COVID isn’t over. Public health communication must reflect that
In the public health world, there is a common saying: “When public health works, nothing happens.” The downward trend of COVID-19 cases in Connecticut and across the United States, the reduction in the number of hospitalizations and deaths, are early signs of our gradual return to “normalcy.”
This trend back to the status quo is a result of a working public health system. The opposite also holds true: when public health fails, people get sick, and people can die.
Despite our signs of a “return to normal,” the SARS-CoV-2 virus remains a formidable menace in the state, the U.S. and across the globe, having claimed close to 3.5 million peoples’ lives worldwide and still counting. Unless we let public health continue to work, the grounds we have gained could be lost. The virus has not been eliminated; and under-vaccinated areas can still become hotspots for future surges and act as community petri-dishes for viral mutations that may lead to resistant strains.
The message of public health must be widely disseminated now more than ever when people’s perception of risk may be falsely low. The goal of health risk communication is not simply to inform the public of available facts. It is a process that is used to engage the public in open dialogue and equip people so that they can make informed decisions to protect themselves and their communities.
This kind of public engagement requires the recognition that peoples’ understanding of the facts on the ground, their concerns and beliefs about events and, more importantly, their perception of risk is highly variable. One of the most prominent risk communicators, Peter Sandman, is known for his formula: Risk = Hazard + Outrage
Hazard is the objective component of the risk (e.g. “In the United States, so far, over 590,000 people have died of COVID-19”), and outrage is the emotional and cultural reckoning of the risk, which includes peoples’ sense of the immediacy or proximity of the problem, their sense of control over the risk, their trust (or lack thereof) in institutions etc.
Risk communicators tell us that in order to have the support and cooperation of the public, we need to address specific “outrage” factors that often vary from community to community and person to person. Preparing a cadre of trained risk communicators who can take the message to select communities is a worthy investment to foster a much needed public engagement on this topic.
Here are a few tips that can help during risk communication:
1. Involving the public as legitimate partners: For populations with low percentages of formal education, strong cultural and religious traditions or difficult socio-economic realities, scientific recommendations that threaten to disrupt the conventional social order or cultural convictions may not be seen as priorities or worse, may be considered suspect. Time and effort will be needed to listen to peoples’ concerns and values, encourage them to ask questions and even challenge the message in order to build trust and engage members in a dialogue.
2. Communicating clearly and honestly: Clarity in communicating what is already known about the risk and risk mitigation factors, including the vaccine, is important. Equally important is being honest about what is uncertain about this pandemic, and what we are continuing to learn about it. This is not only a sign of humility but also a moral obligation without which trust cannot be built.
3. Making clear distinction between scientific guidelines and public health policy: Scientific findings may say something like, “the risk of contracting COVID-19 in fully vaccinated individuals is low.” But in practice, findings have to factor in the social and behavioral aspects of humans. So a real-life application of high vaccine efficacy might be something like, “continued mask wearing is required in this building until there is proof that everyone is fully vaccinated.” It’s important to delineate the difference.
4. Using credible sources and staying abreast of new developments: One of the biggest challenges for the public about this pandemic is that information and recommendations are changing regularly. New information and changing guidelines, however, do not signify that science has failed or that public health experts are unreliable. In the health care field, we are constantly learning new features about diseases that have been with us for generations, and sometimes management guidelines change based on new scientific evidence.
There is an ongoing imperative to communicate the need for vaccination and the practice of public health precautions, especially among under vaccinated communities. We need more people to take this critical message to their own family members, friends, neighbors, co-workers, school mates, patients or any other social connections they have in order to assist the wider public health effort.
We are still in the midst of a global struggle against a deadly virus and it will take good public health citizenship for us to come out of it alive.
Sosena Kebede MD, MPH. The views and opinions expressed here are my own and do not reflect the views and opinions of the organization for which I work.
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