Message, Moment, and Motive

The incredible success of vaccines against the virus of the century should boost confidence in science and gratitude for the people who have led us through the fire. So why, as COVID-19 literally fades in the west, do so many find it so hard to second these emotions?  When communication fails, as it has throughout the pandemic, it is tempting to blame the audience, but that is unfair. When there’s no applause, look first to what’s happening on-stage. In this case, the script is excellent but the performance poor. A series of highly effective and safe vaccines were brought before the nation and world in record time. This amazing feat shows how government and private enterprise can collaborate more effectively than anyone imagined. The US is living up to its global responsibility, sharing the fruits of its achievement around the world. What a shame that this amazing story has been lost in the tangle of mixed messages, poorly timed, and too often, disingenuously delivered. For over a year the audience waited and watched for their chance to bring down the house but cannot bring themselves to cheer public health leadership they see as insincere, insecure, and in some ways as beholden to special interests as to solid science.  

“Following the science,” which started as a pledge has sunk to a cliché. In an unprecedented pandemic, it is reasonable and defensible not to have all the answers. Confident communicators admit it. Effective crisis communication, which like vaccine development is science based, requires full disclosure about the limitations of proposed guidelines, including the pros and cons. When governments limit personal freedoms, as they have throughout the pandemic, there is no place for a “one size fits all” approach. Best communication practice calls for openness, about what is known and not known. Science-based public health recommendations should always weigh potential benefits against the harms for all subsets of the population. Thoughtful, effective guidance is tailored to the needs of specific audiences. Any restrictions are justified in proportion to a group’s vulnerability to the threat. At the same time those at reduced risk from the virus can be safely spared from the harm harsh control measures inflict on lives and livelihoods. The deliberation should be open, inviting those affected by public health restrictions to share in the decision of what constitutes acceptable risk. Such an approach quells dissent by introducing into the conversation, honesty, humility, respect, and civility. Most of this didn’t happen with COVID-19 and now we’re paying the price of lost trust.

Always, everywhere, when communicating risk with adults. respect and candor build support. Just as assuredly paternalism and condescension foster descent.   This fundamental tenet of effective risk communication, when violated, leads to popular skepticism, anger, distrust, and defiance. The further off-track pandemic communication goes, the more damaging these negative effects become. Look, and listen; what’s going on around us speaks volumes. Now, with more than half the US population still unvaccinated, and as the availability of safe, effective vaccines surpasses demand, the communication miscues of the past year have become painfully consequential. Instead of celebrating one of the most amazing triumphs of medical science, the country, and with it much of the world, stands divided over who and what to trust. Blame it on the actors, not the audience.

Incremental Honesty

There should be no debate over the need to find the origin of this outbreak, which at the very least, has caused 168 million infections and 3 and a half million premature deaths, worldwide. And yet, throughout the pandemic scientists, official spokespeople, and journalists have consistently jumped to conclusions, favoring one theory while simultaneously trashing another, with no conclusive evidence to support them. When obstinacy prevails over healthy skepticism, as it repeatedly has throughout the pandemic, trust in science is diminished.

Most agree the pandemic began in Wuhan, China. Typical of Chinese cities, there are live-food “wet “markets there, which have long been linked to animal-to-human disease transmission. In what the Chinese government would dismiss as mere coincidence, not far from one such market, the Wuhan Institute of Virology experiments with various strains of coronaviruses. Past, accidental viral escapes from Chinese viral labs are a matter of record. The Chinese government, initially exposed for covering up the first COVID-19 cases, has been consistently uncooperative in identifying the cause of the COVID-19 pandemic, and has even used American scientists in their hyper-defensive insistence that the Wuhan lab could not possibly be the source. And most of the time world scientists and politicians have let them get away with it. In an apparent strategic step-back from their earlier contention that the pandemic had to come from a natural source rather than leaking from the lab, both Robert Redfield, former director of the US Centers for Disease Control and Prevention (CDC) and Anthony Fauci, a senior National Institutes of Health clinical scientist, and primary Covid scientific advisor to President Joe Biden, both say now, the lab-leak hypothesis is plausible. But, for a year, the very idea was taboo, inflicting a blow to scientific credibility. Scientists should never have backed away from a theory that has always deserved serious inquiry. Their eleventh-hour conversion nudges the official position from intransience towards plausibility, if only the Chinese government would allow a thorough investigation we might finally find out. But China won’t, and the World Health Organization, whose authority includes enforcing the International Health Regulations (IHR) remains timid as does the US government, the European Union, and many other allies. Initially, WHO Director-General Tedros Adhanom Ghebreyesus appeared to downplay the rapidly emerging pandemic, delaying the critical IHR requirement of declaring “a public health emergency of international concern.” Instead, he  praised the Chinese president, even as the regime denied and then minimized the Wuhan outbreak. Last fall, a WHO scientific delegation was refused access to critical information needed to explore the possibility of a lab error triggering the pandemic. Through the news media, the returning team gently admonished their Chinese government hosts, but  their final report, all but dismissed the possibility of lab error stating, the laboratories where coronavirus research was done, “were well managed, with a staff health monitoring programme (sic) with no reporting of COVID-19 comparable respiratory illness prior to December, 2019.” WHO investigators dispatch the topic in little more than a page (page 118) in their 120-page document. 

