A country's outbreak response has to meet certain standards in order to limit prejudicial consequences over its population, institutions and economy. For this purpose, the World Health Organization (WHO) recommends focusing strategies upon four coordinated blocks, each with particular elements: 1) responders, 2) health information, 3) health interventions, and 4) risk communication.
During COVID-19 pandemic times, risk communication is particularly relevant, as health information of all kinds, including unverified and/or biased data, is rapidly spreading through non-supervised channels, such as social networks or public online sources – a phenomenon described as “infodemic.” This situation is worsened by the fact that multiple third parties compete for communicational authority on health matters, and communication response systems are under-resourced with a lack of investment and expertise. These natural but detrimental reactions of our modern communication systems progressively “raise public panic, financial market hysteria, and unintended misunderstandings of the science and epidemiology of SARS-CoV-2.” For this reason, authorities must prioritize “agile, accurate, worldwide-available counter-information that takes the high moral ground and conveys a consistently science-driven narrative.”
Risk communication refers to “the real-time exchange of information, advice, and opinions between health experts or officials and people who face a threat to their survival, health, or economic or social well-being.” While facing emergencies, this dynamic process ensures the population at risk is able to make informed decisions, take protective and preventive actions, and maintain its social, economic and political stability. Developing a timely and sufficient risk communication strategy is an essential need when looking for urgent adherence of public health recommendations from the general population. Its degree of success mainly depends on guaranteeing that specific fundamentals are met and integrated into its work structure. The following characteristics of an effective communication strategy represent these concepts, as suggested by the WHO, the Pan American Health Organization (PAHO), and the Inter American Development Bank.
Public confidence in government may enhance adherence with public health recommendations; without trust, people are unlikely to follow official provisions. Risk communication requires a three-way channel of reliability, which involves the government, the health experts, and the general population. Communicators must demonstrate they are accountable for what they say, promise, and do, as well as be both, consistent and transparent with the information they share. The strategy must be linked to functioning and accessible services, easy to understand, and accessible to different population subgroups. Moreover, any given intervention must empathically acknowledge how the people's perception of risk is influenced by their beliefs, culture, education, political viewpoints, social norms, and prior experience.
Government and health officials must address people's expectations and anxiety at any given moment. Urgent concerns on health matters may evolve to potentially harmful panic given that public perception of risk often does not match the science-based reality. Providing frequent updates – including explicit information about uncertainties associated with risks, events, and interventions – and indicating what is known and not known at a given time regarding emergency health matters in a calm, reassuring, and confident tone may keep the public from turning against public health or national security measures. Adapting the language through which official recommendations are communicated is key to guarantee effective adherence.
The WHO and the PAHO have insisted on avoiding over-reassurance as it could be counterproductive. Taking this into consideration, health authorities must rely on updated information and, if possible, accurate statistical forecasting when addressing the population. Doing so will guarantee transparency within the communicative process as well as a message that does not underestimate the seriousness of any situation. In other words, reassurance is a useful strategy to promote conscious adherence with preventive measures but must accurately reflect current circumstances.
A critical moment for tackling misguiding rumors is just before they arise from knowledge gaps or concerns on the audience. Delayed delivery of information naturally sparks speculation and skepticism; therefore, it is crucial for governmental authorities to launch the first phases of their risk communication strategies even when the health hazard develops exclusively abroad. Defining the degree of risk, describing possible action plans, and justifying with evidence the need for immediate public cooperation prior to facing the threat within national borders helps guarantee credibility over any third parties divulging dubious information on the matter. Making clear the structure and work mechanism of the channel through which recommendations will be published and acknowledging that updates will be provided as soon as the situation changes are also essential.
As events unravel, all disclosed data and recommendations must be backed up by statistical analysis and expert opinion in order to limit the spread of misinformation. The final objective of this process also includes reflecting empiricism and avoiding institutional or political biases. Official communication teams must follow rigorous criteria when selecting sources that will be used for creating, reviewing, and approving accurate content. “For an unknown disease, communication should avoid using certain conclusions or expressions when clinical and epidemiological investigations are ongoing. Once an updated investigation is available, the information ought to be disclosed immediately. Any delay will likely lead to unexpected consequences.” Additionally, explaining how the designated decision-making process works is important to strengthen credibility and increase citizen adherence with public health recommendations. Openly explaining what is yet unknown and what is being done about it – without jeopardizing national security – further increases public confidence in the risk communication strategy.
Risk communication strategies should be coordinated at the local, state, and federal levels across different agencies, avoiding responsibility to be too centralized or decentralized. Nevertheless, the government must play the leading role. In this manner, when executing a given risk communication strategy, essential partners to government leadership include civil society organizations, businesses, social entrepreneurs, and the general public.
