Writing crisis communication history: Insights from health communication executives

By Taylor Voges, University of Georgia, LaShonda Eaddy, Penn State University, Shelley Spector, Museum of Public Relations, and Yan Jin, University of Georgia

This project – researching historical infectious disease communications and interviewing health communication practitioners – began as a way to better understand the seemingly new terrain that began in 2020. It was the early COVID-19 days. Borders shut, businesses closed, and much of the world remained on edge.

In 2021, tensions remain high as uncertainty continues to dictate life. In the midst of these developments and uncertainties lies health and risk communication about infectious diseases: the core of this project.

At COVID-19’s onset, it appeared that many were treating the virus as

1. a non-threatening disease (likening it to the flu)
2. completely novel (not connecting the virus to past situations)
3. some variation of the two

Current trends of communication, such as social media and an even more intense 24/7 news cycle were also coupled with this treatment of the virus. Our team embarked on a research journey to study infectious disease communications using these experiences as a foundation.

The first phase of the project involved conducting original historical analyses of three previous viral outbreaks: the 1918 Flu, Polio, and HIV/AIDs.

These analyses provided a firm foundation for health and risk communication about viral outbreaks. The relationship between the communicators and those being communicated demonstrated the ultimate imperative, which is to cultivate and maintain strong and trustworthy relationships.

They also demonstrated that, should those relationships be neglected, then rival communication groups may rise up (a la grassroots campaigns) and/or those seeking information may look elsewhere.

Using these insights as a base, we pivoted into the second phase of the project: to interview executive health communication practitioners for their expertise and perspectives on the communications surrounding the COVID-19 pandemic. These executive health communication practitioners provided insights on the communication about COVID-19. The insights ranged from past experiences as health communication practitioners and insights on the COVID-19 pandemic to advice for future practitioners.

The first major trend found through the in-depth interviews most clearly reflects the findings found via the historical analysis: health communication executives agree that the COVID-19 pandemic is not novel.

Society continues to evolve and some technological advances have been made that affect communication availability (e.g., social media and the “infodemic”), but health communication practitioners – and society – have dealt with viral outbreaks before.

Without prompting, interviewees referenced their past experiences with Ebola, H1N1, variations of SARS, and more. This insight is important because it implies that the core knowledge – the foundation of health communication – does not need to be re-written. Instead, other factors, like outside pressures, become more important and need to be understood.

All interviewees associated the COVID-19 pandemic with the political happenings in the United States. This exemplifies one of the factors that influence health communications; these external pressures, influencers, and “wild-cards” shift the health communication balance.

The question becomes: do we acknowledge the politically charged communication about COVID-19 and, if so, how? Interviewees said they navigated this space by defaulting to experts at either the Center for Disease Control or the World Health Organization. A few interviewees explicitly stated that consumers need to be educated on how to properly vet information.

Political pressures – and social pressures, for that matter – are not new. Indeed, the interviewees’ insights complemented the trends found via the historical narratives. For instance, the 1918 Flu happened alongside World War I, so political concerns took precedence. For polio, the main figurehead, President Franklin D. Roosevelt, was intimately involved in the process of public health communication about polio as a public health threat.

This demonstrates that political involvement and pressures are not inherently negative. In contrast to the political handling of polio, the political entities during the HIV/AIDs outbreak were silent. The government’s silence and inaction were catalysts for grassroots efforts and new caring relationships were born between activists and those affected by HIV/AIDs. The fact remains the same: political pressures and influences will be present, but the resulting communication and actions may vary.

These health communication findings demonstrate the importance of preparation for future health communication practitioners and organizations. The historical health narrative analysis demonstrated the role communication plays in creating caring relationships between those communicating and those needing communication.

The health communication practitioners provided unique and expert insights because of the sheer nature of their profession: communication health risks to different groups of people. Learning from their experiences and insights is crucial for any positive moves forward.

The following represents the top advice from executive health communication practitioners:

1. Plan and communicate protocol

The communication team needs to understand what should happen in different scenarios. Some situations demand quick information dissemination – plan who should say what. In scenario training, be realistic with your options, question logistics, and use the 10th man theory to avoid groupthink. Bad ideas exist. Having a person question the communication protocol and communication suggestions helps you avoid seemingly good ideas that turn out to be unhelpful, or worse, detrimental to the situation. This better prepares the communication team for real situations.

1.2. Practice the plan

The plan will not help if it sits on a shelf. Put your communication team through the plan(s), scenarios, and the communication protocol.

2. Relationships

Network and determine who understands the situation so that you can get a clear perspective on it. The communication staff should be connected before a crisis or an outbreak happens. Identify and follow your “North Star” expert (e.g., CDC, WHO). Know who your experts are and build trust before a crisis situation.

3. Learn together

Recognize that situations may be unclear. As you (the health communication practitioner) learn more, translate that information shared with the public. This means communicating with emotional vulnerability. Communication is more than talking to someone. Be flexible with different audiences – knowing that different audiences need information in different ways. If you don’t know the information, then redirect the public to the health experts.

4. Think about the communication

Ask yourself questions: What are we foreshadowing? What should we start to tell this story? What assumptions are we making? What are we trying to accomplish? These questions should be at the core of communication. They also should remind us to resist overloading audiences with information. A story needs to be told--even with a viral outbreak. Thinking about health and risk communication from this perspective should provide your audience(s) with clearer information about the issue.

Lessons can be learned from a variety of sources. The past demonstrates how some issues are ongoing and can recur; current experts illustrate how experience, critical thinking, and practice shape communication efforts. Will there be another viral outbreak? Yes. Will society know when it will happen? Perhaps or perhaps not. But fret not, lessons from past experiences and industry experts can shape our preparedness for tomorrow.