A Failure to Communicate? How Public Messaging Has Strained the COVID-19 Response in the United States

"A pandemic, especially when caused by a novel virus, induces tremendous uncertainty, fear, and anxiety. To mitigate panic and encourage appropriate behavioral action, communication is critical."

As in other countries, the widespread public health measures imposed in the United States (US) in response to the COVID-19 pandemic have been accompanied by a massive flow of information, misinformation, and disinformation. Recognising that the pandemic provides an opportunity to develop "infodemic" management approaches, this commentary examines the US Centers for Disease Control and Prevention (CDC)'s Crisis and Emergency Risk Communication (CERC) guidance, which is designed to assist public health authorities, government officials, and other stakeholders in using risk communication during an emergency. Providing illustrative examples, the commentary analyses the use or nonuse in the US of each of CERC's 6 core communication principles in the first 10 months of the COVID-19 pandemic, through October 2020. The goal is to describe lessons learned to strengthen ongoing and planned COVID-19 communication efforts, as well as future infectious disease epidemics that demand effective crisis and emergency risk communication.

To begin, a definition of risk communication is provided: It "focuses on timely, accurate, effective dissemination of high- or low-hazard information to at-risk populations, aiming to minimize the gap between knowledge and action....It also includes communication and advice to the public on behaviors to proactively cope with risk....The risks associated with miscommunication during the COVID-19 pandemic are tremendous, especially because of declining trust in and credibility of authorities and governments."

In this context, CERC integrates elements from risk, crisis, and health communication theories in outlining these principles:

1. Be first - In an emerging crisis, the early voices are often more trusted and become the standard by which future sources are measured. However, "[m]ore than 2 months after the first reported US cases, officials at the highest levels continued to downplay the urgency and severity of the pandemic and stall on a national response or clear public guidelines to mitigate risk."
2. Be right - "Accuracy and transparency are crucial to building and maintaining credibility; the COVID-19 response has revealed critical failures in this area." The example of shifting guidelines on mask use illustrates the challenges of managing unknowns; the key for leaders is to communicate uncertainties and emphasise the work being done to address them.
3. Be credible - "CERC emphasizes the importance of transparency and not shielding the public from information because of fears of panic or embarrassment." Unfortunately, as examples here demonstrate, then-President Donald J. Trump withheld information from the public and communicated known falsehoods, which "undermined credibility and damaged public trust."
4. Express empathy - Leaders who acknowledge people's uncertainty, fear, and anxiety and let the public know they care can thereby build trust, calm anxiety, and restore order. However, several US officials displayed apathy; others expressed empathy that was called into question by subsequent personal actions, which "damaged credibility and reinforced public perceptions that political elites were held to different standards...."
5. Promote action - CERC advises communicators to provide clear, concise, and concrete actions for the public to take. A positive expression of this principle was Republican Governor Phil Scott of Vermont, a "blue" (Democratic-leaning) state. He bridged the political aisle early in the pandemic, noting, for example, that wearing masks should not be a political statement and calling for his citizens to do so.
6. Show respect - For instance, in light of the vaccine hesitancy brought on in some communities by a long history of racist and unethical practice by government authorities and medical institutions, some leaders have wisely acknowledged and acted on other concerns beyond disease control. This demonstration of respect - especially when followed through with concrete, responsive action - has been seen, for instance, in the actions of several states and localities to include small business owners and community leaders on their COVID-19 task forces and to initiate targeted initiatives to support marginalised and minority communities.

In reviewing crisis communication lessons learned beyond what the above probe suggests, the authors provide a few examples from countries outside the US, including New Zealand and Vietnam. The latter government executed a series of information and communication campaigns to keep the public updated on the latest developments related to COVID-19. They set up diverse communication channels to reach the entire population, including short message service (SMS)/text messaging and music videos and short films disseminated through mass media channels and social networks to promote awareness and behaviour change, such as wearing masks in public areas and washing hands. Some additional recommendations to emerge from these other experiences include: "tailoring messaging to meet the concerns of different subpopulations, acknowledging uncertainty to express empathy and subsequently improve trust, building public trust generally to increase compliance with public health recommendations, and communicating clearly and consistently about risk so that individuals are well-equipped to take protective action."

Thus, this analysis has led to the conclusion that the CERC framework's 6 core communication principles have been applied unevenly over the pandemic thus far in the US. Particularly because, at the time of this writing, US states are attempting to roll out vaccines equitably and efficiently, "[t]his is a crucial time to review experiences at the federal, state, and local levels and gather important lessons on the effective use of CERC principles and the consequences of failing to uphold them. The importance of a unified approach to crisis communication across agencies and levels has never been clearer."

In closing, the authors write: "To effectively tackle these new, complex crisis communication challenges, we must revisit the core principles outlined by the CDC and reframe our approach to present a unified voice, respond quickly and accurately, build credibility and public trust, and provide clear and consistent guidance, all with respect and empathy."