The United States is now facing the greatest surge in COVID-19 cases yet. Although the COVID-19 vaccination is now underway—a momentous step toward ending the pandemic—the United States is not expected to reach herd immunity until at least mid-2021. Until that point, sustained public health messaging about the importance of social distancing and other coronavirus mitigation measures is crucial to controlling the spread of the virus and preventing complacency.
In the run-up to Thanksgiving, much of the public discourse centered on the question of whether holidays ought to be “cancelled” rather than emphasizing how they can be different and observed in the safest and healthiest way possible. Framing these discussions at the extremes may have encouraged many people to forgo precautions altogether. It also ignored the fact that, between the extremes, decisions about how these activities are conducted gives people some control over the risk that they or their loved ones potentially face.
Encouragingly, public health experts’ call for a “course correction” in communication for COVID-19 is garnering more attention. The United States needs to embrace a better communication strategy to influence behavior—one that involves harm reduction and a spirit of empathy. This column explains how to translate that tactic into a public outreach strategy and support it with federal, state, and local policy. Overcoming the pandemic will require not just a national plan for testing, social distancing, and vaccination but also a unified national strategy to inform and empower Americans to reduce COVID-19 risk.
Fear-mongering and shame are counterproductive
Over the Thanksgiving holiday, millions of Americans traveled by air and on the roads, contrary to the pleas of many public health officials at a time when COVID-19 hospitalizations were climbing to new record highs. In the end, those Thanksgiving gatherings should be seen not as a failure by the public but rather a wake-up call to reconsider the effectiveness of public health messaging during the pandemic.
While some observers admonished Thanksgiving gatherings as symbols of selfishness or ignorance, resorting to fear and stigma to elicit change is counterproductive to the effort to contain the disease as well as vaccination endeavors. The Centers for Disease Control and Prevention’s (CDC) manual on communications during crises cautions that while fear can sometimes be motivating, it can also be “debilitating” and that feelings of helplessness can render people “less able to take actions that could help themselves.”
In the time since Thanksgiving, the number of new cases and deaths have surged across the country. December 9 was the first time that more than 3,000 COVID-19 deaths were reported on a single day. Hospitals throughout the country report their ICUs have few beds available and some are completely full. CDC Director Robert Redfield has said in all likelihood “for the next 60 to 90 days we’re going to have more deaths per day than we had at 9/11 or we had at Pearl Harbor.” Stopping the rapid rise in COVID cases and deaths will require collective action, which starts with persuading people that their individual decisions to adopt simple measures such as avoiding gatherings, washing hands, opening windows, and wearing a mask can make a real difference.
The effectiveness of government mandates—including masks requirements and bans on gatherings, which can be tricky to enforce—relies upon individuals’ adherence and making clear communication about risk is essential. The primary goal for communication during the pandemic should be to inform people’s decisions rather than spark judgment about whether people are behaving well or badly.
A number of obstacles have stood in the way of the public health outreach effort the country needs right now. Some of these problems, such as the lack of consistency, transparency, and leadership from the federal government appear likely to subside if President Joe Biden’s administration follows through on its commitments to restore “public trust.” Others challenges, such as increasing pandemic fatigue, confusion, and disinformation around vaccines will likely only get worse. Agencies at the federal, state, and local levels of government need to coordinate on a unified, compelling campaign focused around efforts to empower Americans to make the right decisions for themselves. Clear communication is essential to minimizing the spread of COVID-19 in the near term and building momentum for vaccine take-up.
The goal should be to inform and empower
To be effective, public health strategy needs to confront the reality that some people will engage in behavior that endangers their health or the health of others. Like abstinence education or “just say no,” simply telling people to stay home during the pandemic can stigmatize certain behaviors and discourage candid discussion about risk. Shaming also ultimately hurts containment efforts by making people resistant to share information necessary for contact tracing.
While complete prevention may be ideal, public health strategies can also minimize the negative consequences of risky activities—a practice known as harm reduction. For COVID-19, harm reduction should provide alternatives to strict social distancing and help people make informed choices. For example, in addition to reminding Americans that the safest choice is not to socialize with other households during the holidays, officials should share actionable steps that individuals can take—such as limiting the number of guests, staying outdoors, opening windows for ventilation, and having guests bring their own food—that can significantly reduce the risk of transmission.
Public health messaging needs to make clear the link between the population-level crisis and the importance of individuals’ roles in ending the pandemic by explaining what risk reduction means for everyday life. Although the CDC does provide pages upon pages of recommendations drawn from the latest science, that information should be synthesized into clear and simple guidance anyone can use to take action and assess the range of risk for common scenarios.
