With cases decreasing, well more than 65 percent of the eligible population inoculated with effective vaccines, and new COVID therapeutics coming to market, the United States is in very different circumstances than it was in early 2020. Life is currently feeling a little more stable, the future a good deal more clear.
But one thing about the pandemic has remained largely unchanged: Political and scientific leaders are still struggling to communicate recommendations to the American public. Are mask mandates warranted at work and school? First we were told no; then, yes; now the answer, for good reasons this time, is changing again. Are fourth mRNA shots necessary for the most vulnerable? First the CDC said no; then, to get one five months after the third dose; and now the waiting period has been reduced to three months.
The Omicron surge that the country is now exiting may not be our last of this pandemic, and SARS-CoV-2 will surely not be the last virus to cause a pandemic. If we are to get through whatever lies ahead without more unnecessary mass death, we need to reflect on how pandemic communication has fallen short and how the country can get better at it. Over the past six months, I have planned and led a small faculty seminar at the Harvard T. H. Chan School of Public Health on the pandemic, the press, and public policy. I’ve gleaned four lessons about transmitting clear, practical information in changing circumstances. Our leaders would be wise to heed them.
1. The conventional wisdom about avoiding ambiguity and uncertainty is wrong.
A former local public-health official told me last year that aides to the elected official for whom they worked had advised them that the key to pandemic communications was to “keep it simple; never say ‘on the other hand.’” This may (or may not) be good practice in an election campaign, but it has proved both common and exceedingly bad counsel in a pandemic, when officials frequently need to offer guidance from a position of uncertainty.
In March 2020, for example, public-health officials needed to tell people whether they should avoid contact with suspect surfaces and whether they needed to wear masks outside clinical settings. In an excess of caution and based on experience with other pathogens, the CDC advised Americans to wipe things down. But when it came to masks, the agency seemed to abandon that precautionary approach. The situation was complicated: The best masks were in terribly short supply and urgently needed by the health-care system. Rather than receiving an explanation of the situation and advice to improvise cloth masks, the public was told to forgo masks altogether because they were unnecessary.
Public-health officials’ failure to trust Americans with the truth was not sophisticated or even practical. When the advice was belatedly revised in a manner that revealed it had always been faulty, an erosion of trust began and has only accelerated over the ensuing two years.
Moreover, this mistake has been repeated again and again in new contexts. Last summer, for instance, advice was given to take off your mask outside, only to be sort of retracted for fear that people would not wear them in crowds, or inside, especially as Delta struck. Throughout the past year, there has been far too much reluctance to offer varying advice to the vaccinated and unvaccinated, and to the very young and very old.
Officials (and the press responsible for critiquing and distilling their advice) need to be more candid about uncertainty, more open about asking people to mitigate risks temporarily until our knowledge increases, more willing to vary guidance for different groups without worrying that this constitutes “mixed messaging.” In the short run, such an approach may be challenged as weakness, but in the long run it will be revealed as building credibility, trust, and thus strength.
2. In a pervasive crisis, science must adjust to politics.
Over and over in the pandemic, public-health officials have been both surprised and disappointed to find out that concerns they consider “political” have trumped scientific knowledge. Not only their surprise but even a measure of their disappointment is worth reconsidering.
This is not to say that public health should be held hostage to conspiracy theories or sheer mendacity, as was sometimes the case in the first year of the pandemic, when President Donald Trump was promoting quack cures and stubbornly resisting masking. But if “Follow the science” was once a watchword of public-health resistance, it later came to sometimes embody naivete. In a well-functioning system, science is not oppositional to politics, but neither does it supersede politics. Both are essential in a democratic society; they must coexist.
When a public-health concern becomes a pervasive national crisis, under any leadership, it is inevitable—and actually proper—that what may be narrowly in the interest of optimal medical outcomes will be weighed against impacts on the economy, equity, educational imperatives, national security, and even national morale. In our democratic system, that weighing is left to our elected officials. Those officials have a duty to arm themselves with the best public-health advice, and public-health experts are obligated to make sure that both leaders and the public have access to that advice, whether the politicians wish to know it or not.
