Risk communication and community engagement to manage public sentiment and response across stakeholder groups

Setting the context

Why is effective public engagement crucial during a pandemic?

Risk Communication and Community Engagement[80] (RCCE) is integral to the success of responses to health emergencies[81]. When done well, it has been observed to be a vital means of informing and guiding the public during the COVID-19 pandemic.

RCCE supports national governments, national health authorities, regional and local governments and community engagement staff to develop, consistently implement and effectively monitor the impact of a communications plan. It is vital to effective communication with the public and successful engagement of local communities and other stakeholders in order to protect public health during the pandemic[82].

COVID-19 and previous health emergencies such as SARS, MERS and Ebola have placed the public within situations of great uncertainty. RCCE addresses this uncertainty by rectifying the knowledge gap between the originators of information and the public. An effective RCCE response facilitates the conversations between government agencies and the public to reduce anxiety, increase trust and guide recipients of information to make better decisions. 

RCCE has the highest impact in the early stage of a pandemic when uncertainty is rife and the demand for information is at its highest, but it is a critical tool throughout recovery and rebuilding as well. The RCCE ensures that all members of the public are made aware of the risks surrounding the epidemic and understand their role and responsibility in slowing the spread of the virus until a vaccine or treatments become readily available. 

A well-executed RCCE plan: 

  • Demystifies the fear surrounding the epidemic: Through proactively updating the general public with timely, accurate information with the objective of saving lives and minimising adverse consequences. 
  • Prevents the spread of misinformation, builds trust in the response and increases the probability that health advice is followed: Through minimising and managing false rumours and misunderstanding, which undermine responses and may lead to further spread of the virus.  
  • Ensures the protection of all segments of society: Through frequent communication and engagement with the public and at-risk populations to alleviate confusion and misunderstanding.
  • Synchronises community engagement staff, authorities and official spokespersons with accurate information at all levels: Through transforming and delivering complex scientific knowledge in a form which is understood by, accessible to, and trusted by the public.
  • Actively involves communities in slowing the spread of the virus: Through communicating individual and group protective measures.
  • Enables all the other COVID-19 interventions: Through RCCE, which is essential for surveillance, lockdown co-operation and enforcement, case reporting, contact tracing, caring for the at-risk, and gathering local support for any logistical or operational needs of the response.

Key findings from the analysis

Providing prompt, accurate and coordinated information that is tailored to the local context of the epidemic is essential 

Key Finding 1:  Centrally coordinating RCCE efforts ensures higher compliance with government COVID-19 interventions and lowers infection rates.

  • Countries without coordinated RCCE strategy erode the public’s trust toward relevant institutions and risk lower compliance rates to COVID-19 interventions.
  • “Infodemics’ (misinformation about the pandemic) are harder to manage without a coordinated RCCE plan.
  • Countries with coordinated RCCE plans can engage minority communities more efficiently, thus communicating COVID-19 interventions to a larger portion of the public.
  • Countries such as Malaysia and Australia have benefitted greatly from having coordinated RCCE plans.
  • Communication needs to be tailored to the local context based on the stage of the epidemic in specific locations within the country.

COVID-19 has placed the global community in an environment with high levels of uncertainty. Thus, it is imperative for governments to demonstrate a coordinated and unified front during the pandemic. To the public, this is evidenced through unified messaging from the government to its citizens. 

According to Scott Green, a political scientist from the University of Michigan who studied the response to the 2014 Ebola epidemic, the most effective practice for communications during pandemics is the existence of a central message behind every RCCE plan[83].

A centralised and coordinated response is enabled by the fulfilment of the following RCCE guidelines[84]: 

  1. Establishing a Risk Communication System
  • Ensuring that the highest levels of government agree to include the RCCE in preparedness and response activities. 
  • Ensuring that highest levels of government are participating in the information communication exercise. 
  • Agreeing on procedures for the timely release of information such as clearance procedures for messages across platforms. 
  • Setting up a centralised RCCE team with defined roles and responsibilities.  

  1. Internal and Partner Coordination 
  • Identifying partners within relevant agencies, organisations, community planners and other stakeholders. 
  • Assessment of the communication capacity for all relevant partners through identification of typical target audiences and channels of communications. 
  • Setting communication roles and responsibilities through SOPs (e.g. assigning agencies to specific issues, assigning specific topics and audiences to a partner and coordinating the alignment of messaging).

  1. Public Communication 
  • Reviewing and selecting the roster of spokespeople at all levels and, if necessary, training selected representatives in public communication. 
  • Identification of media partners, communication channels and influencers to assess their potential reach for the target audiences (i.e. ideally only trusted and regularly-consulted channels and influencers can be considered).
  • Identification of key media, creating an updated list of journalists and media relations.
  • Identification of the specific messaging in communication campaigns and deciding the frequency of communication to the public. 

  1. Communication engagement with affected communities 
  • Establishing methods for understanding the concerns, attitudes and beliefs of key audiences. 
  • Identification of target audiences and gathering information on their knowledge and behaviours (e.g. likely channels of information, concerns relevant to the community, etc.). 
  • Identify existing influencers within the community capable of bridging cultural and linguistic barriers (e.g. community leaders, religious leaders, health workers) and networks (e.g. women’s groups, community health volunteers, unions, etc.). 

  1. Addressing uncertainty, perceptions and misinformation management 
  • Establishing a system for monitoring and responding to rumours, misinformation and frequently asked questions. 

  1. Capacity Building 
  • If required, train the RCCE engagement staff on key information regarding COVID-19 and current plans and procedures for the RCCE plan. 

An effective RCCE plan requires two broad categories of centralisation: First, the centralisation of information which entails storing all the latest COVID-19 information on a single platform and/or identifying the parties in possession of all relevant COVID-19 information and updates. The second is the centralisation of alignment on key messages. 

The centralisation of information allows for community engagement staff at all levels to access the latest COVID-19 information, thus ensuring the accuracy of data communicated to their respective stakeholders. Centralising information also eases the establishment of an information repository available to the public. This empowers the public to fact-check information independently, a key method of battling misinformation. Australia is among the notable countries to have utilised the centralisation of information in their COVID-19 communication interventions. 

