Some governments have been praised for being forthright about being science-driven in the way they’ve communicated about the Covid-19 pandemic. Other countries, most notably the U.S. and the U.K., have been hit with criticism for public health messages that are confusing or not based in science.

Heidi Tworek, a health communications researcher and an associate professor of history and public policy at the University of British Columbia, Vancouver, joined STAT’s biotech podcast, “The Readout Loud,” this week, to talk about that issue. She and a team of researchers just put out a report examining the Covid-19 communications strategies of nine different nations: Senegal, South Korea, Taiwan, Germany, Norway, Sweden, Denmark, New Zealand, and Canada.

This transcript of the conversation was lightly edited for clarity.

Heidi, among the governments that you looked at, which one has done the best job in communicating about Covid-19?

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Oh, it’s a great question. I think if I had to pull out a couple that were best for very different reasons, I’d say Senegal, South Korea, Taiwan, New Zealand, and British Columbia. They all took extremely different approaches. But they followed some very basic principles that we lay out in the report, including simple things like having transparency, communicating about social values, and having very clear definitions of what they meant by success in combating Covid-19.

So, by contrast, the United States and the United Kingdom have received a lot of criticism for the way officials there have communicated with the public about the pandemic. What have they done wrong?

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What have they done right is another way of phrasing that question. Let me lay out a couple of things. I mean, it begins with even the simple basics.

heidi tworek headshot
Health communications researcher Heidi Tworek Courtesy Heidi Tworek

If you asked 10 people in the United States, what does success look like in fighting Covid-19, you would get 10 completely different responses. If you ask someone in New Zealand, what is success? They understand that it is eliminating Covid-19 in New Zealand. If you are someone in Sweden, what does success mean? They understand that it means a sustainable strategy over the long run. So even if people have fought about, well, has Sweden chosen a good strategy epidemiologically, what we know is they communicated that strategy really quite clearly.

So I think that was a sort of base-level problem [in the U.S. and U.K], a lack of transparency. Importantly, guidelines that are often orders that fluctuate surprisingly swiftly — we see that in the United Kingdom as well. Sometimes orders come down seven minutes before they’re about to be enforced and they’re so complicated that nobody really understands them.

What we’ve seen in places like British Colombia that’s worked very well is you have guidelines that give people some room for autonomy. So you say something like, look, the maximum number of people who can gather is 50. If you, as a workplace or as a restaurant, are going to open, you need to submit a plan about how this is going to be safe. But we give you some autonomy to decide how to do that. A good strategy doesn’t mean orders from the top. It means guidelines that are clearly communicated that give people some room for autonomy, but where they actually have to have some sense of what success, in fact, looks like. And we see all of these kinds of basic principles getting violated in the U.S. and the U.K.

Another effective strategy that you mentioned that I think is linked to that is governments that are not shaming people for breaking the rules. Could you talk a little bit more about that and why it’s effective?

Yeah, it’s actually, I think, quite counterintuitive because we’ve seen so many people shaming on Twitter and elsewhere and saying we need stricter rules, we need more enforcement, more fines, etc. But what we find, counterintuitively, is that places that focus on building trust, giving some level of autonomy, and using fines and shame games as a last resort actually get much higher levels of compliance. So, for example, we compared two provinces within Canada so we could compare places that were quite similar, British Columbia with Ontario.

We saw in Ontario a lot of blame game, shaming, etc., lower levels of compliance and also the use of fines, which sort of escalates the whole situation. Whereas in British Columbia, there’s been much more of an emphasis on trust in the population, do not shame the few people who seem to be contravening guidelines. That has worked much, much better. And it’s also resulted in far less backlash. We’ve seen a few protests in British Columbia against masks, but they are tiny compared to places where masks were made mandatory and there were fines. So if you actually think about how to get more people to comply, you’ve got to take this counterintuitive move of trying not to have blame games, shaming, and enforcement with fines. It doesn’t work as well.

I think we all know that the science behind the pandemic changes rapidly and that must make the communications side of it really tricky. The usefulness of masks, for instance, is a good example of where opinions have shifted from early in the pandemic to today. I wonder how rapidly do you think governments should be in communicating about that shifting science, especially when the evidence is still building?

I think one of the things that that some governments have done well is communicating uncertainty. We’ve seen, I think, many examples of governments doing a poor job of communicating uncertainty. But we’ve seen some instances where governments at least say this is what we don’t know yet, but what we are looking into. And that has, I think, been very helpful because it helps the public trust that this government is honest about what it doesn’t know and will tell you when it knows something better.

