Four Core Risk Communication Messages
for Our Cold Dark Pandemic Winter

My friend Bruce Hennes asked me to write a brief summary of what I think the key pandemic messages should be right now, as COVID-19 vaccines start rolling out while the virus itself racks up unprecedented numbers. What follows doesn’t meet his specs for brief, but then again he didn’t really expect it would. (A briefer version is also available.)

Message 1: It’s an awful time for almost everybody.

Never underestimate the value of showing people you understand how miserable they are. Like most negative emotions, misery is more bearable when it’s validated. Some people may even rebound to the other side of the risk communication seesaw and say (maybe just to themselves) that it’s not that bad.

It’s tempting to sound upbeat, but official over-optimistic perkiness just leaves people feeling alone in their misery.

Some details:

• You might want to deflect the claim a little so you won’t come across as accusing people of being miserable: “A lot of people are miserable in this pandemic,” for example, or “2020 has been a miserable time for so many of us.” Deflection is a useful risk communication strategy I’ll come back to later. It’s a way to be empathic without being intrusive.
• Mention a bunch of ways people are miserable: They’re sick or worried about getting sick; they’re worried about their loved ones and vice-versa; they’re afraid to do stuff; their kids can’t go to school; their job is at risk; they can’t pay their bills; they can’t see their friends and family; they’re going stir-crazy; they’re drinking too much and not sleeping well. It’ll help a bit if readers see a few items on the list that don’t apply to them, as well as a few that do.
• To share the misery, talk a little (but not too much) about the ways you’re miserable too. Then segue to empathy for people whose situations are worse than yours. And invite your audience to offer help to people whose situations are worse than theirs. Give some specific suggestions – doing chores for housebound elderly neighbors, for example. You don’t have to tell them it’ll help them feel better; let them tell themselves that.
• Don’t worry that dwelling on people’s misery will make them more miserable. For the most part, it won’t. It’ll make them feel more understood, not so alone.
• Include everyone. It’s a miserable time too for people who think we’re overreacting to the pandemic – who feel pressured to take precautions they consider foolish, victimized by mandates they consider unnecessary … and on top of it all, hated, mocked, and despised by the powers that be and by many of their neighbors and acquaintances.

Message 2: Things are going to get better, but not right away. They will get worse first.

The vaccine news is incredibly good, and you should say so. Vaccines are coming on line much sooner and turning out much more effective than we dared hope. By this time next year life will be a lot closer to normal.

But even though we can see the light at the end of the tunnel, we are still in the tunnel. No message is more important than that.

So there are two sets of details here: how to talk about the vaccines to come, and how to talk about the dark months to come first (for most of us).

Talking about the vaccines:

• Temper vaccine expectations. Stress that there will be a wait before enough doses are available, then a wait before the vaccines take effect, then a wait before we all start regaining confidence, then a wait before our economy recovers, then a wait before the new normal feels normal.
• Pay attention to COVID-19 vaccine side effects. They’re minor in the vast majority of cases, but they can feel pretty major, especially if people haven’t been forewarned. It’s also crucial to warn that coincidences happen, that some people will inevitably die or get very sick shortly after being vaccinated. There will be (and should be) investigations to determine whether the vaccine had anything to do with what happened afterwards. Unfortunately, there will also be social media posts speculating that the vaccine killed people. And there may be rare instances when people do die because of the vaccine. Again, forewarned is forearmed.
• Warn also about humongous logistical glitches – not just in vaccine distribution, but potentially also in vaccine manufacturing. Nobody knows yet how many doses of how many vaccines will be available when. This sort of anticipatory guidance is crucial so people don’t overreact when the vaccine rollout hits bumps in the road.
• Remind people of all the vaccine unknowns – especially the two biggies: how long immunity lasts; and to what extent vaccinated people can still get asymptomatic infections and transmit the virus. Depending on the answers to these two questions, masks and social distancing and the rest may still be necessary even for people who have been vaccinated. For sure they’re necessary until we learn the answers to these two questions.
• Predict controversy over who gets vaccinated when – who’s allowed to skip to the front of the line, who’s allowed to linger at the back, and especially how we prioritize the groups in the middle. This is another crucial piece of anticipatory guidance. Make it clear that vaccine prioritization may be guided by science, but it is basically about values, so everybody is entitled to an opinion. Vaccinate the elderly and sick because they’re most vulnerable? Vaccinate the young and healthy because they’re economically most productive and responsible for the most transmission? Vaccinate essential workers because they’re, well, essential? Vaccinate people of color because they’ve been last in line too often already?
• Express and urge respect for people with a different vaccine attitude than your own – including people who are more worried about vaccine safety than about COVID-19 itself. Let’s try not to politicize and polarize vaccine acceptance the way we have masks and social distancing and lockdowns and school reopenings and damn near every other key to managing this pandemic.
• Try to convince people that it’s not a good idea to berate friends and family who hesitate to get vaccinated. With a 95%-effective vaccine onboard, an unvaccinated friend isn’t that big a risk to somebody who keeps taking individual precautions despite being vaccinated. And most of the holdouts will find it easier to change their minds if the rest of us respect their preference to hang back for a while and see how things go.
• Talk about the worst case scenario, making it clear that it is worse than we should expect: Vaccinated people can still transmit the virus; immunity doesn’t last very long; lots of people don’t get vaccinated, either because they declined or because there’s a hiatus in the vaccine supply; for the foreseeable future COVID-19 will remain a significant public health threat and we all have to figure out what a new normal is going to look like. (There are always even worse worst case scenarios that are too unlikely to worry or talk about much – for example, the remote possibility that we will blunder into some horrible vaccine side effect after hundreds of millions of people have been vaccinated.)
• Talk about the best case scenario, making it clear that it is better than we should expect: Vaccination not only prevents illness but also prevents transmission; immunity lasts a long time; everyone who wants to be vaccinated is vaccinated by early summer; that’s enough of the population that COVID-19 stops being a major public health threat and life gets back to something like normal.
• Talk about some intermediate scenarios too. For example: Immunity lasts and vaccinated people don’t transmit much (good); lots of people don’t get vaccinated (bad); the death and hospitalization rates still go way down because many of the most vulnerable people got vaccinated (good); there’s a huge controversy over how to deal with the millions of mostly low-risk unvaccinated people who don’t want to wear masks, socially distance, etc. (bad).
• None of the above should take precedence over the wonderfulness of the wonderful news. To avoid sounding like an over-optimistic less-than-candid cheerleader, put the wonderfulness in the subordinate clause: “Even though these vaccines are a miraculous Christmas gift, we have to bear in mind that [whatever downside you want to warn about].”