The centralisation of key messaging ensures that the instructions for and perceived severity of COVID-19 in each country are communicated effectively to the public. Malaysia has made notable strides in ensuring the uniformity of its key messaging in COVID-19 communications across all parties, which has enabled the high compliance rates to COVID-19 interventions in the country, such as the Movement Control Order (MCO), a 49-day lockdown imposed on its citizens. 

Effective Practice Case Study: Australia 

Centralising information and coordinating communication for the wide dissemination of COVID-19 interventions to the public

Australia was highly successful in ‘flattening the curve’ in the first wave of the pandemic. The country ranked first in terms of recovery in the GCI as of 17 May 2020. Whilst recent outbreaks have caused concerns around the country’s response, there is much we can learn from their successful communication strategy in the early stages of the recovery.

In Australia, state and territory governments are mainly responsible for health matters. When major health issues such as the COVID-19 pandemic affects the country, these governments work together with the Australian government to share information and ensure that the response is consistent and integrated across the country. 

The response for the country is coordinated by the Australian Health Protection Principal Committee (AHPPC) which is made up of chief health officers from each state and territory, the chief medical officer and representatives from key departments[85]. 

In terms of centralising information and coordinating communication, the Australian government takes the stance that the government itself should always be the authoritative source of truth during a national emergency. If the information is fragmented or not easily discoverable, then the government will struggle to control the national narrative. 

Coordinating communication is enabled by centralising information. The current practice in Australia is to create a single source of genuine data and information on one site. In facing the COVID-19 crisis, the existing Australian government portal (Australia.gov.au), which is a pre-existing static site which guides users to navigate across all government portfolios, has been transformed for this purpose. 

The Australian government portal has been completely revamped and rebranded as the central portal to bring together federal government agency measures and information. The portal is the central repository for all information including health and safety updates, income support and business safety measures[86].

To guide the public into viewing the portal as the single source of accurate COVID-19 information, all television, radio, print and digital marketing news on COVID-19 now sends users to the portal. The portal springboards into multiple links and sites which encompass the broad sweep of measures and announcements across the 14 portfolios within the Australian government. 

The government has also utilised Google and its official Facebook, Instagram and Twitter pages to direct the public towards the Australian government portal as the official sovereign website. 

Australia’s communication to the public consists of the following information points: 

  • What the government knows about the disease and the outbreak 
  • The risk that COVID-19 represents 
  • Actions taken by the Australian government’s health sectors in response to the pandemic 
  • How the public can contribute to ‘flatten the curve’
  • How the public can manage their own risk and the risk to their family and communities (in English and 69 other languages spoken by minority communities) 
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Figure 52: Active cases vs new cases – Australia

Highlights

  • As of 24 July 2020, Australia has recorded 13,595 cases and 139 deaths.
  • Australia has made a concerted effort to centralise its information repositories. COVID-19 statistics and responses across all Australian states and territories can be found on the portal.
  • Key responses are formulated upon the feedback from individual states and territories. Despite case numbers varying across regions, the response adopted by Australians was kept uniform across the locations.
  • While coordinated information gathering, centralisation and communication cannot be attributed as the sole reason behind Australia’s quick ‘flattening of the curve’, the coordination has allowed for the collective response (including interventions and key messaging adopted in campaigns) taken by the Australian government to address the concerns and needs of its citizens in real time.

Key Finding 2: Centrally coordinating information and key narratives provides cohesion to the overall response of a nation. This allows the key messages communicated to the public to be tailored accordingly to the severity of the outbreaks.

  • Effective communication is tailored to the local context and to the stage of the epidemic in specific locations within a country
  • Without a coordinated message in response to COVID-19, differing responses across states and territories may lead to confusion and distrust among the public.

As the pandemic evolves through the stages of the ‘curve’, the messaging communicated by governments and public health officials must evolve with it. A staged communication approach helps provide individuals, families and communities with clear messages and instructions on how to minimise the risks and support family and community members. 

Anchored on the key message identified by the government and guided by accurate COVID-19 data and information, the messages can be phased over the course of the pandemic[87], depending on the situation. 

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Figure 53: Phases of communication according to the number of cases over time

Stage 1 – Preparedness: Stage one is deployed when there are no or low numbers of COVID-19 cases in a country. They key objectives of this stage are to:

  • Raise awareness about COVID-19. 
  • Communicate the status of cases in the country and what is known and unknown about the nature of the virus. 
  • Educate the public about steps which can be taken to protect themselves, their families and their communities to slow the spread of the virus. 
  • Inform people about the preparedness of the country to face the pandemic and acknowledge challenges. 
  • Establish a source of reliable, trusted and timely information.
  • Express empathy in order to build public trust.

Stage 2 – Containment: While facing an increasing number of cases, the objectives of this stage are to: 

  • Introduce social distancing and explain what it is (including specificity in terms of the distance required between individuals) and why it is important. 
  • Motivate the public to stay home. Clarify early that they will be allowed to go out for essential tasks to avoid panic buying.
  • Build acceptance of measures including the closure of entertainment facilities, places of worship, workplaces, etc. 
  • Educate the public about symptoms, and the procedures involved if someone is suspected of having COVID-19. 
  • Inform the public of screening procedures which will be in place at health facilities. 
  • De-stigmatise the perception of COVID-19 patients by establishing their humanity and emphasising a sense of community in order to encourage people to get tested.
  • Build a sense of community and solidarity to deepen public commitment to staying at home. 

Stage 3 – Mitigation During the Crisis: At the peak of the pandemic ‘curve’: 

  • Educate and inform the public on the government’s response and explain the need for the interventions that have been adopted.
  • Develop methods for communities to provide feedback to the government.
  • Provide timelines for decision-making wherever possible.
  • Manage fear and stigma through reminding the public of public health and social measures which, if adopted, will minimise risk. 
  • Reinforce the need for social cohesion and unity in dealing with the pandemic and remind the public that the measures instituted are for the protection of public health during the crisis. 
  • Acknowledge the community’s efforts to prevent the spread of the virus, including healthcare workers and other essential workers.
  • Balance the news of increase in cases with positive stories of successful recoveries. Messages which focus exclusively on the negative may disempower communities. 