Liwi Z, et al. (2020) described a model that includes three components of communicative interaction for risk management. The first, government-public communication, refers to the external process of providing accurate updates, warnings, and recommendations to the population through mass media or other external communication channels; analyzing public feedback “enables the government to adjust its emphasis of information delivery and provide information in relation to the public´s own interests and values.” The second, government-expert communication, refers to the internal process of evidence evaluation for risk assessment and decision making; for this purpose, researchers and analysts must be empowered with access to enough resources for data collection and study. The author of this model emphasizes that “the very essence of responsible and rational action is to make viable and morally justified decisions in the face of uncertainty based on a range of expert judgments and assessments.” The third, expert-public communication, refers to the process of filling the gap between expert and public views on public health issues through strategic communication, by translating technical facts into understandable content for the general population. Particularly, partnering directly with community associations may accelerate policy-making processes, facilitate monitorization of adherence with public health measures, create accurate situational awareness, reinforce local responses, and establish dynamic feedback systems. Useful feedback approaches include social media, surveys, focus group discussions, community walk-throughs, and key informant interviews with front-line responders, partners, and stakeholders, among other approaches. The United Nations Department of Economic and Social Affairs (UN/DESA) highlights that an inclusive, multidisciplinary approach to risk communication may help tackle socio-economic challenges without leaving anyone behind. Partnerships with private companies or social entrepreneurs have multiple ways of addressing local and regional necessities during a critical situation; for example, government-organized hackathons may encourage innovative solutions to economic, social, and technological challenges during the COVID-19 pandemic.
National risk communication strategies must encompass all items of the current social, economic, structural, and political context, as ignoring vulnerabilities within them results in diminished impact of containment measures. During emergencies, disrupted supply chains, insufficient monetary liquidity, volatile demand and pricing, international trade restrictions, among other phenomena, pose a prejudicial impact on the population´s financial security and food safety, particularly in LMICs. When facing insufficient income or basic life resources under critical national circumstances, containment measures considered in governmental risk communication strategies are expected to fail. For this reason, simultaneous strategies must identify and attenuate all possible vulnerabilities.
Experts of the Organization for Economic Co-operation and Development (OECD) have created a centralized database of government responses to the different dimensions of the COVID-19 crisis, which includes insights into how OECD and G20 countries have responded to it. Regarding fiscal and monetary policy responses, they emphasize expansionary fiscal policies, among which “the most common schemes are deferral mechanisms for tax or social security contribution payments, credit subsidies for firms, and expanded unemployment income support programs for households.” Additionally, the latter includes “targeted support – financial and otherwise – for vulnerable segments of their population.”
Executing an effective risk communication response also depends on sufficient, sustained funding that meets the magnitude of current needs. Broadcasting networks, partnerships, infrastructure and human resources are essential elements for an effective strategy. Unfortunately, these are commonly underfunded to carry out their designated roles on urgent matters. LMICs are at higher risk of suffering communicational gaps due to weak, poor, or fragmented risk communication systems; it is unlikely that a message will reach its recipient without robust transmission channels.
Regarding COVID-19, Laurie Garret considers that governments, agencies and health organizations must urgently fund their messengers at an “unprecedented scale” if they want people at risk of infection to appropriately respond and cooperate with health authorities during the pandemic.
After considering the seven fundamental characteristics described above, we recommend following Peter Sandman’s´ useful four-step process to develop an effective risk communication strategy. According to Sandman, the degree of risk and its perception on people´s mind determine the entire focus of operation. First, the degree of risk depends on multiple variables, which include hazard (“the technical component of risk”), time and resources available, exposure, and vulnerability of the population as compared to its response capacity. In turn, perception, which completely detaches from scientific evidence referring to the degree of risk, depends exclusively on culture and emotions. The latter conditions outrage or “the non-technical component of risk.”
The link between hazard and outrage is that outrage is the principal determinant of perceived hazard. Following this idea, Sandman comes up with four categories of risk communication strategies, one for a specific scenario: intermediate hazard – intermediate outrage; low hazard – high outrage; high hazard – low outrage; high hazard – high outrage. It must be noted that, as events unravel, hazard and outrage degrees must be reevaluated in order to change the risk communication strategy as needed.
Intermediate hazard – Intermediate outrage: the main task is to provide health education, open and rationally discussing the developing situation, answering questions of the public, and guaranteeing accessibility to technical information. Sandman emphasizes on the importance of “interpersonal dialogue, supplemented by specialized media.”
Low hazard – High outrage: when the population is disproportionately responding to a low–hazard situation, the main task is to manage it. Sandman recommends directly listening, acknowledging, apologizing, and/or excessively reassuring, among other actions, to let outrage fanatics, which generally represent a minority of the population, celebrate victory over their claims, thus easing tension towards authorities.
High hazard – Low outrage: when the population is apathetic about a serious, urgent hazard, the main task is to intentionally provoke more outrage. Mass media may be helpful to get the attention of uninterested people, which generally represent a majority of the population. Sandman recommends being ready to change tactics when the audience starts to become more attentive.
High hazard – high outrage: when facing this scenario, the main task is to help people cope with serious risk and bear with fear and/or misery. Taking advantage of mass media communication and in–person dialogue, as the situation allows, Sandman suggests being empathic and acknowledging uncertainty, among other actions, while avoiding over-reassurance.