Andrew Shih, Executive Vice President, Corporate & Public Affairs at M Booth Health and Greg Amrofell, CMO at the Institute for Health Metrics and Evaluation sat down with PRovoke Media’s Aarti Shah for a podcast discussion about the media’s handling of Covid-19 and the lessons learned for public health and communications.
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Aarti Shah:
Welcome to the PRovoke Media podcast. I’m Aarti Shah. I’m Executive Editor for PRovoke Media and host for today’s episode. So today we pick up on a topic that has been dominating the news cycle right now, which is saying a lot considering the state of affairs in the U.S right now. It’s a conversation that we started at PRovoke Global last fall around fighting the infodemic, how communicators can combat the world’s epidemic of science misinformation. And because of course the situation around the pandemic is continuously evolving, we decided to revisit this topic and bring back Greg Amrofell, who’s Chief Marketing Officer at the Institute of Health Metrics and Evaluation. Greg was at our conference at PRovoke Global in October. Welcome back, Greg.
Greg Amrofell:
Thank you, Aarti. It’s great to be here.
Aarti Shah:
And we’ve also brought into the discussion, Andrew Shih, who’s Executive Vice President of Corporate and Public Affairs at M Booth Health. Welcome, Andrew.
Andrew Shih:
Aarti and Greg, great to see both of you.
Aarti Shah:
So, I guess the first place to start here is, the biggest change, or I guess there was a few big changes, but one of the big changes since we last talked about this, of course, is the vaccine has been approved for use in the U.S, and I’d love to hear your perspectives around how has that changed the conversation around trust.
Greg Amrofell:
Well, I think number one, it’s given all of us the light at the end of the tunnel. The question is how long is that tunnel, and what is it going to be like getting to the light? I think, on one level, it’s easy to be excited about that and everyone wants to believe in the end of this pandemic, but it introduced this new challenge too, because it’s not necessarily going to be an easy path. We’re already seeing this, that the rollout of the vaccine has not been straightforward so far, and that calls for vigilance while vaccines are happening, are being met with some skepticism.
So I think the messages that we’ve learned over the last year, and by the way, yesterday marked a year since China reported its first death. The lessons we’ve learned still apply that we have to really send in a strong message about vigilance. We have to have concerted belief and advocacy for that message driven by science. And that’s just not going to change between now and the time when we can safely go back to work and back to school.
Andrew Shih:
I agree with all of that. And I would add that when we think about the code of communications environment, then the only constant is change. When I think about what’s changed between when Greg was speaking at the PRovoke summit and today, in some ways the environment has changed utterly. We now see that the public debate has gone from being focused on masks and social distancing to do these vaccines work, when will these vaccines be approved, and now suddenly, it’s who should be getting these vaccines and how are they being distributed. So everything’s moving very quickly. But at the same time, I think there’s a fundamental underlying truth, which is that you’re going to wake up every morning and something will change, which I think for us as communicators is exceptionally challenging because when you’re thinking about particularly the type of science-based analysis that an organization like IHME or that the CDC is doing, those analyses take time to do.
And so you’re talking about this rapidly changing environment where you’re talking to your scientists about what their findings are, and then trying to figure out what’s the most important public health message in here, and how do we communicate it. And you need to turn that around so quickly because if you wait two weeks, that information, that guidance will be out of date. And I think that’s something that Greg and his team at IHME know extraordinarily well having seen how hard they’ve worked since frankly, the beginning of the epidemic to rapidly turn around that kind of communications. And so, it’s this rapid turnaround environment where you’re constantly trying to stay on top of the cycle.
Aarti Shah:
So, you referenced the fact that every day, the only constant is something is changing. And Greg, you had mentioned that there is this light at the end of the tunnel. But to the point that there’s constantly new information, for instance, with new strains and questioning how does the vaccine work against them at some point, or how quickly will the virus mutate so that it’s not easily dealt with a vaccine, and then of course, to your point about all the distribution questions. So with so many of these moving parts that are changing on a daily basis, is there a North star that you can rely on as public health communicators right now in order to maintain trust even as you’re having to change, and not only change what the messaging is, but also to be able to have to say, I don’t know, like we don’t know certain things at this point? Is there a fundamental tenet that you can hold onto as a public health communicator right now?
