This week, Susan Channa discussed the importance of proper communication between public policy experts and the United States population and several ways one can be an effective communicator. One issue that stood out to me was how much our country’s government and experts struggled to communicate effectively with the US public.

Susan Channa gave clear pointers on how to communicate effectively. Advice such as: Be quotable, deliver key messages, deliver shorter answers, correct misstatements and raise questions yourself. Also, be concise, clear, and compelling and focus on three key messages. This advice made much sense. However, our country and its institutions often failed to follow this advice. Whether it was the CDC, which often released long form and confusing tweets, or President Trump/Biden, whom both have made contradictory statements from public health experts, our country and its institutions have a big problem regarding effective communication.

As we move to a more digital age and an age where public health issues are becoming more and more politicized, what is the best way to move forward so that Americans can receive effective communication? Perhaps the CDC needs more funding to hire better social media experts/training. Maybe public health experts can be given a status and protections that allow them to be more independent, like certain judicial positions in our country.

Public health communication is approached with caution because of its ability to shape perception of diseases and how they should be handled. This is especially the case when communications are being displayed in front of a national, and even global audience. As Susan Channa discussed in our recent lecture, public health experts try to ensure that all circumstances surrounding a communication are displayed in a way to best understand their contentions. For example, offering a conclusion, followed by three arguments with supporting points for each has been psychologically proven to resonate best with readers and listeners. Deploying methods such as bridging, hooking, and flagging are commonly used by experts to pull a conversation in a direction toward the expert’s desired talking points. Experts will even customize their zoom background so listeners can focus on their words without distraction.

Even with preparation, some public health communication may fail at the execution stage. This was evident during the earlier stages of the COVID-19 pandemic, where the CDC failed to make clarifications upon discovery of new evidence surrounding the virus. To illustrate some examples, the CDC initially stood by the position that face masks are not preventative, but later recommended them for multiple years. Quarantine periods for those sick with the virus changed from 14 days to 10 days, then to 5 but with qualifications. The CDC issued a later tweet that contradicted its 5-day period, and the director stated that the shorter quarantine period was fueled in part by a desire to “keep society functioning.” Additionally, the COVID map change on the CDC’s website created the perception that case numbers dropped considerably nationwide in one afternoon. Although the changing recommendations were likely based on new information, contradictions like these caused distrust among the public. Even with up-to-date information, infographics such as the vaccination activities chart that we viewed seemed to confuse readers. Thus, the CDC’s handling of COVID-19 outreach should emphasize the importance of well-prepared and well-executed public health communication.

With proper preparation and execution, public health institutions can gain credibility with the public. Because of communications efforts spearheaded by Susan Channa and other professionals during the COVID-19 pandemic, Emory University significantly increased its prominence in the public health field. Those speaking on behalf of the university were prepped to deal with reporters, utilizing different techniques to get their points across. To provide one example, Channa notes that interviewees have more flexibility to shape the narrative with a less experienced reporter, but also that reporters could play ignorant to catch inconsistencies. Because Emory professionals were equipped to handle COVID communications on a wide scale, they improved the university’s standing in public health discussions at a time when there was greater opportunity to fill information voids.

There’s a basic problem in integrating public health with national politics. At the end of the day, a public health expert makes their analysis and offers it to political entities, elected officials and their appointed agents. And then those individuals are off to the races. The expert has little room to maneuver if they begin to get creative with the expert’s original advice.

I don’t think Anthony Fauci is a hero with a cape or a villain with a goatee, but I think his conflict with Donald Trump displays, in spectacular fashion, this eternal problem such an expert faces – ‘If you jeopardize my messaging or my reelection chances, you are replaceable.’

I don’t know if there is a clean solution to this hard reality. We can discuss measures that would seek to insulate experts from political backlash. But, in the end, as public health and domestic politics become more integrated, the present majority party of the state has a lot of leeway to elevate or sideline such experts. And in a democracy, it becomes messy to argue that should not be that case.

