The Do's and Dont's of Crisis Communication for Public Health

Do's and Don'ts of Crisis Communications for Public Health

Infectious disease outbreaks, though always unique, are not novel. In fact, the Centers for Disease Control and Prevention (CDC) has published a 350-page Crisis and Emergency Risk Communication (CERC) manual that lays out steps for preparing for, and responding to, a public health crisis. Yet even the best-laid plans often go awry.

Crisis Expedites the Flow of Information

During an emergency, everything is moving at warp speed as the normal flow of information turns into an avalanche. To keep up with this heightened pace, normal routines and standards are upended in the name of exigency. While useful (and often necessary), these changes also have consequences.

For example, consider that non-peer reviewed pre-prints became acceptable publications during the COVID-19 pandemic, as researchers strained to share any available data about the novel virus as quickly as possible. Unfortunately, these findings often were taken as definitive statements of fact, rather than preliminary results to be further analyzed and confirmed (or repudiated).

Graph showing increase in the number of pre-prints.
Cumulative growth of journal articles and preprints containing COVID-19–related search terms (as of April 2021).
Source: Fraser, N., et al. (2021). PLOS Biology 19(4): e3000959.

Who to Trust?

Faced with such a deluge of information from scientists, medical and public health officials, policymakers and the media, it is nearly impossible for any individual to sort through what is accurate, what is new and what should be prioritized. Effective crisis communications are therefore reliant upon trusted, respected spokespeople who have the skills, the capacity, the knowledge and the institutional support to engage with audiences about the rapidly changing nature of an emergency. Yet, too often, the public health community’s messengers lack the credibility, training or capacity to reach broad audiences in ways that resonate.

What Qualifies as an Emergency?

How a person responds to crisis communications is also dependent on circumstance. What seems like an emergency to some is just another setback to others. Individuals from underserved communities who are already contending with existing health, environmental and social challenges are less motivated to respond to crisis messaging, and the result is that these groups often end up bearing a disproportionate share of the burden from emergencies, such as infectious disease outbreaks.

Given these challenges, what steps can be taken to improve health crisis communications before the next infectious disease outbreak rolls around?

Image of the CERC manual cover. The Centers for Disease Control and Prevention Crisis and Emergency Risk Communication manual provides a step-by-step framework for responding to an emergency like an infectious disease outbreak.
Source: Centers for Disease Control.
Do: Have a Plan

Part of the solution is just being prepared. Developing an emergency response plan helps organizations define goals, identify effective spokespeople, set up the necessary infrastructure and create a chain of command for collecting and disseminating information.

According to Xun Zhu, Ph.D., assistant professor of communications at the University of North Dakota, having a centralized information distribution center allows organizations "to be able to release information faster and distribute widely in social and organizational networks."

Zhu also recommends being prepared in terms of content. "Having a contingency plan means we would have a set of possible messages ready to go that has been tested for different groups of people," he suggested. This approach would allow scientists to coordinate appropriate strategies to address any potential issues before, rather than during, an emergency.

Do: Put Yourself Out There

The internet gives everyone the ability to broadcast their thoughts, opinions and perspectives. The challenge is being heard above the noise. The most efficient approach for making an impact is working with those who already have the platform and the audience. As Amanda Fine, News Media Branch Chief at The National Institutes of Health (NIH) recommended, "try to use existing channels of communication, like those of your organization, to amplify your message. It's very hard to gain a large following as an individual, and it's more likely that their platform has a much larger audience than yours."

Amplifying your voice also means being willing to talk with journalists. Providing outside expertise and advice on scientific research helps media outlets ensure accuracy, while respecting their publishing process. "If we call you, please answer the phone in a timely way, be willing to talk to us in a timely manner," pleaded Karen Kaplan, Science and Medicine Editor at the Los Angeles Times.

Seek Help From Communications Professionals

Fine suggested that scientists always coordinate with communications professionals when interacting with the media. "You don't want to talk and say something that you didn't mean that's either going to hurt the reputation of your institution or your own reputation," she cautioned. On the other hand, a bonus of this kind of collaboration, said Fine, is that it allows communications staff, who may lack a technical background, to "gain a better understanding of your research and help guide you in your messaging."

Screenshot of Eric Topol's Twitter profile. Eric Topol, M.D., has gained a huge social media following thanks to his in-depth posts about the COVID-19 pandemic.
Source: Eric Topol's Twitter profile.
Going it Alone

A number of scientists have done a great job reaching audiences on their own, primarily through sharing of information on social media. This success is usually attributed to several factors, most of which tie back to a comfort with communicating and a willingness to engage.

