To improve trust in public health agencies, start with a new mantra

Be the first, be fair, be credible.

This is the mantra that public health leaders follow when it comes to communicating with the public in a crisis. Although it is officially promulgated by the Federal Centers for Disease Control and Prevention, it is taught in schools of public health around the world and is a governance philosophy that permeates public health communication.

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


I propose the following: Be fair, be quick, be clear.

There are four changes behind this new mantra.


Being right is the first priority

The old mantra puts accuracy second. I believe it must be the first. In my opinion, this is just common sense. No one will listen to advice they perceive as bad or untrustworthy, and in public health, bad advice causes real harm – and repeated bad advice lowers trust, reducing the likelihood that the public will listen to good advice more late. Health agencies are full of brilliant and dedicated scientists and administrators trying to unravel unpleasant problems complicated by many uncertainties. Putting their correct results at the forefront of public health should be an easy choice.

The data on 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. On several occasions, without clearly communicating that these were the best guesses, officials said that Covid-19 could spread on surfaces, then by droplets, then by aerosols, which caused confusion.

The highly touted early epidemiological models from the University of Washington and Imperial College were easily beaten by a model created by data scientist Youyang Gu.

While public health officials often try to sound authoritative, this means being careful in stating what is known and what is not. Sometimes that means paying more attention to models and assumptions that come from non-traditional 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 asserting their true level of knowledge when talking to each other; they should also use these skills when speaking to the public.

Be quick, not necessarily the first

The new mantra replaces being first with being fast. Being the first is not always the right choice; it can cause people to rush out 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 an executive to know if they are the first because there may be other people working on the same problem, especially in the age of the internet where individual researchers can solve a problem. before an agency can confirm it.

Focusing on being first means that rushing to release a statement can miss important information that comes out days later, thus losing credibility. Plus, aiming for speed means being first most of the time. Focusing on speed instead of being first always forces public health officials to work quickly, regardless of what others are doing.

Today there are many avenues through which new information can emerge. Papers hit bioRxiv and other preprint servers before any agency has had a chance to process them, genetic sequences are published before they’re made “official”, and scientists and others debate questions. scientific, such as the value of antigen tests or even how to interpret vaccine trial results, in public on Twitter. The importance of wearing masks was 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, can be found on Nextstrain, an open-source collection of sequences managed by Trevor Bradford at the Fred Hutchinson Cancer Research Center, and the top state-based Covid tracker. States was The Covid Tracking Project, which was run by The Atlantic, a magazine, until it was shut down in March 2021.

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

The importance of clarity

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

I believe clarity should be the cornerstone of the new mantra, as it is essential for successful communication. It doesn’t matter if what is said is right or quick if no one can understand it. The public disengages from sound advice if it is not understandable or confusing. Public health officials, for example, failed to indicate that the effectiveness of Covid-19 vaccines was measured by hospitalizations, not infections, which has spawned mistrust of vaccines at this point. day.

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

A search for clarity should trigger an investment in data visualization and analysis, as visualizations help clarify things 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 security app. No public health agency has yet built a good visualization tool.

Clarity also means cutting out the noise, as Italian mayors did in March 2020 to impose lockdowns, using humorous rage to clarify what lockdown meant to anxious citizens. Being clear also requires consistency, which means making sure public health officials are saying the same thing. This 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 the number of recommendations. But leaders should at least be in tune with the advice of their own agencies.

The difficulty with clarity is that public health issues are often plagued with uncertainty. Human health is a complicated beast with many caveats and details, and in a crisis, experts have only partial information at best. Scientists often debate science in public and produce conflicting papers in the process, so deciding which viewpoints to support adds to the challenge.

Clarity helps openness by requiring officials to state what they know and don’t know, and how they know it. In public finance, for example, it is common for officials to express their confidence in a public announcement. The Federal Reserve even publishes a “dot chart” of its interest rate forecasts; it helps rather than hurts their communications.

Clarity, however, should not come at the expense of suppressing important information. As Albert Einstein once suggested, it is important to present an idea as simple as possible, but not simpler.

Credibility gets the ax

Credibility, although third on the old list, is in practice usually put first. Indeed, as public health officials know, if you’re not credible, it doesn’t matter what you say. But with believability, the tail often ends up wagging the dog.

The most significant danger is that credibility is often confused with infallibility, so public health officials may be slow to admit errors or advice based on incomplete and changing data, undermining their credibility. . In other words, actions taken only to build credibility often end up hurting it.

Although credibility is important, it is a result of good communication, not a target for her. Successful public health communication leads to credibility because it is reliable and effective. The best and most enduring trust is earned through a track record of success. If the official advice is generally correct, delivered quickly and easy to understand, it will be credible without further manipulation to manufacture credibility.

Life science workers can contribute to public health communication

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

Life science workers have the skills to be translators between the scientific community and the public. Using the principles of being right, being quick, and being clear, they can be extensions of public health officials. Even after the pandemic recedes and other public health issues take center stage, life science 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 exceptional and hardworking people. The new mantra for public health communication that I propose is a praise of their efforts; their genius and hard work deserve only the most targeted operational 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.