Message in a Battle – Why Communications Matter in a Pandemic

Peter Harrington Salimah got in touch and asked me to talk about communications in a pandemic. And I’m so excited by the title that I came up with because I love a pun. So that was reason enough to do it. And it’s really exciting to do this and I’m looking forward to a good discussion. The sort of background of this, for me, is a bit of experience that Salimah just referred to. I worked on Ebola in Liberia. I had lived in Liberia before. And I came back to work on Ebola and I was focused on behavior change communications. I worked between the office of the President, Ellen Johnson Sirleaf, and I also worked in the National Ebola HQ, which was run by Tolbert Nyenswah. Lots of the stuff that we experienced and learned in that time became super relevant again in 2020. But I want to talk about today, mainly about behavior change and why it matters, why it’s important and how to do it. How to use communications to affect change and how to make communications effective. 

Peter Harrington So first of all, why does it matter? Well, some of you might be familiar with the late Swedish statistician Hans Rosling, who was in Liberia at the time. He was working in the Ebola HQ with the Liberian data team. Really amazing that he kind of, he was there, he was really committed and spent a lot time out there. But something he said to me really stuck in my mind, which is this quote, “Ebola is but the biological and a social phenomenon.” And I think this is true. I think if you talk to epidemiologists, you talk to people at the CDC and places like that, there’s a real understanding that communicable diseases are all about human behavior if it’s communicable through, you know, whether airborne or by human touch. It’s about what humans do. These diseases, these viruses, prey on human activity, human compassion, our desire and on our norms to be close to one another, to have physical contact, to be around one another. We’re social creatures and that’s how viruses spread. And so it’s a social phenomenon because what humans do determines what happens to the virus. If you enforce a lockdown, you enforce behavior change and you get a very, very clear and unmistakable change in the end. 

Peter Harrington There’s a bunch of resistance factors. Main thing is risk psychology. Human beings have a bunch of psychological quirks around risk, around in crisis situations which you have to work around. Social norms matter in Liberia and social norms and cultural matters. In Liberia, the number one transmission of Ebola was funeral practices around touching dead bodies and bathing their bodies. And try to tell a parent whose child is sick, don’t touch your child, just forget it. You know it’s not going to happen. Some of it is human and universal and some of it is culturally specific. And it’s that’s enormously important. I’m going to come back to that point several times. Economic conditions matter as well. You know, it’s easy. It’s a social distance in Soho than it is in Soweto. So where you are and the situation really matters enormously. 

There’s also changes in the communications environment. There’s changes in the trust in authority where we get sources of information. So the way the public seek health advice, this is quite universal, but it obviously varies by country. The way the public seek health advice has changed. People now tend to focus on online sources, social networks. Mainstream media doesn’t have people covering health anymore. You don’t have that kind of authority source in the mainstream media. There’s much more opinion. If anyone’s been on the Internet recently, you might have noticed that there’s a lot more opinion and a lot less news that’s really changed the way people consume information and what influences what they think and what they determines how they behave. Experts and authorities are less trusted than they’ve been in the past. This is universal. This is in Liberia. I’m not exaggerating: the most prevalent belief about Ebola was that it was a CIA intervention, it was a CIA creation. You only have to go look at a 5G cell phone masts, you know, in your area to see how misinformation, conspiracies, mistrust of authority can play out. All the controversy over masks, the politicization of mask wearing in some countries, not naming any names. 

Peter Harrington Trust is now the pivotal factor in health communications. It was always important, but it is even more important now because it is in so short supply. Scarcity has made trust just inflate in its value because it so scarce in the world that we’re in now. And that’s the really key thing, and that’s the concept risk communication has to grapple with and work with. So pandemics are complex, adaptive problems that require massive amounts of learning and context. It has to be released into context. And you need risk communications to bridge people with the policies that you’re trying to put in place in your context. The scientific facts, quote unquote, the epidemiological expertize, as we understand it, is an input and that needs to inform policy and policy also says this is the required behavior we need to get the outcome we want. Right. But what policy you create was also causally links to the economic circumstances of the people whose behavior you’re trying to change. You’ve got a bunch of different drivers of how people are currently behaving. Misinformation, that context of mistrust I just spoke about. Their risk perception, which I’m going to go into in a moment. Their social values, their cultural norms and their economic circumstance is so important, you know, if you’re asking them to do something that they actually just can’t do because they’re going to starve then you’re not going to get to change in behavior. The policy has to be realistic and aware and adapted to that context. But it’s the way it’s how you get close that gap between the kind of behavior and the required behavior that you need to get the outcome you want. 