Talking about the dark months:

• Keep saying that masks, social distancing, and the rest are still important. Say it sadly. These pandemic mitigation “non-pharmaceutical interventions” (NPIs, the term-of-art for things we can do without medicines or vaccines to reduce the spread of the virus) are crucial because COVID-19 is spreading exponentially in much of the country, threatening our hospitals, our economies, our lifestyles, and our lives.
• And keep saying that these NPIs will remain crucial for some months to come. Even if vaccination makes NPIs no longer necessary – and we don’t know that yet – it will be some months before enough people are vaccinated to make a difference. Moreover, the vaccines will help sooner if we all also help by reducing viral spread than if we keep making things worse while the vaccine rollout is trying to make things better.
• Explicitly connect NPIs to the vaccine solution that’s on its way. Point out that it’s especially saddening – and maddening – to see people getting desperately sick after surviving this pandemic for ten months, when now they may be only weeks away from that shot in the arm. Nobody wants to die in a war’s final battle, when peace is in sight. In other words, don’t urge people to be careful “even though” vaccines are on the way. Urge people to be especially careful because vaccines are on the way.
• Even so, acknowledge that some people have the opposite reaction. The imminence of a vaccine solution tempts some people to take more risks. That makes psychological but not logical sense, in the same way it makes psychological but not logical sense to go out drinking because tomorrow night a pandemic order will shut down all the bars. Try to be rueful about this, not nasty or supercilious: How foolish we humans are! People will find it easier to resist the temptation if the temptation is mentioned, normalized, and oh-so-gently laughed at.
• NPIs may very well be needed even after a lot of us have been vaccinated – another piece of bad news that needs to be acknowledged. Yes, I have said this already. It deserves repetition. The vaccines approved in the U.S. so far prevent COVID-19 illness about 95% of the time. But we don’t know yet how well (if at all) they prevent infection and transmission. So we don’t know yet how dangerous vaccinated people will be to unvaccinated people. Eventually we’ll know. And eventually, once nearly everyone has been vaccinated, it won’t matter so much. But people aren’t going to be free to throw away their masks and crowd in together right away.

Message 3: We’re all the victims here. And we’re all the perpetrators. We need a truce.

U.S. pandemic response has been politicized and polarized beyond anyone’s expectations. The left claims President Trump and his Republican followers politicized the pandemic – by opposing masks and social distancing; holding super-spreader rallies and other events; claiming partisan credit for everything that went right, from ventilators to vaccines; blaming Democratic governors for everything that went wrong; etc. The right claims Democrats politicized the pandemic – by attacking conservative rallies as unconscionably dangerous while condoning anti-racism demonstrations; expressing skepticism about the safety of vaccines developed under Trump administration aegis; pretending they didn’t get the pandemic just as wrong as Trump in the early days when they were criticizing travel bans as xenophobic and urging everyone to go celebrate the Chinese New Year; etc.