Stage 4 – Suppression:

  • Communicate the importance of continued adherence to public health and social measures. As the number of cases decreases, people may stop following public health and social measures. Reminders of the measures are required.
  • Explain that some measures may be in place until effective treatments are found and tested. 

Stage 5 – Recovery: 

  • Communicate to the public that the crisis point has passed, and the country may be allowed to reopen gradually. 
  • Explain the phased concept of reopening the economy. 
  • Explain government decisions to prioritise the reopening of critical entities based on societal benefit such as childcare or certain religious sites under strict safety measures.
  • Explain that measures may need to be re-imposed if the number of cases begins to rise again. 

Stage 6 – Prepare for and manage re-emergence: 

  • Educate the public of the possibility of re-emergence of the pandemic in the country. 
  • Support the re-implementation of public health and social measures if required.

Effective Practice Case Study: Malaysia 

Evolving the key messaging used in campaigns according to the number of cases over time helped manage COVID-19 anxiety and increase compliance rates

The key messaging for COVID-19 campaigns is centralised by the government of Malaysia under the advice and instruction of the Malaysian Ministry of Health. 

Stage 1

Communications regarding COVID-19 cases began on 25 January, as the country recorded its first case of the virus. While reported cases remained relatively low and confined to imported cases, the Director-General of Health in the Malaysian Ministry of Health began communicating facts and updates about the COVID-19 disease via press releases and the Ministry’s official Twitter and Facebook pages. 

In response to the increasing trend of COVID-19 cases in Malaysia and the sharp spike in cases from 42 on 15 March 2020 to 186 cases on 16 March 2020, the Malaysian Prime Minister made an official speech through live national broadcast to announce the country’s MCO on 18 March 2020. 

Stage 2

In the Prime Minister’s speech, the key message was that the government of Malaysia was genuinely concerned about the nature of COVID-19 and the risk it posed to its people, and thus the country would be deploying ‘drastic’ measures to break the chain of infections and flatten the curve.  

Key Points in the Prime Minister’s Speech[88]

  • COVID-19 had spread to a total of 135 at the date of the speech, and had cost the lives of 6,443 people worldwide.
  • Malaysia’s cases had been increasing, at that time, 511 people being treated for the virus in the country.
  • The leadership was also concerned about a possible second wave of infections, and, to stem the spread of the virus, decided to enforce the ‘drastic’ measure of the MCO which encompassed 6 key actions: 
  1. The prohibition of mass gatherings including religious gatherings 
  2. The closure of borders and cancellation of all outgoing flights and requirement for a 14-day self-quarantine for those who have just returned to the country
  3. The prohibition of all incoming flights and non-citizens entering the country 
  4. The closure of all pre-school, primary, and secondary day and boarding schools
  5. The closure of all private and public tertiary institutions
  6. The closure of all private and government office buildings except for essential services 
  • While the government was sympathetic to the lives which would be disrupted, speed was seen as essential in ensuring lives were not lost to the virus. Other countries such as China had adopted MCOs with success in breaking the chain of infections. 
  • The relevant ministries such as the Ministry of Domestic Trade and Consumer Affairs would monitor the supply of goods, and the National Security Council chaired by the Prime Minister would meet every day in order to monitor and control the COVID-19 situation. 
  • The Prime Minister announced a national operations hotline for all MCO inquiries. 

The Malaysian federal government set the key message for the nation: COVID-19 is a serious threat to our health and security and should be taken seriously. This message was received as an order by all state governments, and private and public sector organisations. This led to the general Malaysian public understanding the severity of the situation and abiding by the MCO. 

The speech was also used as a foundation for the Malaysian National Fatwa Council to announce the adjournment of all religious activities in mosques, including Friday prayers. This was a large step considering 61.3 per cent of all Malaysians are Muslim. In countries with a similarly large group of adherents to any religion which requires mass prayer sessions, controlling mass gatherings has proven to be a challenge without the support of religious institutions. 

Stage 3

At the peak of the pandemic, the Director-General of Health continued to deliver addresses in order to remind the public of the importance of their adherence to the public health and social measures[89]. Changes to the interventions, such as extension to the MCO or tightening of restrictions were announced bi-weekly. The date for the next public address would be communicated at the end of the current address. As of 4 April 2020, after the second extension to the MCO, compliance rates were at 99 per cent. [90]

The centralisation of key messaging in Malaysia also streamlined the communication efforts deployed by the federal government and its communication partners at various levels. COVID-19 updates and key information were disseminated to the general public through the following process: 

  • Malaysians received daily COVID-19 statistics from the Ministry of Health, delivered by the Director-General of Health on the nation’s cumulative number of COVID-19 cases and deaths, number of recoveries, number of new infections and deaths, information on ‘red zones’ within the country and reminders to practice COVID-19 safety precautions.

  • All information regarding current or additional COVID-19 safety information such as the closing of state borders, curfews, and SOPs for travel would be delivered after the speech from the Ministry of Health by the Malaysian Minister of Defence.

  • Key points from both speeches were published on the Ministry of Health’s official Twitter and Facebook pages (the two most-subscribed-to social media platforms in Malaysia).[91]

  • Daily text message blasts are sent out to all Malaysians owning a mobile phone to communicate key points from the Minister of Defence’s speech.

  • General COVID-19 information was also published on the Malaysian government’s COVID-19 microsite.[92] The microsite directs users to the official Ministry of Health Portal which contains daily COVID-19 statistics and the official Facebook page for the Ministry of Health’s Crisis Preparedness and Response Centre (CPRC).

  • This information is picked up by national newspapers and published in print and digitally for public consumption. 

  • Media partners such as telecommunications (e.g. Celcom) and major private sector partners (e.g. Grab) also disseminate information through their mobile apps. 

Campaigns which called for support for frontline workers were also launched to encourage a sense of community and protection over essential workers. Medical health professionals in Malaysia made viral their ‘I stay at work for you, you stay home for us’[93] message and the civil society created the ‘#KitaJagaKita’ or ‘we look after each other’ campaign as a ‘one-stop shop’ that mobilised community COVID-19 efforts and also generated a sense of solidarity and camaraderie among the people. The latter has since garnered 1.2 million mentions on Instagram as of 1 June 2020. 

