Public health messaging lessons for the next pandemic
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Illustration: Megan Robinson/Axios
"Be first, be right, be credible" is the mantra of public health experts in a crisis. It's difficult to argue that the health community has regularly managed to be any of those three during COVID-19.
Why it matters: A pandemic isn't just a medical emergency — it's also a communications emergency. The U.S. public health establishment, hamstrung by bad data and political interference, has struggled with the latter.
- It may be too late to repair the bad messaging that has marred the COVID-19 response, but better communication strategies will be needed for the inevitable next pandemic.
Driving the news: An FDA expert panel on Tuesday endorsed Pfizer's COVID-19 vaccine for 5-to-11-year-olds, with 17 votes in favor and one member abstaining.
- The decision is a significant step toward the end of the pandemic in the U.S., as the last major age group is now on track to become eligible to be vaccinated. But it will present yet another communications challenge for the public health establishment.
- Members of the advisory board argued over the potential risk-benefit balance of vaccinating kids, given their relatively low threat from COVID-19 and the small increase in the risk of myocarditis from vaccination, as well as the question of whether vaccine mandates would follow.
Be smart: This is how science actually works — theories are argued about in academic conferences and the scientific literature, and advanced or abandoned as new data and results come in.
- The difference during the pandemic is that all of it has happened in real time and in full view of an often confused and irate public, with politicians hovering in the background.
- Partially as a result, there have been no shortage of times when communication from public health agencies has been badly muddled.
Details: Early in the pandemic many officials actively discouraged wearing masks, even as evidence was gathering about their effectiveness, only to do a 180-degree turn later.
- Agencies were slow to approve rapid COVID tests out of an abundance of caution that the public might misuse them, and in doing so left the pandemic without a countermeasure that has proven highly effective elsewhere.
- The CDC said in May that vaccinated Americans no longer needed to wear masks, without leaving the door open to the possibility that the advice might change, only to flip again in July when it became clear that the more contagious Delta variant could cause breakthrough cases.
- In August, federal officials assured Americans that booster shots wouldn't be needed, then contradicted themselves days later when they announced that boosters would indeed be offered.
Between the lines: The pandemic is a constantly moving target, as the Delta variant has demonstrated, but public health agencies have struggled to keep track of the resulting uncertainty — and struggled even more to communicate it effectively to the public.
- "What people need to understand is that science is ever-changing and mutable," Kasisomayajula Viswanath, Lee Kum Kee director of the Applied Risk Communication for the 21st Century program at the Harvard T.H. Chan School of Public Health, said recently.
- "All knowledge is partial knowledge, and [the pandemic] is an illustration of that."
What's next: To improve the response for the next pandemic, public health officials will need to upgrade how they measure uncertainty as well as how they communicate it.
- Fully reliable data on the pandemic's spread in the U.S. has been spotty from the start — so much so that the best source in the early months was the volunteer effort of the COVID Tracking Project. But the CDC's new Center for Forecasting and Outbreak Analytics should help provide better data tracking in the future.
- Instead of constantly trying to communicate risk in an absolute way — and risk being caught out when the disease changes — epidemiologists could take a page from engineers, who regularly update their picture as new data and tools become available.
- Most of all, public health experts need to be honest about what they don't know, straightforward about the fact that guidance in a disease emergency is always conditional, and clear about the data that drives that guidance.
The bottom line: Public health officials can't talk us out of a pandemic, but they can make it worse. Protecting the U.S. from the next outbreak will require communication strategies as innovative as mRNA vaccines.
