Keeping public trust in public health and regulatory communication
Public trust depends on agencies explaining their decisions, listening to concerns and communicating as evidence changes. Institutions need the staff, processes and relationships to do this continuously, including outside emergencies.
Explanations, uncertainty and accountability
Public health depends on trust, which is difficult to recover once eroded. Changes in evidence and circumstances should be expected, and agencies should explain repeatedly both what has changed and why. Early COVID-19 advice on surfaces and masks and later changes in vaccine recommendations illustrated how evolving science and circumstances could be perceived as inconsistency.
Regulators should move beyond distributing regulatory information to explaining the scientific work, evidence and reasoning behind decisions. Transparency alone is insufficient: explanations must be understandable and address stakeholders' concerns, or less trustworthy sources may fill the information gap. Clear, high-quality information is therefore part of the regulatory process needed to protect public health. Agencies also need to communicate through the digital platforms people use, where information and disinformation travel rapidly.
Three recommendations for public-facing communication emphasise honesty, values and accountability.
- Be transparent and intellectually honest about nuanced issues. Three pro-vaccine conference attendees feared being labelled anti-vaccine for asking about immunity after infection; discouraging such questions can make people suspect information is being hidden. Early-pandemic mask communication could have acknowledged possible benefits, uncertainty and the need to reserve scarce masks for healthcare workers; limited monkeypox vaccine supply likewise required honest discussion of rationing. Mitigation measures have costs as well as benefits, and withholding parts of the truth can further erode trust.
- Acknowledge that science alone does not settle policy. Decisions about acceptable infections, hospitalisations and deaths also involve values, and recommendations must consider what the public will follow. Harm reduction can offer protection where people will not follow restrictions, rather than relying on unenforceable recommendations. Returning to ordinary activities and pursuing changes such as better ventilation, paid sick leave and access to healthcare can both be supported.
- Seek difficult truths with fairness and empathy. Investigate neglected disparities and social determinants, obtain missing data, scrutinise public spending and identify statements taken out of context to manufacture controversy. Conflict among communicators can erode trust and obstruct cooperation on other public health problems.
Communication embedded in public health
A five-part approach proposed in 2023 makes communication part of public health training, practice and institutional capacity.
- Become visible. Scientists and clinicians should communicate directly with communities; public health and communication schools can collaborate on training. Leadership should recognise communication as essential, allocate resources and establish a scientific communication core where needed. Clearance processes that obstruct frequent sharing between scientists and communication teams should be reduced.
- Put the public back into public health. Listen actively, acknowledge legitimate concerns and past failures, seek questions through channels such as tip lines, and identify recurring themes in messages. Maintain this relationship outside emergencies. Balance nuance with readability, equip trusted messengers such as pastors, educators and physicians, and communicate inclusively and empathetically rather than alienating people with dismissive labels.
- Adapt to the information environment. Communicate where people obtain information, including social media, and emphasise prevention through proactive communication rather than only reacting to misinformation. Communicate quickly, continuously and empathetically, anticipate concerns and explain what is known, what remains uncertain and how answers are being sought so people can follow changing guidance.
- Engage with politics. Public health responses are human endeavours implemented through political processes; framing should fit the audience. Terms such as inequities and harm reduction may reach one political audience, while a frame such as biosecurity may reach another.
- Innovate. Public–private partnerships, entrepreneurship, communication incubators and design studios can expand capacity. A community of practice and information-exchange hub could provide a home for responsive communication outside the constraints of government, academia and for-profit organisations, using networks to reach communities. This proposal addresses political pressure on US federal institutions, slow and inaccessible academic communication, and public perceptions that for-profit organisations are partisan or conflicted.
The political approach differs from a 2022 proposal to depoliticise public health by shifting attention away from COVID-19 towards other health issues less entangled in culture-war disputes. The five-part approach instead treats political processes as inherent to public health responses and recommends adapting their framing to different audiences.
A survey of 77,000 readers of Your Local Epidemiologist showed that its science communication reached trusted messengers, including physicians, education boards, neighbours and people at the White House and NASA, who passed information to others. An institution's immediate audience can therefore be an intermediary in a wider information network.
An institution's science communication programme
Five recommendations address the organisation of an institutional science communication programme.
- Coordinate internally so colleagues share an understanding, and externally to bring other trusted sources into the conversation.
- Collect audience data and conduct research systematically to identify needs, priority facts, serious misconceptions and audience characteristics that should shape communication.
- Help scientists and their institution become familiar, liked and trusted. Familiarity with a scientist can help people identify whom to trust; in a 2009 survey, about 65% of Americans could not name a living scientist.
- Build an interdisciplinary team covering scientific content, social and decision science to understand how audiences think, feel and behave, and communication expertise to reach them.
- Prioritise programme evaluation to assess communication quality, identify improvements and improve future communication research.
Coordinated responsibilities for vaccination confidence
The 2019 Salzburg Statement on Vaccination Acceptance committed its signatories to universal childhood vaccination and to developing, testing, implementing and evaluating fact-based communication programmes. These programmes should explain vaccination to parents and caregivers, answer questions, address concerns and maintain confidence, including explaining the dangers of vaccine-preventable childhood diseases.
Its calls to action assigned responsibilities to four groups.
| Group | Requested action |
|---|---|
| Search engines and social media organisations | Develop principles distinguishing levels of evidence in vaccine information to improve identification of disproven or inaccurate safety claims, as with sexually explicit, violent and threatening messages; include robust scientific information, since misinformation creates avoidable risks of serious complications, long-term disability and potentially death for babies, people with cancer and immunocompromised people. |
| Governments, policymakers, advocacy groups, educators and philanthropists | Support childhood vaccination mandates where likely to improve public health, with systematic behavioural and social research and long-term evidence-based communication building vaccine literacy; disseminate reliable, accurate plain language information through mass and social media and trusted sources, including celebrities, faith leaders and parents; promote community protection in law and communication as an essential public service comparable to law enforcement, firefighting and sanitation. |
| Health professionals and educators | Join forces to correct misleading information online and in communities; counsel parents and children about vaccine safety; listen to parents' barriers and concerns to make vaccination and health services more health literate, accessible and user-friendly. |
| Parents | Seek vaccine information from sources with documented scientific and medical expertise, without agendas based on misinformation or unproven alternatives. |
Institutional responses to online misinformation
During 2020, major social media companies worked with the WHO to filter unfounded medical advice and risky behaviours, including unprescribed drug use, drinking toxic detergents, panic shopping and conspiracy theories. Direct social media communication by scientific organisations, policymakers, health professionals and institutions helped mitigate the COVID-19 infodemic and raise awareness of misinformation.
Governments and institutions should create guidelines and mechanisms for online information flow, while health writers should critically assess information and help filter and adapt it for particular audiences. The COVID-19 infodemic also exposed a need for accessible public education about clinical trials and how scientists, regulators and manufacturers establish medicine safety and effectiveness.