New Cochrane review weighs up the evidence on public health communication & Covid-19: what worked, what didn’t & why
A new Cochrane review explores the different approaches governments and health authorities around the world used to communicate critical public health information throughout the COVID-19 pandemic. Last month, review authors Rebecca Ryan and Shauna Hurley submitted the review along with five key recommendations to the Australian Government’s Inquiry into the National COVID Response. Here, they share a snapshot of the review findings and clear, evidence-based recommendations for current and future public health crisis messaging.
From March 2020 onwards, governments around the globe faced the urgent challenge of communicating complex facts, figures and directives to diverse populations about a rapidly unfolding pandemic.
Explaining the urgent need and changing mandates for physical distancing measures many of us had never heard of or imagined (think isolating, quarantining, contact tracing, mask wearing, home schooling) was a complex, multi-faceted and ongoing necessity.
To compound this profound challenge further, social, political and health landscapes were shifting rapidly as new and often contradictory evidence and policies emerged. Add to that a deluge of mis-information, dis-information and conspiracy theories that confused, confounded and often enraged people in equal measure. Against this backdrop, clear, consistent and up-to-date messaging that cut through in all corners of the globe was a very tall order.
As Cochrane authors, we wanted to look back and comb through the evidence from this time to understand what worked, what didn’t and why. Because we know that evidence from past disease outbreaks and the COVID-19 pandemic has much to tell us about future pandemic preparedness and response.
Here’s what we found…
Key findings
In the context of a pandemic, clear and effective communication with the public can mean the difference between life and death. And like any other health intervention, communication can be done well or poorly. It can also be especially difficult to measure, evaluate and consistently prioritise.
Our latest research findings support and underscore the urgent call to action that the WHO and US Centre for Disease Control (CDC) began making long before the COVID-19 pandemic hit. That is, public communication during health crises is a proven and vital ingredient to any successful response. As such, it must be a central focus for all governments.
The core message is that clear communication isn’t just a ‘nice-to-have’. Accessible and accurate information is the foundation for getting pandemics and other health crises under control. It can save lives.
More detailed key findings and our top five evidence-based recommendations are outlined below. We submitted these recommendations to the Australian Government’s Inquiry into the national Covid response last month. Taken together, they highlight the need for real national and international action in recognition of and in response to this salient fact.
Top five evidence-based recommendations for public health communication and future pandemic preparedness:
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Communication is not a one off intervention to be considered only when a pandemic begins. Information, messaging and engagement must evolve over time, and be formulated with an eye to the public’s openness, willingness and ability to follow protective measures.
Additionally, shifting individual perceptions of what constitutes risk and cumulative pandemic fatigue mean public communication must be alert and responsive to both the health landscape and public sentiment. Change over time is critical if public communication is to be effective.
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Public trust in authorities is vital and the need for it cannot be overstated. The evidence base increasingly shows that better COVID outcomes correspond with high levels of trust in government. A 2022 Lancet paper measuring the levels of trust in governments and interpersonal trust and found they were directly proportional to fewer infections and higher vaccination rates in both high-income and middle-income countries. The Lancet findings suggest that if communities had had greater trust in governments, there would have been 13 per cent fewer COVID infections globally.
The consensus is that in the context of future pandemic preparedness, trust in governments will be a crucial factor in public adherence to and confidence in public health directives. Here in Australia, building trust in local, state, territory and federal governments now – and before the next health crisis emerges – is an integral part of equipping humanity to deal with future pandemic threats.
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Misinformation is an ever more critical concern here in Australia and around the globe. Online misinformation travels further, faster and is more influential than the truth. On social media platforms, fake claims are 70% more likely to be shared than accurate news, particularly when it comes to health information.
It is essential that health authorities focus on and work together with media and social media platforms to coordinate responses to:
promote awareness of and access to accurate information
combat and counter misinformation
ensure accurate information is accessible to all communities (including underserved groups)
increase people’s digital and health literacy. We recognise this is a profound challenge, but it has never been more urgent.
Accumulating evidence points to the complex adverse social effect infodemics have during health emergencies. While social media is universally recognised as the battleground for mis- and disinformation, podcasts pose an equally serious range of problems. This is exemplified by the Joe Rogan Experience controversies that played out during the COVID pandemic.