WHO’s reluctance to seriously pursue a fundamentally important issue, that is, how the most catastrophic global pandemic in modern history might have begun, undermines trust in the institution and public health in general. It stands to reason vaccine skepticism is running high. After all it’s the same scientific establishment that’s assuring us—and in this case, correctly—that COVID-19 vaccines are safe and effective, that has obfuscated the essential science of what caused the pandemic.

The Politicization of Science

Parts of the country kept schools closed for a year. At every age and grade children have been deprived of learning and forced to endure heartbreaking social and mental health stress. Substantial harm, including sharp increases in pediatric suicide have been the result despite CDC’s position a year ago  encouraging in-class instruction over home-learning under most circumstances. At the time CDC reasoned “other mitigation efforts (e.g., handwashing, home isolation of infected persons) are more effective controls on the spread of disease. In other countries, those places who closed school (e.g., Hong Kong) have not had more success in reducing spread than those that did not (e.g., Singapore).” But officials in many US states closed schools anyway, often under substantial political pressure, especially from teachers’ unions. A CNN interview in February of this year illustrates the tension, and the yielding of science to President Biden’s Left-leaning administration and union supporters. Throughout the pandemic the news media have rarely questioned CDC or other official public health guidance, but, appropriately, they’ve finally become bolder. USA Today carried scientists’ accusation that CDC distorted their data in the Morbidity and Mortality Weekly Report (MMWR) an official CDC periodical, in acquiescence to political pressure from Washington and organized teachers’ groups in California, New York, Illinois, and elsewhere. Last summer, political pressure from then President Trump and conservative interests, tilted the Agency the opposite direction, albeit one consistent with scientific evidence supporting the safety of in-class instruction. But the Agency has not pushed the issue either way, appearing to attempt—without success—to appease both sides. 

Throughout the pandemic science communicators have blurred the scientific rationale for mask use, social distancing, and what, that seemingly ancient goal of “flattening the curve” really means or meant.

After more than a year of such waffling, the country’s premier public health voices have lost enough trust, so that sizable numbers of people turned hostile towards reasonable pandemic control measures and are now refusing to take the shot, even though data show vaccination to be so important to ending the pandemic.

 What to do?

Scientific and political roles are both important, and when properly played, mutually supportive. The message must be clear, presented at the right moment. The motive behind it must be honestly acknowledged, and candidly explained. Public health guidance based on science can be justified, even when the recommendations require personal sacrifice. Trust provides that advantage, but a year of mixed and illogical messages catering to hidden agendas has squandered trust in the public health institutions we all rely on. Regaining trust starts with confessing when COVID-19 guidance has been unduly influenced by political interests over public safety. It’s a difficult first step, but necessary to restoring reputations of the world’s most important public health entities, including the WHO and CDC. Defensiveness on their part will only make matters worse.

Political leaders must hold nations accountable. In this pandemic that means coordinated pressure on the Chinese government to allow the global family of nations access to information we all deserve, that can reveal the origin of a pandemic of epic proportions. Few wars consume more lives or wreak the extent of societal and individual havoc than the coronavirus pandemic has done. Requiring China to cooperate to find the cause does not imply the pandemic was purposely caused. If it was human error, the scientific community needs to understand what happened in the interest of preventing another catastrophe. It is not racist, or in anyway unfair to demand the Chinese government to participate fully and openly in that quest, wherever it may lead us. It is necessary and right to do so. Good science leaves no stone unturned. The media, so quick to speculate, second-guess, and exploit controversy should sharpen its focus on what good science needs to accomplish in order for us to learn lessons from the past year of global turmoil and tragic loss.

Through much of this year, technical experts have hung-on to their illogical insistence that fully vaccinated people remain bound by liberty-limiting restrictions. Finally, the grip is being relaxed but the damage lingers. Many who reasonably questioned contradictory messaging are now rejecting the vaccine. Some remain unnecessarily fearful of others, needlessly trapped behind their masks or self-imprisoned in their homes. Now, more than ever, it is necessary to place risk and benefit in proper context and begin the slow process toward restoring trust in public health science and making it possible for people to enjoy others instead of fear them.

As the pandemic winds down, we’ve left a communication mess in its wake. Let’s fix it.

 Dan Rutz, retired CDC communications strategist co-led communication strategy and behavior change policy in several national and international outbreak responses, including SARS-1, monkeypox, West Nile Virus and Avian (H5N1)Influenza. He represented the US in pandemic collaboration with the G-7 countries, plus Mexico, through the Global Health Security Initiative treaty. As part of the World Health Organization (WHO) outbreak communications cooperative he shared in the development of global outbreak risk communications standards which were also integrated into the revised (2005) International Health Regulations (IHR).  As part of CDC’s Center for Global Health, he advanced HIV/AIDS prevention initiatives across eastern and southern Africa.  Currently, he consults with global public health and diplomatic agencies on public health risk communication practices and with journalists on responsible coverage of public health emergencies. His specific interests include vaccine advocacy and domestic violence mediation. As visiting professor, he has, since 2008 taught Integrated Communication Strategy for Master of Public Health candidates in the Emory (Rollins) School of Public Health.    Rutz served as on-air CNN Medical and Senior Medical Correspondent from 1981 through 1999.

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