Democratic Health Communications during COVID-19: A RAPID Response
Authors: Heidi Tworek, Ian Beacock, and Eseohe Ojo
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This report recommends how to put health communications at the heart of democracies’ response to Covid-19. Communications are an effective non-pharmaceutical intervention (NPI) for Covid-19; other NPIs include travel restrictions, physical distancing, or personal protective equipment—each of which, in turn, requires clear, rapid communications. More effective communications could save lives.
Effective communications are essential in the short-term for uptake of public health measures like face coverings. But they matter more over a longer time horizon, whether to forestall compliance fatigue, lay the groundwork for vaccine uptake, or encourage the public to engage proactively with the healthcare system for concerns unrelated to Covid. They also matter for cultivating trust among citizens and their governments—trust that is critical for the future stability of democratic institutions.
If communications are a health intervention, democratic communications can be a civic intervention. Many democracies were already struggling with distrust before the pandemic: anti-vaccination activism, conspiracy theories, sinking faith in institutions, populism, rising inequality, the erosion of local journalism, and so on. This rolling democratic crisis is now interacting with the pandemic. Our report lays out a framework for how to communicate—even or especially during a public health emergency—in ways that strengthen democratic norms and processes rather than undermining them.
We draw our recommendations from in-depth studies of nine jurisdictions and two provinces on five continents: Senegal, South Korea, Taiwan, Germany, Norway, Sweden, Denmark, New Zealand, and Canada (for which we also studied two provinces, British Columbia and Ontario). Each of these cases managed relatively effective responses on their own terms; each of them also took democratic communications seriously. Where appropriate, we compare with democracies that struggled to communicate around Covid-19, particularly the United Kingdom and the United States.
This report proposes five broad principles that can underpin any democratic public health communications strategy. Our principles draw upon research from a range of disciplines, including political science, social epidemiology and public health, behavioural science, sociology, media and communications studies, history, and political theory. We call them the RAPID principles, because rapidity is an essential element of an effective response:
Rely on Autonomy, Not Orders
Pandemic responses should emphasize autonomy where possible, in alignment with national traditions and local political cultures, supported by thoughtful and clear communications. We identify two particularly salient forms of autonomy: personal and institutional. This means developing and repeatedly communicating a set of universal principles for making responsible and safe decisions during a pandemic. Autonomy is not anarchy, but rather a policy that includes stakeholders, assumes good faith, and reinforces democratic self-understanding.
Attend to Emotions, Values, and Stories
To complement autonomy, the most effective democratic health communications sustain and build community by incorporating societal values, emotions, and stories. Facts alone are insufficient. Emotions, shared values, and narratives build trust and make health information reliable. There is no single best practice for how to do the work of values-framing, or who should be responsible. What is important, however, is that someone repeatedly and carefully communicates how pandemic measures relate to existing social and political values. Effective communicators considered the diversity of the population and found strategies that avoided stigmatization; they relied on pro-social hygiene and behavioural messaging; they articulated positive emotions like gratitude and acknowledged mental health struggles; they sought to build rapport with citizens.
Pull in Citizens and Civil Society
While officials play an essential role, citizen participation and civil society are also essential. Too often, public health engagement occurs based on what officials think the public looks like, rather than trying to understand citizens as many overlapping groups of individuals with different ideas, beliefs, or capacities. It is essential to establishing feedback loops through techniques like surveys or text mining to understand a population’s diverse experiences, their feelings about the response, and their needs from government. Officials should also consider finding trusted local validators to share health information with friends, families, and followers (e.g. young people, social media influencers, celebrities, religious leaders). Encouraging participation and collaboration, especially on issues like public health, also reduces burdens on public-sector actors. Collaborating with citizens and civil society may create a more robust response; in turn, listening and responding to citizens’ concerns strengthens democratic values such as solidarity and collective responsibility.
