Reputational impact of Covid‐19 pandemic management on World Health Organization among Indian public health professionals

Abstract

Organizational reputation is critical for successful stakeholder engagement. A crisis can affect the organizational reputation and alter stakeholder perception about organizations. The current study investigates the impact of the Covid‐19 pandemic and its management on the World Health Organization's (WHO's) reputation among Indian public health professionals (PHPs). The study applies the situational crisis communication theory (SCCT) model to investigate the reputational impact of the pandemic on WHO among the study subjects. The study results indicate that most Indian PHPs attribute the current Pandemic to WHO. Their current reputation has dropped compared to their earlier reputation among Indian PHPs. The same is reflected in their behavioral intent, with the PHP's willingness to follow WHO guidelines on public health issues significantly reduced. The study also finds empirical support for the SCCT Model.

1. INTRODUCTION

Reputation is an intangible and non‐replicable asset that can attract and retain an organization's various stakeholders. Reputation lends credibility to the organization and assures the stakeholders of its ability to serve them. Reputational loss drives the stakeholders away from the organization (Bromley, 2000; Nguyen & Leblanc, 2001). Though a reputational loss is a gradual process, crises can alter organizational reputation overnight—effective management of crises is crucial to preserving a corporate reputation for organizations of all ilk. Maintaining good relations with the different stakeholders during a crisis involves effective communication. Crisis makes communications challenging, and ineffective crisis communication can damage an organization's relationship with its public. Effective crisis communication in crisis management has been an emergent topic in communication and public relations research.

Though well researched, crisis communication studies have primarily focused on commercial, political, or government organizations. The study of health crises and the role of crisis communication in its management have been lacking. It has been more than 18 months since Covid‐19 was declared a pandemic by the World Health Organization (WHO). There have been intensive efforts to control the pandemic, albeit with mixed success. Though vaccines have been introduced, their administration on a large scale will take longer. Resurgent infections are still shutting down countries and affecting lives. Under such circumstances, WHO's role—mandated with managing worldwide health emergencies‐faces scrutiny. The verdict is still not out on the pandemic crisis responsibility as the world grapples with follow‐up waves of infection and efforts to control them. However, two entities—WHO and China, to whom the problem is attributed in varying degrees, have been at the center of the crisis. The political institutions across, especially in the developed world, have held the two jointly responsible for the crisis and attributed it to their negligent or deliberate actions (Horsley, 2020; Mulier & Gretler, 2020; Silver et al., 2020). Though the framing of crisis responsibility has been clear from the developed world's angle, the same is not true for the rest.

WHO is a specialized agency under the United Nations (UN) with primary responsibility of monitoring health risks, coordinating medical emergency responses, and promoting health worldwide. Especially so for developing and underdeveloped countries that lack internal healthcare mechanisms to independently formulate public health policies and strategies. These economies foster close relationships between their Indian public health professionals (PHPs) and WHO in delivering health to their citizens. WHO has a reasonably successful history of global public health crisis management through timely interventions and advice to UN members, especially when the problem is international (Buranyi, 2020; Huang, 2020). However, once in a millennium event, the current pandemic is a different ballgame because of its speed, scale, and rarity. The current pandemic has derailed WHO's health management capabilities. The organization has frequently changed its pandemic control and management position, creating confusion among health professionals (Chappel, 2020; Maxmen, 2021; Sharma, 2020). The wide use of digital communication has only helped create a contagion of every mistake WHO has made in the pandemic management (Coombs, 2002). After more than 1 year of outbreak, the inability to provide a clear pandemic management strategy has dented WHO's reputation among the PHPs—a primary constituent in promoting health worldwide. The current study aims to assess pandemic management's impact on the reputation of WHO among PHPs in India.