Both sets of claims are correct. It would help to say so, and propose a truce. Even a unilateral truce will help: Stop blaming “them” even if they’re still blaming you.

It’s not just about politics. A key element of the truce is messaging that encourages citizens to stop blaming their neighbors:

• Normalize pandemic fatigue. We are all sick to death of taking precautions. We’re all cutting more corners than we used to, and more corners than we admit even to ourselves. (If you think your audience might experience this as an accusation, deflect it so you’re talking about yourself or people you know or “some people” – anything except the accusatory “you.” Deflection should help also with the next two bullet points.) Officials have no choice but to take pandemic fatigue into account; lockdowns have become “lockdown lite” and even the CDC recently shortened its quarantine recommendations in hopes of getting more people to comply. Put pandemic fatigue on the table (suitably deflected), especially if you’re an official whose pandemic policies are fatiguing people, and you’re trying to find ways to help them tolerate additional fatiguing policies in the coming difficult weeks.
• Normalize pandemic uncertainty. We have all listened while experts serve up pandemic information that is totally inconsistent with what some other expert is saying … or even inconsistent with what that same expert was saying a month or two earlier. We’re all a bit dizzy trying to make sense of what we’re hearing. We’re all desperately guessing what’s more dangerous than what. Even the experts are full of uncertainties, though they often have trouble admitting it. They know things the rest of us don’t, but this is their first severe pandemic too. As a world-famous expert said during the 2003 SARS crisis, we are all “building our boat and sailing it at the same time.” Inevitably we’re getting a lot of it wrong.
• Normalize pandemic hostility. We’re all feeling enough on edge to be at risk of blowing up even when we realize we’d be wiser to stay calm. Some of us are blowing up at what feels like other people’s insufficient precautions. “How dare that person be so careless when I’m being so careful!” (Envy may hover just below the surface at these moments; disapproval of others’ self-indulgent or oblivious misbehavior often has an envy component.) Some of us are blowing up at what feels like other people’s intrusive insistence that we’re not being careful enough. Nearly all of us are blowing up at minor irritations we used to take in stride.
• Encourage people to cut some slack for each other … and for themselves. That’s the point of normalizing pandemic fatigue, uncertainty, and especially hostility. Say this explicitly. The vast majority of us are doing the best we can in an excruciatingly difficult situation. Sometimes those around us mess up and frighten, anger, or disappoint us. Sometimes we mess up and frighten, anger, or disappoint them. Hard times can drive people apart, or they can pull people together. We’ve all seen both in this pandemic, and we’ve nearly all contributed to both. We will have a better chance of pulling together if we consciously try, bearing in mind the pressures that are driving us apart – and forgiving others and ourselves for the moments when they and we give in to those pressures.
• It also helps to point to the ways we actually are pulling together already. A small, concrete example: Tips to delivery people have increased during the pandemic. We may not be clanging pots for healthcare workers anymore, but the gratitude remains widespread and genuine. This illustrates a key social marketing truth with many pandemic applications: Bandwagoning works far, far better than finger-wagging. People want to do what their friends and neighbors are doing, and what their friends and neighbors approve of doing. So we should focus approvingly on the majority who are wearing masks and planning to get vaccinated, rather than ranting about the minority who aren’t.
• Resist the temptation to carp. I know it’s tempting to wonder aloud at how awful U.S. pandemic response has been, compared to so many other countries we’re used to feeling superior to. And having marveled at our national fall from grace, it’s tempting to cast blame. I’m not denying that some people are blameworthy, from our president to your neighbor who stands too close in the supermarket line. But the next few horrible months demand a truce. Acknowledge the failures, not just in others but in yourself as well. Try to forgive the failures, and focus more on the successes. And urge everybody else to do likewise.

Message Four: We are all in charge of ourselves.

Let me underline (and yes, overstate) an important truth: Trust in experts and trust in officials have taken a severe hit in this pandemic. The hit is largely justified. Experts and officials have been consistently overconfident as they oscillated wildly between underreacting and overreacting to the COVID-19 threat. They’ve never lived through a severe pandemic before either, and they’re doing their best, just like the rest of us. Ultimately we should try to forgive them for being so often wrong, and so reluctant to admit it when they were wrong. They should try to forgive us for so often disregarding them even when they turned out right. We should try to forgive each other for the many pandemic precautions that didn’t pan out well here – all the things some other countries managed to do successfully and we didn’t: testing, contact tracing, quarantine….

The bottom line is that many people are now relying more on their own common sense than on what experts and officials are telling them to do. And this is likely to become even truer in the next few months. That’s what I mean when I say we are all in charge of ourselves.