I like to offer solutions where I can, though this one is tough. Perhaps this is an argument for the case that public health experts should try to maintain political distance to the extent that they can. Money and status from politics aren’t offered without expectations. TINSTAAFL. But nothing gets done if there’s no money for salaries, studies, and keeping the lights on.

With Tuesday’s lecture focused on effective communication strategies and both great and poor communication examples shows, I have been thinking of message tailoring. During the COVID-19 pandemic we saw more attention being paid to this. Diverse and marginalized groups have historically faced medical racism, or worse, medical violence. In the United States, there has been the forced sterilization of Indigenous women, the Tuskegee syphilis study, and experimental treatment on incarcerated individuals. How do you gain trust during a public health crisis when these populations have experienced trauma at the hands of experts?

Within the African American community, there exists a rightful hesitation with regards to the COVID vaccine. With time and attention brought to more tailored approaches of messaging, this has improved. However, as each new booster rolls out, oftentimes concern remains. When thinking about both acknowledging the mistrust and providing education, it’s a careful balance. After doing some more research, I found this interesting infographic published by the Association of Immunization Managers.

Association of Immunization Managers

While the issue of gaining trust is incredibly complex, what I appreciate about this message are the points of ‘acknowledge values and lived experiences’ and ‘support the process of decisions making’. I believe that a good public health message does include both aspects; saying ‘you have every right to feel this way’ and ‘you have the right to make this health decision’ returns autonomy to the individual. For tailoring communication, both must be included in order to even be heard. To use these techniques first and foremost with marginalized groups can not only get your foot in the door, but also considers the ethical principles of public health.

When COVID-19 began it’s sweep across the globe, we bore witness to some incredible missteps by our country. We’ve discussed in detail how and why that happened; leadership that doesn’t value science or unity breeds mistrust. How could we have built more trust in public health in the United States during COVID? More importantly, how could we have communicated science, vaccines, public health, and empathy more effectively? In class, we saw an inspiring example of that kind of communication with New Zealand’s Prime Minister, Jacinda Ardern.

. PM Ardern has delivered inspiring speeches that demonstrate strength under pressure, empathy, accountability, foresight, and a dedication to science. She has worked hard to sow trust in public health within her country: while they have experienced spikes recently, New Zealand had faced some of the lowest COVID rates in the world. PM Ardern has been a crucial figure in the effort to stop the spread, her communication being one of her greatest strengths.

That being said, communication should be followed with action, and this does demonstrate a short coming of the PM. Despite Ardern’s effective elimination strategy, it is important to look at what populations were left out of the conversation. The Māori population faced disparities in vaccination access and hospitalization rates, illustrating that when programs are developed on a broad, general scale – even if these programs are strong and scientifically backed – they often overlook the needs and inequities of health for marginalized groups. While PM Ardern’s communication is often inclusive and intentional with the Māori population, her actions that follow do little for health equity for indigenous people.

There is much to be learned from PM Ardern and New Zealand’s response, but like the United States, they too uphold systems of oppression when it comes to their indigenous populations. While I hope to see the United States take a similar science-led, consistent, and reliable approach, I think the pandemic has highlighted health inequity specifically for indigenous and marginalized populations around the world. Health communication is only as effective as the action that follows.

During public health crises, the most important communications lie between health experts and the public. As Susan Channa discussed in her talk, a major pitfall of communication during the COVID-19 pandemic was that experts and organizations like the CDC failed to communicate information like number of cases and precautions early enough. As such, the public turned to either social media platforms or news sources for help. While some sources like the NYTimes COVID Tracker provided generally helpful and reliable data, other platforms spread misinformation. The communications of experts and organizations like the CDC are crucial to ensuring that false “truths” don not spread alongside illness. In the World Health Organization Bulletin, Rajiv N Rimal and Maria K Lapinski detail that there are three crucial considerations of health communications: first, that communications do not fall into a social vacuum; second, that messengers should expect discrepancies among the information disseminated by the source and received by the listener; and third, that the roles in communication are dynamic such that the source and receivers of information frequently switch positions. Given that pandemics introduce health crises to a large group of people, it is important to apply these considerations to health communications during HIV and COVID-19.