Greg Amrofell:
Look, the name of the game is saving lives and that hasn’t changed. And I think as Andrew points out, the dynamic nature of this pandemic has humbled all of us. And so, I think given that orientation to saving lives, I think it helps us underscore points that we know are proven out by science to save lives, things like wearing masks and maintaining social distance. And it also highlights for us the opportunity to say, we don’t know. Interestingly, to start this year, we’ve not been able to produce a new forecast yet of COVID because, and we’ve been honest and straight forward in communicating this because the holiday data was such a mess. And so we could have put out a forecast just to maintain our drumbeat, but we thought it could have really set the wrong expectation. And while people would love to see us provide new information, they also seemed to have that understanding that accuracy in the face of a very dynamic situation is paramount.
Aarti Shah:
So, Andrew, is there anything you wanted to add to that?
Andrew Shih:
I think Greg got at it about being honest and being humble about what we can and can’t assess, but you also, I don’t want people to overlook this. Greg, I think you raised a really important point in the initial part of your response there, which is that there are these fundamental truths about masks and social distancing to save lives that haven’t changed. So despite this incredibly dynamic environment, there are a set of core messages that responsible leaders have been communicating consistently throughout the pandemic, and that needs to continue. Because regardless of whether or not there’s a vaccine available, regardless of how widespread access to it is, as long as COVID is with us, those preventative measures like mask and social distancing are going to save lives.
Aarti Shah:
So, on that note, are you having to triage what is the most important message that you want to communicate to the public at any given moment? Because there does seem to be some amount of fatigue, right? And between the fact that wearing masks is still important, herd immunity, we don’t really know the date on when that will be achieved, the social distancing still matters, that the vaccines are safe, there’s just so many different pieces of information that you all are trying to communicate to the public, are you having to triage and say, okay, let’s focus on getting to make sure that this message resonates or are you just moving forward with all of those because they’re also important?
Greg Amrofell:
The short answer is yes, we are having to triage. We are having to decide how to focus our attention. Right now, that story continues to be on the importance of mask wearing and social distancing. We also are well aware that the public and political appetite for strong lockdowns has evaporated. So where we’re trying to get to is an articulation of the nuance lockdowns that can be most effective. And we have a lot of data to react to now. One example is school reopening that in several places, they have been able to successfully reopen schools and solve for that. So we’re evaluating the scenarios in which that can work so we can make clear recommendations by location. When we do that, we’re going to have to be very focused because it is such a complex and dynamic story. We can’t talk about the whole wide range of factors. I think we’re going to have to talk about something very particular.
Aarti Shah:
As you… Oh, go ahead.
Andrew Shih:
You mentioned your audience fatigue, and I think that it’s also fatigue amongst the media. They’ve been reporting on this pandemic and on the mitigation steps like lockdowns and social distancing for months upon months. And we all know in our business, it’s the nature of the beast to look for the next new thing and to report on the new story. So it’s very challenging to be able to consistently convey these messages to encourage these responsible protective behaviors.
And so looking at where the narrative is going and looking at ways that we can shoehorn those messages in, is something that’s commenting on what’s happening today. So when people were reporting on vaccines, okay, let’s talk about vaccines. Let’s talk about the potential impact of vaccines. Then as we’re doing that, our primary message is going to be, despite the vaccine rollout, we still need to be taking steps to protect our community.
Aarti Shah:
That’s an excellent point. So as the media maybe moves on to a different part of this pandemic story, is to sort of reiterate some of these pieces that maybe they’ve moved on from. And let’s talk specifically for a moment about social media, because as we all know, that is where a lot of this misinformation proliferates and finds audience and interaction. And what are you all doing specifically around social media in combating misinformation there?
