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COMMENTARY: Public health's share of the blame: US COVID-19 risk communication failures
Filed Under: COVID-19
By: Peter M. Sandman, PhD
|Aug 24, 2020
Editor's Note: After 40+ years as a risk communication consultant, Dr. Sandman came out of retirement in January 2020 to try to help with pandemic risk communication. Following is an abridged form of a commentary published on his website Aug 4, 2020, with new material added.
A reporter recently asked me what I consider "the single biggest communication failure" of public health experts and officials with regard to COVID-19. It took me a few weeks to think it through, but I now have a five-part answer to this question.
Let me state the obvious at the outset: Public health professionals are not single-handedly responsible for the dire COVID-19 situation in which the United States finds itself. If I had to specify a single culprit, I'd name the federal government, and especially President Trump. But I believe the public health profession bears a good deal more of the blame than it's getting.
Several public health professionals who gave me comments on an earlier version of this article said a lot of the failings I attribute to public health professionals are actually down to the President and the federal public health agencies that report to him. There's enough blame to go around. But I have spent the past 7 months reading and watching media, zeroing in especially on what experts and officials (especially those outside the federal government) were saying about COVID-19 in news stories, interviews, and op-eds. I don't have a formal content analysis of their messaging and how it morphed over time. But my strong impression, bordering on conviction, is that their messaging often misled the public, and the political leadership as well. How that happened is the subject of this article.
I want to look at the big picture. I'll ignore public health professionals' smallish risk communication failures, such as their abrupt about-face without an apology on the advisability of wearing masks and their absolution of antiracism protesters for gathering in large crowds. The story I want to tell focuses on how the public health profession drastically underreacted to COVID-19 at first and left us unprepared, then overreacted and sent us into lockdown, and then justified the lockdown by switching from a "flatten the curve" narrative to a "prevent infections at all costs" narrative instead of teaching us to balance priorities and "dance" with the SARS-CoV-2 virus.
Part 1: Public health over-reassures the public
The most obvious communication failure of most public health professionals vis-?-vis COVID-19 was their huge failure to warn governments, companies, and the rest of us to prepare in January, February, and into March.
Almost from the outset, it was apparent to most experts that COVID-19 would probably keep spreading—that it was much likelier than not to "go pandemic." But it wasn't apparent at first how severe the COVID-19 pandemic would be. So the right messaging would have addressed logistical and emotional preparedness for the hard times that might (or might not) be coming.
Public health experts and officials chose instead to reassure the public. Alas, to everyone's subsequent dismay, they succeeded. They were worried about public panic. So they validated the public's complacency—and with it, the complacency of government officials and corporate leaders—and left us incredibly unprepared.
Not content merely to reassure, some leaders went out of their way to attack the very idea of anyone being frightened about what the world might be facing. Here is what World Health Organization Director-General Tedros Adhanom Ghebreyesus tweeted on February 28:
Why did public health professionals downplay the danger of the SARS-CoV-2 virus? As the quotation from Tedros suggests, the root of the problem was what I have called "fear of fear"—especially experts' and officials' unjustified concern that vast numbers of people would freak out or even panic.
There was a more justified concern as well: experts' and officials' fear that they would be criticized for unduly frightening the public if COVID-19 fizzled or turned out to be mild. They had aggressively warned the world about a possibly disastrous bird flu pandemic in 2005 and it never happened; they had aggressively warned the world about a possibly disastrous swine flu pandemic in 2010 and it ended up less deadly than a typical flu season. In the wake of these two false alarms, this time they elected not to shout from the rooftops. Their warnings were sotto voce, easy to ignore. And their warnings stayed that way even after it was clear they were being ignored.
In those key early weeks, the main message from the public health establishment was that "the risk to people here in [wherever] is low." This was technically true, since there weren't yet a lot of COVID-19 cases in [wherever]. But public health professionals know that risk is often about the future. In any given October, before the start of the northern hemisphere's flu season but well into flu vaccination season, they would never say that the risk of flu is low. Focusing on the known current risk instead of the likely near-term future risk allowed public health professionals to keep saying the risk was low for far too long, inducing massive complacency in citizens and leaders alike...
