If someone had told me a few months ago that I would be in ‘lockdown’ and ‘social distancing’ in order to ‘flatten the curve’, I would have looked at them blankly.
This is where public health messaging comes in: It doesn’t only make these terms understandable, it helps contain the pandemic by raising public awareness and encouraging people to act on them as medical interventions alone cannot stem the spread of the virus.
But the COVID-19 ‘infodemic’ which has spread as quickly as the pandemic itself and overload of available information has made it difficult for people to find reliable resources that tell them what preventative actions they should take.
What, then, does it take to develop effective public health messages around COVID-19 that people can hear? A look at previous health crises offers some lessons.
At the start of the Ebola epidemic in West Africa in 2014 to 2016, people with Ebola-like symptoms were asked to isolate themselves from their households even though they had nowhere else to go, attend treatment centres that had not yet been established, and call helplines that often didn’t function properly. Misinformation and advice that could not be acted upon heightened people’s sense of panic and reduced their trust in government communications.
Similarly, at one point during the Zika outbreak in Latin America in 2015 and 2016, more than 30 preventive behaviours and messages were promoted by different implementing partners, including some as vague as “keep your patio clean”. The sheer amount and varying quality of some of the messages created a great deal of public confusion. Through an evidence-based and consultative process, these 30 messages were narrowed down to seven more specific ones, such as “remove sources of standing water from your patio”.
Also, during the Ebola epidemic, traditional burial practices were identified as a key transmission route in Sierra Leone. However, messaging was initially not culturally sensitive as it simply instructed people what not to do, not what to do differently. This pushed these risky practices underground where they continued, hidden from the public gaze. The government rectified this by supporting research into understanding these practices better, engaging with communities to find alternative solutions, and involving trusted and influential stakeholders such as religious leaders to promote safe burial practices.
Rumours that undermine the credibility of scientific evidence have proven to be a dangerous hindrance to response efforts. In the Democratic Republic of Congo, ‘rumour mapping’ in the current Ebola epidemic identified 33,016 separate rumours and beliefs, of which 8% claim that Ebola does not exist, 7% invoke supernatural theories involving witchcraft and demons, and 4% allege that Ebola was engineered by foreigners with murderous or malevolent intent. These rumours stop people from taking preventative measures and visiting health facilities when they need help. They also promote stigma and violence towards healthcare workers.
Drawing on these experiences, the following five recommendations can help governments and agencies involved in the COVID-19 response develop effective public health messages:
- Design and deliver information that can be trusted. Trust can easily be broken so efforts to build and maintain it should be central in any COVID-19 public health messaging strategy. This requires governments to share accurate information, acknowledge uncertainty, and think carefully about who is best placed to deliver messages. For instance, during the West African Ebola epidemic from 2014 to 2016, the public didn’t trust information shared by paid individuals as much as by influential community stakeholders.
- Messages should be research-based and context-specific. Even in a time of crisis, research must inform the design of context-specific communication. For instance, guidance to wash hands under running water will need to be adapted for the many parts of the world where access to running water is limited. As the pandemic evolves, messages should be updated on an ongoing basis to respond to misinformation or any other health issues that may arise as a result of a disruption of non COVID-19 related health services.
- Messages shared by agencies involved in the response efforts should be consistent: The current COVID-19 ‘infodemic’ shows that an information overload and contradicting messaging causes public confusion and panic. Due to the large number of actors, such as governments, UN bodies, non-governmental organisations, media companies and others involved in the pandemic response, coordination and information sharing through emergency response coordination mechanisms, such as clusters or government-led working groups, is crucial according to the World Health Organisation (WHO), which is currently writing a framework to guide a response on this matter.
- Communities must be engaged as part of the response team. Community-level action and engagement to jointly identify solutions that work will be fundamental to making the emergency response a success. In Sierra Leone for example, the Social Mobilisation Action Consortium (SMAC), which was founded by a group of non-governmental organisations and was the largest social mobilisation intervention in the country’s Ebola response, developed the Community-led Ebola Action (CLEA) approach to identify ways of working with communities to develop local action plans to prevent disease transmission. These involved supporting households to improve their sanitation facilities or requesting ambulance drivers to drive more slowly through villages, and helped facilitate a response that was both effective and consistent with local interests.
- Public health messages need to be hopeful: It can be easy to despair - it’s not often that we find ourselves faced with a global pandemic. But messages should convey that each of us can do something that will contain the spread of COVID-19.
We urge all involved in disseminating COVID-19 public health messages to consider these lessons and recommendations to ensure that they will effectively cut through the ‘noise’ of the infodemic and spur preventative behaviour, and contribute to a stronger, swifter response to the pandemic.
This blog was written by Alice Tilton (Technical Offcer, Options).
 Sugg, “Coming of Age: Communication’s Role in Powering Global Health.”
 Breakthrough Research, “Social Behavior Change Programming for Public Health Emergencies: Lessons Learned from the USAID Zika Response.”
 Sugg, “Coming of Age: Communication’s Role in Powering Global Health.”
 Amzath Fassassi. Managing rumours and misinformation in West Africa. SciDev.Net
 Martin, Andy. “Ebola Is Killing People but Rumours about Ebola Are Killing Even More.” The Independent, June 20, 2019. https://www.independent.co.uk/independentminds/long-reads/fake-news-ebol....
 World Health Organization, “Communicating Risk in Public Health Emergencies.”
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 “Coronavirus Disease 2019 (COVID-19) Situation Report -85 HIGHLIGHTS,” n.d. https://www.who.int/docs/default-source/coronaviruse/situation-reports/2....
 Skrip et al., “Unmet Needs and Behaviour during the Ebola Response in Sierra Leone: A Retrospective, Mixed-Methods Analysis of Community Feedback from the Social Mobilization Action Consortium.”
[JH1]Deleted bit about ‘medical interventions alone cannot stop the spread of the virus’ because we used that same sentence at the top so felt that we could jump right in.