Setting the Stage

On May 20, 2021, the National Academies of Sciences, Engineering, and Medicine held a virtual convening of public health and communications practitioners to examine the challenges, opportunities, and lessons they saw while executing effective communications and community engagement in response to the COVID-19 pandemic. This conversation was held during a time when racial and socioeconomic inequities in the vaccine rollout were becoming apparent; the Delta variant of the virus had not yet fully emerged in the United States; Pfizer/BioNTech had requested emergency use authorization to include adolescents aged 12 to 15 years of age in vaccination; and administration of the Johnson & Johnson vaccine had paused. The changes in the landscape of the pandemic between the convening and the issue of this paper illustrate one of those challenges they identified – a pandemic can seem to morph more quickly than communications practitioners can anticipate or even respond.

While the conversation was initially intended to be about COVID-19 specifically, it became clear that the discussion needed to focus more broadly on crisis communications to better prepare for future pandemics and ensure the lessons learned from COVID-19 can be carried into the future. Participants contributed their insights on improving the nation’s approach to communicating about urgent and complex health issues.

In advance of the convening, the National Academies communications staff held a series of meetings with participants to explore COVID-19 communications strategies and how they evolved as the pandemic unfolded. These conversations confirmed that the country was at a critical juncture in the COVID-19 pandemic. Group by group, segments of the population were facing the decision to take the COVID-19 vaccine, “wait and see,” or reject this personal and public health safety measure. The pressure to reopen the economy, the shift to warmer weather, the emergence of new strains of the virus, the introduction of multiple vaccines, and ongoing politicization of public health issues had complicated the communications landscape.

More than 30 participants representing diverse perspectives attended the convening, held virtually. Attendees included practitioners and researchers from government agencies, research and academia, nonprofit foundations, community organizations, and the private sector. In addition to seeking participation from a wide range of organizations, the convening also featured a diversity of individual representation in terms of race and ethnicity, geographic location, age, and experience. While there was a broad range of expertise represented in the convening, there were critical perspectives that were missing and could be included in future conversations, noted several participants, including a global perspective and the lived experiences of some communities that were under-resourced during the pandemic.

At the beginning of the convening, participants shared their thoughts on the COVID-19 pandemic in general. While some perceived that the “end is in sight,” others pointed out that while this might be true in some parts of the United States, any optimism was not evenly distributed across the country, nor the case in other parts of the world. The disparity of experiences connected to COVID-19 domestically and internationally was a recurring theme throughout the discussion. In addition, participants were conscious of the risks associated with drawing conclusions about the pandemic while still being in the midst of it.

This paper captures the lessons and insights shared during the convening. It summarizes key themes identified by the participants and their perspectives on issues to further explore or consider in strengthening the communications and community engagement capacity of the public health sector when anticipating and responding to future crises. In addition, this paper has been informed by insights shared by email or in phone conversations after the convening. It is important to note that the participants were engaging in a conversation. They were not reporting on research, or claiming an evidence base beyond their lived experience and years of professional work. The contents reflect the perspectives of individual participants and do not reflect consensus, nor the views of the National Academies.

Challenges in Crisis Communication Revealed by the Pandemic

Participants in the convening discussed how communicating about COVID-19 to their audiences and communities was hindered by various factors. Among the factors cited were the enormity of the challenge; the speed at which the pandemic was evolving; and misinformation and disinformation being distributed by the news media and social media.

Another frequently cited factor was the change in presidential administrations in the United States during the period of the first COVID-19 vaccine rollout in late 2020, which had further complicated efforts at national-level coordination, noted several participants. Another challenge identified was related to the gaps in coordination among federal, tribal, state, and local governments, which resulted in part from their independence from one another.

In addition, disparities in how the COVID-19 pandemic was affecting different communities—and how the response to it was being designed and delivered (e.g., access to a vaccine)—posed and continues to pose significant challenges not just in addressing the public health crisis, but also in communicating accurately and effectively about it. Participants in the convening were keenly aware of the vast disparities in the impact of COVID-19 on communities of color and tribal nations resulting from deeply embedded systemic racism. They acknowledged how the broader environment of systemic racism impacts every aspect of crisis communications.

Observations and Insights About Future Public Health Crisis Communications

Following the discussion on the overall challenges associated with communicating about COVID-19, participants identified issues to consider to strengthen the capacity of the public health sector at all levels to more effectively communicate during a future public health crisis.

Communications must be grounded in reliable data and inclusive of communities most impacted.

Participants expressed concerns about the data used to inform decision making about various communications and responses to the pandemic. These concerns were primarily centered around “data absenteeism,” or under-representation or exclusion of certain population groups from data gathering, and the reliance on survey data over more specific behavioral data.