Stage 4

Centralisation of key messaging allowed for Malaysia’s COVID-19 spread to remain relatively stable after its 49-day MCO was eased to the Conditional Movement Control Order (CMCO). 

Any divergence from the CMCO instructions were from state governments, which added additional safety and precautionary conditions according to the severity of infection rates in the states. Ultimately, the various levels of leadership were guided by a central body. 

The communication adopted in the states with higher infection rates involved warning the residents in the area of the impact of being too relaxed. [94] As several major ‘hotspots’ were also home to the Bottom 40 per cent (B40) communities in the country, the government deployed communications which sympathised with their situation, and reminded them that the measures in place would ensure the restarting of the economy and their livelihoods without seeing a resurgence in cases.

Stage 5 

As Malaysians adapt to the ‘new normal’ business conditions under the CMCO, public health officials have reminded the public that while it is considered safe to conduct business under the ‘new normal’, reopening the economy too quickly risks a resurgence in cases.[95]

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Figure 54: Active cases vs new cases – Malaysia

Highlights

  • Malaysia’s centralisation of its key messaging made the government’s stance against COVID-19 clear. 
  • The central coordination of its communication efforts made it clear that its Ministry of Health prioritises the health of the public, and the federal government and Ministry of Defence worked with the Ministry of Health to flatten the curve. This led to higher understanding and acceptance rates of the MCO and other safety interventions in Malaysia.  
  • Malaysia’s communication efforts included: explaining its rationale for interventions, communicating basic health and safety practices (e.g. social distancing by ensuring 1 metre between individuals and the importance of washing hands), sending clear and consistent (daily) messages to the public and engaging the community through its #JustStayHome campaign.
  • The central coordination of information has distinguished the Ministry of Health as the sole source of current and accurate information on the state of COVID-19 in the country. The federal government microsite, which directed users towards the Ministry of Health portal, further solidified this. 
  • The streamlining of communication efforts and information has empowered the Ministry of Health and multiple parties to disseminate information through traditional media (television, radio, print) and digital campaigns (government portals, social media, text messages).
  • The central coordination of updates and information has allowed for the public to understand the possible legal and health repercussions of non-compliance with government instructions.

Case Study: The United States of America

If RCCE communications and narratives are uncoordinated, the conflict in messaging and instructions undermines trust and reduces adherence to COVID-19 interventions

According to the WHO, good communication helps manage individuals’ expectations and fears[96], thus increasing compliance to COVID-19 health and safety interventions. If communications during pandemics are managed poorly, the result is an erosion of trust within the public, which in turn impacts its compliance to COVID-19 interventions. 

In the US, communications during the pandemic response have been fragmented.

Unlike the federal government of Australia, which has provided an overarching view of the COVID-19 situation and response across states, the US has yet to establish a similar mechanism. 

Conflicting views have been expressed at federal and state levels. 

As the US federal government has attempted to coordinate the response of COVID-19 by releasing a set of guidelines[97] of effective practices, there appears to be an absence of a mechanism to achieve the following: 

  • Compile and organise COVID-19 facts based on sound science 
  • Align differing viewpoints 
  • Appoint appropriate spokespeople to address updates, risks and address community concerns across various levels of the public
  • Ensure all recommendations and directives are based on the latest statistics and scientific suggestions 

The four points above are the key steps to establish an RCCE plan according to the RCCE Guidelines released by the WHO. [98]

According to its former director, Tom Frieden, the US Centers for Disease Control and Prevention (CDC) has taken the central role in every public health emergency since its inception 75 years ago in 1945. However, they are not playing that role in this pandemic. While the CDC was represented on the White House’s coronavirus task force[99] various other members of the task force took on the role of informing the public – and the task force has since discontinued this role. [100]

The federal government uses its centralised website (https://www.usa.gov/coronavirus) to direct citizens to different agencies and their individual responses. The absence of a central body to coordinate communication and information has left local mayors and politicians to lead communication efforts in their respective constituencies. As a result, the President of the US, various state and local officials and public health authorities have delivered conflicting messages[101]. The differences in their key messaging ranges from indifference to alarm, which impacts the policy decisions adopted in their constituencies during the crisis. 



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Figure 56: Excerpt from NBC News on impact of conflicting instructions at various levels of communication

While public health officials and the CDC field detailed questions about what is scientifically known and what is not, political conflict over the degree of threat and the appropriate response have caused confusion.

For instance, on 25 March 2020, the White House indicated that the public might return to work as early as Easter of the same year[102]. This statement was directly in contrast to the science-based outlook communicated by federal public health authorities who had stated that social distancing might need to last for several months in order to halt the spread of the disease and protect human life. 

Amongst politicians, differing attitudes towards COVID-19 are partly a result of the varying severity of case levels in each state. Additionally, in the absence of federal-level mandatory instruction, some governors who typically hold powers to shut businesses and enforce curfews are reluctant to invoke their powers without clear national direction.[103]

New York, which was the first epicentre of COVID-19 cases in the US has seen its governor take a stricter stance against COVID-19, reflected in his frequent communications on the state of COVID-19 in New York: 

  • At the peak of infections in New York, the governor warned his constituents that 80 per cent of his state could contract COVID-19 unless actions were taken.
  • The governor has declared that while stakes are high in New York, expert scientific opinion is more valuable than political opinion and employed two international experts in epidemiology on New York’s progress and metrics in the face of COVID-19. 
  • The governor provided daily COVID-19 updates to the citizens of New York for 111 straight days, reducing the frequency only after the epidemic came under control.[104]

By contrast, the governor from the State of Florida delayed ordering a state-wide ban of beaches and public facilities, and reopened his state earlier than most others. He was quoted to be unwilling to cross the tourism industry players in the state. Other state and local leaders have faced similar pressures. The result is that the pandemic has taken different courses in different parts of the country, with outbreaks peaking at different times in different places.[105]

The multiplicity in narratives against COVID-19 and the lack of centralised information on the current situation also led to difficulties in engaging the minority communities in the US. Translating COVID-19 resources has been challenging as instructions are frequently changed and often conflicting. This has contributed to the rise of infection rates within these communities.[106]

As a result of the conflicting messaging, polls[107] in the US have shown that Americans trust the measured, fact-based communications of public health institutions for their information more than they do the federal government. A CBS[108] poll from 24 March 2020 also found that respondents trusted health authorities (doctors and nurses – 88 per cent; the CDC – 82 per cent) more than the president (44 per cent) to deliver accurate COVID-19 information. 

