Opinion: Want to improve trust in U.S. public health agencies? Start with a new mantra

Be first, be right, be credible.

That’s the mantra public health leaders follow when it comes to communicating with the public in a crisis. Though it is officially promulgated by the federal Centers for Disease Control and Prevention, it is taught in public health schools all over the world and is a governing philosophy that permeates public health communication.

Yet the decrease in public trust for U.S. public health agencies during the pandemic — a poll indicates that only 52% of Americans trust the CDC, compared to 37% who trust the National Institutes of Health and the Food and Drug Administration — makes clear that public health needs a new philosophy for risk communication, and a new mantra to go with it.

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I propose the following: Be right, be fast, be clear.

There are four changes behind this new mantra.

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Being right is the first priority

The old mantra puts correctness second. I believe it must be first. In my view, this is just common sense. No one will listen to advice they perceive to be bad or untrustworthy, and in public health bad advice causes real harm — and repeatedly bad advice decreases trust, reducing the likelihood that the public will listen to good advice later. Health agencies are full of brilliant, dedicated scientists and administrators trying to untangle nasty problems complicated by lots of uncertainty. Putting their correct results at the forefront of public health should be an easy choice.

The data upon which public health communication is based are often uncertain and incomplete, making predictions highly subject to change. Take, for example, early advice on the spread of SARS-CoV-2, the virus that causes Covid-19. At various times, without clearly communicating that these were best guesses, officials said that Covid-19 could be spread on surfaces, and then by droplets, and then by aerosols, leading to confusion.

The highly vaunted early epidemiological models out of the University of Washington and Imperial College were handily beaten by a model created by data scientist Youyang Gu.

While public health officials often try to appear authoritative, this should mean being careful in stating what is known and what is not. Sometimes this means paying more attention to models and hypotheses that come from nontraditional sources, as in the case of Gu’s model. Other times it means being specific in the level of certainty, as in the case of how Covid-19 is transmitted. Scientists are good at stating their true level of knowledge when speaking to each other; they should use these skills when speaking to the public as well.

Be fast, not necessarily first

The new mantra replaces being first with being fast. Being first isn’t always the right choice; it can lead people to rush and say something incorrect or misleading, so it follows from the first principle that firstness is the wrong target. It is also impossible for an agency or leader to know if they are first because there may be others working on the same issue, particularly in the age of the internet where individual researchers may solve a problem before any agency can confirm it.

Focusing on being first means that rushing to put out a statement may miss important information that comes out a few days later, thus losing credibility. Besides, targeting speed means being first much of the time. Emphasizing speed instead of being first still forces public health officials to work quickly regardless of what anyone else is doing.

There are many avenues today through which new information can emerge. Papers come out on bioRxiv and other preprint servers before any agency has had a chance to process them, genetic sequences are published before they are made “official,” and scientists and others debate scientific matters, like the value of antigen testing or even how to interpret vaccine trial results, in public on Twitter. The importance of wearing masks was being discussed in the media before the CDC made its official recommendation. The fastest epidemiological genomic data for many infectious diseases, like Covid-19 and Ebola, is on Nextstrain, an open source collection of sequences run by Trevor Bradford at the Fred Hutchinson Cancer Research Center, and the best U.S.-based Covid tracker was The Covid Tracking Project, which was run by The Atlantic, a magazine, until it stopped in March 2021.

To expect to be first in today’s fast-paced science communication environment will often lead to error.

The importance of clarity

Being clear somehow escaped inclusion in the old public health communication mantra. The CDC’s communication handbook lists six principles of “effective emergency and risk communications,” and none of them involve clarity.

I believe clarity must be a cornerstone of the new mantra because it is essential for successful communication. It doesn’t matter if what is being said is right or fast if no one can understand it. The public disengages from sound advice if it isn’t understandable or is confusing. Public health officials, for example, did not communicate that the effectiveness of Covid-19 vaccines was measured by hospitalizations, not infections, which has bred mistrust of vaccines to this day.

Clarity also drives prioritization, since clarity requires simplicity, forcing public officials to communicate only what is important.

A drive for clarity should trigger an investment in data visualization and analytics, since visualizations help make things clear and drive engagement with good advice. The Economist has published one of the best visualizations of excess mortality despite being a financial newspaper. Similarly, one of the best real-time Covid-19 trackers is made by Citizen, a safety app. No public health agency has yet to build a good visualization tool.

Clarity also means cutting through the noise, like Italian mayors did during March 2020 to enforce lockdowns, using humorous rage to clarify what lockdown meant for anxious citizens. Being clear also requires consistency — that is, making sure public health officials say the same thing. That is a tall order, given the abundance of public health officials at the federal, state, and local levels, as well as in other countries, and given how many recommendations there are. But leaders should at least be in step with the guidance of their own agencies.

The difficulty with clarity is that public health issues are often beset with uncertainty. Human health is a complicated beast with many caveats and particulars and, in a crisis, experts have only partial information at best. Scientists are often debating the science in public and producing contradictory papers in the process, so deciding which views to support adds to the challenge.

Clarity aids in candidness by forcing officials to specify what they know and what they don’t know, as well as how they know it. In public finance, for example, it is common for officials to say how confident they are in a public announcement. The Federal Reserve even releases a “dot plot” of its interest rate forecasts; this helps rather than hurts their communications.

Clarity, however, should not come at the expense of cutting out important information. As Albert Einstein once suggested, it is important to present an idea as simple as possible, but no simpler.

Credibility gets the axe

Credibility, despite being third on the old list, is in practice usually put first. This is because, as public health officials know, if you aren’t credible it doesn’t matter what you say. But with credibility, the tail often ends up wagging the dog.

The most important danger is that credibility often gets confused with infallibility, so public health officials may be slow to admit mistakes or advice based on incomplete and changing data, thus hurting their credibility. In other words, moves made purely to prop up credibility often end up hurting it instead.

While credibility is important, it is a consequence of good communication, not a target for it. Successful public health communication leads to credibility because it is reliable and effective. The best, most durable trust is earned through a track record of success. If official advice is mostly right, delivered quickly, and simple to understand, it will be credible without other maneuvers to manufacture credibility.

Life sciences workers can help with public health communication

Good communication principles can be put to use by everyone working in the life sciences. Many of us have received articles from family members or friends over the past two years trying to make sense of Covid-19 developments or asking what to make of sometimes overly technical or contradictory communications.

Life sciences workers have the skills to be translators between the scientific community and the public. By using the principles of being right, being fast, and being clear, they can be extensions of public health officials. Even after the pandemic has receded, and other public health issues take center stage, life sciences workers would benefit from using these principles when explaining what they normally work on to family members, neighbors, partners, investors, regulators, and others.

Public health is a difficult practice populated by many outstanding, hardworking individuals. The new mantra for public health communication I propose is in praise of their efforts; their brilliance and labor deserve only the most focused operating slogan.

Evan J. Zimmerman is an entrepreneur and investor, founder and chairman of Jovono, a venture capital firm, and founder and CEO of Drift Biotechnologies, a bioinformatics company.

Source: STAT