The study primarily investigates how much Covid‐19 crisis responsibility is attributed to WHO and its effect on reputation and behavioral intention. The study also investigates the moderating effect of crisis history, prior reputation, crisis response perception, emotions of responsibility attribution, organizational reputation, and behavioral intentions. The study applies the SSCT model (Coombs, 2007) to attain the proposed research objectives. A detailed list of proposed hypotheses is provided in the objectives section. Organizational reputation and behavioral intentions are the primary dependent variables, crisis responsibility is the independent variable in the model, and the four moderating variables are constituents' crisis response perception and emotions and the organization's prior reputation and crisis history. The relationship between the variables is described in Figure 1. Though the pandemic has been a global phenomenon, the current study is limited to PHPs in the Indian subcontinent due to limitations induced by resources and pandemic restrictions.

FIGURE 1.

Proposed research model

1.1. Literature review

1.1.1. Crisis and its impact on the reputation

Reputation is an aggregation of stakeholder evaluation of how an organization meets their expectation based on its past behavior (Fombrun et al., 2000, p. 243; Wartick, 1992). Reputation is also defined as “a set of beliefs about an organization's capacities, intentions, history and mission that are embedded in a network of stakeholders” (Carpenter & Krause, 2012). Reputation is more critical for public organizations as it influences their administrative autonomy and discretion. Reputation is a valuable asset that can attract, engage, and retain various stakeholders (e.g., donors and healthcare specialists). Its loss will curtail the autonomy and discretion WHO currently enjoys in managing public health globally. A crisis can threaten the organizational reputation and affect how stakeholders interact with an organization (Barton, 2001; Dowling, 2002). A crisis typically results in adverse outcomes like losing physical assets like men and materials or intangibles like credibility and reputation. A crisis causes an inability of the organization to continue its daily operations and reduces its ability to serve its stakeholders (Argenti, 2013; Coombs, 2007). However, crises may also improve organizational reputation when well‐managed though such examples are rare and few (Fink, 1986).

Crisis can have varying origins and are generally classified into three categories. It might result from a deliberate act by an individual or organization where the organization will be held responsible for the consequences—commonly called the preventable cluster. In the accidental type, organizational accidents may cause crises, and they will be both responsible for and victims of the crisis. The last type of organizational crisis is the victim type. Here the cause of the crisis is beyond the organization's control, and it is generally considered a victim of the crisis. The crisis management strategies and the reputational impact depend on the type of the crisis. It is the maximum for the preventable cluster and significantly reduces the accidental cluster. The victim type of crisis affords the lowest attribution and reputational loss for the organization involved (Coombs, 2007). Using an appropriate crisis strategy is critical for successful crisis management and reputation protection, and the current pandemic crisis type is still being debated. There have been claims of the pandemic being a preventable crisis, with China being the perpetrator. Another narrative is the crisis being an accident with a laboratory virus leak from a Chinese lab in Wuhan. Yet another narrative, including WHO, has been that the pandemic is a victim type of crisis. The debate notwithstanding, pandemic management has been complex and ongoing almost 2 years after it started.

Crisis communication is critical in managing the crisis, and crisis managers can benefit from understanding its usage in protecting organizational reputation during the crisis. Communication becomes difficult during the crisis due to the chaotic nature of the events and the lack of adequate information (Sanjeev et al., 2021). Effective crisis communication helps organizations provide relevant information to the stakeholders to cope with and adjust to the crisis and make the suitable attribution of the crisis responsibility. It also allows the organization to project its side of the story, thus preventing reputation and credibility loss and maintaining relationships with its stakeholders. A crisis causes attribution (assigning causes to events), triggering emotional reactions among stakeholders. When an organization is attributed with the responsibility for a crisis, stakeholders are angered—triggering a negative emotional reaction and disengagement with the organization. Such disengagement emanates from the stakeholder's belief that the organization has lost its reputation—a belief that the organization can effectively serve its cause. Situational crisis communication theory (SCCT) is an empirical framework that helps understand the reputational threat. Reputation protection has been one of the primary objectives of SCCT (Coombs, 2007) and helps minimize reputational loss through appropriate communication during a crisis. SCCT assumes a direct relationship between crisis responsibilities, crisis response, and organizational reputation. Built on attribution theory and image theory, SCCT posits that a stakeholder's reaction to a crisis depends on the attribution of responsibility, the suitability of crisis response, crisis history, and pre‐crisis relationship (Ma, 2018). When the crisis is attributed to the organization and crisis response is considered inferior, the reputational loss will be the highest. The crisis type and response type matching, according to SCCT, will help organizations reduce the reputational impact of the crisis. Attribution of the crisis is dependent on locus, stability, and controllability. The higher the crisis responsibility the stakeholder attributes to an organization, the more negative their response to it. The negative reaction may manifest as customer disengagement, organizational disparagement, and anger toward the organization (Coombs, 1995). SCCT helps organizations choose the most appropriate crisis response strategies based on the crisis types to reduce perceived crisis responsibility levels (the degree to which stakeholders blame the organization for the crisis) (Sisco et al., 2010).