Greg Amrofell:
I don’t know that the word combat is the right verb because going head to head with very adamant people who may or may not be informed by science hasn’t served us. I think the overall lesson we take is that we just have to stay constant. We have to keep putting out a good science, explain it as clearly and as simply as possible, and also continue to listen because sometimes the criticism we hear has fueled really important changes in our models and projections. But when we do that, that we just keep coming with new information and put it out through social media, put it out through traditional media because those channels seem to reinforce each other. And I think we’ve seen that when we do that, we can kind of outlast the less informed critics and see our influence grow.
Aarti Shah:
So one of the, looking forward, it’s like the next challenge is going to be, as people start to get their second shots and the vaccine start to take effect, there’s going to be a lot of confusion around what’s safe, what’s not, are people going to have an urge to just, like you said, drop all of these other protocols that will still be required at least for the foreseeable future. So as we start looking at folks getting their second shots and as the vaccines start to take effect, what will be the core communications messages that you want to get across?
Greg Amrofell:
I’ll take a shot at that, Andrew. I’m sure you’ve got a perspective but I would say this is still kind of a work in progress. But look, as you say, the end game here is herd immunity, which is the point at which people have either gotten a vaccine or been infected for the disease to stop spreading and effectively go away. There is a hard way to reach that and there is an easy way. The hard way is letting infections run rampant at the cost of many more lives and much suffering and much economic loss. And the easy way is to continue to protect ourselves to stay vigilant with really common sense, cost-effective measures like masks and social distancing while vaccines can reach a critical mass.
And look, I know the vaccine rollout is not going as smoothly as people hope. We take a lot of faith from the example of flu vaccine, which in the U.S reaches 180 million people over the course of about 90 days every year. There is very strong incentive for it to move faster than that with COVID. We just need to work through the kinks. So we think that can happen. We think that people should take hope from that. We know, I know I’m dying to see my friends and family. I can’t wait to hug my mom and dad, but we can stay patient for a few more months while while everyone gets vaccinated. And if it means staying at a distance and maintaining a mask wearing, that feels like a really acceptable cost.
Andrew Shih:
And I think it’s going to take a really concerted communication and public education effort to make that happen. The big public health word for this is disinhibition. When people feel that they’re at risk, that they’re threatened, they’re more likely to protect themselves to do the things that are going to keep them safe, but the less they feel that this is a crisis, that this is an urgent threat to their personal health, the more likely they are to take risks. And I think as more people become vaccinated and perhaps knock on wood, death rates start down. We may see that disinhibition.
The early part of my career was spent focusing primarily on HIV/AIDS, and I’m old enough that that was right around the period when HIV treatments were beginning to roll out and become more widely available around the world. And this was a critical issue that the HIV communications community was dealing with at the time. Everyone’s very excited about and everyone wants to talk about these amazing treatments, which is wonderful, but how do we get people to understand that they’re still at risk and they still need to take steps to protect themselves?
Andrew Shih:
One of the projects I worked on was in the early 2000s with the Bill & Melinda Gates Foundation. They saw this risk emerging that everyone was talking about HIV treatment, but no one was talking about prevention, which means more people were putting themselves at risk and being infected. And so, they funded a global HIV prevention working group, which is basically a bunch of experts that essentially just served as an advocacy in communications platform, making sure that they maintained focus on these messages about prevention, about protecting yourself. And I think we may need to see that at least here in the United States, over the coming year, as people increasingly see that, Oh, maybe this isn’t as big of a risk as it used to be. Maybe I can take more steps and be a little bit less cautious, but there’ll need to be a concerted public education effort ideally led by our government to help people recognize that they need to continue protecting themselves.
