A Better Prepared Public Needs Clear Communication

A Better Prepared Public Needs Clear Communication

by CYNTHIA BAUR

Throughout the COVID-19 pandemic, experts, politicians, commentators, and the public have criticized government agencies, oftentimes the U.S. Centers for Disease Control and Prevention (CDC), for their communications substance and style. They called out the agencies for confusing information and recommendations. My observation is that COVID messages come from many sources, not only CDC, and even those sources providing accurate information often didn’t communicate clearly about COVID risks. From the beginning, scientists labeled the virus a “novel” threat with many unknowns for human health. This means we all began with little knowledge and understanding about what was to come. Practical plain language explanations of risks along the way could have better prepared the public for the long haul.

Plain language puts audiences’ information needs at the center of the process, and COVID communications have prioritized some audiences over others. Epidemiological data have driven COVID messaging rather than the public’s need to understand and respond to the virus’ threat. From the beginning, the numbers of cases, hospitalizations, and deaths have been the lead, not just from CDC but in many media reports, commentary, and policymakers’ statements.

If I’m a policymaker, hospital administrator, or even frontline clinician, then illness, hospitalization, and death data are relevant for planning, resource allocation, and service delivery. Members of the public trying to gauge their personal risk, however, need simple, actionable information that aligns with how they live their lives. For example, the UMD Horowitz Center for Health Literacy made an animated video for college students to show them more and less risky realistic situations.

Research shows people don’t trust what they don’t understand, and a lot about COVID has been hard to understand. The specialized language or jargon has been overwhelming: airborne versus droplets, herd immunity, underlying health

conditions, flatten the curve, mRNA technology, to name a few. For example, plain language explanations weren’t easy to find about what clinical trials are and why they are the best way to know the vaccines worked as intended and are safe enough for millions of people. Instead, the official messages were “Vaccines are safe. We know because we tested them in clinical trials.” As many have noted, people excluded or abused by prior medical research especially needed plain language information about the science behind the vaccines and why they could trust both the scientists and the science. Technically, “risk” is a numerical probability, but practically, risk is our personal, shifting sense of how dangerous something is. Explaining risks in plain language builds people’s understanding and confidence. For example, recent testing messages show the confusion that happens when people can’t figure out what’s risky or not. Testing Cynthia Baur demand confirms many people want to do the right thing and

Practical plain language know if they’re infected, but explanations of risks along the they couldn’t make sense of being told to test before seeing way could have better prepared friends and family during the the public for the long haul. holidays but that testing wasn’t necessary to leave isolation. If the risks were different in these situations, then the public needed a clear statement about why. As we reflect on this pandemic and anticipate the next, we must consider if we want to replicate COVID communication missteps for future outbreaks. Despite misinformation, we know enough about clear communication to do better. The question is, how much effort are we willing to spend to have a public with an accurate understanding of the health risks they may face? RF Cynthia Baur, PhD, is the Director of the Horowitz Center for Health Literacy, University of Maryland School of Public Health. Prior to joining the Center in 2017, Dr. Baur spent ten years working in CDC health communication roles, participating in pandemic influenza communication planning, and leading the agency’s health literacy and plain language work.

Messaging Failures of the Pandemic

by ERIC D. HARGAN

As we grapple with the continuing problems stemming from COVID-19 and the lockdowns, we must also face a wider issue: the failures of communication that have plagued the response.

Americans have lost trust in our public health officials – with the Centers for Disease Control and Prevention (CDC) taking the brunt of the nation’s anger. It’s understandable why Americans feel angry – the public health community at large has offered the public constantly changing information and advice on topics vital to Americans’ lives: getting back to normal, masking, boosters, quarantines, and social distancing. It’s been such an avalanche of confusion that the phrase ‘the CDC recommends’ has become an internet meme – a joke.

This mockery bodes ill for America’s ability to best promote the future of medical progress, not just to react to health emergencies or pandemics, but also to advance innovations like telehealth and artificial intelligence and help lead to new modalities of care.

America’s health care future depends on robust publicprivate sector partnerships, like Operation Warp Speed, where government works with our nation’s innovators to find new cures and medical breakthroughs. A trusted public health community, and especially the CDC, is a prerequisite to such a future. However, the enduring lack of normalcy and the endless state of emergency continue to erode the American people’s trust in the public health community’s competence to get us through COVID or, indeed, do anything in the future.

The public health community can rebuild its reputation and gain back the trust of the American people, but it must recognize that its communication problems stem, partly, from the inherent democratization of information and knowledgesharing. People can do their own research now, and they evaluate the data and recommendations in a far different way than they used to. The information revolution has transformed how Americans receive, understand, and trust the experts

because the public has access to the same information. Therefore, public health experts must not exaggerate or over promise, but rather tell the truth and be transparent; admit mistakes and move forward. Operate like this—such as communicating how and why science evolves— so the American people will forgive mistakes and accept changes in policies and protocols. Simply, trust the American people and they will trust you back. Calls by individuals for censorship or the demonization of scientific or political opponents do not reflect confidence in their positions. We must recognize that democratization of information has led to widespread divergences of attitudes, beliefs, policies, and even factual predicates regarding the pandemic. It’s understandable that such divergence has produced anxiety among authorities. Daniel Patrick Moynihan put it best, “You are entitled to your opinion. But you are not entitled to your own facts.” And the authorities believe they are acting on facts, and in everyone’s best interests. However, often what the experts thought was ‘the science’ just 6 months earlier has shifted. These changes in scientific understanding happen all the time, but these changes in the facts and consensus should pull everyone toward humility. The best course of action is to rely on empathy and evidence over partisanship and intimidation. The CDC and the public Eric D. Hargan health community generally will recover their reputation Public health experts must not and trust over time by exaggerate or over promise, returning to their true roles as scientists and doctors, and by but rather tell the truth and be exiting the political theater transparent; admit mistakes that they were pushed into by and move forward. an unprecedented pandemic. Those who have entered into politics should drop it, leave the politics to the politicians and get back to even-handed, principled medicine and science. And as we enter into the process of learning (and in many cases re-learning) the lessons of the pandemic, we must understand that an information-savvy public will be watching and judging. This is not a bad thing, and it should elevate and inspire the public health community. If it does, it will recover trust and regain the useful and, indeed, necessary role it has occupied in Americans’ lives. RF Eric D. Hargan served as the Deputy Secretary of the Department of Health and Human Services (HHS) from 2017 to 2021, as well as Acting Secretary in 2017-2018. He is the Founder and CEO of The Hargan Group.