According to the SCCT model, attribution of crisis responsibility and appropriateness of the organization's crisis response strategy is critical to the organization's reputation. The reputation impact will be minimal when the crisis is not attributed directly to organizational actions, and its response to the crisis is considered appropriate. Attribution of the crisis responsibility also triggers negative emotional reactions among the stakeholders, which along with organizational reputation, decide future behavioral intentions. Two other critical components of the SCCT are crisis history and prior reputation. Crisis history refers to the stakeholder assessment of the organization's earlier involvement in a similar crisis. If the stakeholder feels that the organization has faced similar situations earlier, it will adversely impact its reputation. Prior reputation is the stakeholder's perception of how truthful the organization was in handling earlier crises. An excellent prior reputation helps an organization moderate the impact of a crisis on its current reputation. The effect of the current pandemic on WHO's reputation, according to the SCCT model, will depend on PHP's attribution of the pandemic to deliberate (as in hiding or covering up initial outbreak news) or negligent actions (as in neglecting actionable information of initial outbreak). The reputational impact will be moderated by PHP's perception of the suitability of the pandemic crisis management strategy adopted by WHO and its past behavior during healthcare emergencies (e.g., the Ebola or SARS outbreaks)—reflected in the crisis history and the prior reputation.

The SCCT model has universal applicability, making it an attractive option for studying the reputational impact of the crisis on organizations. It can be used for organizations of all ilk—be it private or public, for‐profit or non‐profit across all industries. SCCT model has already been used in studying a health crisis (Roundtree, 2018; Sisco et al., 2010; Zhang et al., 2021). Sisco et al. (2010) used the SCCT model to understand the suitability of crisis response strategies used by the American Red Cross from 1997 to 2007. The SCCT model treats the organization holistically and looks at the impact of the crisis on the organization's reputation and not its parts. However, the model can also be treated in a modular fashion—for example, to study the impact of crisis management strategy on organizational reputation. Another good feature of the SCCT model is comprehensiveness. The model not only considers the reputational impact of the stakeholders' crisis attribution on corporate reputation but also the moderating effects of crisis response, history, and prior reputation. In addition, the SCCT model measures the constituents' emotional reaction to the organization and its impact on their future behavioral intentions.

1.1.2. WHO and public health

World Health Assembly is the decision‐making body of WHO and is represented by all member states. The assembly is governed by a board of 34 technically qualified members elected for 3 years. WHO was created in 1948 to coordinate global health efforts within the UN system. It works firmly rooted in the philosophy of the right to health and well‐being for all (WHO, 2021). It works globally to promote universal health coverage and well‐being and prevent health emergencies, focusing on the underprivileged. Though initial priorities were infectious diseases, women and child health, nutrition, and sanitation, increasingly, they have been at the forefront of global health crisis management in recent decades. The outbreak of Ebola in Congo in 1995, unbeknownst to WHO, highlighted the need for global public health surveillance and notification. To meet these needs, WHO rolled out a global public health intelligence network (GPHIN) in 1997 and a global outbreak alert response network (GOARN) in 2000 (Lundberg, 2013). The last four decades have seen health emergencies due to AIDS, Ebola, SARS, H1N1, MERS, Zika, Nipah, and Covid‐19 (Council on Foreign Relations, 2021). WHO has been at the forefront of managing these international health crises. These pandemics have affected several countries posing significant health, social, and economic risks—criticism notwithstanding, WHO has done a commendable job of managing them.