The federal government should fund and support direct outreach
The U.S. Department of Health and Human Services (HHS) has announced a new outreach campaign that coincides with the arrival of the COVID-19 vaccine. Given the months it will take to vaccinate at least 75 percent of the U.S. population, it is crucial that the HHS campaign focus not just on making the case for the vaccine but also on educating people on the need to continue to take precautions against the spread of COVID-19. In addition, Congress should fund HHS to provide grants to state governments; city and county health departments; and nongovernmental organizations to manage complementary campaigns tailored to local audiences.
State and local health departments, as well as the CDC, should be speaking directly to the public, conveying recommendations in plain, nontechnical terms. The federal government should make public health messages ubiquitous through paid advertising—including television, radio, digital, print, posters, and billboards—and organized public-private initiatives rather than relying on earned media and the voluntary efforts from the private sector. The government should be delivering the same messages via social media, text outreach, and direct mail.
In the nine months of the pandemic in the United States, the federal government has sent only one piece of direct mail related to COVID-19 recommendations; this is simply not enough. To be most effective, an outreach campaign needs repetition, getting in front of people multiple times across multiple platforms with a simple, memorable message along the lines of “Keep calm and carry on” or “Loose lips sink ships” from the World War II era or “Only you can prevent forest fires.” Early in the COVID-19 pandemic, Japan advised citizens to avoid the “three C’s”—crowded places, closed spaces, and close-contact interactions—and the clarity of that message has been a cornerstone of Japan’s success in containing the virus, along with contact tracing and universal mask-wearing.
Some portions of outreach for both COVID-19 mitigation and vaccination will need to be tailored to reach different populations, including communities of color and tribal communities, and be made available in languages other than English. Governments will need to engage a variety of trusted messengers, coordinating with health care organizations as well as religious leaders, local community groups, media figures or other celebrities, and COVID survivors within the community. Special attention should also be paid to reaching communities who have a history of vaccine hesitancy. In particular, many Black Americans—who have been nearly three times as likely to die from COVID-19 during the pandemic than white Americans—may not trust the health care system due to facing racism when obtaining medical care and the history of Black Americans being subjected to exploitive and unethical experiments, such as the Tuskegee study.
Communication and policy must bolster each other
The government needs to reinforce public health guidance with policies that make it easier and less costly for Americans to adhere to recommendations. For example, more people would get tested if antigen tests for screening purposes were widely available and free. In order to encourage lower-risk outdoor play for children, municipalities that chose to “dial up” closures of business and other venues should ensure that public parks and playgrounds remain open. Workplace safety regulations should make masks mandatory for employees and customers, and the U.S. Postal Service should carry out its proposal to mail masks to every American. Extending emergency paid leave for workers would allow more people to stay home when ill or during recommended periods of quarantine or isolation.
Indoor dining carries a particularly high risk of transmission and runs against best practices for minimizing COVID-19 spread by bringing together groups of people without masks, often in poorly ventilated spaces. At the same time, it presents a conundrum for business owners trying to make ends meet and keep workers employed as well as a dilemma for local governments concerned about dampening economic activity and therefore losing the tax revenue they depend on to provide services and employ state workers. To lessen the financial burden of targeted closures of dining and other industries that depend on in-person gathering, Congress should vote to provide relief for businesses and extend support for workers during the pandemic.
Conclusion
In these trying times, it can be tempting to give into the impulse to shame and judge others, whether for their beliefs; the COVID-prevention measures they pursue; or the precautions they decline to take. Misinformation takes root where there is a void, and it is imperative to fill the voids around COVID-19 with actionable guidance—not just statements of principle. To put the politicization of the pandemic behind us, policymakers and other public figures must adopt a more practical, compassionate approach to mitigation and recognize the sacrifices that Americans are making in their daily lives, and they must bring policy into alignment with public health recommendations. Public health officials, including the CDC, must be allowed to help guide the communication campaign aimed at giving people a better sense of control over the risk they and their families face.
Our holiday celebrations may look different this year. But there are reasons for hope: With vaccination underway and with better leadership through communication and policy, Americans have a good chance of being able to safely gather with friends and family next year.
Emily Gee is the health economist for Health Policy at the Center for American Progress. Wesley Thompson is senior manager at Ward Circle Strategies and a COVID-19 survivor. He served as an appointee at the U.S. Department of Health and Human Services in the Obama administration. Thomas Tsai is a surgeon at Brigham and Women’s Hospital, assistant professor of surgery at Harvard Medical School, and assistant professor in health policy and management at the Harvard Chan School of Public Health. The opinions expressed in this article are solely the authors’ own and do not reflect the views and opinions of Brigham and Women’s Hospital.
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