"You write, you talk, you share," explained Monica Ponder, Ph.D., assistant professor of health communication at Howard University. "And people want to listen in. They want someone that is relatable and personable to explain these complex topics."

Choice of platform is also important. Whether it be Twitter, LinkedIn, press releases or TikTok, where you choose to engage dictates who you are reaching and how your message is both constructed and received.

Engage in 2-Way Communications

Scientists also must be willing to engage in 2-way communications with different communities, especially those who have been traditionally underserved, marginalized and ignored. As Ponder explained, "We as scientists need to be in those spaces, making sure that we are countering incorrect information and giving context in a way that is accessible, fun, creative and colorful."

Only by making an honest effort to establish relationships with these groups can the public health community hope to build the trust and credibility that is required to promote an effective crisis response.

ASM Ambassadors reflected on how communities around the world were impacted at the start of the COVID-19 pandemic. Here they share how crisis communication affected their communities’ responses to the outbreak.

Don't: Let it Consume You. Do: Take a Breath

"Be First" is listed as the top principle of effective emergency and risk communications in the CDC’s CERC manual. However, as Fine warned, "once you say it, you can't take it back. And once it's in writing, it's forever." Rather than sacrificing accuracy for speed, a better approach is to pause to think about what is being communicated and who is being reached before disseminating the information on a given platform.

Readers also benefit from a "less is more" approach, according to Rebecca Rozelle-Stone, Ph.D., professor of philosophy and religion at the University of North Dakota. "Online articles and social media can feel like images and headlines are just screaming at you," she said. "You can walk away quickly, but you feel exasperated and distraught."

Instead, Rozelle-Stone encouraged an approach of consuming less information and taking more time to read content. "Thinking about local issues, which gives us a greater sense of efficacy and agency, tends to happen when we’re reading at a slower pace," she pointed out. "Connecting the dots between social contexts and crises are steps that increase empathy into the plight of other people," which helps ameliorate crisis fatigue.

Do: Change the System.

Communications for Microbiologists Logo. ASM's 'Science Communication for Microbiologists' course offers training on effectively communicating science to different audiences.
Source: American Society for Microbiology
Some solutions will require a sustained, coordinated effort, involving stakeholders from across different sectors, making structural changes to how science is communicated. Institutions should adopt programs that integrate communications training as part of their curricula (similar to ASM's "Science Communication for Microbiologists" training course).

Improve Cultural Competency

There is also a great need for cultural competency training that provides opportunities for raised awareness and mutual learning about different perspectives, backgrounds and experiences. Research shows that a critical factor for trustworthiness of crisis communication messages is transparency. "We have to begin to speak the same language, even if we're all just addressing the problem from a different angle," urged Ponder.

Enhance Accessibility and Responsiveness.

Other recommendations focus on making the scientific process more accessible and more responsive. Ponder suggested adding accessible information to journal articles. "I would love to see more explanation in discussion parts of articles that are prescriptive," she said. "Connecting those dots so that the data gets out of the lab itself and gets out of the clinical language."

For her part, Kaplan would love to see greater efficiency in the peer-review and article publication process. "If journals were able to turn things around faster, there'd be less need to throw so many things up on a pre-print," she explained.

The Need for Better Communication

Addressing issues that are internal to the public health community would also positively impact how scientific and medical information is communicated to broad audiences. "When crises are there and facts need to be relayed, there’s no way around it," admitted Rozelle-Stone. However, she added, "keeping people’s eyes on just the catastrophe increases the sense of impotence."

Instead, Rozelle-Stone suggested a different approach. "Interspersing crisis stories with stories of hope, agency and dignity can prove useful" in overcoming feelings of hopelessness and helplessness that often lead to despair and inaction.

Ultimately, the public health community needs to start addressing these challenges now in order to see results when the next infectious disease outbreak hits. Admittedly, there is a lot of work to do, and hardly any of it is easy: nobody likes thinking about worst-case scenarios. Yet, a crisis is a crisis because it is an unexpected change from normal. Only by changing what normal looks like can we do a better job communicating when the next infectious disease outbreak occurs.

Author: Geoff Hunt, Ph.D.

Geoff Hunt, Ph.D.
Geoff Hunt, Ph.D., is the Public Outreach Program Officer at the American Society for Microbiology.