Four communication lessons we learned the hard way during the pandemic

Now that the Covid-19 public health emergency has ended, it’s awfully tempting to put the pandemic firmly behind us. But now is the time to look at what we have learned so that our public health communication can be more clear, consistent, and effective from now on.

One thing that we haven’t talked about enough is the victories.

While the media often focused on bad actors, in reality vast majorities of Americans got the message and changed their behavior to follow public health guidance. You can see this by looking at data from the Rockefeller Foundation, where I work. We commissioned Hattaway Communications to conduct tracking surveys from August 2020 to February 2022 to gauge Americans’ attitudes on a wide range of Covid-19 actions, including vaccinations, testing, masking, and social distancing. In all of those surveys, majorities of Americans said they were “very willing” to take these actions. And more than 270 million Americans — over 80% of the population — have received at least one Covid vaccination shot.

These shifts represent real, dramatic behavior change. When you consider that some of these behaviors, like masking or social distancing, were close to zero pre-pandemic, that means we’ve moved the needle more than 50 percentage points.

I’ve been working in public health long enough to recall when getting a behavior change of 10 or even just 5 percentage points was a huge victory. For example, smoking causes 1 of 5 U.S. deaths each year and costs the U.S. $600 billion in health care and lost productivity costs annually. Any public health official would agree that the significant reduction in smoking rates over the past several decades is a big victory, yet overall smoking rates U.S. adults declined by only 9 percentage points from 2005 to 2020. That’s 15 years.

While our pandemic behavior changes are big accomplishments, it’s undeniable that communication has also at times been confusing, inconsistent, or ineffective. Here are four clear lessons the public health community should take with us to help ensure our messages connect with our audience.

1. Don’t assume science is enough.

We put tremendous resources nationally toward scientific research on the virus and how to combat it, but communicating the results of that research in a clear and simple way seemed to elude us. While we were intently focused on what was done under the microscope, we should have invested more on what’s said behind the microphone. The U.S. government and public health field created many of our own communications hurdles, starting with the about-face on masking. Another good example of this was the emphasis on the speed of vaccine development. Even the name “Operation Warp Speed” planted seeds of doubt that undermined our vaccination efforts.

Scientifically, the vaccines were miracles, but the Rockefeller Foundation’s tracking survey found that 4 in 10 people were concerned that they were developed too quickly. Clearer communication around vaccine development would have helped people understand and have confidence in the safety of the vaccines.

2. Reliable messengers matter.

As the pandemic rapidly evolved, clear messaging failed to change with it. The jargon that the public health community used was confusing and unclear to the public. Our surveys found over 70% of people were frustrated by guidance on when to wear a mask, who should get vaccinated, and what to do if you tested positive — some of the basic actions we were being asked to take. In time, people turned away from public health and elected leaders and relied more and more on their own judgment.

To address this, the Rockefeller Foundation tested a new system for local outreach and communication: the Equity First Vaccination Initiative. A key facet of that work was to support and empower trusted local messengers to provide timely high-quality data and messages directly to communities. This led to significant increases in vaccination among target communities, even as overall vaccine uptake rates declined.

3. Tested messaging matters.

Because the Rockefeller Foundation realized the importance of good messaging early on, we invested in our ongoing tracking survey (and a dedicated community of practice to help public health communicators engage and learn from each other) to provide public health leaders with message insights based on real-world findings, not media reports or the public health echo chamber.

By testing messages that reflected what was going on in the pandemic as it evolved, we ensured that health communicators had smart, real-time insight. As just one example, we were able to show that sweepstakes and lotteries to encourage vaccination made for great headlines, but not great vaccine uptake: 44% of people said they didn’t need any incentive to get vaccinated. In fact, a driving factor for many people was the ability to socialize with friends and family.

4. An achievable call to action matters.

Public health guidance has to be actionable to be effective. For instance, during the pandemic, health leaders urged symptomatic people to get tested — even when tests were scarce and difficult (if not impossible) to get. Words weren’t enough; what was really needed were creative solutions to put tests in people’s hands.

This led us to work with states to create programs like Project Act, a bespoke purchasing and delivery system for state public health departments. Project Act — still active today — has delivered millions of free Covid tests directly to highly vulnerable people. And it’s an efficient and highly effective system that can be repurposed for future public health needs far after this pandemic is officially over.

While we don’t like to think about it, another pandemic is likely — and I hope that we’ll be able to recall these critical lessons as we navigate communications challenges in the confusing early days and in the roll out of lifesaving public health measures.

Estelle Willie is director of health policy and communications for the Rockefeller Foundation.

Correction: A previous version of this essay misstated the decline in smoking rates among U.S. adults.