What the U.S. did wrong on Covid-19 — and what others did right

Some governments have been praised for being forthright about being science-driven in the way they’ve communicated about the Covid-19 pandemic. Other countries, most notably the U.S. and the U.K., have been hit with criticism for public health messages that are confusing or not based in science.

Heidi Tworek, a health communications researcher and an associate professor of history and public policy at the University of British Columbia, Vancouver, joined STAT’s biotech podcast, “The Readout Loud,” this week, to talk about that issue. She and a team of researchers just put out a report examining the Covid-19 communications strategies of nine different nations: Senegal, South Korea, Taiwan, Germany, Norway, Sweden, Denmark, New Zealand, and Canada.

This transcript of the conversation was lightly edited for clarity.

Heidi, among the governments that you looked at, which one has done the best job in communicating about Covid-19?

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Oh, it’s a great question. I think if I had to pull out a couple that were best for very different reasons, I’d say Senegal, South Korea, Taiwan, New Zealand, and British Columbia. They all took extremely different approaches. But they followed some very basic principles that we lay out in the report, including simple things like having transparency, communicating about social values, and having very clear definitions of what they meant by success in combating Covid-19.

So, by contrast, the United States and the United Kingdom have received a lot of criticism for the way officials there have communicated with the public about the pandemic. What have they done wrong?

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What have they done right is another way of phrasing that question. Let me lay out a couple of things. I mean, it begins with even the simple basics.

If you asked 10 people in the United States, what does success look like in fighting Covid-19, you would get 10 completely different responses. If you ask someone in New Zealand, what is success? They understand that it is eliminating Covid-19 in New Zealand. If you are someone in Sweden, what does success mean? They understand that it means a sustainable strategy over the long run. So even if people have fought about, well, has Sweden chosen a good strategy epidemiologically, what we know is they communicated that strategy really quite clearly.

So I think that was a sort of base-level problem [in the U.S. and U.K], a lack of transparency. Importantly, guidelines that are often orders that fluctuate surprisingly swiftly — we see that in the United Kingdom as well. Sometimes orders come down seven minutes before they’re about to be enforced and they’re so complicated that nobody really understands them.

What we’ve seen in places like British Colombia that’s worked very well is you have guidelines that give people some room for autonomy. So you say something like, look, the maximum number of people who can gather is 50. If you, as a workplace or as a restaurant, are going to open, you need to submit a plan about how this is going to be safe. But we give you some autonomy to decide how to do that. A good strategy doesn’t mean orders from the top. It means guidelines that are clearly communicated that give people some room for autonomy, but where they actually have to have some sense of what success, in fact, looks like. And we see all of these kinds of basic principles getting violated in the U.S. and the U.K.

Another effective strategy that you mentioned that I think is linked to that is governments that are not shaming people for breaking the rules. Could you talk a little bit more about that and why it’s effective?

Yeah, it’s actually, I think, quite counterintuitive because we’ve seen so many people shaming on Twitter and elsewhere and saying we need stricter rules, we need more enforcement, more fines, etc. But what we find, counterintuitively, is that places that focus on building trust, giving some level of autonomy, and using fines and shame games as a last resort actually get much higher levels of compliance. So, for example, we compared two provinces within Canada so we could compare places that were quite similar, British Columbia with Ontario.

We saw in Ontario a lot of blame game, shaming, etc., lower levels of compliance and also the use of fines, which sort of escalates the whole situation. Whereas in British Columbia, there’s been much more of an emphasis on trust in the population, do not shame the few people who seem to be contravening guidelines. That has worked much, much better. And it’s also resulted in far less backlash. We’ve seen a few protests in British Columbia against masks, but they are tiny compared to places where masks were made mandatory and there were fines. So if you actually think about how to get more people to comply, you’ve got to take this counterintuitive move of trying not to have blame games, shaming, and enforcement with fines. It doesn’t work as well.

I think we all know that the science behind the pandemic changes rapidly and that must make the communications side of it really tricky. The usefulness of masks, for instance, is a good example of where opinions have shifted from early in the pandemic to today. I wonder how rapidly do you think governments should be in communicating about that shifting science, especially when the evidence is still building?

I think one of the things that that some governments have done well is communicating uncertainty. We’ve seen, I think, many examples of governments doing a poor job of communicating uncertainty. But we’ve seen some instances where governments at least say this is what we don’t know yet, but what we are looking into. And that has, I think, been very helpful because it helps the public trust that this government is honest about what it doesn’t know and will tell you when it knows something better.

Something we also found to be quite effective, in Norway, for example, was also admitting mistakes. There’s this tendency, I think, from a lot of governments to use spin — we’ve seen that in the U.K., for example, not to want to admit missteps. But we found in Norway when the prime minister actually said later, I’m sorry, the lockdown was probably much too stringent, we didn’t necessarily need to do that — that actually ended up building trust because the government was willing to admit where it had done something wrong. So I think it’s actually a very important lesson because as we learn more and more about this disease, there all going to be missteps. And if a government admits them, then it will be in better shape than if it tries to constantly spin that everything it’s doing is completely flawless.

One of the most alarming things we’ve seen in the communications realm during the pandemic has been the spread of misinformation online, particularly on Facebook. How are governments communicating with the public about the spread of misinformation?

It’s been an enormous problem, but actually what I found quite inspiring is to find that there were some places where it’s been less of a problem than others. And one of the key reasons for that was public health communicators getting out early and often on as many channels as possible.

We found, for example, in places like South Korea, misinformation has not been a big issue. Part of the reason for that is that the South Korean Centers for Disease Control has an office of communication that has been dedicated for several years now to figuring out how do you communicate on as many channels as possible. You do it frequently and also you bring the public in. So we’ve been talking quite a lot about what public health officials should do. But one thing they should do is pull in citizens and civil society to tell you if your communications are working, to tell you how to reach your population.

If we’re talking about what do you do as a government right now, you get out early and often as many channels as possible so that people turn to you first and not to Facebook for information.