Peter Harrington So let’s talk about risk psychology, I’ve mentioned it a couple of times. Humans are terrible at risk. We’re really bad at it. We misperceive risk in general. There’s a great quote from Dan Ghana that we live in an information age, but our brains are stone age. So we really struggle to process all that complexity around us. Right. It’s kind of overwhelming. And our little brains are pretty smart, but not that smart. And another quote from a guy called Peter Sandman observed that the risks that actually kill people and the risks that really upset people are completely different. People get like super, super upset about certain things. There’s like other stuff kills you way more like shark attacks versus road traffic accidents. This is true. This is statistically true. Right. He did research to kind of show this. And so this kind of outrage, the risk that upsets people is the risk that people change their behavior to avoid. They don’t go swimming when they’re in Australia. I would never go anywhere near the sea if I’m in Australia. Forget it. I’m not going to get attacked by a shark. But I think I am. So those are the ones that change your behavior. So just keep it in mind. What gets people upset and what’s that about? That’s about emotion. We’re also all subject to cognitive biases, which massively cause us to overestimate or underestimate the likelihood of all sorts of events. So that’s the kind of backdrop of risk psychology. 

Peter Harrington There’s a few more specific things about risk psychology, particularly related to crisis situations. This guy, amazing guy, Vince Cavallo did a load of research that the AGL is your average grade level. It’s a kind of measure of like peoples like cognitive functioning. And he did a lot of research that showed that in a crisis situation, people’s average grade level drops four levels, in a situation of stress. So we get slower. We kind of get dumber in crisis situations. That’s a human thing, right? 

Peter Harrington 1N equals 3P, one negative message roughly weighs about three positive messages. Right, so people remember negative stuff way more than they remember positive stuff. It’s just the bias that we have. Probably some real good reason for it some heuristic kind of logic. But you’re swimming against the tide when you’re trying to manage and get messaging out if you’re a government or a policymaker or a leader, you’re already walking uphill because for every one negative message, three positive messages. 

Peter Harrington Primacy recency is another phenomenon observed in the trials and the studies. So people remember the first thing you say and the last thing you say, they have no idea. So we’re roughly in the middle of the Powerpoint now you’re going to forget everything I’m saying. You remember the first thing and the last thing you know, this is a very, very well established, well observed phenomenon that this primacy recency. 

Peter Harrington And this equation, which I love, which is kind of the perception of risk, is the actual risk, plus emotion, some kind of emotional quotient, some kind of emotional factor. And that’s quite actually subjective to different people. Depends on who they are, where they live, which bubble of Facebook they inhabit or who they follow on Twitter. You know if you think about how balkanized society is now in terms of different views, you start to see how if emotion matters this much you have a serious problem when you’re trying to kind of get people to change their behavior to kind of all get on the same page. So that’s very universal risk psychology. 

Peter Harrington A great bit of work that Vince Covello did was he showed that in high stress situations. What are the things that people pay attention? First of all, they make up their minds in about 10-30 seconds. In terms of, you know, if you’re talking to them and if they’re stressed, they’ll make up their mind about you in 10-30 seconds. Right. They’re judging your competence and your expertize, your honesty and openness. They’re listening for your caring, your empathy, your compassion. Does this person care about me and my situation? So the problem that we have all the time, the mistake that leaders made is they talking to people who are super stressed, upset, riddled with cognitive biases. And it completely misses. Right. It doesn’t land because we dealing with the right hand low stress more ordinary kind of comms. But we’re talking to people who are on the right hand side. 

Peter Harrington So risk communication takes all these things into account. It looks for ways to generate consent and understanding and behavior change and it’s based on this kind of science this understanding of how people think and how people behave. It’s recognizing the centrality of trust in emotion, it’s evidenced-based and it’s looking at what’s effective in a crisis situation when stress levels are elevated. 

Peter Harrington What are some of the things that work? There’s this famous three nine twenty seven. So you’ve got basically for people’s attention span in high stress. You’ve got time for three messages, about nine words and about twenty seven letters. It’s not a lot. That’s what you’ve got time for before people switch off. 

Peter Harrington What Vince Covello has shown to work is the, “I don’t know” template, which is when people ask something, if you’re a leader and you don’t have the answer to. You have to be willing to say, “I do not know the answer to that because of this this this reason. However, this is what we’re gonna do to get that information. And this is our plan.” That’s very effective, to be honest and straightforward and say, “I do not know the answer.” Don’t pretend. You know, let’s say. But dot, dot, dot. And explain to provide that reassurance. 

