Eight Rules for Communicating Public Health Risk in a Crisis–From Horsemeat to Covid
This piece was originally published in Civil Service World here.
Over the last two years, the risk of Covid-19 to public health has fluctuated according to case rates, variant severity and transmissibility, restrictions and vaccination. So too have public perceptions of risk.
How has the UK government sought to inspire trust, discredit misinformation and change public behaviour in order to slow the spread of Covid-19? How have its crisis communications compared with Labour’s handling of the swine flu pandemic in 2009 or the Coalition’s response to the horsemeat scandal in 2013? By evaluating government communications during each of these threats to public health, we can identify eight fundamental rules for communicating risk in a crisis.
1. Estimating–Clarifying the difference between NHS planning assumptions and public health risk
At the beginning of a public health crisis, the government is under huge pressure to calculate the level of public risk based on limited evidence. Italy’s experience of Covid-19 provided the UK some insight into the risks posed. However, when swine flu hit the UK, there was little data on which to base decisions. The government risked either underestimating the threat or causing unnecessary panic.
The government mitigated reputational risk by being open and frank about the levels of uncertainty. It targeted different messages on the level of risk: health services were given planning assumptions to help them prepare for the worst, while the public was made aware of the current threat to health. Despite government making it clear that planning assumptions were not predictions, certain media outlets used them to create sensationalist headlines. The chief medical officer’s “reasonable worst case” planning assumption of 65,000 fatalities on 16 July 2009 was widely reported in alarmist terms.
Unavoidably, those modelling the level of public risk continue to be criticised for over- or under-estimating the threat. This year, Professor Graham Medley, chair of the government’s Covid-19 modelling committee, acknowledged that worst-case scenarios were not coming to pass, insisting it was his job to warn ministers how bad things could get and that he would “just have to accept” criticism from MPs and the media–“when I say they were not predictions, I mean they were not predictions.”
2. Targeting–Target high-risk audiences with tailored messaging and representative spokespeople
Just as separate communications strategies need to be implemented to meet the respective needs of the public and NHS, the public itself should be segmented to target high -risk groups. As the chief executive of the Race Equality Foundation Jabeer Butt said in 2021, the government needs to get data on “who has been offered the vaccine, who has taken it up and use that to target messages.”
To increase vaccine uptake in Black and Asian communities, then-vaccines minister Nadhim Zahawi, Labour MP David Lammy and Conservative James Cleverly featured in a video, that was promoted on social media, about how they had lost relatives to the virus. A targeted approach was also taken when pregnant women were identified to be at greater risk of swine flu: media coverage was generated in women’s magazines and the director of immunisation Professor David Salisbury and then-health secretary Andy Burnham took part in webchats to reach this group.
In both pandemics, at-risk groups were targeted through the media channels they typically consume. The current government selected spokespeople that represented an at-risk community, in this case racially, knowing that they would resonate more with the target audience. The discipline of communications has evolved to be more representative – it is hard to imagine webchats targeting pregnant women today being fronted by two men as they were in 2009.
3. Public information–Influence behaviour change to help individuals reduce health risk
Efforts to increase vaccine uptake are part of a wider behaviour-changing strategy to persuade people to limit the spread of disease and lower personal risk. The “Catch It, Bin It, Kill It” swine flu campaign and “Hands, Face, Space” of the Covid-19 pandemic used paid-for advertising to extensively communicate health messages and change behaviour.
A consumer-focused response to the horsemeat scandal saw Defra hosting live Q&A sessions on Twitter, while guidance on swine flu was published weekly on the Health Protection Agency website. In the Covid-19 pandemic, BBC online has been regarded by many as the go-to source of reliable information; the government website lacks a consumer focus and has not been foremost in Google searches about vaccine safety or latest restrictions. In December, it was announced that vaccinations would be offered to at-risk five to 11-year-olds but no information was shared about how they would access them until five weeks later. During this period, parents searched Google and called local NHS services in unsuccessful attempts to find out how the policy change would work in practice. Government communications have been weighted more towards reputation management than anticipating and communicating the information people need to know. Both are vital in a crisis.
4. Coordination–Promote consistency across government and the public sector
In a crisis, central government should coordinate with other public sector organisations to ensure a smooth and consistent response and inspire the public’s trust. Yet just a fortnight into the first lockdown of March 2020, there was a widely reported disconnect between how the government expected lockdown to be enforced and what the police understood their role to be. Derbyshire police was criticised for filming dog walkers with drones and telling a shop to stop selling Easter Eggs. With the number of enforcement notices issued in the first week ranging from 123 in Lancashire to none in Bedfordshire, it is unsurprising that the NPCC chair, Martin Hewitt, wrote to police chiefs about the need for greater consistency in the application of emergency powers.
Better government communications would have ensured consistency from the beginning. At the time, cabinet minister Dominic Raab told reporters that “obviously we need some common sense” from the police. Rather than hope for sensible interpretations, the government should have collaborated with police on the development of precise guidelines in advance of the lockdown.
In a better coordinated approach during the swine flu pandemic, the Department of Health worked closely with devolved administrations, the NHS and the Health Protection Agency to agree on strategy and ensure consistency in messaging. During the horsemeat scandal, Defra worked with police press offices to ensure that the public received one, clear message on the role of the police in investigations and raids.