WHO coordinates global health efforts to deliver universal health coverage and prevent health emergencies. However, increasingly they have been criticized for their insufficient efforts in global health crisis management. The once‐in‐a‐century pandemic crisis posed by Covid‐19 has been different, and it has tested the professional and organizational capabilities of WHO to the hilt. The preparedness and monitoring board (GPMB) is an independent body co‐convened by the world bank and WHO to monitor and fix accountability in a global health crisis. GPMB's 2020 report, A World in Disorder, highlights the collective failure in Managing Covid‐19 and its after‐effects (World Bank, 2021). WHO has been increasingly attributed these failures, including the current pandemic. The western world has accused WHO of colluding with the Chinese government in concealing information about the Covid‐19 outbreak, eventually causing the current pandemic. There has been an increasing accusation of collusion with national health authorities and pharmaceutical firms, derailing international health crisis management efforts, especially during the current pandemic (Hameiri, 2020; Lakoff, 2020). The initial lack of actionable information and the frequent changes in Covid‐19 management guidelines have increased the attacks on WHO (Chappel, 2020; Maxmen, 2021). These narratives have dented their reputation among PHPs globally, who look up to them for effective public health policies for improved healthcare delivery and health crisis management. WHO has had to defend its pandemic management efforts and the “infodemic” to save its reputation as the harbinger of global health (BBC, 2020; Mullen, 2020).

1.2. Research objectives

Research involving healthcare organizations has been restricted mainly to non‐profit organizations like Red Cross (Sisco et al., 2010). Though WHO has been at the forefront of managing global health crises—the impact of these crises on WHO's reputation has not been investigated earlier. A search of the Boolean word string “World Health Organization AND Crisis Management AND Reputation” yielded seven results from the Scopus database. A closer examination revealed that none of the articles directly dealt with a health crisis and its reputational impact on WHO. A similar search in two other leading databases—Google Scholar and ProQuest, returned no results. The database search results indicate a clear need for academic research in a healthcare crisis involving WHO and its reputational impact. Though a black swan event, the current pandemic offers a perfect setting for the study.

The primary objective of the current study is to investigate the reputational impact of the Covid‐19 pandemic management on WHO's reputation and its subsequent effect on the behavioral intentions of the PHPs. The study applies the SCCT model due to its comprehensiveness and universal applicability. Four moderating variables in the SCCT model affect the crisis responsibility‐organizational reputation‐behavioral intention pathways. These are the constituent's perception of crisis response strategies, emotional reaction toward the organization, its prior reputation, and crisis history. Crisis history and prior reputation moderate crisis responsibility and organizational reputation. The perception of the crisis's response moderates crisis responsibility, organizational reputation, and emotions. Finally, emotions moderate behavioral intentions (Figure 1). The study verifies the following hypothesis (Figure 1).

PHP's perception of crisis response will be positively associated with the organizational reputation of WHO.

PHP's perception of crisis response will negatively impact crisis responsibility attribution to WHO.

PHP's crisis responsibility attribution will negatively impact WHO's organizational reputation.

PHP's perception of crisis response will positively impact PHP's emotions toward WHO.

PHP's perception of crisis history will positively impact crisis responsibility attribution to WHO.

PHP's perception of crisis history will negatively impact the organizational reputation of WHO.

PHP's perception of prior reputation will negatively impact crisis responsibility attribution to WHO.

PHP's perception of WHO's prior reputation will positively impact its organizational reputation due to the crisis.