Peter Harrington Compassion, conviction, optimism. This is a kind of you know pneumonic that has been fancy, really effective in environmental disasters, different crises. First of all, you show compassion because remember that fully half of it is all about how you connect with people emotionally. Then you got to say, however, we are going to do the following with conviction. And if we adhere to that it is going to address and solve this problem. Also, if you want to get into the kind of technical skills there’s a methodological message mapping, which I’m not going to go into in detail here, but you can look it up if you’re interested in it. If you work in communications, there’s a methodological message mapping where you map out the kind of structure and you use these techniques and these insights from topology someone to kind of address that. It’s not about how well you construct the message and are you within twenty seven letters? There’s a lot more to it than that. It’s also about clarity and regularity. So that kind of combination of giving information, empathy, but also hope and optimism. And we’re going to talk about the importance of who who’s actually talking, the medium. 

Peter Harrington So harking back to Ebola, what West Africa learnt, and we can talk about what we’ve learned this year as well. I mean, behavior change is partly driven by what people see if, like someone, you know, gets sick and dies. Then you change your behavior. In West Africa, we learned a lot about risk communications. And I think some of that learning was apparent this year. But some of it was not. And it depends really. There is enormous variation this year. West Africa, we simplified everything down to a very simple one page message map from 70 pages into one page. We simplified the message. We put it in vernacular language. We went and engaged with different, local communities and understood what the concerns were and what the challenges around you know funeral rights, for example. Taking those social cultural norms into account connected to the values and most importantly, using and delivering the message through existing networks of trust. Remember the communications environment that we’re in. People don’t want to listen to a national leader behind a podium, they do listen to their community leader in Liberia. In other parts of the world, they might listen to someone else. You’ve got to look at in a context specific way, who will people listen to? Who do they trust? Mainly, actually people in the developed world, OECD countries, listen to their peers and that kind of immediate network more than anything else. And social media is a kind of extension of that. Some people depending on their generation might turn on the Prime Minister or the Queen, and different people take authority from different place. But that trust infrastructure, whatever that looks like in your context, you have to use that trust infrastructure you can’t bypass it because this is emotional. And people don’t trust anyone, trust is so scarce. 

Peter Harrington So I’m going to take U.K. examples. A lot of messaging started badly with COVID. There’s a huge amount of variation from country to country places that did really well as it did really badly. U.K. started pretty badly, which it shouldn’t have done, really it had enough people with enough experience about this. So some people got better, some didn’t. The early days of COVID in Britain was it was a muddle for about a month. Then they came up with a good slogan which was Stay Home, Save Lives, Protect the NHS. If you know anything about the UK, you know that the NHS is this is kind of revered institution. And so that’s a nice concise, it uses three parts, roughly six and three nine twenty seven rule, it’s good. Then they got confused a couple of months later and did a really weird one which was Stay Alert, Control the virus, Save Lives. I mean, no one really knew what stay alert means. What I did to control the virus. So everyone got confused again. And now they’ve come back to something even simpler, which is hands face space, which is not terrible. 

Peter Harrington So I’m just giving in one example, the UK, which is kind of some learning around what messaging was working, what wasn’t. And you probably know from all from all over the world and you will have seen examples of good messaging, bad messaging that is not concise, is not clear giving people information about what do they have to do. Coming back to this point about what actually motivates people to change their behavior and who do they listen to? My beloved Prime Minister, Boris Johnson, who gave us sort of daily briefing. I think a lot of people didn’t really pay attention or listen to that. And actually, in the initial stages in March, no one was really changing their behavior no one was taking this seriously because they weren’t hearing these messages from people they care about. No one listens to Boris Johnson, but everybody worships the NHS and the intensive care staff. And so it’s a message from people that you’re actually listening to and care about and it’s appealing to people’s sense of responsibility and citizenship. People know good messaging from bad messaging. They respond to people they trust. And that trust is influenced by a lot of different drivers, which I’ve spoken about.

Peter Harrington So leadership I’ve spoken a little about is really important part of this. I think let’s look around the world a bit. There are people who’ve done this really, really badly. I think anyone can quite easily think of a couple of leaders who have done this spectacularly badly. Very unclear. Very inconsistent. But there are some people who have been very good. So the Premier of Singapore. He’s excellent. And he’s been very clear, very calm, composed in his communications. His body language. It’s very culturally appropriate, it’s balancing emotion, factual. It’s simple messaging. I think another person who I would say is very good has been Jacinda Ardern from New Zealand’s been excellent in the clarity and consistency of our messaging. Andrew Cuomo is a more emotional kind of  speaker, but there’s people from all over the world. I think Ramaphosa in South Africa and other leaders in South Africa have done actually pretty good in just putting that balance. And it all depends on context. Singapore is different from New Zealand, from South Africa from other places. But this calm body language, talking to people, acknowledging the emotion, but providing reassurance and clarity. Emotion is crucial. Target the values rather than the science. Mobilize people. So good leadership is about people’s delivering the message to the public trust and listen to most of what I talked about is pretty applicable in any country. I would say a lot of these things are human traits. I emphasize cultural specificity a lot. I think some of the communications environments that I talked about might apply a bit more to the high income countries. In lower middle income countries trust maybe low, but you might have stronger existing networks. You know, community networks, community leadership. People in the community, who people listen to. Whether that’s through their church or other religious structures that exist. The key thing is that you still need consent for any mass measures that you kind of bring in you still need people to agree and go along with what you’re doing. You can’t forcibly locked down the country. I think every lockdown that happened around the world, it was still needed. Even the lockdown in Wuhan, it needed consent. It had the overwhelming consent of the public. Even though it looks kind of enforced. Yes, it was straight, but it had consent on a fundamental level. 

