4. Milkman states that the evidence for incentive-based persuasion is “quite disheartening in general”.

She is currently studying a new twist to the lottery strategy that could deliver more value for money, a regret lottery. This involves telling people that they have been entered in a draw to win large amounts of money. However, if they are not vaccinated, they will have to decline the reward. When Milkman and her team tried this in Philadelphia5, vaccine rates in the area increased slightly compared with those in other, similar areas that did not have a regret lottery. Milkman states that the one data point she has “looks promising”, but more research is needed to confirm it.

Our better nature

While personal gain may not be a strong motivator for many, empathy might be. Encouragement of empathy could encourage people to act in a more compassionate way to help others in times of crisis. One group of researchers reported6 that people who watched a video of a 91-year-old man describing being unable to visit his sick wife because of the COVID-19 pandemic were more likely to want to practice physical distancing than people in a control group who were not shown the film. Emotional appeals could encourage people to adopt helpful behaviours.

Invoking empathy can be used even in cases where people are skeptical about pandemic control measures. In a survey7 of more than 6,000 people in the United States and Europe, researchers found that people opposed to vaccines were most likely to draw back from their stance when presented with appeals to protect the health of others. They were less likely to be moved by messages that stated they would personally benefit from the jab. According to the researchers, policymakers should emphasize vaccines’ collective benefits. This includes protecting others and keeping the economy going. Balboni states that most people don’t like being told what to do. “It’s really helpful to get people to take responsibility and take ownership of their actions. That way, they can protect others .”

Getting accurate information is key to winning over skeptical members of society. During the COVID-19 pandemic, disinformation played a major part in sowing division and undermining the authority of health officials, Gauri says. This allowed for rapid viral spread and low vaccination rates.

To prevent fake news from taking root, Milkman advises that health departments must be transparent with the public when communicating with them. This doesn’t necessarily mean that you have to describe every aspect of a crisis, but it does mean that the messages at the core of health campaigns are bulletproof. This principle was ignored by leaders when they said that masks were ineffective. People began to ignore official health communication. This gave conspiracy theories a chance to slip in.

Behavioural scientists also want to teach people how to distinguish between legitimate health advice and conspiracy theories. Jon Roozenbeek is a University of Cambridge psychologist who is currently testing a strategy to ‘immunize’ people against disinformation. He exposes them to controlled doses of the virus, just like a live-virus vaccine protects them from a full-blown illness. This approach has been made into a series free video games. One of them, called Go Viral! , teaches people to be sceptical of pandemic fake news by playing at being outrageous disinformation czars, publishing false headlines such as “I was silenced for trying to speak out about unsafe coronavirus vaccine!”

After playing an inoculation game, people interpret fake-news tweets as less reliable than they did before, and they’re better able to spot deceptive tactics in a series of fake headlines8. “The robustness is quite good from a 15-minute intervention,” Roozenbeek says.

But, preparing the public is only the beginning. Gauri believes that public-health authorities must take a more legislative approach to future pandemics to limit the impact of disinformation. He says, “If you have a good regulatory system in place to prevent it,” that’s really important. This could be, for instance, the creation of transparency laws that require online platforms and other entities to inform users about suspect health content without encouraging active censorship.

Former US surgeon general holds out a face mask stands next to Donald Trump during a White House briefing.
An ex-US surgeon general advises people to wear masks, contrary to previous advice. Credit: Hum Images/Universal Images Group via Getty Images

A trusted voice

Health information is essential for people to distinguish fact from fiction. One of the major insights that behavioural scientists gleaned from the 2014 Ebola epidemic in West Africa was that the messenger mattered even more than the message being conveyed. People were more likely to follow lifesaving advice and seek Ebola treatment if they had local leaders rather than Westerners. Willer states, “If you don’t have credible, respected, and trusted authorities in the community, it didn’t really matter what content your message was.” “If you’re not trusted outsiders, you won’t get anywhere

One team of researchers has memorably shown the lifesaving wallop a well-chosen pandemic messenger can pack9. The team culled footage of former US president Donald Trump urging people to have the COVID-19 vaccine, then wove the clips into a 27-second YouTube video. The researchers broadcast the Trump message online in US countries with low vaccination rates. Hundreds of thousands more people were vaccinated. Willer states that “for the most opposed people”, he was “arguably the most respected person to tell them .”