In retrospect, the United States might have been wise to impose fewer restrictions on elementary and secondary schools over the past two academic years—not because school closures didn’t help stop the spread of the virus, but because the educational and economic losses from widespread remote schooling might have outweighed the gains in reduced cases. The question is clearly more than scientific.
Top officeholders and scientists alike can do a better job of accommodating each other. On the one hand, political leaders would do well to remember that many of the most senior officials in relevant agencies, even those with appropriate professional training, have likely been selected (by them!) for political reasons, and may or may not be the most expert in a particular situation. It can be a grave error, particularly in a place like the White House, to make the leap from “We have our own doctors” to “We have the best doctors.”
On the other hand, scientists (and even amateur epidemiologists) would do well to formulate their advice to political executives with empathy for their perspective. This does not mean shading the truth or telling someone what you think they want to hear, but it does mean safeguarding a leader’s credibility and acknowledging the political or practical constraints they face. It also means understanding that, once decisions are made, as President John F. Kennedy reportedly observed, leaders must live with them while advisers can move on to other advice. President Joe Biden, for instance, has too often found himself personally announcing conclusions that were not yet certain and guidance that was likely to soon change.
3. Speak the same language the public does.
Communication is difficult when people are not speaking the same language. In the pandemic, we have seen this play out in two major ways. First: Scientists use words they think their listeners understand, only to find out much later that they don’t. Some researchers concluded early on that SARS-CoV-2 was what they term “airborne.” When many people responded by limiting the big change in their behavior to standing six feet apart, the scientists were enormously frustrated. That’s because by “airborne,” they didn’t mean merely that the virus was borne through air, but that it was aerosolized, and thus highly contagious, especially indoors. They wanted the public to stop interacting closely, especially indoors and unmasked. Recognizing earlier that the scientific and colloquial understandings of airborne didn’t match in this context would have made a difference, at least in messaging and possibly in consequences.
Second: Only a distinct minority of the population has a firm grasp of statistics, but many scientists communicate as if everyone does. In addition to emphasizing the rarity of vaccine side effects or the significant protection offered by the shots, officials must give the public a lens through which to understand the exceptions some of them are sure to encounter in their daily lives.
If a particular finding, for instance, applies to 99 percent of Americans, scientists and public officials need to acknowledge—clearly, candidly, right up front—that more than 3 million people will have a different experience from that norm. To duck this reality is to risk the sheer number of counterexamples seeming to “disprove” the valid conclusion. This is especially important in communicating to and through the press.
4. Never forget the heroes.
The darkest early days of the pandemic were redeemed somewhat by the national rallying around health-care professionals, first responders, and other essential workers. That focus on the heroes among us underlined the fact that, in a pandemic, we are fundamentally in the fight together, and the virus is our common enemy.
Leaders made a crucial communications mistake in not extending this lesson to the rollout of the vaccines, which were the result of both the genius and the hard and astoundingly fast work of another set of heroes. Greater celebration, beginning in late 2020, of these innovators, inventors, and even manufacturers could, I think, have made widespread division over the vaccines less likely and less pervasive.
It would, for instance, have helped if the editors of Time magazine had felt compelled to name the inventors of the mRNA vaccines as the 2021 “People of the Year,” rather than deeming them runners-up to Elon Musk. Glorifying pharmaceutical companies may be a stretch, but why not loudly praise the workers who churned out the “Warp Speed” vaccines as modern-day Rosie the Riveters?
In the absence of these sorts of celebrations, the division over vaccines remains the greatest failure of the U.S. experience of the pandemic. More than a quarter of a million deaths were likely directly preventable by available vaccination. Undervaccination contributed to the horrible strength of the Delta and Omicron waves, lingering economic pain, and remote schooling, which might also have been avoided. Next time, the communication breakdown may or may not center on vaccines. But we’d all be much better off if we didn’t have a breakdown at all.