COMMENTARY: Public health's share of the blame: US COVID-19 risk communication failures
Filed Under: COVID-19
By: Peter M. Sandman, PhD
|Aug 24, 2020
Editor's Note: After 40+ years as a risk communication consultant, Dr. Sandman came out of retirement in January 2020 to try to help with pandemic risk communication. Following is an abridged form of a commentary published on his website Aug 4, 2020, with new material added.
A reporter recently asked me what I consider "the single biggest communication failure" of public health experts and officials with regard to COVID-19. It took me a few weeks to think it through, but I now have a five-part answer to this question.
Let me state the obvious at the outset: Public health professionals are not single-handedly responsible for the dire COVID-19 situation in which the United States finds itself. If I had to specify a single culprit, I'd name the federal government, and especially President Trump. But I believe the public health profession bears a good deal more of the blame than it's getting.
Several public health professionals who gave me comments on an earlier version of this article said a lot of the failings I attribute to public health professionals are actually down to the President and the federal public health agencies that report to him. There's enough blame to go around. But I have spent the past 7 months reading and watching media, zeroing in especially on what experts and officials (especially those outside the federal government) were saying about COVID-19 in news stories, interviews, and op-eds. I don't have a formal content analysis of their messaging and how it morphed over time. But my strong impression, bordering on conviction, is that their messaging often misled the public, and the political leadership as well. How that happened is the subject of this article.
I want to look at the big picture. I'll ignore public health professionals' smallish risk communication failures, such as their abrupt about-face without an apology on the advisability of wearing masks and their absolution of antiracism protesters for gathering in large crowds. The story I want to tell focuses on how the public health profession drastically underreacted to COVID-19 at first and left us unprepared, then overreacted and sent us into lockdown, and then justified the lockdown by switching from a "flatten the curve" narrative to a "prevent infections at all costs" narrative instead of teaching us to balance priorities and "dance" with the SARS-CoV-2 virus.
Part 1: Public health over-reassures the public
The most obvious communication failure of most public health professionals vis-?-vis COVID-19 was their huge failure to warn governments, companies, and the rest of us to prepare in January, February, and into March.
Almost from the outset, it was apparent to most experts that COVID-19 would probably keep spreading—that it was much likelier than not to "go pandemic." But it wasn't apparent at first how severe the COVID-19 pandemic would be. So the right messaging would have addressed logistical and emotional preparedness for the hard times that might (or might not) be coming.
Public health experts and officials chose instead to reassure the public. Alas, to everyone's subsequent dismay, they succeeded. They were worried about public panic. So they validated the public's complacency—and with it, the complacency of government officials and corporate leaders—and left us incredibly unprepared.
Not content merely to reassure, some leaders went out of their way to attack the very idea of anyone being frightened about what the world might be facing. Here is what World Health Organization Director-General Tedros Adhanom Ghebreyesus tweeted on February 28:
Together, we are powerful. Our greatest enemy right now is not the [coronavirus] itself. It's fear, rumours and stigma. And our greatest assets are facts, reason and solidarity.
Why did public health professionals downplay the danger of the SARS-CoV-2 virus? As the quotation from Tedros suggests, the root of the problem was what I have called "fear of fear"—especially experts' and officials' unjustified concern that vast numbers of people would freak out or even panic.
There was a more justified concern as well: experts' and officials' fear that they would be criticized for unduly frightening the public if COVID-19 fizzled or turned out to be mild. They had aggressively warned the world about a possibly disastrous bird flu pandemic in 2005 and it never happened; they had aggressively warned the world about a possibly disastrous swine flu pandemic in 2010 and it ended up less deadly than a typical flu season. In the wake of these two false alarms, this time they elected not to shout from the rooftops. Their warnings were sotto voce, easy to ignore. And their warnings stayed that way even after it was clear they were being ignored.
In those key early weeks, the main message from the public health establishment was that "the risk to people here in [wherever] is low." This was technically true, since there weren't yet a lot of COVID-19 cases in [wherever]. But public health professionals know that risk is often about the future. In any given October, before the start of the northern hemisphere's flu season but well into flu vaccination season, they would never say that the risk of flu is low. Focusing on the known current risk instead of the likely near-term future risk allowed public health professionals to keep saying the risk was low for far too long, inducing massive complacency in citizens and leaders alike...