The National Academies of Sciences, Engineering, Medicine: COVID-19 Communications Perspectives

Participants in the convening discussed how communicating about COVID-19 to their audiences and communities was hindered by various factors. Among the factors cited were the enormity of the challenge; the speed at which the pandemic was evolving; and misinformation and disinformation being distributed by the news media and social media.

Another frequently cited factor was the change in presidential administrations in the United States during the period of the first COVID-19 vaccine rollout in late 2020, which had further complicated efforts at national-level coordination, noted several participants. Another challenge identified was related to the gaps in coordination among federal, tribal, state, and local governments, which resulted in part from their independence from one another.

In addition, disparities in how the COVID-19 pandemic was affecting different communities—and how the response to it was being designed and delivered (e.g., access to a vaccine)—posed and continues to pose significant challenges not just in addressing the public health crisis, but also in communicating accurately and effectively about it. Participants in the convening were keenly aware of the vast disparities in the impact of COVID-19 on communities of color and tribal nations resulting from deeply embedded systemic racism. They acknowledged how the broader environment of systemic racism impacts every aspect of crisis communications.

Following the discussion on the overall challenges associated with communicating about COVID-19, participants identified issues to consider to strengthen the capacity of the public health sector at all levels to more effectively communicate during a future public health crisis.

Communications must be grounded in reliable data and inclusive of communities most impacted.

Participants expressed concerns about the data used to inform decision making about various communications and responses to the pandemic. These concerns were primarily centered around “data absenteeism,” or under-representation or exclusion of certain population groups from data gathering, and the reliance on survey data over more specific behavioral data.

Messaging must be tailored, culturally congruent, and delivered by trusted messengers.

Participants identified several challenges in messaging about COVID-19. Some shared that the messages they saw were often confusing, contradictory, unapproachable, too academic in their framing, dismissive, and/or delivered by messengers who were not always trusted by audiences.

Some participants suggested that public health leaders and practitioners must increasingly put themselves in the shoes of people who are not scientific experts and realize that especially in the first year of the pandemic, members of the public were “drinking from a fire hose” and inundated with large amounts of complex information from many different sources. They noted that audiences may have limited experience in parsing evidence from opinion, useful from extraneous information, and good from bad.

Participants identified an opportunity to mitigate confusion about COVID-19 messages among communities by ensuring that information is delivered by messengers who are embedded within their communities and are trusted resources. Participants acknowledged that mass media outlets (e.g., cable and radio news, major daily newspapers, online news sources, etc.) often look for high-profile academicians or government officials to serve as spokespersons, but these can be the same kinds of individuals that many communities do not trust. Participants shared examples of the success of using trusted messengers, including the ability to develop a shared language to which communities and individuals can relate and thus more easily act on recommendations. For example, a family physician or local authority is often more relatable, capable of speaking in an understandable manner, and therefore, trusted.

Participants also noted that in addition to developing messaging and training messengers, strategies to disseminate messaging must be culturally congruent and tailored to meet the unique needs of communities, population groups, and tribal populations.

Misinformation and disinformation must be countered quickly.

Concerns about misinformation and disinformation associated with COVID-19 were widely expressed during the convening, as they have been elsewhere since the pandemic began to dominate public discourse in early 2020. Participants distinguished between misinformation resulting from genuine misunderstanding and disinformation intentionally spread by individuals and organizations. These concerns were so prevalent that they could easily have filled the convening’s entire agenda, but given the extensive conversations happening elsewhere at the National Academies and externally on this topic, facilitators made the intentional decision to limit the time spent on it.

A contributor to misunderstanding is that most members of the public do not have a deep understanding of science, biology, medicine, and public health. Yet, during the COVID-19 pandemic, complex information about the rapidly expanding, escalating, and evolving public health crisis was disseminated with insufficient attention to explaining why something was happening or needed to be done, or with little effort to help demystify key concepts and processes required for people to make decisions around their health. Participants noted how confusing and sometimes contradictory the messaging had been about mask wearing and the unsuccessful response to widespread concerns about the speed with which vaccines had been developed, tested, and approved. In both cases, the public health response was inadequate, providing fertile ground for misinformation and disinformation, complicating communications practitioners’ efforts and undoubtedly increasing vaccine hesitancy.

Funding is needed at the local level to reach vulnerable communities.

In identifying steps to be taken by the public health sector—including more representative data gathering, tailoring of messaging, and use of trusted local messengers—participants in the convening recognized that funding is essential to ensure that community-based organizations have the resources necessary to act on these recommendations.

Participants also challenged the expectation that funding of well-resourced institutions would be distributed to community-based organizations. Currently, public resources for health programs in the United States flow more easily to institutions and existing grantees with established ongoing relationships, with relatively little funding reaching implementing organizations that serve vulnerable communities and those with weaker ongoing connections with funding sources. In addition, participants observed that many local health departments are unevenly resourced. One participant noted that some county and city health departments have received limited funding for work related to COVID-19 over the past 18 months and that many are dipping into reserves until reimbursement is possible or funding is more equitably allocated.

Crisis communications must be bidirectional.

Participants in the convening expressed concerns about the top-down nature of much of the messaging about COVID-19. They observed insufficient engagement with community-based organizations in shaping the messaging drawing on their unique insights about what their communities needed and wanted to hear, and how best to communicate with them. Participants also recognized that few community-based organizations had the resources and capacity to develop their own messaging, leading many to rely on messaging developed by others, including federal and state agencies or private sector collaborations.

In addressing these dual challenges, participants expressed that crisis communications must be bidirectional, when possible. Without the resources (and infrastructure) to allow this to happen, important perspectives are not often included in the development of communications, which limits their relevance to many communities.

Communications infrastructure needs new or revitalized convening and coordinating bodies.

The need for a new—or at least a reconfirmed and revitalized—communications infrastructure was a recurring theme in the interviews leading up to the meeting on May 20, during the meeting itself, and in post-meeting conversations. Over the course of the conversation, it became clear that both a convening body and a coordinating body would be valuable components of that communications infrastructure.

Some participants noted the need for a centralized convening body to allow for building ongoing relationships, sharing lessons learned, and more effective coordination. Such a centralized convening body could be a facilitator of bidirectional coordination, and compile and aggregate communications materials, messaging, and best practices to the benefit of everyone.

Such a convening body could generate several benefits, including leveraging existing assets to benefit community-based organizations without the resources to develop their own, and providing a mechanism to identify and respond to misinformation in real time.

Participants acknowledged that it would take time to create such a convening body and establish its credibility to the point where people and organizations would look to it as a valued resource. The need for funding of the centralized convening body was also acknowledged.

Participants also discussed the need for a body to effectively coordinate communications, ensuring the bidirectional interaction described earlier. The following table describes the roles of the convening and coordinating bodies.

In many ways, the May 20 meeting of public health communications practitioners offered a snapshot of what was happening in the United States at that particular moment in the pandemic. While there was some cautious optimism that the country was approaching (or had already passed) an infection point in the progress of the pandemic, this was tempered by the realization that it was not yet over, and some communities were continuing to be disproportionately impacted in the United States and around the world.

Yet, participants in the meeting were able to identify lessons from the pandemic to strengthen the capacity of the communications practitioners in the public health sector at all levels to more effectively anticipate and respond to future public health crises. These critical conversations must continue beyond the current pandemic. They require deep engagement from organizations at all levels to ensure the public health sector is collectively prepared for future moments of inevitable but manageable crisis.