by Jill Sakai, PhD, writer
Communications have always been an essential element of successful public health efforts, but perhaps never more so than during the COVID-19 pandemic, when the world suddenly faced a brand-new, poorly understood threat that seemed to be everywhere. Everyone had questions. What was this new virus? How did it spread? How do you avoid it? How do you know if you have it? What do you do if you get sick?
In addition to their round-the-clock work on testing, public health laboratories quickly became a focal point for providing information. And as misinformation seemed to spread as quickly as the virus itself, APHL and laboratory staff found themselves in the role of “truthtellers.” Ensuring that timely, fact-based information was reaching health and other officials, policymakers, the media and the general public was vital in the effort to slow COVID-19. It was also critical in the effort to communicate the role public health laboratories played—and the challenges their teams faced—to a much broader audience.
This environment presented both challenges and opportunities. Especially early on, questions far outnumbered answers. The sheer volume of laboratory work was overwhelming and unrelenting. Illness and social distancing left everyone stretched thin. And for many laboratorians, talking about their work to external audiences hadn’t been a big part of what they were used to doing. Laboratory directors, staff and others had to step into more public-facing communications roles.
But all that attention also created opportunities to stay visible and share messages about the essential work and services that public health laboratories provide for their communities. Advocacy efforts at both federal and state levels have boosted government funding for public health. The American Rescue Plan included $7.6 billion for public health workforce. And this year in Indiana, coordinated communication efforts helped lead to a 1,500% increase in public health funding.
Such outcomes are far from certain everywhere, however. “Any time things are in the consciousness of the public, through the media, that can be both a time of opportunity and a time of risk,” said Judy Monroe, MD, president and CEO of the CDC Foundation. Poorly executed communications can sow confusion and create division. But authentic and transparent communication can be a powerful tool to build authority, support and trust with communities and other stakeholders. So how can directors and other laboratorians learn to wield them more effectively?
Knowing Your Messages
The essence of good communication is knowing what you want to say, and finding the right words to convey the messages to the target audience.
The first step is to figure out the key ideas you need to get across, and state them in clear, concise, understandable terms: Masks help reduce the spread of the virus that causes COVID-19. PCR tests are very effective at identifying whether a person has the coronavirus. Effective messages should be accurate and fact-based, but it’s often not possible to convey the full nuance and detail you might tell a fellow laboratorian—and that is okay.
“People don’t need to know all the caveats,” said Kelly Wroblewski, MPH, director of APHL’s Infectious Diseases program, who became a frequent spokesperson for APHL throughout the pandemic. She noted it can be paralyzing to try to say the perfect thing when information is complex and shifting quickly. Over time, she’s gotten more comfortable “not to give the technically 100% accurate answer, but give the ‘close enough to correct’ answer that people are going to understand.”
It helps to consider the perspective of your intended audience and what they really need to know from you. That will vary from place to place, said Scott Shone, PhD, HCLD(ABB), director of the North Carolina State Laboratory of Public Health. His state has a mix of very urban and very rural areas with very diverse needs, he noted. “I have to be able to figure out the message that’s going to address the community to whom I’m speaking … and how do I hone my message to address their concerns or where they might be getting other messaging.”
Some of this comes down to word choice. Shone quickly learned to say “test” instead of “assay” and “look at the virus’ genetics” instead of “whole genome sequencing.” With practice, he was able to reach people from the Research Triangle to eastern farm communities to western industrial centers. The team’s efforts paid off. At a time when governmental trust took a big hit, he said, “trust in the North Carolina Department of Health actually was one of the highest in the country because of the way we communicated.”
Remember, too, that good communications can encompass more than just words, said Myra Kunas, director of the Minnesota Public Health Laboratory. Dashboards, data visualizations, infographics and even spreadsheets can all be valuable ways to share information. Early in the pandemic, her team even gave a staff member from the governor’s office a tour of the laboratory to help convey the complexity of the testing environment. What’s most important is to share the laboratory’s expertise as best you can in that moment. “Communications sometimes needs to be fine tuned, but when you get it right you can reach someone you couldn’t before,” Kunas said. “At the end of the day, that’s what we’re here for—to prevent disease outbreaks, make sure babies are safe, and ensure drinking water is safe.”
Breaking Through the Noise
With the extra visibility and awareness of public health has also come an influx of misguided and misleading information—intentional and not—said Peter Kyriacopoulos, APHL’s chief policy officer. COVID-19 “has inextricably linked public health into the cycle of active disinformation that has been going on in other arenas for decades,” such as politics, he said.
Active disinformation is an organized effort to push back against governmental views and actions. In public health, Kyriacopoulos said, “it really came to the fore during the COVID-19 response with all of the suggestions that the pandemic wasn’t a big deal; that you didn’t need to pay attention to anything that scientists were saying”—especially those from governmental organizations. Disinformation, by design, seeds confusion, which leads to distrust. Ultimately, it hinders the effective delivery of public health services.