Aarti Shah:
I want to circle back on the government piece in just a second. But just closing off the vaccine, at the beginning of the pandemic, it seemed like there were largely two camps. There were the science-driven camp about washing hands and social distancing and masks, and those that wanted to defy that. But now it seems like even within the science community, there’s some conflicting, do we do fast distribution or fair distribution? What’s better? Is 70% efficacy enough? Do we do one dose like they were doing in the UK just to get the vaccine around as many people as possible or two? So what do you do when there is not necessarily a consistent message even within a science community?
Andrew Shih:
Normally, the course these things take is that these questions are addressed and answered by research within the scientific community, and then it becomes communicated more broadly. And I think what we’re seeing with COVID is that the sausage making process become public. And the media are jumping on that and they’re covering well, there’s this finding, this contradicting finding and what should people be doing? And I think one of the biggest challenges that we as a global community in the United States particularly face is that we don’t have, there’s no clear leader you can point to to give you the authoritative answer. The closest we have is Anthony Fauci. God bless his 82 year old heart.
But even still, as you said Aarti, there’s this ongoing debate about what should be the truth that people cling to, and that people recognize. And I think for those of us who are not working directly with Dr. Fauci, it’s really just a question of making sure that our own communications are based on our expert’s best understanding of what steps people should be taking and not stepping outside of our bounds. If we are not the vaccine distribution experts, that’s probably not an area where we should be putting forward expert opinion.
Aarti Shah:
So on this point about trust and the government, we have a new administration being sworn in next week. And with the Biden administration, how would you recommend that they deal with some of these issues around trust, especially in the last year when we did see some institutions like the CDC and to some degree, the FDA, that had traditionally been apolitical become politicized, how would you recommend that these institutions regain public trust?
Greg Amrofell:
I think we have to look at organizations like CDC and FDA as, to some degree, serving incredibly important and useful scientific functions, but also that their communications were built kind of in an era of broadcast TV and a few major newspapers governing the public dialogue. In an era where information proliferates on the Internet, the idea of a command and control communication infrastructure ceases to work. And so I think the role that the Biden administration can play is to insist that information flow more freely to organizations like IHME, but all the many other modelers and forecasters who are experts at making sense of the data and working very quickly and cooperatively to land on interpretations so that we can arrive at truth more quickly with flux reliance on one smart bureaucrat in Atlanta.
I think that’s some pretty good examples of how command and control approaches over the last year have really slowed down response or led to poor response efforts. So I’m hopeful that information is going to flow. And I’m also hopeful that, in a country like the U.S that represents now over a quarter of total global cases and total global deaths, that just stepping in and asserting federal leadership in coordination with governors is going to go a long way if the government can demonstrate that it is asserting leadership and following through on what it says it will do in the spirit of protecting lives and getting economy back to normal. I think that’s going to go a long way because they’re just so many different forms of sufferings people are going through that are influencing their perspective on what is true and what is not.
Andrew Shih:
And I’m optimistic that the incoming administration will recognize the importance of this kind of openness and this kind of leadership. We’re recording this podcast on January 12th, and in The New York Times today by Rochelle Walensky, who’s going to be the incoming CDC director. And it talks about this very issue about the issue of trust in CDC, trust in America’s public health officials. There are no great revelations or insights in what she writes, but it’s very reassuring to see someone who’s coming into that position who speaks very frankly about the importance of rebuilding trust.
I think unfortunately, rebuilding trust in our public health institutions and officials is going to be the work of a generation. I think we’ve seen such a crisis of mistrust and misinformation over the past year during the COVID epidemic, that rebuilding that and particularly in those parts of our society where that trust has cratered dramatically, it’s going to take a very long time and will take a consistent series of leaders who do, as Greg was saying, who do share information to openly and honestly provide clear leadership, clear vision. And to a point that we raised earlier in our discussion, are upfront about what we know and what we don’t know.
Aarti Shah:
No, I think that’s quite humbling to think about this will be the work of a generation. And one thing you all can start thinking about is, well, I’ll end this podcast with a question around what’s the key lesson learned around public health and communications for future pandemics. So don’t answer that yet, we’ll end on that, but you can start thinking about that.
