Communication missteps during COVID‐19 hurt those already most at risk

Abstract

Emergency risk communication is a crucial part responding to crises. Right now, vulnerable groups are experiencing disproportionately negative outcomes from communication missteps surrounding COVID‐19. In this commentary, we describe the missteps and outline strategies that response organizations can take to improve communication for vulnerable groups.

Although the scale of the novel coronavirus (COVID‐19) outbreak is extraordinary, what remains consistent with other crises is that the virus appears to be discriminating, impacting minorities, ¹ poorer people, those who are housing insecure, ² older adults ³ , and people with pre‐existing health conditions. ⁴ These impacts are reported not only for the United States, but globally: across the world, vulnerable populations more likely to suffer from the pandemic and its related impacts (Lavell, Mansilla, Maskrey, & Ramirez, 2020). ⁵ These populations tend to experience more communication gaps compared to less vulnerable populations. ⁶ Such communication gaps are particularly problematic for the COVID‐19 pandemic, reflected in the World Health Organization's (WHO) description the pandemic as an “infodemic,” an overabundance of information, both accurate and inaccurate, that can make finding trustworthy sources incredibly difficult. ⁷

Other disasters, from fires and floods to hurricanes, also appear to discriminate. Yet, when these disasters are examined, it becomes clear that differences in impacts are not the result of a disaster or the victims, but rather inequitable policies and institutions that place those already at risk in perilous positions. ⁸ For example, in New Orleans, African Americans were much more impacted by Hurricane Katrina in 2005. ⁹ Simply, if you were African American, it took longer to recover from the hurricane. Of course, the hurricane did not target anyone based on their skin tone. Instead, institutional racism led to more black and brown people to live in substandard housing, breathe unhealthy air, work in service sector jobs and have fewer financial assets. More recently in Puerto Rico, challenges related to the U.S. federal government's response to Hurricane Maria, similarly rooted in a history of colonialism and racism (Moulton & Machado, 2019; Rodríguez‐Díaz, 2018), severely limited the resources available to support recovery on the island. ¹⁰ So, too disproportionate impacts of hurricanes and storms have been reported in Bangladesh, Myanmar, Sierra Leone, the Philippines, Haiti, and other countries (Johnson, von Meding, Gajendran, & Forino, 2019). ¹¹

Already at a disadvantage, vulnerable populations will also likely bear the brunt of COVID‐19 information insufficiency and misinformation. The consequences of such communication missteps are serious and compounding negative outcomes for many vulnerable groups. To address this global pandemic, response organizations across the world must employ crisis communication strategies specifically designed to improve communication and limit the spread of misinformation for vulnerable groups who need it the most.

1. VULNERABILITY AND MISINFORMATION

Communication challenges can exacerbate risks that vulnerable groups face. However, crisis communication is rarely adapted to meet the needs of vulnerable populations. Right now, vulnerable groups are experiencing disproportionately negative outcomes from the infodemic surrounding COVID‐19 in several ways:

1.1. Lack of access to communication channels

One of the great challenges is the ability to reach vulnerable groups in order to deliver updates and provide guidance surrounding protective actions. When it comes to targeted prevention and public health education, vehicles such as community health fairs and other face‐to‐face consultations served the essential need for the uninsured, those with translation needs, or with other barriers to accessing health services. ¹² This type of outreach will be off the table for the foreseeable future. It is also no surprise that vulnerable groups often lack access to technology including tablets, computers and smartphones in addition to high‐speed Internet. ¹³ Yet, finding means of optimizing digital channels will be more important than ever before.