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Figure 57: Active cases vs new cases – United States of America

Highlights

  • The US recorded its first case on 19 January 2020. The US registered its highest number of daily cases on 24 April, recording 48,529 cases, and is the only country so far to record more than two million COVID-19 cases.
  • The need for a centralised information repository where all citizens can receive an overarching view of countrywide statistics and measures is essential to allay misinformation. 
  • The need for a centralised communication plan and messaging is required to avoid conflicting messages and eroding public trust. 
  • Directives should be science-based. When the answer is uncertain, it is better for spokespeople to admit to uncertainty, allowing people to take precautions and prepare for possible outcomes. 
  • Politicians can be excellent spokespeople. However, the messages and instructions they deliver should be guided by public health experts and coordinated across multiple levels of government. 
  • Spokespeople need to offer clarity of message, transparency and honesty. 

Understanding how the public consumes information dictates the type of communication campaigns deployed and helps to manage misinformation and rumours 

Key Finding 3: The medium of communication matters as much as the content communicated in ensuring awareness and compliance to COVID-19 health and safety measures

  • During crisis, the need for information increases rapidly. Tools used to communicate to the public should be those with high reach and rapid news cycles in the country (e.g. television, radio or social media).
  • The frequency of press briefings needs to be daily in order to deliver latest COVID-19 statistics and responses to address community concerns, and dispel misinformation.
  • The information sources in each country (federal government, Ministry of Health, public health experts) play an important role in supporting news sources with accurate information in order to avoid extensive misinformation.

Traditional media campaigns have been deployed over decades in response to various health emergencies. With increasing internet connectivity around the world, information which was previously only accessible through traditional media and official press conferences from the government is now readily available online. 

Having awareness and recognising the various modes of communication utilised by the public is a key factor in developing a RCCE plan. While some countries with low mobile penetration and basic communications infrastructure may rely on traditional media channels, digital campaigns may prove worthwhile for countries with connected users and high mobile penetration rates. The adoption of digital campaigns in the former enables the government to reach a wider public population not covered by traditional media campaigns. 

Traditional media campaigns encompass the following mediums: 

  • Television broadcast: Enables rapid news cycles
  • Radio broadcast: Enables rapid news cycles
  • Newspaper and print advertisements: Utilised for general COVID-19 awareness, precautions and reminders
  • Posters and billboards: Utilised for general COVID-19 awareness, precautions and reminders

Countries embracing digital communication campaigns have also utilised the following methods and mediums: 

  • Existing government portals 
  • Newly established COVID-19 portals or microsites 
  • Countrywide text alerts
  • E-mail updates and alerts 
  • Social media platforms such as Facebook, Twitter and Instagram
  • Social influencers 

All forms of digital communication mediums are capable of rapid news updates. However, the reach of the platforms matters as much as frequency of news updates when determining efficacy. Consistency is essential. 

Considerations for Digital Campaigns 

Whilst digital campaigns may require less budget to execute depending on communication channels used, they require just as much planning and effort as conventional media campaigns. Consistency across the different channels of communication is fundamental.

Another consideration is that some countries lack the financial and human resource capabilities to efficiently develop digital tools that can support people during a crisis. To circumvent this, some countries have begun building partnerships with private and international technology companies to meet the needs of people and soften the impact of the COVID-19 epidemic on their lives. 

For instance, the US government issued a Call to Action (CTA) to key industry stakeholders and artificial intelligence experts to develop new text on data mining techniques that can help the scientific community answer high-priority questions related to COVID-19. [109]

Effective Practice Case Study: Vietnam

Developing a COVID-19 digital communication campaign to ensure higher compliance rates to health and safety interventions

Vietnam has one of the most successful COVID-19 responses in Southeast Asia so far. Unlike its Association of Southeast Asian Nations (ASEAN) counterpart South Korea, which has spent a considerable amount on testing, or Singapore, which has established strong epidemiological surveillance, Vietnam has followed an economical approach which, when combined with a strong communication campaign, has been effective in maintaining a strong recovery to COVID-19.

 

In line with its developing economy, Vietnam’s ICT infrastructure has also grown. In 2019, Vietnam saw both of its fixed-line and mobile broadband services penetration grow, together with smartphone penetration. Even though Vietnam is one of the last of Southeast Asia’s larger economies to roll out 4G, its Ministry of Information and Communications has prioritised and encouraged the development of broadband infrastructure, which includes the fast completion of 4G network coverage and the early rollout of 5G.

Due to its increased connectivity, 65 per cent of Vietnam’s population are online[110]. Despite its growing economy and digital population, the Communist Party retains a strong hold on the media and the state controls all print and broadcast outlets. Though there are myriads of newspapers and magazines, the Communist Party, government bodies and the military own or control almost all of them.[111]

Bloggers and citizen journalists are the only sources of independent news. However, material deemed to threaten Communist rule, including political dissent, is blocked. In Vietnam, official news outlets and social media channels have been communicating information about COVID-19 consistently. 

To get ahead of potential misinformation regarding COVID-19, Vietnam has harnessed the power of volume and frequency. Between 9 January 2020 and 15 March 2020, an average of 127 articles on COVID-19 were published daily on 13 of the most popular online news outlets in Vietnam, leaving little room for rumours and misinformation to spread. 

Additionally, Vietnam has utilised its government portals to provide up-to-date information on the outbreak and tips for disease prevention. The use of government domains and social media accounts have helped to prevent misinformation quickly, collect information from the public systematically and identify case clusters as early as possible. 

Social media has also been used as a tool to create viral content for increased public awareness on COVID-19 health and safety measures. The most notable of which is the song ‘Ghen Cô Vy’ which helped build public awareness of the new virus and the importance of handwashing in the country. The video, released in March 2020, has garnered over 47 million views on YouTube.[112] 

On social media, individual updates and reviews about the availability and quality of government-mandated quarantines have attracted thousands of views on Facebook. The updates speak about the food served during quarantines, the health check-ups which are available and COVID-19 testing carried out during quarantine. These reviews have circulated so widely that the two-week isolation period is favourably perceived, which has increased compliance with the government’s quarantine intervention. 