.”

In future pandemics well-chosen pastors and community leaders could be used more liberally in order to promote important public-health messaging. Although some celebrities and sports stars did this during the COVID-19 pandemic, health authorities could reach out to a wider pool of candidates who have their own distinct followings. Gauri states that if we can find them early or pre-record them, it might be helpful to have that information ready for when the time comes.

It is important that public-health messaging be delivered at the right time. The sooner health departments provide clear guidance on how to respond to a pandemic, then the better. Willer says that people are more open to persuasion if they have first learned the facts. “You want to jump on the critical window .”

A study of the Italian population, which was among the hardest hit by the first waves of COVID-19, found that almost everyone believed public-health messaging during the early stages of the pandemic–even people who did not generally trust the government10. This high level of buy in allowed strict quarantine strategies to limit the spread of the pandemic.

But once people feel overwhelmed with information, the power and effectiveness of public-health messaging can begin to diminish. When people received informational messages about how COVID-19 spreads, these messages decreased trips outside the home only for those who had started socially distancing in the past couple of weeks11. The messages did not have any effect on those who had been practicing distancing for more than a month. They even led to a decrease in compliance with distancing guidelines.

Once people are bombarded with messages on a topic, “your message will struggle to have an influence in that cacophony,” Willer states. The best time to convey the message is over at that point.

Preventive behaviour

Health officials still have a lot to do to create pandemic communications that encourage unified public action. The next level goal, which is to stimulate behaviour in advance of a potential pandemic, might seem unrealistic. Pre-emptive action is better that trying to stop global disease spread. Some researchers are now asking if behavioural science can be used to achieve this goal.

Some pathogens can easily jump from wild animals to humans. Coordinated public-health messaging regarding the importance of safe animal handling could help prevent the next pandemic. Rapid action could be possible with disease-detection platforms such as the National Respiratory and Enteric Virus Suveillance System (CDC) of the US Centers for Disease Control and Prevention.

But leaders must start promoting trust in officials in order to get the public to follow the CDC’s Center for Global Health’s guidance on animal handling and respond to virus alerts promptly. Tom Kenyon, who was previously the director of the CDC Center for Global Health and chief executive at Project HOPE in Washington DC, says that to get people to believe in their health officials, they need to promote trust in them now.

Kenyon believes that governments should provide more funding for local public-health departments to help them raise their profile in communities and prevent the next deadly virus from emerging. He argues that residents will learn more about the work of health departments and be more likely to follow official guidelines on how to prevent a pandemic. “People know the mayor’s office, the fire station and the police station. Kenyon states that they don’t know about the health department. “The first thing is to demonstrate to the public what good public-health infrastructure does for them on a day-to-day basis.” Countries with low levels of COVID-19 spread are consistently those where people have high levels of trust in their governments and communities, researchers have reported12.

It will take a while to reach the trust levels required to eradicate pandemics. Missteps made in the past months to respond to the spread of monkeypox have shown that health departments still have a lot of work ahead of them. Researchers stress that it is possible to contain the pandemics better thanks to increasing knowledge about how to encourage coordinated public action. Milkman states, “It’s possible.”

Balboni believes that improved preparedness efforts should include the recognition of the fact that if leaders communicate clearly and honestly about pandemic policy, a large portion of the public will follow their lead. “When we can demonstrate to people why it is important that they change their behavior, and not just ‘Do it cause I said so’, you actually push them in a direction that’s beneficial .”

This article is part of Nature Outlook: Pandemic Preparedness, an editorially independent supplement produced with the financial support of third parties. About this content.

References

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ABOUT THE AUTHOR(S)

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    Elizabeth Svoboda is a science writer in San Jose, Calif., and author of What Makes a Hero? : The Surprising Science of Selflessness (Current, 2013). Credit: Nick Higgins

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