One thing I do want to talk about is looking at the media a little bit more closely. And one is, are there stories in the media that you wish would be covered or covered perhaps differently than the narratives that seem to dominate? Are there any gaps in the media coverage?
Greg Amrofell:
Yeah. I can think of a few. Some of them I think are obvious. At the moment, I’m really interested in understanding what the barriers are to vaccine distribution and I feel like there’s much more to learn there. Fast versus fair is a really great characterization of that as you said earlier, Aarti. I’m interested in knowing more about what kinds of lockdowns, what sort of nuanced lockdowns can be effective during the middle stage between full-blown pandemic and reaching herd immunity, we’re going to need more vigilance what and what.
I’m also interested in understanding more explicitly the trade-offs between lockdowns and economics. And I think the press is portraying that in very short terms. So the key question is what is the long-term effect? Why is [inaudible 00:24:18] announce prevention worth the kind of cure if it means that our recovery is going to be accelerated economically? So that, I think an affordable area. And then the key question in front of all of us, media researchers, et cetera, is when will it be safe to go back to work and go back to school, and what does safety mean and how is that going to vary place by place? Because saying that the U.S has reached herd immunity isn’t going to apply if one county in one state has very low levels of vaccination, or has a lot of vaccine hesitancy.
So I think there’s going to need to be kind of a drill down from the national data to the state data, to the county data that will be really important to keep this from becoming an endemic disease.
Andrew Shih:
The news media by and large has done extraordinary work throughout this pandemic trying to digest and communicate to the public all of this very complex information. But you can tell, Greg from everything you were just saying, there’s so much more ground built to be covered. Not just because it’s interesting news stories and all of those things I think would make for very interesting good stories, but because having those investigations, those insights are actually going to prove critical for public health over the long-term.
The other to my mind, largely untold story and one that I fear is going to move larger as we get later into this year and 2022, is what does the COVID pandemic look like in the poor countries of the world. So beyond countries like the United States and in Europe, where we expect that access to vaccines will be relatively widespread, but countries with poor healthcare infrastructure that don’t have the resources to procure the vaccines in the quantity that they need. And we could be looking at a pandemic that suddenly looks again like the HIV epidemic did in the early 2000s, where there’re these gross global inequities. It seems like things may move in that direction. And if in fact that’s going to be the case, that could be the next big global health story of the next several years.
Aarti Shah:
So, thinking about diseases outside and health issues outside of COVID, I know the age, you will cover a lot of health issues, are you all having to balance attention to the pandemic while continuing to keep the public informed around other health issues in other areas?
Greg Amrofell:
Yeah, needless to say, the world’s attention is squarely on COVID, as it should be as it’s become one of the leading causes of death in many places around the world, but that’s it, right? We do have the big picture perspective on the complete set of causes of death. And so increasingly we’re [inaudible 00:27:16] COVID on a list of other issues and starting to anticipate drawing attention from the other things on that list as hopefully knock on when COVID subsides. So that’s on our minds. And then yes, we’ve had a few different moments over the last year where we’ve been able to really concentrate our attention and media attention on some other very important health issues. We were able to roll out a population forecast out to 2100 that got a lot of attention only because we really focused all of our communications on that.
Similarly, we rolled out our annual Global Burden of Disease report, and I think have started to make some headway and drawing attention to the silent pandemic of obesity and diabetes and other related issues. So I think we’re laying the groundwork for shifting attention from COVID to other things. There’s some people saying to us we should expect global health will just fall off the radar as COVID goes away. I think the opposite. I think that we have seen other proof that health is inextricably linked to economy, is inextricably linked to determinants like education and gender and race. And I think we aren’t going to have to work that hard to make the case for continued attention on leading health issues.
Aarti Shah:
That leads me to my final question here. What are the lessons learned? Greg, you just pointed out that the way that everything is connected and the fact that our public health infrastructure is so critical to all aspects of our lives, that seems like something that hopefully we’ll continue to be front and center. But as we think about the next pandemic, which I know nobody wants to be thinking about that, what are the core lessons that you have learned that can be applicable to the future?
