Health messaging in the disinformation age

As the director of the United States Centers for Disease Control and Prevention (CDC), Rochelle Walensky recently acknowledged that poor public health communication and messaging throughout the COVID-19 pandemic has damaged the public’s trust in health agencies and institutions. This, in turn, contributed to well-known problems, such as vaccine hesitancy, noncompliance with mask recommendations and other protective measures, and general misinformation about the virus and how it is transmitted.

According to a 2021 poll from the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, the positive ratings of the public health system declined from 43 percent to 34 percent between 2009 and 2021.

Clearly, public health agencies need to win back the public’s trust—not just to combat crises like COVID-19 and monkeypox, but also to address a wider range of ongoing health issues.

Public health officials must often base their recommendations on incomplete data; as the data evolve, so will the recommendations. However, in a misguided effort to appear authoritative, public health officials are rarely transparent about the nuances and fluid nature of what they are communicating.

A perfect example is the early advice on how SARS-CoV-2 is transmitted. The CDC was adamant that the coronavirus was spreading on surfaces and not through the air, rather than acknowledging that airborne transmission was still a strong possibility. This approach bred confusion and distrust, because the CDC eventually had to change its advice. After acknowledging that SARS-CoV-2 was spreading through droplets, it finally also conceded that it was spreading through aerosol particles.

As this example shows, credibility often gets confused with infallibility, resulting in public health officials being slow to admit mistakes—further undermining their credibility. Transparency is key, especially at a time when peddlers of online misinformation will seize every opportunity to discredit public health officials. Successful public health communication establishes credibility by being effective, not by being unchanging.

Another cornerstone of sound communication is clarity. Public health officials must explain how data and recommendations relate to people’s everyday lives. Whether the information is correct or incorrect is a moot question if the public doesn’t understand what is being communicated.

Here, US officials failed the messaging test again when they did not make clear that the effectiveness of COVID-19 vaccines was measured by hospitalizations, not infections. The public believed that vaccines would block transmission and infection. Instead, health experts could have emphasized how much the vaccines reduce the burden on hospitals. So when the Delta and Omicron variants emerged and caused breakthrough infections to surge, distrust and “booster shot fatigue” duly followed. As of Aug. 3, only 32 percent of Americans had received their first booster shot.

Many public health officials have been committing the same grave error by stigmatizing monkeypox as a disease that only threatens gay, bisexual, and other men who have sex with men. Yet while it is true that this population has been disproportionately affected by the current outbreak, monkeypox can be transmitted in any situation where there is close skin-to-skin contact with lesions.

By depicting monkeypox as a sexually transmitted infection, health officials could give people the false impression that they are not at risk, preventing them from seeking a diagnosis or isolating if they do contract the virus. The situation is similar to the (incorrect) early messaging about HIV/AIDS spreading only among homosexuals.

More broadly, public health messages are best understood and most likely to be believed when they come from trusted individuals within the communities that need to be reached. The messenger is often as important as the message, especially in communities where structural racism and historical traumas have left people disinclined to trust medical authorities.

Rather than issuing authoritative statements and assuming they will be heeded, health officials should think of their messaging as being part of an inclusive conversation. They should seek out community voices and trusted advocates, such as faith leaders, to collaborate on messaging and reaching populations that may be vulnerable to health disparities.

The current climate of “alternative facts” and rampant disinformation presents many challenges to effective public health communication. But by learning from past mistakes and developing messages that are clear, inclusive, and conveyed by the right sources, we can start the difficult but necessary process of rebuilding trust in public health agencies before the next big crisis strikes. Project Syndicate

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William A. Haseltine is a scientist, biotech entrepreneur, and infectious disease expert. He is chair and president of the global health think tank ACCESS Health International.