Joe Rogan, eponymous host of the world’s most popular podcast, quickly became synonymous with controversial pseudoscience and dangerous misinformation about Covid and vaccination which was regularly shared at length with his audience of 11+ million people around the globe from 2020 onwards. The reach and influence of Rogan’s podcast content – which was consistently contrary to public health advice and basic science – galvanised a coalition of hundreds of scientists, medical professionals, academics and science communicators to sign an open letter to Spotify in 2021 highlighting a raft of critical issues that represented not just medical or scientific concerns, but ‘a sociological issue of devastating proportions.’
This is just one high profile example among many that highlight the urgent need for concerted and co-ordinated action by governments, public health authorities and platforms on this intractable issue. The need to work proactively to produce and share reliable and up-to-date information to support people’s decisions related to COVID-19, vaccinations and other issues of importance to the public’s health is clear. This necessitates better and more detailed planning, tailoring for reach and acceptability and the adoption of new media in different formats to spread the word, and adding pressure for media and social media to meet ethical standards that underpin a public benefit.
The challenges of introducing regulation in this area are evident in the current hotly contested debate around the Australian Government’s draft Communications Legislation Amendment (Combatting Misinformation and Disinformation) Bill 2023. The stated purpose of the draft Bill is ‘to provide greater transparency of the actions taken by digital platforms to manage seriously harmful misinformation and disinformation on their services’.
While this purpose is broad, our recommendation is that public health is afforded particular attention. Combatting health mis- and dis-information needs to be expressly addressed in the context of the evidence we have about the ill effects of misinformation during Covid.
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All communication about how people can protect themselves needs to be developed in consultation with the people who ultimately need to follow the advice. Involving communities can ensure the needs of different people (such as underserved, culturally diverse and vulnerable groups) are acknowledged and addressed in planning, communicating and implementing protective measures. This improves the chances people will take up and follow public health advice, and enables authorities to gauge whether communications are reaching different audiences and meeting their needs – and where changes are needed.
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People need to be equipped with knowledge about what’s needed to protect themselves, why protective measures are needed, and how to go about it. They also need access to practical help including direct services and financial support, to take up and follow protective measures, with recognition that people may need different types and levels of support to prevent worsening inequities.
Next steps
In a nutshell, our findings consistently highlight that effective public health communication to protect communities requires resources, planning, and information tailored for diverse audiences that is readily available from day one of a public health crisis.
This much is clear from the deluge of COVID-19 research we now have to draw on, but significant gaps in the evidence need to be filled. More work needs to be done on communicating with people at higher risk of severe illness or death from COVID-19, so that they can be better informed and supported.
Here in Australia, we need to take seriously the challenges of effective public health messaging and mechanisms to tailor future responses to the needs of particular populations – including across genders, age groups, socio-economic status, geographic location, people with disability, First Nations peoples and communities and people from culturally and linguistically diverse communities.
We hope our recent findings will contribute to advancing our understanding of how governments, policy makers, health authorities and communities can better prepare and communicate to save lives in future public health emergencies within Australia and beyond.
Victoria: an (unusual) snapshot of government public health communication and community engagement
Victorian Premier Dan Andrews’ Covid press conferences were a key source of public health information for Victorians through the dark days of Covid lockdowns. They were also the stuff of memes, fashion commentary and even dance tracks…
There are few people more familiar with government mandated public health measures than Melbournians. During the second wave of the COVID pandemic, residents of the world’s most locked down city tuned into Premier Dan Andrews’ extended press conferences for 120 days straight. His appearances were a key source of information for both the public and the media throughout the dark days of the prolonged lockdowns.
Reflecting the polarising and often controversial nature of policy decisions and public health measures, journalists who regularly covered the premier’s press conferences were subjected to torrid personal abuse on social media. Elsewhere in the twittersphere, the pro-Dan Andrews hashtag #IStandWithDan and anti-Dan Andrews hashtags #DictatorDan and #DanLiedPeopleDied were trending.
Whether inspiring loyalty or loathing, one thing was clear – the Premier’s approach to communicating about urgent public health measures had an impact. His daily pronouncements became the stuff of endless memes, fleecy jacket fashion commentary and even a dance track that sampled his infamous directive not to gather and ‘get on the beers’ after pubs had been shuttered in 2020. The viral hit for Mashd N’ Kutcher climbed to #2 on the iTunes charts, racked up almost 1.5 million Spotify streams and took out a coveted top 20 spot in the Triple J Hottest 100 that year.
From what we can tell, this is a more unusual example of public health messaging in action…