PHP's attribution of crisis responsibility will negatively impact their emotions toward WHO.

PHP's emotions will positively impact the behavioral intentions concerning WHO.

WHO's organizational reputation will positively impact PHP's behavioral intentions concerning the organization.

2. METHODS

2.1. Design

the current study is a cross‐sectional causal investigation assessing the impact of WHO's Covid‐19 response on organizational reputation. The data is collected using a survey instrument developed based on SCCT. The survey instrument was administered online, paper, and pencil (self‐administered), and an interviewer‐administered telephonic survey. Using multiple data collection techniques ensured that method biases were reduced due to similar data collection techniques.

2.2. Participants and procedures

Participants in the study were PHPs with a minimum of 1 year of experience and were involved in Covid‐19 management. The participants were recruited through snowballing—a chain referral sampling technique. The initial respondents, contacts of the investigators, were approached for referrals to recruit further respondents. The first 10 respondents were selected from the personal connections of the researchers. The initial contacts helped draft the following 30 samples from whom 90 more PHPs were enlisted for the study. The third sampling stage helped recruitment the final 270 samples for the study. A total of 400 PHPs were finally enrolled in the study through snowballing. However, to prevent biases, no more than three referrals were included from each recruit. The respondents belonged to six Indian states that have contributed to 60% of the Covid‐19 infections in the country and included Maharashtra, Kerala, Karnataka, Tamil Nadu, Andhra Pradesh, and Uttar Pradesh. These states contributed nearly 200 million cases of 318 million patients in the country as of August 1, 2021 (Statista, 2021; Worldometers, 2021). All referrals from other than the six states were excluded from the study.

2.3. Measures

All the seven SCCT parameters were calculated using homogenous item composites (Loevinger, 1957). “Organizational reputation” was measured using a 3‐item scale adapted from Coombs and Holladay (2002), adapted initially from McCroskey's scale for measuring Ethos (Coombs & Holladay, 2002) (four items proposed originally and one rejected by an expert panel). “Crisis responsibility” was measured using two items adapted from the three‐item blame scale (Griffin et al., 1992) (three items proposed originally and one rejected by an expert panel). “Behavioral intention” was assessed using a three‐item scale and measured the intentions to continue adherence to WHO guidelines in public health matters (similar to purchase intent or otherwise) and word‐of‐mouth behavior (similar to support for the organization or otherwise). Five items were initially proposed, and the expert panel rejected two items. “Emotions” were measured using a two‐item scale, one item each measuring positive and negative affect. The measures (“behavioral intention” and “emotion”) were developed as proposed in “Protecting Organizational Reputations during a Crisis: The Development and Application of Situational Crisis Communication Theory” (Coombs, 2007, p. 169). Where the word “organization” appeared in items, it was replaced with “WHO” to suit the context.

A crisis response strategy is critical in how constituents attribute crisis responsibility. The crisis response strategy has been a weak link‐in establishing the universal applicability of SCCT. Constituent's assessment of the crisis responses is hugely contextual and culture‐dependent and has been empirically proven (Barkley, 2020). Also complicating the measure is that crisis response strategies depend on the crisis types, crisis history, and prior relationship reputation. A pandemic crisis, like Covid‐19, often requires multiple crisis responses, which may include the ethical base response of providing adjusting and instructing information, reminder, and ingratiation, among others (Coombs, 2007, p. 170). Under such circumstances, a measure of overall “perception about crisis response strategy” as professional/ appropriate (or otherwise) would be suitable. Hence, stakeholder perception of the “crisis response strategy” was measured using a two‐item scale. Such a perception measurement will also help overcome differences in stakeholders' assessment of the crisis response strategy, as it is culture and context‐driven and make SCCT more universally applicable.