With regard to data absenteeism, participants noted that systemic racism in data collection resulted in the absence of significant underrepresentation of data from some groups such as communities of color, tribal nations, rural communities and populations with a politically conservative worldview.

As one participant noted, some population groups are not “hard to reach” but “hardly reached” since the concern is less that they are choosing not to be involved in data collection but that authentic attempts to include them are not made. Excluding these groups prevents both meaningful segmentation and understanding of how to address their unique context and needs. It was noted that during a pandemic, communities can spread a virus between each other even though they may ordinarily be socially distant, making communications within communities essential to successful communication across communities.

Without the availability of complete, accurate, and timely data, there was a gap in understanding how COVID-19 was affecting certain groups. This gap can be exacerbated by overly rigorous adherence to research consistency across audiences, which can inadvertently result in inaccurate findings. As a result, communicating in real time about various aspects of the pandemic became more complex.

Insights:

• One proposed solution to address data absenteeism was to provide resources and support to build a national infrastructure that can facilitate an authentic feedback loop with communities to prioritize needs, facilitate partnerships, collect data, and support best practices and innovations during COVID-19 and beyond. Participants acknowledge that such a system does not currently exist but could fill an important role in crisis communications.

• Participants also identified the need to share methodologies and communicate about data and conclusions in culturally congruent ways, tailored to appropriate health literacy levels and other unique needs of diverse populations.

Messaging must be tailored, culturally congruent, and delivered by trusted messengers.

Participants identified several challenges in messaging about COVID-19. Some shared that the messages they saw were often confusing, contradictory, unapproachable, too academic in their framing, dismissive, and/or delivered by messengers who were not always trusted by audiences.

Some participants suggested that public health leaders and practitioners must increasingly put themselves in the shoes of people who are not scientific experts and realize that especially in the first year of the pandemic, members of the public were “drinking from a fire hose” and inundated with large amounts of complex information from many different sources. They noted that audiences may have limited experience in parsing evidence from opinion, useful from extraneous information, and good from bad.

Participants identified an opportunity to mitigate confusion about COVID-19 messages among communities by ensuring that information is delivered by messengers who are embedded within their communities and are trusted resources. Participants acknowledged that mass media outlets (e.g., cable and radio news, major daily newspapers, online news sources, etc.) often look for high-profile academicians or government officials to serve as spokespersons, but these can be the same kinds of individuals that many communities do not trust. Participants shared examples of the success of using trusted messengers, including the ability to develop a shared language to which communities and individuals can relate and thus more easily act on recommendations. For example, a family physician or local authority is often more relatable, capable of speaking in an understandable manner, and therefore, trusted.

Participants also noted that in addition to developing messaging and training messengers, strategies to disseminate messaging must be culturally congruent and tailored to meet the unique needs of communities, population groups, and tribal populations.

Insights:

• Messaging needs to be relatable, plain, and honest. The public health sector must increasingly shift toward the practice of “radical transparency” by telling people what is known, what is not known, and why.

• Public health experts should focus on listening and nonjudgmentally providing information to people responding to genuine questions and needs, focusing on education and knowledge before behavior change.

• Communications should be adapted at the individual and community levels and take into account how centrally developed communications methods can be rooted in patriarchy, colonial oppression, and structural racism. Without this understanding, communications cannot be appropriately adapted to local contexts, and therefore may be rejected by many communities.

• Spokespeople at the national level need to be credible, speak plain language, and be trained in how to effectively deliver messages in a way that audiences can digest.

Misinformation and disinformation must be countered quickly.

Concerns about misinformation and disinformation associated with COVID-19 were widely expressed during the convening, as they have been elsewhere since the pandemic began to dominate public discourse in early 2020. Participants distinguished between misinformation resulting from genuine misunderstanding and disinformation intentionally spread by individuals and organizations. These concerns were so prevalent that they could easily have filled the convening’s entire agenda, but given the extensive conversations happening elsewhere at the National Academies and externally on this topic, facilitators made the intentional decision to limit the time spent on it.

A contributor to misunderstanding is that most members of the public do not have a deep understanding of science, biology, medicine, and public health. Yet, during the COVID-19 pandemic, complex information about the rapidly expanding, escalating, and evolving public health crisis was disseminated with insufficient attention to explaining why something was happening or needed to be done, or with little effort to help demystify key concepts and processes required for people to make decisions around their health. Participants noted how confusing and sometimes contradictory the messaging had been about mask wearing and the unsuccessful response to widespread concerns about the speed with which vaccines had been developed, tested, and approved. In both cases, the public health response was inadequate, providing fertile ground for misinformation and disinformation, complicating communications practitioners’ efforts and undoubtedly increasing vaccine hesitancy.