HIV

During the HIV pandemic, communications remained in a social vacuum and were not brought to the public until later into the crisis. In the beginning, most discussions around the virus occurred in LGBTQ+ spaces and among infectious disease specialists. However, through protests and campaigns, activists were able to bring the issue into the public sphere. As Ms. Thurman mentioned in her talk last week, these messengers were vital in bringing the discussion to the table. However, misinformation about HIV/AIDS was rampant, with individuals believing you could contract the virus from a toilet seat or even by touching an “infected” surface. These myths about HIV made public health communications even more difficult.

COVID-19

Similar to the HIV pandemic, we saw myths about the nature of COVID-19 enter into the public sphere. This time, however, social media was the main culprit. Instead of misinformation being spread face-to-face as seen for HIV, misinformed posts were shared screen-to-screen.To combat this, the CDC worked with platforms to create notifications that the information in the Tweet or post might not be “reliable” and that updates could be found on the CDC website. However, it may have been better if the information in each post could be reviewed and “debunked.” Working with communication scientists, computer programmers, and health experts, an algorithm or system could have been created to do this. For the future, health experts should collaborate more with communication scientists to track the spread of misinformation.

This week, we spoke to Susan Channa, who previously worked at Emory during the time of the pandemic and helped to clarify information about COVID-19. She provided an in-depth presentation of how to handle the media if one were to interview with the press. As the CDC was unable to clearly provide necessary information to the public, other institutions, such as Emory helped to fill that gap.

Susan Channa’s work is especially important as science communication is clearly lacking in the general public. It’s not as if most people can pick up a generic scientific article and understand it. Because the CDC and other public health institutions have been unable to clearly and effectively communicate to the public, others have stepped up to fill the void. While most have good intentions, such as Emory, and others simply make mistakes, this has also provided the perfect breeding ground for misinformation to spread, such as through the conspiracy theory, QAnon.

So what factors of QAnon make it so effective in its communication? One of the answers lies in its ability to communicate. Some describe the conspiracy theory as a game, akin to Dungeons & Dragons, where anyone can contribute to the story that they’ve crafted. QAnon platforms employ memes and a way of interaction that makes you believe that you have come up with new ideas and see novel patterns. In this, accessibility is increased, so anyone can join and contribute towards a community of like-minded people that ultimately becomes addicting. It does not help that social media algorithms are able to easily recommend similar groups that serve as the gateway to this cycle. Furthermore, social media influencers gain trust and perpetrate the lies for their own financial or other personal gains.

But why did QAnon conspiracies gain traction in the first place? Most of this can be attributed to growing partisanship and distrust in the government. When the CDC sends out unclear, mixed messaging at one of the most vulnerable times in recent memory, and the President of the United States, the most powerful person in the United States, is contradicting that messaging, it’s no surprise that people look to alternative sources for an all-encompassing explanation of their world. And this is what QAnon achieves.

During a time when we’ve been accustomed to looking up to higher authorities, it was refreshing to hear of an approach of community involvement from Stacey Thurman. Her perspective of creating trust within communities by using public health advocates that are more familiar and accepted seems retroactively obvious. This begs the question of why did we go so wrong with COVID-19 communications, leading to the extreme politicization of public health unlike ever before. One answer may be due to the unprecedented and urgent nature of the pandemic however it also could be attributed to experts wanting to be the one to be accredited for the big breakthrough. A lesson I hope we learn from this disappointment is humility. Moving forward in public health matters, including for example the growing antivax movement, authorities need to collaborate within communities in order to mitigate politicization unearthing thought to be dead diseases. In times of mistrust and uncertainty it is much easier to villainize a stranger you only see in the media than it is to a local medical hero, nonprofit leader, MD in state office, and so on. As we go forward into our public health careers and scatter outside Atlanta into new horizons, Tulane has some advice on how we can advocate for public health. https://publichealth.tulane.edu/blog/community-health-advocate/

When considering the United States’ COVID response, a large majority of people will immediately think of former President Donald Trump. Of course, this response is not unfounded–if it were not for the politicization of science, as well as his defunding of the White Houses’s Pandemic Response Team, we certainly would not have seen the abysmal case and death numbers that the US touted throughout the pandemic. However, in an interview with 60 Minutes on Sunday, September 18, 2022, President Joe Biden declared that the “pandemic is over.”