1.2. Lingering mistrust in official sources

Due to histories of discrimination and mistreatment, vulnerable populations may distrust authorities, including the federal or central government, which can lead some to want to ignore the advice of officials (Andersen & Spitzberg, 2009). We know that, for example, decreased confidence in governments can have serious impacts on health decision‐making across the world. ¹⁴ A particular egregious case is from Pakistan, where militants disrupted ongoing polio immunization efforts in response to CIA attempts to use fake immunization campaigns to obtain DNA from Osama bin Laden's relatives. ¹⁵ A slightly less egregious but no less serious example comes from the 2014–2016 West Africa Ebola crisis, where long‐standing lack of confidence in the ability of the governments of Sierra Leone, Liberia, and Guinea to provide basic services fostered mistrust that impacted the Ebola public health response. ¹⁶

Civil society organizations such as faith‐based institutions, non‐profit organizations and community centres are some of the most important alternative sources for information for vulnerable populations. These organizations often offer trusted healthcare services as alternatives to traditional healthcare facilitates. ¹⁷ Many are also trusted sources of health‐related information. For example, in the U.S. Gulf Coast African Americans are more likely to trust news provided by religious institutions. ¹⁸ Similar trends can be found internationally. ¹⁹ Fortunately, many civil society organizations are working to counter misinformation and provide information related to the COVID‐19 pandemic. ²⁰ Unfortunately, many are sidelined due to social distancing guidelines and inadequate funding. As these partner organizations close their physical doors, lose volunteers and face their own financial challenges, there is an urgent need to assess the capacity of civil society organizations and how they are responding to COVID‐19.

1.3. The perfect conditions for misinformation

Challenges in access and mistrust in official communication channels mean that alternative forms and venues of communication are more prevalent. Not all alternatives have been reliable. In the United States, the Federal Emergency Management Agency started to tackle rumours directly by cataloguing them on a newly developed rumour control webpage. ²¹ The WHO is making similar efforts globally. ²² Tech giants such as Facebook are rolling out new features to help stop misinformation from spreading across its platforms. ²³ Of course, no one is more or less immune to COVID‐19. The echo chamber online, however, can reinforce falsehoods and exacerbate an infodemic that drives inappropriate behaviour by the public.

2. CONFRONTING THE COVID‐19 INFODEMIC FOR VULNERABLE POPULATIONS

What can be done to address these issues and reduce the COVID‐19 infodemic for vulnerable populations across the globe? Although caused by deep social and historical forces, several actions can be put in place to lessen the damage. First, the infodemic is ultimately the product of a differentiated risk profile, meaning that addressing the infodemic is about tailoring interventions to fit the various needs of different populations. Instead of a one size fits all communication strategies, efforts need to develop differential strategies. This can involve specific interventions to shore up communication infrastructure that populations use, for instance by providing batteries and charging stations for people experiencing homelessness or interrupted services. ²⁴ Cell phone credit could be provided to lower income populations to access Wi‐Fi. Solutions are needed to chip away at the digital divide today more than before.

Secondly, we need more knowledge of the new partner landscape to understand available support systems. Who is rising to meet the needs of vulnerable groups? Are local NGOs, churches and other community‐based civil society organizations collaborating with leading response agencies to amplify public health communication? If not, what are the financial, institutional, and other barriers limiting collaboration? Right now, the reports suggest that many civil society organizations are under strain from the pandemic and its effects, ²⁵ but we still have little understanding of how these organizations are working to disseminate critical information. Identifying and supporting “linchpin” organizations that are connected with leading response agencies and with vulnerable groups could improve communication in the months and years to come.

We still are learning how information and misinformation are spread to different populations during this crisis; so thirdly, additional research is urgently needed related to COVID‐19 communication—and again that research has to be comparative. For instance, as responders use social networking sites like Facebook and Twitter to communicate information, it is unclear which messages reach different groups in different places and how communication can be modified to improve information spread and reduce misinformation among vulnerable populations. Targeted and rapid research is therefore necessary to improve communication with these groups during the pandemic and its aftermaths. These data will be essential, especially until a vaccine is available and widely accessible. Indeed, the work that we undertake now to keep audiences updated, build goodwill, and foster trust will affect the likelihood of vaccine uptake down the road across the world. ²⁶

Clark‐Ginsberg A, Petrun Sayers EL. Communication missteps during COVID‐19 hurt those already most at risk. J Contingencies and Crisis Management. 2020;28:482–484. 10.1111/1468-5973.12304