Greg Amrofell:
Andrew, do you have thoughts?
Andrew Shih:
I think what COVID pandemic communications have reinforced to me is that the basic tenets of Public Relations 101 still hold, that the most important things are clear messages deployed consistently and repeated and repeated and repeated. And that is a fundamental truth of communications, and I think COVID has borne out how important that is. When you look at countries where the national leaders, the government leaders have used clear, consistent, strong messaging throughout, you see that the pandemic hasn’t been as bad.
In best case scenario, a country like New Zealand has very clear, consistent messages from their leaders from day one, they’re doing great. In other countries, unfortunately, including the United States, there has been mixed messaging. It’s changed frequently. It hasn’t been delivered across the board by our political leadership, had different messages from different people at different times. And as a result, people aren’t sure what to do. People are engaging in behaviors that aren’t as safe and the pandemic has gone down a much different path here.
Greg Amrofell:
I totally agree with Andrew’s point about consistent messaging. I would elaborate on that to say that we’ve learned a lot about the nature of that consistent messaging that, that communicating the story very simply is really important in order for that message to land. So, forecasting a pandemic is massively complex. If I voiced it scientific papers on the general public, I don’t think that would work. We’ve been able to communicate them in the form of very digestible visualizations that have proved effective, very effective at certain points, and in stories focused on those same messages.
I mentioned before the importance of criticism and dialogue, but also the importance of persistence. Having the courage of our convictions driven by science has been really important. And I would also say that in terms of our role assisting decision-makers, we’ve learned that having forecasts are really the ticket to ride and they have to be carefully derived. This isn’t just about dragging a cell in Microsoft Excel, it’s a lot more complex than that. But using forecasts is what decision makers really rely on. And then when you can couch forecasts in terms of scenarios that quantify and visualize the trade offs between specific options, it helps them do their job. And again, I think these are all elaborations on Andrew’s very good point that clear, consistent messages delivered repeatedly is absolutely vital in public health communication and all communication.
Aarti Shah:
Okay. One last thing I’m going to ask based on this is you talking about behavior change and how successful that was in a country like New Zealand, where people did adopt the protocols. Has there been any conversation about how we define freedom in this country and how that’s been such a challenge to behavior change? Because as we know, there’s freedom to and freedom from, and it seems like in this country we really focus on freedom to, I have the freedom to not wear a mask or whatever it might be, versus I have freedom to protect myself from disease. So has there been any conversation around that word and how that word needs to perhaps evolve in this country so that things like public health initiatives can be more successful?
Andrew Shih:
I’d be very interested to see. And I would be surprised if someone isn’t already actively looking at this, actually doing some research on that various question and how people’s different perceptions of their personal freedoms and how those freedoms are discussed. Literally, the language used. How that has informed their behaviors during this pandemic, because I think you’ve hit on a very salient point there, which is within the United States, you’re right. There is freedom to culture where it’s sort of deeply ingrained that we should have a very broad range of liberties, and we can have an entire podcast debating what those are, but that lends itself to natural pushback against guidance telling people what they should be doing. But I think you’re getting at something that’s just deeply ingrained in our culture and I’m not sure that there is an easy way to turn that around. I think it’s really just about finding the ways to communicate most effectively in that framework, just practically.
Aarti Shah:
Well, Greg and Andrew, this was a great conversation. And I think if we brought you guys back into the podcast in three months it would be a completely different conversation.
Greg Amrofell:
I think you’re right.
Aarti Shah:
So hopefully, we’ll have you all back, honestly, at some point, maybe to talk more about the herd immunity once we get closer to that. In the meantime, this is a conversation that we’ll continue to have across our editorial channels, but thank you both for making the time today.
Greg Amrofell:
That’d be great. Thanks so much.
Andrew Shih:
Thank you, Aarti.