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Figure 58: Active cases vs new cases – Vietnam

As of 23 June 2020, Vietnam had recorded 349 COVID-19 cases and zero deaths, among the lowest numbers among Southeast Asian countries. [113] Vietnam’s experience demonstrates that effective communication paired with government-citizen cooperation can be effective in managing COVID-19 RCCE. 

However, it is worth noting that in a Communist Party-led country where expression is heavily monitored, occurrences of public dissent and non-compliance may be lower than in democratic countries. 

Highlights

  • Vietnam tightened border controls and set hospitals and local health departments on high alerts for new pneumonia cases on 3 January 2020, before the first fatality in China and only three days after confirmation of the outbreak there.
  • Vietnam’s RCCE efforts began on 9 January in order to inform the public and have them be on alert for COVID-19.
  • Vietnam’s first cases were recorded on 23 January 2020. The situation was under control until an additional wave of cases was triggered by foreign tourists and returning travellers and students on 6 March 2020 [114]
  • Vietnam’s success in controlling the media’s narratives and controlling the misinformation online is possible due to the country’s close media monitoring and laws which allow the government to remove news which may affect public order.
  • In countries with higher levels of democracy, Vietnam’s daily COVID-19 news updates on its government platforms, online news outlets and social media pages (Facebook being the platform of choice for the Vietnamese public) could be emulated in order to ensure a steady stream of reliable information for the public.

Effective Practice Case Study: Finland

Harnessing the power of social influencers for COVID-19 communication 

Finland helps demonstrate the value of harnessing the power of social influencers in its digital campaigns. As of June 2020, the country had supplied COVID-19 advice and precautions to its network of 1,500 social influencers consisting of bloggers, writers and songwriters in order to communicate information to those not reached by traditional media campaigns. 

The aim of the cooperation between Finland’s mainstream media and social media is to provide better access to information for those who are difficult to reach through traditional channels. The COVID-19 pandemic has demonstrated how panic can spread on social media, and the difficulty involved in curbing the panic if the authorities’ messages do not reach the demographic on the platforms. 

PING Helsinki, the Finnish government’s social media partner for this intervention edits the government’s messages into bite-sized information in a social media format. 

This information is then sent to its network of influencers who are free to use the message as they wish. Platforms utilised by influencers are Instagram and Facebook. The Finnish government is also exploring other social media platforms such as Tik Tok. Influencers involved in the intervention participate voluntarily and do not get paid. 

Despite the country’s relative advancement in embracing social media trends, Finland is not immune to fragmented news landscapes. Tero Koskinen, the Head of Preparedness for the media section of the Finnish National Emergency Supply Agency stated that a portion of Finland’s populationtrust social media influencers more than the media. The collaboration between the government and social influencers is to instil a procedure that would help social media influencers to communicate fact-based information. 

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Figure 59: Active cases vs new cases – Finland

Highlights 

  • As of 21 July 2020, Finland has recorded 7,347 COVID-19 cases and 328 deaths. 
  • Globally, reports show that screen time has increased by 76 per cent since the COVID-19 pandemic began. Finland used this opportunity to deploy its communication plan and reach a captive audience. 
  • Finland has been planning and working towards establishing its social influencers as a credible source of information over the past two years. In the absence of such efforts, countries with a larger population and increased bureaucracy could consider setting up official social media accounts for their relevant agencies in order to achieve the same outcome as Finland. 

Effective Practice Case Study: Uganda 

Retaining traditional media campaigns for greater reach 

Uganda’s experience in managing public health emergencies has led to its preparedness in responding to the COVID-19 outbreak. In March 2020, prior to the country recording its first COVID-19 case, the government launched its eight-pillar response plan, among which was the Risk Communication, Social Mobilisation and Community Engagement pillar (RCSM-CE).

  

UNICEF, which co-chairs Uganda’s RCSM-CE sub-committee, led the resource mobilisation efforts and initiated the mass printing of nine ‘Information, Education and Communication’ materials on COVID-19. These materials have since been translated into 30 languages, including eight spoken by refugees and distributed to 135 districts.[115] All collaterals were produced with the aim of promoting preventive behavioural practices. 

Historically, physical interaction was a key part of social mobilisation. Under the lockdown, Uganda has taken to the following information dissemination methods[116] to spread awareness and health and safety precautions across the country: 

  • Radio Transmission: This is one of the main channels of communication used in Uganda. 
  • Audio-mobile vans: The vans are utilised to drive through different villages broadcasting messages, distributing flyers and responding to queries.
  • Television programmes and talk shows.
  • Posters and flyers: These are placed in public placesto display COVID-19 information.
  • Fact Sheets and Talking Points: Guidelines and talking points have been designed to involve various leaders across the board, including local councils and village teams, in conducting awareness campaigns at district and village levels.  
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Figure 60: Examples of COVID-19 information posters and flyers in Uganda

Community Help 

The RCSM-CE sub-committee was also aided by community volunteers, who offered a range of services from illustrating key messages, producing short plays on prevention and developing a mass social media campaign dubbed ‘Tonsemberera, Luganda’ for ‘keep your distance’. The campaign, which encouraged social distancing and other precautionary measures recommended by the national task force, has been adopted by the sub-committee and is the official national campaign for Uganda’s COVID-19 response. [117]

As a result of Uganda’s communication efforts, a Ministry of Health online survey in April 2020 revealed that 98 per cent of over 12,000 social media users are significantly aware of COVID-19 and 100 per cent perceived the severity of the outbreak. In the last week of April, a total of 7,979 calls were received at Ministry of Health call centres inquiring about the disease or reporting suspected cases.[118]

Responses from station managers in Uganda have noted that the messages have helped dispel rumours and promote self- and community-policing. Its wide use of radio broadcasts has also empowered feedback and community response through phone calls and short messages/SMS to radio stations. 