“Prior relationship reputation” was measured using a three‐item scale developed based on two previous scales (five items proposed initially). The organizational reputation scale of Coombs and Holladay (2002) and a scale used to measure the past attitude of constituents toward the National Hockey League (NHL), before the 2004–2005 NHL lockout (Coombs & Holladay, 2002, p. 174; Formentin, 2010, p. 98). “Crisis history” was measured using two items which involved recalling survey participants' memory of WHO's past healthcare crisis management efforts and based on the NHL crisis mentioned above (three items proposed initially). All the items were subject to the content validity test after item development before the final survey, using an expert panel (consisting of 7 medical practitioners with a minimum of 20 years' experience in public health and 3 communications expert with at least 10 years' experience). All items garnered the minimum recommended content validity ratio (CVR) of more than 0.62 (based on a panel size of 10 at a 95% confidence interval) (Lawshe, 1975). The items were worded without reference to “China” or “Wuhan” to prevent any context‐induced mood, causing method bias due to the ongoing India‐China border row (Podsakoff et al., 2003). Informed consent with the right to refuse was obtained from the survey participants. The study also incorporated multiple media to collect the data (online, paper and pencil, and telephonic) and ensured respondent anonymity to reduce common method biases. The data analysis was done using SPSS and AMOS (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: I.B.M. Corp) (AMOS Version 23.0. Chicago: IBM SPSS).

3. RESULTS

Two hundred ninety‐four responses were received from the six states (32 responses from other states were excluded from any analysis). As the questionnaire requested to share the survey among other PHP colleagues, some participants might have shared the link with PHPs working in states outside the six study states. The response rate based on the initial emails sent was 73.5%. Eighteen responses were removed due to missing items (only in the paper and pencil format) or for being non‐modern medicine practitioner responses (many alternative medicine practitioners were assigned duty due to a shortage of modern medical practitioners); 244 responses were selected for final analysis. As the SCCT model has seven parameters, the best sample size for path analysis was calculated at 140 (StatisticsSolutions, 2021), well below the survey sample of 244. Maximum responses were from Uttar Pradesh, followed by Maharashtra, Kerala, Karnataka, Tamil Nadu, and Andhra Pradesh (88, 53, 35, 26, 23, and 19, respectively). The responses were not proportionate to the infections recorded in these states. The respondent experience ranged from 1 to 46 years, with a mean of 15.36 years and a SD of 10.67 years. Sixty‐one females and 183 males responded (25% and 75%, respectively). Sixty‐three respondents were graduates, 152 post‐graduates, and 29 super‐specialists (25.8%, 62.3%, and 11.9%, respectively). Harman single factor test conducted to detect common method variance, using all 17 items, returned 42.88% variation by the single factor extracted. The test value is below the 50% discriminant level, indicating an absence of any severe method bias (Podsakoff et al., 2003). The final parameter scores for the seven parameters of SCCT were calculated as the mean score of the items used for measuring the parameters. For parametric test application, the data normality was ascertained by calculating Kurtosis and Skewness. The Skewness and Kurtosis for all variables were well below the ±3 mark (Table 1), indicating suitability for applying parametric tests (Hair et al., 2010). The mean parameters score and the frequency of responses in the “<three,” “three,” and “> three” categories for each parameter are also provided in Table 1.

TABLE 1.

Descriptive statistics

Variables	Mean	SD	Skewness	Kurtosis	Scores distribution
					Score <3 (%)	Score = 3 (%)	Score >3 (%)
Organizational reputation	2.55	0.87	0.194	−0.345	65 (26.6)	59 (24.2)	120 (49.2)
Crisis responsibility	3.30	0.93	−0.034	−0.555	44 (18.0)	47 (19.3)	153 (62.7)
Behavioral intention	2.40	0.82	0.310	−0.447	90 (36.9)	70 (28.7)	74 (34.4)
Emotions	3.25	1.02	−0.137	−0.749	53 (21.7)	39 (16.6)	152 (61.7)
Crises response perception	3.43	0.91	−0.481	−0.089	77 (31.6)	51 (20.9)	116 (47.5)
Prior reputation	3.53	0.90	−0.264	−0.336	148 (60.7)	44 (18.0)	52 (21.3)
Crisis history	3.04	0.68	0.310	−0.113	165 (67.6)	34 (13.9)	45 (18.5)

Source: Survey data.