A rapid response, paradoxically, requires structures built far in advance. Countries without communications units have sometimes struggled to deliver consistent information over time or to update citizens swiftly on how pandemic guidelines are changing. On the other hand, jurisdictions with institutional strategies for pandemic communications had the capacity to produce differentiated government messaging that embraced openness and transparency. An institution enables a swift response. A pandemic communications unit could also lay the groundwork for communicating quickly during future epidemics, follow the latest research on effective communications, and establish liaisons with large social media companies to combat misinformation. Finally, a specific unit indicates that communications are seen as an integral part of public health rather than ancillary.
Describe It Democratically
The most obvious way to keep democracies healthy during an emergency is to maintain the business of institutions like parliaments. But if democracy is not reducible to formal institutions, neither are effective democratic health communications. Communicators should describe the pandemic response democratically. This means avoiding militaristic metaphors that are hierarchical and limit space for agency. Instead, pandemic messaging should rely on more democratically-aligned metaphors. Just as citizens need repeated messaging on handwashing or physical distancing, they need repeated messaging on compassion or their democratic duties during times of emergency. Framing the Covid-19 response as a democratic challenge matters not only for the present; it could shape how citizens will remember it in the future. Like institutionalization, democratic framing better prepares us for the next pandemic even as it gives citizens new tools for addressing this one.
The five principles for effective democratic health communications in this report are a toolbox for sustaining democratic trust, practice, and self-understanding in an age of great uncertainty. They enable policymakers to recognize and frame this crisis not only as a threat to democracy—but as an opportunity for citizens to feel more trust than they did before, more resilient than they did before, and more sovereign than they did before Covid-19 emerged. It’s important that policymakers, elected officials, and citizens alike recognize the importance of clear, consistent, compassionate, and contextual communications during a time of crisis. Public health depends on it. The health of democracy does, too.
This report is brought to you by:
- Listen: Heidi Tworek on Combating Vaccine Hesitancy and the Importance of Clear Messaging. Mankiran Aujla, Spice Radio Van. June 4, 2021.
- Heidi Tworek says the WHO’s name change for COVID-19 variants will make it easier for us to remember them. COVID-19 variant of concern B.1.1.7 has a new name: Alpha. Will it stick?
- Heidi Tworek explores the power and limit of statistics to drive public health interventions. Stories, Statistics, and Authenticity in Health Communications. May 25, 2021.
- Listen: Heidi Tworek on how governments should communicate with the public about vaccines. Can Better Communication Curb Vaccine Hesitancy? Jackie Lamport, Capital Daily Podcast. May 19th, 2021.
- Heidi Tworek explains that what is sometimes labeled or viewed as vaccine hesitancy is actually a lack of access. COVID-19: Fraser Health becomes “flexible, agile and adaptable” to cool hot spots. Glenda Luymes, The Province. May 16, 2021.
- Heidi Tworek encourages greater transparency around vaccine bookings and availability. COVID-19: B.C. pushes vaccine registration as only 260,000 are signed up who haven’t had a jab. Gordon Hoekstra, Vancouver Sun. May 15, 2021.
- Heidi Tworek discusses the need for greater transparency in politicians’ COVID-19 communications. UBC policy professor calls for politicians to take accountability for B.C.’s COVID data leak. Charlie Carey and Bethlehem Mariam, News 1130. May 9, 2021.
- Listen: Heidi Tworek discusses vaccine hesitancy as Health Canada’s announcement that Pfizer vaccines are safe for young people between 12- 15. The Early Edition with Stephen Quinn. CBC Radio. May 5, 2021.
- Heidi Tworek discusses vaccine booking logistics. Do not book: British Columbians asked not to double up on first dose. Bhinder Sajan, CTV News Vancouver. May, 2, 2021.
- Watch: Heidi Tworek discusses the gaps of the government vaccine booking systems. CTV News with Sandie Rinaldo. May 1, 2021.
- Language barriers make good health communication difficult. The Translator Kids. Christopher Cheung, The Tyee. April 30, 2021.
- Heidi Tworek discusses the missteps Canada has taken during its COVID-19 response. What’s gone wrong in Canada. Justin Giovannetti, The Spinoff. April 23, 2021.