So pandemic messaging needs to appeal more to common sense. It’s still important to tell people what experts recommend and what officials demand. But it’s just as important to connect those recommendations and demands to your audience’s common sense. If what you’re urging people to do is sensible, explain why. If there are ways it’s likely to seem not so sensible to them – for example, if it conflicts with what you used to say – acknowledge that and explain why you think you’re more on target this time. Ground your messaging in the reality that expert authority and official authority understandably don’t feel all that authoritative anymore to much of your audience.

In fact, it’s time I stopped calling people “audience.” Better to think of them as decision-makers, and of ourselves as consultants, gently trying to guide their commonsense decisions.

Details:

• Introduce the concept of a risk budget. We each get to decide how much risk we’re willing to take – and willing to impose on loved ones and others. Then we get to allocate the risk, based partly on expert advice insofar as the experts have any, but largely on our own seat-of-the-pants common sense. Going out to dinner one time shouldn’t set a precedent; instead, it should use up a hunk of our risk budget, so we’re less rather than more likely to go out to dinner again a few days later. If we really, really want to get a professional haircut, maybe we should decide not to go out to dinner for a month. If food delivery works for us, we can reallocate our grocery store risk budget to an occasional restaurant dinner or a periodic haircut … or hugs with our grandkids or whatever.
• Use the risk budget concept as yet another reason to cut slack for other people when we see them doing risky things. Okay, she’s taking a risk you wouldn’t take, but she may be avoiding risks you do take. Maybe he “budgeted” to take that risk this one time, and you happened to be there to see it. Maybe she’s desperate beyond anything you can imagine. Or maybe he’s just a jerk. Not every pandemic risk people take is the outcome of a thought-through risk budgeting decision. But the more of us who decide to make thought-through risk budgeting decisions, the better for all of us. And the more we can picture others making thought-through risk budgeting decisions, the likelier we are to be civil even when we feel endangered by what they’re doing.
• Talk about harm reduction as the commonsense replacement for the futile pursuit of zero risk. In our expectations of ourselves and each other, aiming for perfection is self-defeating. This is always true, but never truer than when trying to stay safe in a pandemic. “Safe” is the wrong concept to start with. Try “safe enough” or “safer than if I did that other thing I was considering” or “as safe as I can reasonably manage.” The fatal flaw of pursuing zero risk is the despairing “screw it” response when we can’t measure up. When people on overly strict diets inevitably succumb to a momentary temptation, they tend to feel like they have failed the diet challenge and might as well binge eat. We all need “permission” to have less strict standards, and “permission” to violate even those standards from time to time. Otherwise learned helplessness and fatalism may set in, and we stop trying.
• Build an individualistic case for pandemic precautions. The societies doing the best jobs of pandemic management (isolated islands aside) tend to be strongly authoritarian or strongly communitarian – or both, like Communist, Confucian China. The U.S. is having a tougher time because fierce individualism is central to our national identity. So telling Americans to obey draconian pandemic regulations is problematic, and so is asking Americans to take responsibility for the welfare of strangers. Appeals to obedience aren’t useless, nor are appeals to community spirit. But we need to frame more messaging in terms of helping people decide what is best for themselves and their loved ones, because that’s what they most want to do.
• It’s important to try to make the rules reasonable (especially if you’re the one making the rules) – and important to explain the reasons. Rules that feel unreasonable undermine people’s already weakened willingness to obey. Ideally you want people not just to obey the rules, which is tough enough, but also to take onboard the reasoning behind the rules, so they can figure out their own commonsense “rules” for themselves, grounded in the same reasoning.
• But it’s just as important to acknowledge that sometimes a rule might be wise even if it’s more than a little arbitrary, even if there’s not much science or even reasoning to back it. What I’d like to see some governor or mayor say someday:

  Why did we close X’s and not close Y’s? Well, we needed to close a lot of things to get the case count down and keep the hospitals open. But we didn’t want to close everything, and there wasn’t a lot of great evidence to tell us what’s more dangerous than what. And some things are easier to close than others, or easier to police, or less likely to ruin people’s lives and arouse intense opposition. It’s not science. And it’s not fair, especially if you run one of those X’s we closed. But it’s better than closing everything, better than closing nothing, and better than waiting for definitive scientific proof on what we should close. Maybe next month we can reopen all the X’s and close the Y’s instead.

  You probably have sound legal reasons not to say anything like that. But insofar as your lawyers will let you, try to stop pretending that you’re “following the science” when you actually have no choice but to make a whole lot of pretty arbitrary, debatable judgment calls. People dislike the arbitrariness, sure, but I suspect they object even more to the pretense of sound science.

Copyright © 2020 by Peter M. Sandman

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