As homogenous item composites were used to measure the seven parameters in the SCCT model, further factor analysis was not attempted (measurement model). Instead, a path analysis was conducted (structural model) using AMOS to calculate the path coefficients and the overall model fit. The individual path coefficients, their significance, and the hypothesis implications are in Table 2. The fitness indexes exhibit good model fit (Table 2), and there were no collinearity issues (all the value inflation factors were below 3.0). GFI, CFI, and RMR (0.953, 0.961, and 0.034; respectively) indicated good model fit. However, CMIN and RMSEA (6.216 and 0.147; respectively) indicated a moderate fit (MacCallum et al., 1996; Marsh & Hocevar, 1985). The fit indices empirically indicate the nomothetic validity of the SCCT model. Such empirical verification of the model has not been attempted (based on the extant literature available to the authors). Most attempt to apply the SCCT model has been partial (testing only some of the posited models) in earlier crisis studies using the model (Figure 2).

TABLE 2.

Path analysis

Path	Regression weights	SE	C.R.	Hypothesis tested
Crisis response perception → Organizational reputation	0.296**	0.062	4.813	H1 —Not Rejected
Crisis response perception → Crisis responsibility	−0.313**	0.075	−4.149	H2 —Not Rejected
Crisis responsibility → Organizational reputation	−0.340**	0.051	−6.724	H3 —Not Rejected
Crisis response perception → Emotions	0.620**	0.052	11.984	H4 —Not Rejected
Crisis history → Crisis responsibility	−0.178	0.117	−1.523	H5 —Not Accepted
Crisis history → Organizational reputation	0.163	0.092	1.762	H6 —Not Accepted
Prior reputation → Crisis responsibility	−0.022	0.087	−0.257	H7 —Not Accepted
Prior reputation → Organizational reputation	0.008	0.069	0.117	H8 —Not Accepted
Crisis responsibility → Emotions	−0.377**	0.051	−7.455	H9 —Not Rejected
Emotions → Behavioral intentions	0.222**	0.034	6.587	H10 —Not Rejected
Organizational reputation → Behavioral intentions	0.582**	0.040	14.688	H11 —Not Rejected

Note: CMIN = 6.216, GFI = 0.953, CFI = 0.961, RMR = 0.034, RMSEA = 0.147.

^** p < 0.01.

^* p < 0.05.

Source: Survey data.

FIGURE 2.

Path analysis—Situational crisis communication theory (SCCT) mode

The mean crisis responsibility score was 3.30 and fell in the agreement range of a five‐point Likert scale. Such a score indicates that the Indian PHPs attribute the current pandemic to omissions of WHO, at least partly. The frequency distribution indicates that 26.6% PHPs are not attributing the crisis to WHO (score below three), 24.2% are neutral about attribution (score of three), and 49.2% attribute the situation to WHO (score of more than three). The mean organizational reputation score was 2.54 and fell in the disagreement range of the five‐point Likert scale (148 (60.7%) respondents in the <3 category). Such a score indicates a fall in WHO's reputation among the PHPs, especially considering the prior reputation score of 3.52 (153 (62.7%) respondents in the >3 category). The Indian PHPs think WHO has lost some credibility in serving the cause of public health in the current pandemic. The mean crisis response perception (PHP perception of whether WHO took appropriate measures in controlling the pandemic) score was 3.43 on a five‐point Likert scale agreement range (152 (61.7%) in the >3 category). It indicates that the PHPs consider WHO to have taken appropriate response measures like declaring the Covid‐19 a pandemic, providing adjusting information, and instructing information. The mean crisis history score was 3.09 and on the mid‐point of the five‐point Likert scale (90 and 74 (36.9% and 34.4%) respondents in the <3 and >3 categories, respectively). The score indicates that the PHPs consider WHO to have a mixed history of success and failures in controlling global health crises in the past. The mean emotion score was 3.25 and on the agreement range of the five‐point Likert scale (116 (47.5%) respondents in the >3 categories). Such scores indicate that PHPs still have a positive affect for WHO, irrespective of its pandemic handling. It is in line with the mean “crisis response perception” score, which also lies in the agreement range and is positively correlated. The mean behavior intention score was 2.40 and lay in the disagreement range of the five‐point Likert scale (165 (67.6%) respondents in the <3 category). Such a score indicates that the PHPs may be unwilling to follow WHO guidelines for public health management completely. However, the behavior intention scores positively correlate with the organizational reputation and emotions scores. The low behavioral intention may be due to WHO's lack of control over the pandemic and its many mistakes and retractions, especially during the initial stages (Altug, 2020; Fottrell, 2020). The same also may be attributed to the maturing of domestic healthcare agencies like the Indian council for medical research (ICMR). ICMR has been at the forefront of the nation's pandemic management and vaccine development efforts. Such efforts have provided the country's PHPs the confidence to rely on internal health organizations and rely less on multi‐lateral agencies (Bhargava, 2020; Nilima, 2020).