In such an environment, it’s critical to “present accurate facts in an accessible way so that people can understand,” he said, with simple, consistent narratives that can cut through a swirl of noise. “I think it is really going to call on all of us to tighten our language skills and our collaborations so that there is a very solid, unified front” from public health organizations across all levels of government and beyond.
But it became clear early in the pandemic that the American public did not have a clear understanding of what public health was or did, said Brian C. Castrucci, DrPH, president and CEO of the de Beaumont Foundation. As federal agencies issued guidance, it was often left up to local officials, the media or even the general public to interpret what those statements meant for people’s lives and actions. “If we can’t effectively communicate what public health is, how are we ever expecting legislators and the public and business leaders to understand?” Castrucci said. “Our strength would be in having a consistent set of messages that were vetted and tested.”
In summer 2020, that collective sense among public health leaders spurred the creation of the Public Health Communications Collaborative (PHCC). Initially founded by the CDC Foundation, de Beaumont Foundation and Trust for America’s Health, the PHCC launched as a centralized communications hub to produce timely, science-based public health messages and resources and coordinate their dissemination to health departments and agencies throughout the country.
Over time, the group expanded its efforts to include misinformation alerts about worrying trends and messages, said Monroe. “In today’s world, there needs to be incredible diligence.”
From Information to Communication
The challenge is further compounded by an erosion of public trust in health information from government officials during the pandemic.
To ensure people hear and—crucially—believe you, it’s imperative to establish yourself as a voice of authority and source of valuable, trustworthy information. One piece of this is to be as transparent as possible about what you know and how, as well as the expectation that recommendations may change as better science becomes available, said Wroblewski. It’s best to assume people are unfamiliar with public health and may need extra context. Wroblewski tries to align herself with her audience. “I have the same desire for answers,” she said. “I can share how I think about things day-to-day, how I decide when to test, what I tell my family and friends and what I’m doing to keep myself and my family safe. But I can also speak to how new information changes my thinking.”
“Our health officers … have an opportunity now to be heard. My advice to everyone is start by listening,” said Monroe. Intentional listening lets you take the pulse of your community and understand what people are feeling and experiencing and what they need from you. If people are angry or frustrated, for example, that’s where you need to start, she said. “When you listen intentionally, they will have messages for you that you can translate into really productive communications.”
To resonate, communications need to acknowledge the reality of people’s lives, Castrucci noted. This is especially true when public messages from experts about how people should be living their lives may seem out of touch. The recommendation to stay home if you’re sick may seem straightforward. But missing work has high consequences for some people, Castrucci said. “If the choice was either I get someone sick, or my kids don’t eat, I’m getting you sick.”
He recommends embracing the human side, balancing messages about case counts and school closings with empathetic messages. “I know this is hard. But I believe this is the right thing for our community,” he said. “We will get through it. We will band together as this community always has.”
Sometimes, though, public health officials simply aren’t the best messengers. In such cases, an effective strategy can be to tap into existing social networks and find someone who’s already part of the community to help carry your message. “What I think we did smartly was engage trusted community partners,” such as religious leaders, college basketball coaches and social media personalities, said Shone. “I think that was quite effective.” The state health department even got NASCAR driver Richard Petty to do a public service announcement. In North Carolina, “he’s the king,” Shone said. When he speaks, “it carries weight.”
Even local voices can be powerful—business leaders, a local DJ, the parent who runs the local youth soccer league, Castrucci said. “There’s good data that show that those microinfluencers are better at getting people vaccinated for flu than the CDC messaging.”
Turning Visibility into Support
Such experiences highlight the value of community partnerships. Communications with other types of external groups can also build on the increased visibility of labs and maintain momentum, said Kyriacopoulos. Now is a great time to share the services public health laboratories provide and why you are valuable to your community.
Since the start of the pandemic, Megan Crumpler, PhD, HCLD(ABB), director of the Orange County Public Health Laboratory in California and APHL president-elect, has seen more recognition within her broader agency and interest in the laboratory’s projects and publications. Now she makes a point of sharing regular updates about the laboratory’s work—“kind of like keeping a CV” for the laboratory—and is getting encouraging feedback, she said. “It’s a great mechanism for us to be able to show that we’re still relevant and doing good work.”
She is also building on relationships with public health leadership organizations in the state to play a larger role in advocating for public health policy. She has spoken in front of the California Senate Health Committee and had the opportunity to contribute to relevant legislation, such as for an emerging infectious disease surveillance system and funding for public health laboratory workforce training.
“It’s been a really cool experience to be able to have a seat at the table, and now when anything laboratory-related comes up, they come to me,” Crumpler said. “There’s mutual respect between the organizations, and they see us as a good source of trusted information."