Although messaging is, obviously, not the only piece of a government’s response to a pandemic, statements like that from the face of the United States’ government, are a particularly interesting contrast to the ~400 COVID related deaths per day that the US is currently averaging. Such statements often come with lessening financial support, as well as an even further amount of public flippancy toward a disease that is still ravaging communities.

Perhaps I feel particularly strongly about COVID because my mom is an ICU nurse. I’ve heard countless horror stories from her times at work in the throes of the pandemic, and I’ve watched her come home day after day absolutely wrecked by her 12-hour shifts. From the perspective of a healthcare worker, the pandemic is anything but over. Healthcare workers are certainly not the only people who are still actively avoiding COVID, of course; many people who are disabled and/or immunocompromised are staying home to protect their lives.

However, to the general public, the pandemic is over. At least, the pandemic as we knew it pre-vaccine, in the midst of lockdowns. Many people have gotten COVID and survived–I (finally?) got it for the first time in August of 2022, right after I moved back in for the school year. As I isolated in my dorm room, I could not stop thinking about how I currently had the disease that I once regarded as a death sentence–and I was surviving.

What is more important, then, when issuing public health guidance: the general public, or the marginalized–often disabled, and/or poor, and/or BIPOC–communities? Although my heart wants the US to emulate New Zealand in its COVID response, my mind knows how unrealistic that is. Guidelines, as we have discussed time and time again, should be strict enough that they will keep people safe, while being lax enough that they are realistically able to be adhered to. Regardless, is it responsible for the “leader of the free world” to tout that the “pandemic is over” despite so many factors pointing in the opposite direction?

This past Tuesday, Ms. Sandy Thurman gave a presentation that included a brief history of AIDS, an explanation of PEPFAR, and a discussion on the relationship between the government and pandemics. A message that Ms. Thurman continuously shared in her conversation was about the importance of collaboration—she mentioned that not everyone will always agree, but the best initiatives will leverage people’s passions. For example, when the Clinton administration wanted to raise money for Africa as individuals were suffering from AIDS, a conservative Senator from North Carolina, Jesse Helms, did not want to support the initiative as he did not want to endorse homosexuality tacitly. Therefore, the Clinton administration decided to make an announcement about AIDS and how the disease affects numerous resilient children in Africa. Senator Helms, who was vital in financing programs, loved helping kids—Ms. Thurman and her team knew that the Senator would provide his support to provide hope for the children in Africa. 

A federal court judge recently ruled in Braidwood Management v. Becerra that an Affordable Care Act mandate that requires employers on most health insurance plans to provide HIV PrEP is unconstitutional as it violates the Religious Freedom Restoration Act (Gonzalez 2022). The plaintiffs were two Christian-owned businesses and six individuals (Gonzalez 2022). Regardless of one’s views on the LGBTQ+ community and the judicial approaches used in the decision, the ramifications of this case can be significant. HIV PrEP, a preventative measure recommended especially for men who have sex with men as they are at a heightened risk of contracting HIV, has a high efficacy rate and helps limit the spread of HIV (Gonzalez 2022). HIV PrEP has been noted to lower the likelihood (by up to 98%!) of people initially testing negative for HIV and later suffering from the virus (International Association of Providers of AIDS Care [IAPAC] 2022). This decision can be a significant roadblock to the United States’ goal of lowering the amount of new HIV infections by 75% in the next three years (IAPAC 2022). 

Given what Ms. Thurman shared in class, I wonder if the Department of Health and Human Services can, if not already being done, provide information on how older adults, for example, are also at risk of contracting HIV in a supplemental briefing that needs to be filed—perhaps such details can sway the judge’s opinion before a final decision must be made on whether HIV PrEP violates the Religious Freedom Restoration Act (Human Rights Campaign 2017 and Gonzalez 2022). What do you all think?