- Heidi Tworek discusses the provincial government’COVID-19 directives. Is B.C.’s COVID-19 messaging getting through? Mike Lloyd and Hana Mae Nassar, NEWS 1130. April 13, 2021.
- Watch: Heidi Tworek interviewed about confusing public health messaging by Natasha Fatah. Inconsistent Covid Messaging. CBC News. April 4, 2021.
- Heidi Tworek discusses the elements contributing to vaccine hesitancy. Manitoba campaign aims to combat COVID-19 vaccine hesitancy. Cameron MacLean, CBC News. March 17, 2021.
- Heidi Tworek discusses the spread of misinformation on COVID-19. Radio station at SFU temporarily suspends program linked to website with pandemic conspiracy theories. Vancouver Sun. Tiffany Crawford. March 13, 2021.
- Heidi Tworek and the challenge of crafting messaging on COVID-19. Threading the Needle (PDF). Winnipeg Free Press. March 10, 2021.
- Heidi Tworek discusses the threats and abuses directed at Dr. Bonnie Henry, Threats against Dr. Bonnie Henry ‘unacceptable,’ B.C. health minister says. CBC News. February 25, 2021.
- Heidi Tworek comments on Dr. Bonnie Henry’s COVID-19 briefings, Some watch B.C.’s COVID-19 briefings ‘religiously.’ Others have tuned out. Alex Migdal, CBC News. February 22, 2021.
- Heidi Tworek discusses transparency and the vaccine rollout, Lack of transparency about Manitoba’s vaccine eligibility plan erodes public trust: health experts. Cameron MacLean, CBC News. January 24, 2021.
- Heidi Tworek’s report, Democratic Health Communications during COVID-19: A RAPID Response co-authored with Ian Beacock and Eseohe Ojo is featured in the New York Times, Financial Times, CNN, and STAT News.
- Listen: Heidi Tworek on Solving Heatlhcare podcast with Dr. Kwadwo Kyeremanteng. COVID-19 (Livecast): The Path Forward with Zain Chagla, Heidi Tworek & Stefan Baral. January 21, 2021.
- Heidi Tworek discusses the democratic health communications project in The Toronto Star. It’s cold, it’s dark, we’re tired. Canada, meet the COVID-19 wall. Alex Boyd. January 17, 2021.
- Listen: Ian Beacock on CBC Ontario Today with Rita Celli. The Language of Lockdown. January 14, 2021.
- Ian Beacock and Heidi Tworek for First Policy Response on how Canada can reboot its communications strategies. Beyond briefings: How Canadian officials can communicate more effectively during the COVID-19 endgame. January 13, 2021.
- Listen: Heidi Tworek and Kulpreet Singh on CBC’s On The Coast with Gloria Macarenko discussing how the province can improve multilingual Covid-19 communications. Covid-19 Communications. January 8, 2021.
- Listen: Heidi Tworek on BC Today with Michelle Eliot, CBC. Covid-19 Restrictions and Communications. January 7, 2021.
- Essay by Ian Beacock and Heidi Tworek published in The New Republic. Simply Talking About the Pandemic the Right Way Can Help Rebuild American Democracy. December 24, 2020.
- An interview with Heidi Tworek and Gregg Gonsalves on how finger-pointing may be undermining the coronavirus response. The Salt Lake Tribune. We need to get past the COVID shaming for public health’s sake. Robert Gehrke. December 21, 2020
- Listen: Heidi Tworek on the Solving Healthcare Podcast with Dr. Kwadwo Kyeremanteng. COVID19: Communication Strategies To Engage The People, Promote Vaccination & More. December 15, 2020
- Heidi Tworek in The Abbotsford News. ‘Respond with empathy’: B.C. expert breaks down COVID vaccine myths, reasons for hesitancy. December 13, 2020.
- Listen: Ian P. Beacock on CBC Ontario Today with Rita Celli. Does comparing Covid to war give you comfort or concern? December 11, 2020.