Something we also found to be quite effective, in Norway, for example, was also admitting mistakes. There’s this tendency, I think, from a lot of governments to use spin — we’ve seen that in the U.K., for example, not to want to admit missteps. But we found in Norway when the prime minister actually said later, I’m sorry, the lockdown was probably much too stringent, we didn’t necessarily need to do that — that actually ended up building trust because the government was willing to admit where it had done something wrong. So I think it’s actually a very important lesson because as we learn more and more about this disease, there all going to be missteps. And if a government admits them, then it will be in better shape than if it tries to constantly spin that everything it’s doing is completely flawless.

One of the most alarming things we’ve seen in the communications realm during the pandemic has been the spread of misinformation online, particularly on Facebook. How are governments communicating with the public about the spread of misinformation?

It’s been an enormous problem, but actually what I found quite inspiring is to find that there were some places where it’s been less of a problem than others. And one of the key reasons for that was public health communicators getting out early and often on as many channels as possible.

We found, for example, in places like South Korea, misinformation has not been a big issue. Part of the reason for that is that the South Korean Centers for Disease Control has an office of communication that has been dedicated for several years now to figuring out how do you communicate on as many channels as possible. You do it frequently and also you bring the public in. So we’ve been talking quite a lot about what public health officials should do. But one thing they should do is pull in citizens and civil society to tell you if your communications are working, to tell you how to reach your population.

If we’re talking about what do you do as a government right now, you get out early and often as many channels as possible so that people turn to you first and not to Facebook for information.

  • President Trump’s message was clear:
    Don’t let the cure be worse than the disease.

    As Fauci put it, he is just one member of what he called a “team,”
    consisting of medical/public health experts and business/economist experts.

    President Trump’s translation was clear:
    protect the identifiable vulnerable, open up the schools for kids and
    open up business for the already employed with appropriate protections,
    get herd immunity that way, use the “game changer,” what he called hydroxi, as a prophylactic or for treatment.

    Confusion shredded President Trump’s clear message because of the politicization and criminalization of the new corona by some certain segment of our country.

    That happened because of the other part of President Trump’s message,
    that he won’t mandate because he follows the Constitution and its
    underlying principles of limited government and federalism.

  • es correcto la desinformación nos ha costado muchas vidas y perdidas laborales innecesarias,tristemente supuestas potencias mundiales como EUA e INFLATERRA y por supuesto MEXICO tratando de imitarlos por quedar bien con ellos,somos los 3 paises anivel mundial mas afectados,no por el virus sino por la negligencia y desinformación que proporcionaron tales como: no hay reinfecciones,no hay secuelas, es algo leve y hoy estamos viviendo eso,reinfeciones,secuelas y lo peor no saben como manejarlas puesto que nunca se informo correctamente.Afortunadamente quienes ejercemos la medicina correctamente y no somos títeres del sector salud, hemos aprendido de korea, senegal suecia,japon china y hacemos lo que podemos por la población y nuestros pacientes.

  • Taiwan, New Zealand and South Korea, are the 3 most loudly touted paragons of success in beating back Covid-19. However is it not self evident that each one is an island (in the case of South Korea this is not literally true yet it may as well be since the only land access is via North Korea)? As a practical matter it may not be so easy to keep this pandemic at bay when a country shares 1000s of mile borders with other countries especially when those health care systems are underdeveloped and the border is largely open?

  • With all due respect, why did Professor Turek did not cover Japan and Australia?

    Compared to New Zealand which she did cover in her report, Australia is a much larger country. Japan is a bastion of democracy in Asia and it has the third largest economy in the world after China and the US.

    It is IMO an inexcusable omission.

  • What’s missing here is actual facts…how do you back u these seeming opinions? How could these ideas be implemented in a constitutionally supported way? It is my own opinion that allowing individual states (in the US) to set their own rules regarding shutdown and mitigation was, and remains, the source of the confusion and frustration many people feel. Can that be demonstrated statistically? Or is this what it seems, an opinion piece?