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Figure 61: Active cases vs new cases – Uganda

Highlights 

  • Uganda’s measures to curb the virus included a mass shutdown and a five-week extended lockdown.[119] Its parliament has also passed a supplementary budget of approximately USD 82 million to fight COVID-19.[120]
  • Uganda’s understanding of the channels through which its public obtains information was crucial in its COVID-19 communication plan. Although social media and digital means such as its Ministry of Health’s webpage were utilised, Uganda also ensured its use of traditional modes of communication such as radio broadcasting and television talk shows to establish two-way communication between public officials, health experts and its people. 
  • Establishing two-way communication is essential in Uganda. Previously, risk communication and public engagement efforts have involved face-to-face engagement to address community concerns and questions to establish compliance with public health emergency responses. Two-way communication through radio talk-shows (where citizens call in) has allowed for the government to emulate a communication approach which is well received in Uganda without potentially risking Ugandans through face-to-face engagement efforts.
  • To ensure further penetration of COVID-19 information and PHSM information, Uganda has also taken to using mobile vans with loudhailers, information posters, flyers and infographics to reach an even wider segment of the population.
  • Political leaders have also recorded messages in local languages to sensitise communities, as the country is also home to large refugee and migrant communities. 

Challenges to be addressed during RCCE

  • The longer the time lapse between reports of the first suspected case of COVID-19 and the first confirmed case, the more speculation will occur in the media. Thus, the faster official news is published, the higher the likelihood of the leadership being able to retain control of the narrative.
  • COVID-19 and similar public healthcare emergencies will lead to massive demand for information from the public. Health authorities, media partners and other regulatory entities need to collaborate in order to meet this demand. Failure to fulfil the demand may lead to the community turning to less credible sources of information.
  • Misinformation and rumours are likely to fill gaps in communication by health authorities. Governments need to be proactive in ensuring updates provided by their health authorities take place daily.
  • In countries with high numbers of online users, social media activity may increase the pressure and demand for information exponentially. Public education needs to be rolled out to educate the public in differentiating misinformation from valid news. 
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Figure 62: 2X2 matrix of Severity Index vs Recovery Index for good practice countries

Between 16 April 2020 and 17 May 2020, each country under the Global Pathfinder 2×2 Severity-Recovery trend has shown improvement in their recovery rankings from the COVID-19 pandemic, with the exception of Vietnam and Uganda, who have both recorded slight increases in the number of COVID-19 cases. In the US, which has suffered from a lack of coordination in its communications, the country showed only a marginal improvement in its recovery index over the same time period. 

While communication is not the key reason behind the reduction of cases in these countries, if trusted, it is the most effective method of ensuring compliance to government-sanctioned COVID-19 interventions. Other methods such as enforcement and control over the media would be more controversial in democratic countries and have the potential to be abused in countries with less democratic freedom. 

Recommendations: Interventions for countries to consider

Recommendation 1: Run clear and simple campaigns with high communication frequencies. 

  • Messages delivered to the public need to be factual and cohesive. 
  • Facts and statistics can be broken down into easy-to-understand forms in order to be accessible to those with little or no education. Visual aids such as graphics, diagrams and videos help.
  • Key messages can be adapted to different cultures and language groups while keeping the key themes consistent. 
  • In delivering news within the campaign, balance the negative updates with positive news (e.g. the number of people who have recovered) in order to delay risk perception fatigue from setting in. 
  • Instructions in messaging need to be clear and specific, for instance: ‘stay six feet away from each other at all times’ is more effective than ‘practice social distancing’; ‘stay home to help save lives and ease the burden on hospitals’ carries more meaning than ‘flatten the curve’. 

Recommendation 2: Engage local communities in the communication process. 

  • Identify the people within communities who the public trust and use them as spokespeople for COVID-19 updates and statistics. 
  • Engage with community members, including religious leaders or community leaders, early in the response. 
  • Influencers such as social influencers, musicians or athletes can be partners to disseminate information. 
  • Identify key informants in each community for real-time feedback on the COVID-19 response in their area. 

Recommendation 3: Understand the channels through which the public obtains their information.

  • Prioritise media which has high reach and rapid news cycles so updates can be communicated quickly. 
  • Provide daily press briefings to keep the public informed on the latest COVID-19 statistics and responses. 

Recommendation 4: Address rumours and misinformation swiftly. 

  • Establish two-way communication such as hotlines or call-in radio programmes where the public can interact with public health officials or representatives capable of fielding their questions.
  • Establish dialogues with key informants in the community such as leaders and health care workers to get real-time feedback about the response operations. 
  • To minimise the spread of misinformation, provide essential information to the public as soon as it becomes available.
  • Utilise social media monitoring to identify concerns and guide responses. 

Healthcare infrastructure as a fundamental basis from which all other interventions are built

Setting the context: The GHS (Global Health Security) Index as a measurement of country readiness to manage in a pandemic

The GHS Index was established as a joint project under the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security (JHU) and was developed together with The Economist Intelligence Unit (EIU). It is the first comprehensive assessment on benchmarking of health security and related capabilities across 195 countries.

The GHS Index was developed to understand and measure improvement in global capability to prevent, detect and respond to infectious disease threats, whilst highlighting capacity gaps in healthcare readiness to encourage political will and funding.

The GHS Index is organised into six categories based on 140 questions. The categories are:

  • Prevention
  • Detection and Reporting
  • Rapid Response
  • Health System
  • Compliance with International Norms
  • Risk Environment

The GHS Index prioritises not only countries’ capacities, but also the availability of functional, tested and proven capabilities for stopping outbreaks at the source. All this is captured via the 140 questions. Additionally, several questions in the GHS Index are designed to determine not only whether capacity exists, but also whether that capacity is regularly tested and shown to be functional in exercises or real-world events.

The GHS Index is also designed as an indicator of a country’s capacity and capability to reduce Global Catastrophic Biological Risks (GCBRs), which are biological risks of unprecedented scale that could cause severe damage to human civilisation at a global level, potentially undermining civilisation’s long-term potential. These are events that could easily reduce all the progress made in sustainable development and global health because of their potential to cause national and regional instability, global economic consequences and widespread morbidity and mortality, which is similar to the threat posed by COVID-19.

The GHS Index relies entirely on open-source information: data that a country has published on its own or has reported to or been reported by an international entity.

For more information on the 2019 GHS Index, please visit www.ghsindex.org/.