- Heidi Tworek in The Vancouver Sun. COVID-19 is a dress rehearsal for next pandemic. Lessons learned about building trust and battling misinformation will be crucial to managing the next health crisis. Randy Shore. December 10, 2020.
- Heidi Tworek interviewed on CBC The Current. Pandemic decision-making requires politics and science to work ‘hand in glove’: expert. December 2, 2020.
- Heidi Tworek on CBC The Current with Matt Galloway. Scientists, Politicians, and the Pandemic. December 2, 2020.
- Heidi Tworek on CBC Ontario Today with Rita Celli. What Leaders Say in a Pandemic: What Works, What Doesn’t. December 2, 2020.
- Heidi Tworek on CBC BC Today with Michelle Eliot. Covid-19 Communications and Resilience. December 1, 2020.
- Listen: Heidi Tworek on the Lynda Steele Show (CKNW). Do BC health officials need help spreading the COVID-19 message? November 30, 2020.
- Report featured in The Globe & Mail. Inside the communications battle to reach pandemic-weary Canadians. Eric Andrew-Gee. November 29, 2020.
- Listen: Heidi Tworek on Information Morning Fredericton (CBC Radio New Brunswick) discussing Pandemic communication and the balance between too little and too much communication. (Apple podcast; 13 min.) November 23, 2020.
- Coverage of the Democratic Health Communications report in Maclean’s. The pandemic has proven that the individual is not supreme. Jason Markusoff. November 17, 2020.
- Heidi Tworek on CBC News BC discussing BC’s new regulations. Clear messages are essential in fight against COVID-19, says UBC researcher. November 9, 2020.
- Heidi Tworek on WebMD. U.S. Tops 10 Million Cases Amid COVID-19 Surge. November 2, 2020.
- Heidi Tworek, Ian Beacock, Eseohe Ojo for Policy Options. New research on pandemic communications from nine democracies reveals pioneering methods for reaching citizens and supporting public health. November 5, 2020.
- Heidi Tworek Q&A with Institut Montaigne. When Democracy Meets Efficiency: How communication can end a pandemic. November 5, 2020.
- Heidi Tworek quoted in Stat News regarding public health in the US after the election. ‘Science was on the ballot’: How can public health recover from a rebuke at the polls?. Nicholas Florko. November 4, 2020.
- Listen: Heidi Towrek on TVO’s The Agenda with Steve Paikin on Ontario’s Second-wave pandemic governance. Episode: Ontario’s Government Under Pandemic Strain. October 28, 2020.
- Heidi Tworek quoted in The Province on turnout in the BC election during a pandemic. Low voter turnout in BC pandemic election likely a ‘blip’, say experts. October 27, 2020.
- Report cited in the World Health Organization Regional Office for Europe report, Pandemic fatigue: Reinvigorating the public to prevent COVID-19. October, 2020.
- Heidi Tworek and Ian Beacock in the Ottawa Citizen. Ontario’s COVID-19 messaging needs a reset. Here’s what to do. October 19, 2020.
- Report featured in The New York Times. Don’t Shame Your Neighbors. Op-ed by
- Heidi Tworek for Centre for International Governance Innovation. How a Public Health Approach Could Help Curb the Infodemic. October 15, 2020.
- Report referenced in CNN. The West is being left behind as it squanders Covid-19 lessons from Asia-Pacific. Analysis by Tara John. October 13, 2020.
- Heidi Tworek quoted in The Globe and Mail. Public health officials look to change their messaging after surge in Covid-19 cases in Edmonton. October 9, 2020.
- The report is cited in a research brief published by the Ontario Hospital Association: Effective Communications Strategies for Covid-19. Our report’s findings were used to develop a toolbox for Ontario’s hospital communications staff. October, 2020.
- Heidi Towrek for the Brookings Institution. Lessons learned from Taiwan and South Korea’s tech-enabled COVID-19 communications. October 6, 2020.
- Heidi Tworek quoted in Vice. COVID and Climate Change Should Be the UN’s Priority, New Global Poll Says. October 1, 2020.