5. Government action–Promote every government action to reduce health risk
In both the swine flu and Covid-19 pandemics, regular press briefings were held to promote every action taken in response to the crisis. During the horsemeat scandal, the government raised awareness of efforts including Food Standards Agency raids, meetings with the food industry and the environment secretary leading the response in Brussels. Social media drove traffic from Twitter to the government website, using the hashtag #horsemeat to widen the reach, just as the current government is doing with #vaccine.
In the horsemeat scandal, the government defended its reputation by stating that there were private companies that should also be held accountable. Its commitment to identify what went wrong and make the system stronger was communicated alongside the point that retailers, manufacturers and suppliers were legally responsible for ensuring correct food labelling. This strategy successfully prompted Tesco and other industry representatives to publicly acknowledge their responsibility.
During the recent pandemic, however, the public would have been critical of any attempt by the government to deflect accountability elsewhere. In fact, the government managed its reputation well by promoting its collaboration with industry and academia, especially with regards to the Oxford AstraZeneca vaccine development. In all three crises, promoting every action that is being taken in response to the threat wins public confidence and pre-empts criticism.
6. Response–Rebut inaccurate information and develop strategy to counter these narratives
A successful reactive media strategy involves quickly identifying and correcting misinformation to minimise the number of people misled. The coalition government robustly rebutted inaccurate claims made by media and stakeholders about the horsemeat scandal. When the Financial Times reported horse DNA at levels of less than one percent “will not be considered a problem,” Defra promptly published a “myth bust” on GOV.UK and promoted it on Twitter before the FSA chief executive issued a statement later the same morning. The current administration has taken the same approach, listing and rebutting “multiple inaccurate and misleading claims” regarding ventilator procurement.
Reputation management involves anticipating criticism and preparing reactive statements to be issued to media within press deadlines. Just as with Covid-19, it was alleged that the swine flu vaccine had been rushed into production, without rigorous testing, and was therefore unsafe. Both governments consistently countered these allegations in media reports.
As well as rebutting misinformation, the best communications teams use inaccurate claims to inform their proactive communications strategies and messaging. Ministers and medical experts have proactively used press briefings and media engagements to communicate the Covid-19 vaccine’s safety, effectiveness and role in ending restrictions. And in the swine flu pandemic, government used concerns voiced on Mumsnet forums to inform targeted messaging for pregnant women.
7. Probability–Contextualise the level of risk to keep it in perspective
Putting the level of risk into context helps counter sensationalist headlines and provide the public with a truer picture of the likelihood of harm. Anti-vaccination rhetoric has persisted throughout the Covid-19 pandemic and health risks of the swine flu vaccine were still being reported years after the World Health Organization declared the pandemic over. When new evidence emerged of a link to narcolepsy in 2013, NHS Choices made clear the statistical level of risk by putting the Daily Mail headline, “Fears one million children received jab” into perspective with the statement: “if one million children did receive the vaccine (which is a matter of debate), even at the highest risk estimation (one in 52,000), just 19 children would be expected to develop narcolepsy.”
During the horsemeat scandal, concerns about food safety generated very high-profile media coverage, particularly when the horse medicine, bute, was detected in product tests. In response, the trusted and politically neutral chief medical officer made clear in broadcast interviews that a person would need to eat between 500 and 600 horsemeat burgers containing bute to experience any ill effects. This everyday analogy very convincingly substantiated the government’s position that there was no risk to public health.
8. Transparency–Inspire the public’s trust by communicating the latest information openly
In all three health crises evaluated here, public trust was won when government communicated the latest information on public risk promptly and transparently. In both pandemics, regular press briefings have helped to prevent an information vacuum emerging that could otherwise have been filled by dramatic speculation. Choosing politically impartial medical and scientific experts to communicate updates, such as the chief medical officer, has further enhanced public confidence. During the horsemeat scandal, the latest product test results were communicated in real time on Twitter. These direct communications reassured the public of the government’s continued action and inspired trust.
By contrast, briefing stories to a select newspaper undermined trust and fostered a sense of uncertainty during the Covid-19 pandemic. For example, on 27 January last year, the prime minister told the House of Commons when a roadmap out of lockdown would be published and when schools would reopen. While all newspapers reported the PM’s plans the following day, one uniquely quoted “a Whitehall source” which made the PM’s position far less clear: “The Telegraph understands that officials are working on proposals which could see most shops closed until April… it could be at least another month after that before non-essential shops would be allowed to open…shops would be unlikely to get the green light until April, while pubs and restaurants could remain closed until May.”
Giving an “exclusive” to one newspaper is a long-established practice on Whitehall to generate detailed coverage the day before an announcement. It is a misguided tactic to deploy when government should be open with the latest information on a public health crisis. By briefing out information selectively, the government opened the door to speculation and uncertainty.
During a public health crisis, government communications should prevent speculation by communicating the latest evidence transparently and comprehensively. Managing reputation includes promoting each action taken to reduce the level of public risk and responding promptly to criticism or misinformation. To win public confidence, strategy and messaging should be coordinated between government departments and public sector organisations, in advance of a public announcements. To help people reduce their risk to health, public information and behaviour changing strategies should be deployed, targeting high-risk groups where necessary. Lastly, probabilities, when communicated effectively, give the NHS planning assumptions and the public an accurate understanding of their own level of risk.