Key findings from the analysis: Correlations between country readiness and their recovery rate

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Figure 63: GHS Index 2019: Top 30 countries

Based on the initial findings, it is evident that a country’s healthcare readiness according to the GHS Index may not necessarily translate to a successful campaign in combatting COVID-19. Despite recording favourable scores across the six categories which measure improvement in global capability to prevent, detect and respond to infectious disease threats, a country’s actual implementation approach in practice during a pandemic may not prove as effective as its capability and capacity readiness suggests. 

For example, the US is ranked number one in the overall GHS Index. However, it has been well documented that the country has been struggling to combat the spread of COVID-19. Other countries which have ranked highly in the GHS Index such as the UK, Sweden and France, have also fared relatively poorly in the management of COVID-19 as well, despite access to modern infrastructure, qualified healthcare professionals, and ample resources. Therefore, healthcare security and preparedness alone clearly do not guarantee a country’s ability to manage a pandemic. Instead, it can be accompanied by a measure of its ability in practice to respond, coordinate, communicate and rapidly mobilise the country into action.

However, there are also other countries high on the GHS Index that have done well to contain the spread of the pandemic, such as Australia, Thailand and South Korea. In general, it can be concluded that the common denominator across the successful countries is the anticipation, speed and coordination of deploying the highlighted intervention categories. The implementation model of these countries has been decisive and clear, based on lessons learnt from past pandemic experiences and trends from countries that were impacted during the early stages of the spread. Most countries that rank highly in the GHS Index and performed well in curbing the pandemic were early adopters and implementers of the intervention categories.

Recommendations: Ensuring minimum healthcare infrastructure is in place to manage a pandemic.

  • In an age where there is constant threat of a global pandemic, it is crucial for countries to invest and develop adequate healthcare infrastructure, talent and procedures to be able to respond effectively. The recent virus outbreaks of SARS, MERS, Ebola and COVID-19 have taught us that no country can be fully immune to a pandemic, and that the spread can be rapid and deadly. Having access to basic healthcare infrastructure assists with early detection and classification of a potential disease and is vital to efforts to contain the spread.
  • Equally important is the establishment of a rapid response system and a robust implementation plan to mobilise resources, coordinate initiatives and communicate with the masses. As the GHS Index shows, having healthcare infrastructure is only one part of the equation. The execution of national-level plans, effective implementation and monitoring are also essential.


[80] Risk Communication and Community Engagement (RCCE) Guidelines, World Health Organisation

[81] World Health Organisation, January 2020

[82] Coronavirus Disease (COVID-19) Technical Guide: Risk Communication and Community Engagement, World   Health Organisation (WHO)

[83] Sciencemag.org

[84] Risk Communication and Community Engagement Readiness and Initial Response for novel coronaviruses (nCoV), Interim Guidance v1, World Health Organisation, January 2020

[85] Government Response to the COVID-19 Outbreak, Health.gov.au

[86] Australia.gov.au becomes Central Portal for all Coronavirus Info, The Financial Review, 22 March 2020

[87] Effective Risk Communication to Save Lives, Vital Strategies, May 2020

[88] Prime Minister’s Special Message on COVID-19, Prime Minister’s Office of Malaysia, 16 March 2020

[89] Health DG: Play your part, Malaysians, New Strait Times, 31 March 2020

[90] MCO Compliance Rate Now at 99 pc says IGP, Malay Mail, 4 April 2020

[91] Social Media Stats Malaysia, Global Stats, April 2020

[92] Malaysia.gov.my/portal/content/30936

[93] ‘I stay at work for you, you stay at home for us’, The Star, 18 March 2020

[94] Stay Home Even if MCO Lifted, says MOH, Code Blue, 20 April 2020

[95] MHC: Reopening of Economy must be done Gradually, New Straits Times, 10 May 2020

[96] Risk Communication and Community Engagement Readiness and Response to COVID-19: Interim Guidance, 19 March 2020

[97] Sciencemag.org

[98] Risk Communication and Community Engagement Readiness and Initial Response for novel coronaviruses (nCoV), Interim Guidance v1, World Health Organisation, January 2020

[99] Statement from the Press Secretary Regarding the President’s Coronavirus Task Force, Press Release, White House, January 29, 2020

[100] https://www.bloomberg.com/news/articles/2020-06-19/white-house-s-virus-task-force-will-no-longer-brief-public

[101] Young People Didn’t Social Distance because the Government Kept Telling them to Not Worry, NBC News, 22 March 2020

[102] ‘My Mother is not expendable’: As Trump itches to get U.S back to work, experts warn of deaths, economic calamity’, NBC News, 25 March 2020

[103] Pandemic Politics: Timing State-Level Social Distancing Responses to COVID-19, University of Washington, 28 March 2020

[104] https://abc7ny.com/cuomo-final-presser-briefing-coronavirus-in-new-york/6256097/

[105] https://www.theatlantic.com/health/archive/2020/05/patchwork-pandemic-states-reopening-inequalities/611866/

[106] Race to Translate COVID-19 Information as some U.S Communities Left Out, Al Jazeera, 1 April 2020

[107] SurveyMonkey and Axios poll of 7,925 adults in the U.S in response to the question ‘How much do You Trust Each of the Following to Protect Americans from a Major Outbreak of Coronavirus, March 9-13, 2020

[108] Most Americans don’t trust President Trump for Accurate COVID-19 information says CBS/YouGov poll, YouGov, 24 March 2020

[109] UN Policy Brief: Embracing Digital Government During the Pandemic and Beyond

[110] Internet user penetration in Vietnam from 2017 to 2023, accessed 21 May 2020, Statista

[111] Vietnam 2020 World Press Freedom Index, accessed 21 May 2020, RSF.org

[112] Youtube views as of 21 May 2020

[115] At the front-line in the fight against COVID-19 in Uganda, 8 May 2020, UNICEF Uganda

[116] Engaging from a distance during COVID-19, 11 May 2020, UNICEF Uganda

[117] Tonsemberera – Ministry of Health | Government of Uganda

[118] Engaging from a distance during COVID-19, 11 May 2020, UNICEF Uganda

[119] Uganda Extends Coronavirus Lockdown for Three More Weeks, Reuters, 14 April 2020

[120] Uganda’s Musicians are Fighting COVID-19 – Why Government Should Work with Them, 8 May 2020

[121] Global Health Security Index, 2019

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