Lessons from the Pandemic: The Need for New Tools for Risk and Outbreak Communication

Pandemics such as the 2009 H1N1 pandemic (and COVID-19) can be a testing time for the field of risk and emergency communication. This article surveys existing guidelines and makes recommendations for additional tools to be developed in 4 areas: integrating long-term behaviour change models with outbreak communications; developing better strategies for communicating through the internet; understanding how to use communications to build trust; and constructing principles to understand the political nature of disease outbreaks.

1. Integrating risk and emergency communication with health communication

A pandemic is more than an outbreak; communication needs change over time. The focus shifts on what the public needs to do to reduce transmission and how to seek treatment toward more complex issues such as the need for continued vigilance and questions about the quality of, and accountability for, the public health response to the pandemic. These issues are no longer within the realm of crisis or risk communication; rather, they are part of long-term health communication and health promotion, focusing on behaviour change in areas such as cough etiquette, hand hygiene, and vaccination and vaccine safety. For this reason, the World Health Organization (WHO) has not only created outbreak communication guidelines for emergencies, but it also has developed a communication for behavioural impact model, which has used to support leprosy control campaigns in India and Mozambique, dengue prevention in Malaysia, and tuberculosis (TB) prevention in Bangladesh and Kenya and in other places. The United Nations Children's Emergency Fund (UNICEF) and the World Bank have advocated similar social mobilisation communication strategies.

During the 2009 pandemic, a survey of the needs of developing countries conducted by the WHO and other UN agencies showed that many developing countries found communicating at the community level a problem and were requesting support for planning for behaviour change communication at the community level. At the time of this writing, this was not an area covered by the existing outbreak and risk communication guidelines. Therefore, there appears to be merit in combining longer-term, participatory health communication approaches with the more short-term communication principle for disease outbreaks and emergencies into a broader framework for strategic communication for disease outbreaks.

2. Understanding and effectively using the internet

Unlike traditional top-down communication from expert to audience, blogs and other user-generated content have turned the internet into a conversation space in which everyone can participate. Evidence-based guidance on use of the internet, particularly social networking tools such as Facebook and Twitter, during disease outbreaks and for longer health crises would be helpful.

3. Creating trust in a post-trust society

Being regarded by the public as trustworthy is a basic component of risk communication. However, establishing trust is a complex process that requires more than applying guidelines such as openness and transparency, particularly because public trust in policymakers and officials has been found to be in decline (especially in western societies). "A research agenda for risk communication needs to understand the trust building process better and offer insights from the published literature in various disciplines, as well as suggest new areas for study."

4. Considering the political, social, and economic environment of risk communication

Infectious disease outbreaks and other health emergencies are highly charged political and social events. For example, decisions over vaccine procurement, travel restrictions, and other public health measures all have economic and political consequences; therefore, those who communicate about these issues find themselves confronting questions that are not essentially about health but about other aspects of society. Thus, "it is necessary for health communication guidelines and principles to be broadened so that they equip communicators to address the underlying social and political questions about blame and risk distribution that are on the public mind during disease outbreaks and emergencies, and to have the tools to be able to respond to these queries."

Based on this discussion, it is suggested that tools and principles of risk communication be expanded in the following areas:

• The integration of communications tools and guidelines for long-term behaviour change and social mobilisation, especially in developing country settings, into existing guidelines for outbreak communication;
• Guidance on how to use the internet, including social networking tools, effectively to provide the public with health guidance;
• Research into how to build and maintain trust with the public before, during, and after disease outbreaks; and
• Guidance on how public health communicators can understand and negotiate the political and cultural complexities of pandemics and other disease events.