  • The US was clear in its strategy — The aim was to flatten the curve so the health system was not in crisis mode. This doesn’t mean that no one would be exposed; in fact, a slow ramp-up to herd immunity is arguably the best solution in the long run. With the notable exception of NYC, the strategy worked – and is working – well. The general population, fueled by the news media, have forgotten the aim of the majority of the earliest US COVID measures.
    Although not explicitly stating it, the authors point out that the differences in the way the “successful” countries handled the pandemic are primarily due to the culture of the population rather than the actions of the government. I find it ironic that the success stories they shared talk about positive communication and not assigning blame, yet their article is entitled, “An expert’s take on what the U.S., U.K did wrong in Covid-19 communications…”

    • Excellent comment.
      “…a slow ramp-up to herd immunity is arguably the best solution in the long run”

      I would argue the ramp up has been too slow. I was just reading Sebastian Rushworth’s blog entry “How bad is covid really? (A Swedish doctor’s perspective)” from August 8th:

      “Unlike other countries, Sweden never went in to complete lockdown. Non-essential businesses have remained open, people have continued to go to cafés and restaurants, children have remained in school, and very few people have bothered with face masks in public.”

      “But the size of the response in most of the world (not including Sweden) has been totally disproportionate to the size of the threat.”

      “Basically, covid is in all practical senses over and done with in Sweden. After four months.”

  • No mention of Sweden of course. The prediction made by their chief epidemiologist has come true. Lockdowns will only lead to serial opening, surges, and further lockdowns.

    Amusing how the US left regularly points to Sweden as its (phony) model for its socialist fantasy but ignores Sweden’s actual success in dealing with the Covid pandemic.

    • Short, but Sweden figures in the 4th paragraph. People should read carefully if they feel inclined to comment.

  • Good article on communication. I’ve been saying this since the beginning: you get better results when you ask people and back it up with logic.

    The press, including this website, should strive harder for a more balanced approached to Covid coverage. I would appreciate more coverage on the reduced severity of Covid versus predicted models from February and how that is still affecting current policy. For many of us, we’re frustrated with the ever moving goalposts. Initially, we were to flatten the curve because overwhelming medical capacity would cost additional lives. Made sense. Didn’t happen. It was obvious by May this wasn’t a problem. Now we’re down to the absurdity that no one can get Covid. In some parts of the country the press screams “Spike” and “Surge” when cases go from a small number to a slightly higher small number. The press seems to be very much in line with supporting and endorsing government action to curtail Covid at cost of everything else. It would be wise for all, including the authors, to remember we live in liberal democracies and respecting individual freedoms even in the face of costs for doing so is something we should cheer in a government.

    Also, the mask policy of “everyone wear a mask everywhere” falls in line with this article as to how blanket policies not backed by science creates resentment. Norway, Denmark, The Netherlands, Sweden and Finland don’t wear masks with regularity. They don’t wear them outside (because they’re not needed) and have identified where they’re actually needed. You’re not going to get Covid walking past someone. The have a more intelligent response in line with the science. If consistent guidelines were created that explained where to wear them and why; you’d get a better response.

    • Reniam-I have been saying this EXACT same thing for quite a while.
      My state has had <10 deaths a day from covid (population over 3 million), yet all the headlines EVER say is "Local family who lost (70 year old father with multiple co-morbid conditions)plea for public to take covid more seriously"-ignoring the fact more and more older older and once independent adults are coming into my rehab with debilitating falls and fractures due to the isolation they've endured. Statistically they are at much higher risk for dying in the next year now-but hey it is not covid right?? So why care about ANYONE else?
      And has anyone bothered to notice that the second moving goalpost of "excess deaths" has improved to the point we are BELOW average for excess deaths now and have been for 3 weeks??
      Nope as you point out all the headlines are "surge" "spike" when in context the numbers are continuing to fall decrease and deaths are NOT increasing.

    • Thanks Monyka,
      The “excessive death” argument is hard to quantify to me. The implication is all, or statistically all, of the excessive deaths were due to Covid. How many of the deaths are due to patients not receiving care from a shuttered medical system? I don’t know the answer, but of course preemptive care saves lives. My daughter’s friend went to a funeral last month for her ex-teacher. He was 57 years old and died of cancer. Apparently, his care was severely interrupted this spring. Hard for me to say if it would have made a difference, but the consensus among his family is it would have.

      Also, the excessive death tally isn’t showing up in the aggregate death count. Given our population and death rate, we expected 2.9 million people to die in the US this year. As of the end of August, there were ~1.84 million deaths; which is slightly lower than expected. We’re on track to have 2.9 million deaths +/- the error rate. Put another way, 7 months of Covid hasn’t moved the needle on expected deaths at all.

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