Health and Risk communication, a scientist’s opinion
Interview with Professor Anat Gesser-Edelsburg, Associate Professor and Head of the Health Promotion Programme at the University of Haifa, and Founding Director of the Health and Risk Communication Research Center in Haifa, Israel.
What are the common mistakes or failures in communication during an infectious disease outbreak and what consequences do these have on the public?
The coronavirus outbreak has brought to a climax the uncertainty narrative, which is part of every unexpected epidemic, when we do not know its exact origin, how it is transmitted, how it develops, how long it will go on, and when a vaccination will be found for it. Uncertainty arouses fears and concerns in the public, sometimes even outrage, and poses complicated challenges for health authorities. Public health experts tend to believe the public is incapable of dealing with uncertainty, and that it might create panic, confusion, and mistrust of the authorities. This stems from the belief that the public generally wants to receive simple black and white messages — bad or good. A complex or ambivalent state evokes the sense of instability and leads to cognitive dissonance. Sometimes such thinking seems convenient for leaders to control the narrative, but when it comes to complex situations involving uncertainty, such narratives can lead to a boomerang effect and expose the falsehood of certainty and thus undermine public confidence. At times of crisis, the public wants full transparency.
In previous epidemics, such as the swine flu (H1N1), Ebola, Zika, and MERS, the authorities sometimes communicated the uncertainty about them to the public as certainty. By doing so, they created a crisis of trust with large parts of the public, which thought the authorities were hiding information and trying to create a false appearance of control. Early in the current coronavirus crisis, the authorities managed to declare uncertainty. In WHO’s information sheets and press releases, the word “uncertainty” appears and is updated according to the developing and changing information. The question is whether the very declaration of uncertainty is enough to maintain public trust.
The public not only seeks recognition by the authorities of the situation as it is, but has a deep need for transparency and sharing of the health information and decision-making processes. Yet, here again, we see history repeating itself. Instead of addressing the fears and concerns, communicating the risk and addressing different subpopulations differently, the authorities continue to frame the public’s speculations as misinformation. In previous crises, health authorities divided information into myths versus facts in order to clarify to the public that the information that is not conveyed by themselves is not scientifically based. Studies have indicated that the dichotomous division between myth/lie and fact/truth does not do away with the perceptions of parts of the public, but sometimes leads to the opposite effect, a rejection of the messages communicated by the authorities.
In the present crisis, the health authorities are calling the myths an “infodemic”, unreliable information that is spreading everywhere. So instead of answering the questions directly, in some cases authorities have chosen to cooperate with commercial giants such as Google, Facebook and Amazon, to remove information from the Internet that is not communicated by them, including public speculations that do contain scientific truth. The inherent contradiction of recognising uncertainty while maintaining the monolithic voice of the authorities raises the question of public trust during the epidemic and on the day after.
How do the different mediums of communication impact human behaviour, and how does effective communication change bad or non-compliant behaviour?
The media operates in two directions: on one level, it shows its responsibility by reporting and updating the public on the authorities’ specific guidelines. Sometimes it also carries the voices of other experts who criticise the authorities, and does its own research. On another level, the media behaves like a commercial marketing instrument by fanning sensationalism in an attempt to stir up drama, arouse fear in the public, and to help it sell newspapers and raise TV ratings.
An inclusive and transparent communication, and especially one tailored to subpopulations, can have an impact on public trust and get the public to cooperate. When the public is exposed to feelings of fear, confusion and helplessness, it is very important to examine the information transmitted and the ways it is being conveyed to the public. At times of uncertainty, the variables affecting different populations are different than they are in routine times and they must be examined and adjusted. The authorities must work on the assumption that there is a connection between the population profile and the kinds of information and ways it is conveyed. There is a connection between levels of fear and acceptance of recommendations of behaviour change in conditions of uncertainty. Messages that emphasise situational factors (a population’s barriers that prevent it from changing behaviour) will be more effective in conditions of uncertainty.
That is why it is important for the authorities’s goals in each of the different countries to be as follows: check what kind of information should be conveyed to which subpopulation (scientific information, short messages, information that presents disputes, information that refers to personal risk versus public health risk); check who would be a credible spokesperson for which subpopulation (for instance, the Prime Minister, the director of the health ministry, the health minister, virologists, representatives of the population itself, etc.); identify ways of conveying information to subpopulations (different degrees of intimidation, positive/negative framing, inclusiveness, empathy, etc.); identify the appropriate information conveyance channels for each subpopulation.
How could your health and risk communication findings from the TELL ME project specifically apply and help the Covid-19 pandemic?
There has been much progress since the predominance of the principle of the “hypodermic needle”, where the public is “injected” with the message. However, in practice, information flow remains unilateral in many countries — where information flows from the organisation down to the ground — and we see it now in the Covid-19 pandemic. Such linear communication contradicts the social sphere as it exists today. To understand the major challenge facing the health organisations, we created a conceptual map as part of the EU-funded project TELL ME.
The framework emphasises that different elements overlap because communication does not have clear-cut limits: formal stakeholders are not at the centre of this model, but rather encompass (and constitute part of) the public. The diagramme illustrates the transformation of the public from recipient to equal partner. In the coronavirus crisis, we see that the social sphere turned the pandemic into an awareness pandemic. This means that the open borders and speed of information transmission led to the emergence of divergent narratives over which the authorities have no control. And the big problems arise when the public does not feel that its questions and dilemmas are being answered.
• Gesser-Edelsburg, A, Diamant, A, Hijazi, R, Mesch, GS (2018). Correcting misinformation by health organizations during measles outbreaks: A controlled experiment. PLoS ONE 13(12): e0209505.
• Graves, C. (February 20, 2015). Why debunking myths about vaccines hasn’t convinced dubious parents: The Harvard Business Review
• Horne, Z., Powell, D., Hummel, J. E., & Holyoak, K. J. (2015). Countering antivaccination attitudes. Proceedings of the National Academy of Sciences of the United States of America, 112(33), 10321-10324.
• Nyhan, B., & Reifler, J. (2015). Does correcting myths about the flu vaccine work? An experimental evaluation of the effects of corrective information. Vaccine, 33(3), 459-464.
• Nyhan, B., Reifler, J., Richey, S., & Freed, G. L. (2014). Effective messages in vaccine promotion: A randomized trial. Pediatrics, 133(4), e835-e842.