- Ian Beacock and Heidi Tworek op-ed in The Province. B.C. shouldn’t be afraid of a pandemic election – it could strengthen our democracy. September 29, 2020.
- Heidi Tworek on #onpoli – A TVO Podcast with Steve Paikin & John Michael McGrath. Ep. 81: Ontario’s second wave is here. September 29, 2020.
- Heidi Tworek quoted in The Globe and Mail. Death threats among abuse reported by B.C. Provincial Health Officer Bonnie Henry, other officials. September 23, 2020.
- Heidi Tworek quoted in The Georgia Straight. COVID-19 in B.C.: Eight schools with cases, active cases decrease, and Dr. Bonnie Henry targeted by threats. September 22, 2020.
- Heidi Tworek on Global BC News. Comparing B.C.’s COVID-19 communications strategy. September 20, 2020.
- Listen: STAT News podcast. The CDC’s credibility crisis, pandemic PR, and virtual conference malaise. Or read the transcript. September 17, 2020.
- Financial Times Alphaville. Further Reading. September 16, 2020.
Dr. Heidi Tworek is Associate Professor of History and Public Policy at the University of British Columbia, Vancouver. She is a non-resident fellow at the German Marshall Fund of the United States and the Canadian Global Affairs Institute. She is the author or co-editor of three books as well as over 30 journal articles and book chapters. Her latest book is the prizewinning News from Germany: The Competition to Control World Communications, 1900-1945 (Harvard University Press, 2019). Her current work examines the history and policy around health communications. She has testified before and advised governments around the world on social media, hate speech, and disinformation. Alongside regular appearances on radio and TV, her writing in English and German has appeared in media outlets including The Atlantic, Foreign Affairs, Washington Post, Columbia Journalism Review, The Independent, and Süddeutsche Zeitung. She is a contributing editor to the Brookings Institution TechStream.
Dr. Ian Beacock is a prizewinning historian and journalist. He holds a PhD in History from Stanford University, where he specialized in modern Europe, modern Germany, and the history of democracy. His work has been supported by major research fellowships from the Stanford Humanities Center, the German Historical Institute in Washington, DC, the Hoover Institution Library and Archives, the Europe Center at Stanford University, and elsewhere. His reporting and analysis on contemporary politics, as well as his criticism, has appeared in publications including The New Republic, The Atlantic, Aeon, and The Walrus. He is currently working on a book about democratic feelings in modern history.
Eseohe Ojo holds a BSc in International Relations from Lead City University, Nigeria and a Master of Public Policy and Global Affairs (MPPGA) from the University of British Columbia where she studied as an African Leader of Tomorrow (ALT) Scholar and a R. Howard Webster Foundation Fellow. Her work focuses on policy, advocacy and communications around gender, youth inclusion, and human rights, particularly freedom of expression, access to information, digital rights and Internet freedoms. She also works on civic engagement, transparency and other good governance issues globally and on the African continent. Her most recent publication is “Redefining Policy and Practice: Unraveling Definitions of Sexual Violence Through a Survivor Centered Approach,” a report on the impact, limitations, and approaches to improving current definitions of sexual violence.
Sudha David-Wilp is a Senior Transatlantic Fellow and Deputy Director of the Berlin Office of the German Marshall Fund of the United States.
Victoria Ker is pursuing her Master of Public Policy and Global Affairs (MPPGA) at the University of British Columbia, Vancouver. She holds a BSc in Microbiology and Pacific and Asian Studies from the University of Victoria.
Yoojung Lee is a BA student majoring in International Relations and minoring in Law and Society at the University of British Columbia, Vancouver.
David Metzger is a student assistant at the Berlin office of the German Marshall Fund of the United States and is currently pursuing a Master’s degree in International Relations at the joint study program of Freie Universität Berlin, Humboldt-Universität zu Berlin and Universität Potsdam.
Sean Wu holds a Master of Public Policy and Global Affairs (MPPGA) and a BA in History and Political Science from the University of British Columbia, Vancouver. His research interests include policy communications, the digitization of government, and digital diplomacy.