Peter Harrington When we look to COVID, when we go back in sort of April, this is what it was meant to look like, right? You’ve had this kind of rapid response, you have this overload period. Then you had this kind of exit and this kind of recover and reform kind of process. Right. That you’d have this spike and then it would gradually we’d kind of we’d kind of hammer the curve, really lockdown’s behavior change and so on. And the messaging needs to adapt as you go along. So emergency behavior change is about adherence then it’s about new behaviors and new norms. What it actually looks like is extremely problematic. And that’s what we’re seeing in a lot of countries at the moment. And there are reasons for that. And the most powerful reason for that is people’s behavior is lapsing. It’s going back, right? Yes, it’s partly driven these second waves are partly driven by returns to economic activity. We couldn’t maintain the sorts of restrictions of March, April, May for indefinitely. So we had to return to economic activity in the hope that we can do something with new norms and new behaviors. But this yo yo-ing that we’re seeing in a lot of countries, these multiple waves is I think primarily driven by behavior. Whether people are really adapting to a new normal and really in a sustained way, changing their behavior, whether it’s distancing, mask wearing. It’s really important to note that there’s a lot of uncertainty about what measures and interventions are going to have the most impact. There’s nothing was known about COVID before it arrived. That’s a massive learning exercise. People knew a lot about Ebola already when 2014 happened, no one knew anything about COVID so there’s a huge amount learned. Message fatigue is a is a really well documented aspect of this field right. People just get tired and they kind of get “Ugh I’ve heard that…” At first t’s kind of it’s a little bit exciting and a bit new, a little bit of novelty, though, we’re all home, I can make sourdough or pick up Italian. Or in other parts of the world. It was impossible for people to make that lifestyle change or not go out, but wherever they are in whatever part of the world, message fatigue is is a human trait. So it’s very difficult to counter that, actually. Also, messages just lose effectiveness over time, even if the people aren’t sick of hearing it, it just doesn’t really land in the same way. 

Peter Harrington What countries are going to need to do now is to reset their risk communications. It needs a kind of like a reboot because if you keep going with the same tired stuff, people will say, “Ok, I have heard that.” Their sort of, you know, ears get closed. I’ve heard that before. And actually, the dangers will get stuck in that kind of yo yo-ing situation because it’s lurching in and out of lockdown, which is going to obviously be extremely detrimental to all kinds of things, not just economies, but all sorts of vulnerable groups and people’s mental health and all the other things that have been so impacted in this past year. 

Peter Harrington So I’m going to sum up controlling something like COVID or Ebola is all about human behavior. All of these policies, all of these measures, it’s all about changing human behavior so that the virus, cannot just jump from one person to another. Right. We have to change our behavior. We’ve all had to do that this year. Everybody on the planet has something in common this year. We all have to change our behavior. Right. But how much? And different people have different views on how much necessary or whether they should do it. Just to recap, it’s driven by lots and lots of different factors. But communications absolutely can influence behavior, if it’s done well adhering to the kinds of science based on evidence-based techniques and methods which I’ve talked about. There is a science of risk communication and an art and it works. It actually works. I mean, we’ve seen it work this year. Yes other things influence changes in behavior. But if you go with the grain of what people are doing and draw their attention to the right things, and utilize people they trust that it works. So that cultural sensitivity and context is absolutely essential. You know, the messaging in Uganda has be completely different from the messaging, not completely different, but framed and delivered in a different way from the messaging somewhere else. And if you take away one thing from this, it’s if the whole ballgame is about human behavior and the whole game of human behavior is about trust, fundamentally, that is the most single, most important currency this year, maybe for the next few years. It is an incredibly short supply and effective leaders, effective policymakers, effective anyone trying to work to stem and cancel this epidemic or in any context, their ability to be effective is going to hinge very significantly on their ability to build trust with their audiences and with that, back over to you Salimah.