Insights:

• The public health sector should build its capacity to respond in a timely manner to credibly rebut misinformation. In part, this would entail monitoring and evaluating messaging and its delivery to generate understanding of what works and what does not, in order to build trust in the public health sector.

• Combating misinformation and disinformation is too large a task for any one source; it requires an confluence of voices from a group of organizations and media sources that can consistently address misinformation and disinformation in a coordinated manner.

• Because large institutions can be bound by policies and procedures that limit their ability to respond to misinformation in real time, public health officials and entities (and academic institutions) should educate and communicate consistently and authentically with the public in ways that build public trust before a crisis occurs.

• Polling can be a powerful tool to understand how people with varying beliefs are interpreting information and to provide the insights needed to develop shared language that will resonate with audiences. Currently, public health practitioners have a difficult time obtaining comprehensive survey data that are valuable, credible, and include a range of perspectives (including those in hard-to-reach communities).

Funding is needed at the local level to reach vulnerable communities.

In identifying steps to be taken by the public health sector—including more representative data gathering, tailoring of messaging, and use of trusted local messengers—participants in the convening recognized that funding is essential to ensure that community-based organizations have the resources necessary to act on these recommendations.

Participants also challenged the expectation that funding of well-resourced institutions would be distributed to community-based organizations. Currently, public resources for health programs in the United States flow more easily to institutions and existing grantees with established ongoing relationships, with relatively little funding reaching implementing organizations that serve vulnerable communities and those with weaker ongoing connections with funding sources. In addition, participants observed that many local health departments are unevenly resourced. One participant noted that some county and city health departments have received limited funding for work related to COVID-19 over the past 18 months and that many are dipping into reserves until reimbursement is possible or funding is more equitably allocated.

Insights:

• It is critical to create funding streams that directly reach community-based organizations. These organizations provide a trusted voice during crises. During the COVID-19 pandemic, they may have not had sufficient access to materials, funding, or resources needed to spread their messages within communities. It is critical to engage implementing organizations that work directly with those most at risk and provide them with the necessary funding.

Crisis communications must be bidirectional.

Participants in the convening expressed concerns about the top-down nature of much of the messaging about COVID-19. They observed insufficient engagement with community-based organizations in shaping the messaging drawing on their unique insights about what their communities needed and wanted to hear, and how best to communicate with them. Participants also recognized that few community-based organizations had the resources and capacity to develop their own messaging, leading many to rely on messaging developed by others, including federal and state agencies or private sector collaborations.

In addressing these dual challenges, participants expressed that crisis communications must be bidirectional, when possible. Without the resources (and infrastructure) to allow this to happen, important perspectives are not often included in the development of communications, which limits their relevance to many communities.

Insights:

• ​​​​​​Bidirectional communications recognize the value of high-level communications coming from credible sources that can be translated for use in specific communities, while also integrating the expertise of community-based organizations. It calls for providing flexible funding that respects the ability of community-based communications practitioners to adapt high-level communications to the unique context and specific needs of their communities.

Communications infrastructure needs new or revitalized convening and coordinating bodies.

The need for a new—or at least a reconfirmed and revitalized—communications infrastructure was a recurring theme in the interviews leading up to the meeting on May 20, during the meeting itself, and in post-meeting conversations. Over the course of the conversation, it became clear that both a convening body and a coordinating body would be valuable components of that communications infrastructure.

Some participants noted the need for a centralized convening body to allow for building ongoing relationships, sharing lessons learned, and more effective coordination. Such a centralized convening body could be a facilitator of bidirectional coordination, and compile and aggregate communications materials, messaging, and best practices to the benefit of everyone.

Perspectives:

In considering the creation of a standing convening body for crisis communications, participants noted that it would be important not to reinvent the wheel but to leverage what already exists. The following were offered as examples:

• The National Association of Community Health Workers has worked with Native Ways Federation, Partners In Health, and Health Leads to develop a repository of research materials and communications materials from large and micro-community organizations.

• The Public Health Communications Collaborative (PHCC) is a landing spot where collective information (already vetted) is shared. The PHCC also works with Common Good to actively track bots across the country and on social media sites to identify, illuminate, and dispel misinformation and disinformation.

• The National Institutes of Health funds similar initiatives (e.g., Community Engagement Alliance) to build repositories of materials generated by community-based organizations.

Such a convening body could generate several benefits, including leveraging existing assets to benefit community-based organizations without the resources to develop their own, and providing a mechanism to identify and respond to misinformation in real time.

Participants acknowledged that it would take time to create such a convening body and establish its credibility to the point where people and organizations would look to it as a valued resource. The need for funding of the centralized convening body was also acknowledged.

Participants also discussed the need for a body to effectively coordinate communications, ensuring the bidirectional interaction described earlier. The following table describes the roles of the convening and coordinating bodies.

Conclusion

In many ways, the May 20 meeting of public health communications practitioners offered a snapshot of what was happening in the United States at that particular moment in the pandemic. While there was some cautious optimism that the country was approaching (or had already passed) an infection point in the progress of the pandemic, this was tempered by the realization that it was not yet over, and some communities were continuing to be disproportionately impacted in the United States and around the world.

Yet, participants in the meeting were able to identify lessons from the pandemic to strengthen the capacity of the communications practitioners in the public health sector at all levels to more effectively anticipate and respond to future public health crises. These critical conversations must continue beyond the current pandemic. They require deep engagement from organizations at all levels to ensure the public health sector is collectively prepared for future moments of inevitable but manageable crisis.

Participants

Susan Bakken
Alumni Professor of Nursing and Professor of Biomedical Informatics
Columbia University

Georges Benjamin
Executive Director
American Public Health Association

Kathleen Bennett
Associate Corporate Manager
National Association of Community Health Centers

Delores Brisbon
Senior Advisor
Historic Black Theological Schools

Brian Castrucci
President and CEO
de Beaumont Foundation

Laura DeStefano
Director of Communications
National Academy of Medicine

Abigail Echo-Hawk
Director
Urban Indian Health Institute

Monica Feit
Deputy Executive Director
Division on Behavioral and Social Science and Education
The National Academies of Sciences, Engineering, and Medicine

Baruch Fischhoff
Howard Heinz University Professor
Department of Engineering and Public Policy and Institute for Politics and Strategy
Carnegie Mellon University

Lisa Fitzpatrick
Founder and CEO
Grapevine Health

April Finnen
Senior Health Communications Specialist
U.S. Food and Drug Administration

Lori Freeman
CEO
National Association of County and City Health Officials (NACCHO)

Bill Hallman
Professor/Chair, Department of Human Ecology
Rutgers University School of Environmental and Biological Sciences

Claire Hannan
Executive Director
Association of Immunization Managers

Kathleen Hall Jamieson
Elizabeth Ware Packard Professor of Communication at the University of Pennsylvania’s Annenberg School for Communication

Kevin Kirkpatrick
Senior Executive Vice President/Principal
Metropolitan Group  

Gayle Lawn-Day
Chief Executive Officer
MHP Salud

John Lumpkin
President, Blue Cross and Blue Shield of North Carolina Foundation

David May
Chief Communications Officer
The National Academies of Sciences, Engineering, and Medicine

Alan Morgan
CEO
National Rural Health Association

Alexandra Nicholson
Senior Director
Metropolitan Group

Jenna Ogilvie
Deputy Director of Communications
National Academy of Medicine

Devona Overton
Director of Communications
Health and Medicine Division
The National Academies of Sciences, Engineering, and Medicine

Esther Pak
Communications/Media Specialist
Health and Medicine Division
The National Academies of Sciences, Engineering, and Medicine

Selena Ramkeesoon
CEO and Founder
DualStar LLC
Adjunct Professor
American University

Scott Ratzan
Founding Editor-in-Chief
Journal of Health Communication: International Perspectives
Distinguished Lecturer
Community Health and Social Sciences
CUNY School of Public Health

Holly Rhodes
Senior Program Officer
Division on Behavioral and Social Science and Education
The National Academies of Sciences, Engineering, and Medicine

Michael Schoenfeld
Vice President for Public Affairs & Government Relations and Chief Communications Officer
Duke University  

Denise Smith
Executive Director
National Association of Community Health Workers

Lynn Sokler
Senior Communication Advisor
Office of the Associate Director for Communication
U.S. Centers for Disease Control and Prevention

Erwin Tan
Director of Thought Leadership - Health, AARP

Kasisomayajula “Vish” Viswanath
Lee Kum Kee Professor of Health Communication
Department of Social and Behavioral Sciences
Harvard T. H. Chan School of Public Health

Peter Zandan
Global Vice Chairman of Hill+Knowlton Strategies

Suggested Citation

Overton, D., S. A. Ramkeesoon, K. Kirkpatrick, A. Byron, and E.S. Pak (Eds.). 2021. Lessons from the COVID-19 Crisis on Executing Communications and Engagement at the Community Level During a Health Crisis. Washington, DC: National Academies of Sciences, Engineering, and Medicine.

Digital Object Identifier

https://doi.org/10.17226/2634

Disclaimer

The views expressed in this paper are those of the authors and not necessarily of the authors’ organization, or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the National Academies. Copyright by the National Academy of Sciences. All rights reserved.