The relation between crisis response perception and crisis responsibility was negative (RW = −0.313, p < 0.01). Such a score indicates higher the PHP's perception of the suitability of WHO's crisis response strategies, the lower their attribution of the pandemic crisis to WHO—as hypothesized in H2. The current study results are similar to earlier research on the two variables (Claeys et al., 2010; Coombs, 2012). Crisis response perception had a positive relation with emotions and organizational reputation (RW = 0.620 and 0.296, p < 0.01 and 0.01; respectively)—as hypothesized in H4 and H1. The weak association between crisis response and organizational reputation (R = 0.296) in an earlier meta‐analysis of attributed responsibility and response strategies on corporate reputation by Ma and Zhan (2016). The relation between crisis attribution and emotions has returned similar results earlier also (Jin et al., 2014). As the PHP's perception of the suitability of WHO's crisis response increased, there was an increase in their current reputational rating of WHO and emotional connection with the organization. Crisis responsibility had a negative relation to organizational reputation and emotions (RW = −0.377 and −0.340, p < 0.01 and 0.01; respectively)—as hypothesized in H3 and H9, respectively. The relationship was in line with earlier studies on attributed responsibilities and organizational reputation (Ma & Zhan, 2016; Schwarz, 2012).

As the PHP's attribution of the crisis to WHO increased, their emotional connection with the organization and current reputational ratings dropped. Prior Reputation and Crisis History showed no statistically significant relationship with either crisis responsibility or organizational reputation—this contradicts hypotheses H7, H8, H5, and H6, respectively. The results are contrary to earlier studies where prior reputation and crisis history have significantly correlated to organizational reputation (Jarim, 2017; Kiambi & Shafer, 2016). It is contrary to the SCCT model, in which a good prior reputation and good crisis history helped reduce crisis attribution and improve organizational reputation during the current crisis. Such relations may indicate that the PHPs consider the current pandemic very different from earlier ones that WHO has handled, and their current appraisals are independent of earlier ones. However, the prior reputation is higher than the current reputation, indicating a loss of reputation among the key stakeholders. Emotions and organizational reputation showed a positive relation with behavioral intention (RW = 0.222 and 0.582, p < 0.01 and 0.01; respectively)—as hypothesized in H10 and H11, respectively. Emotional reactions to crisis and their impact on behavioral intentions have been tested and were found to be significantly related (Nguyen et al., 2021). It indicates that the PHPs with higher emotional connect and reputational rating of WHO would result in continued future engagement with WHO. In WHO's case, it may be a continued reliance of the PHP on WHO guidelines for public health management or positive word of mouth.

4. DISCUSSION

As every crisis is unique, comparing the current study results with earlier ones is difficult. Also, the lack of comparative research on earlier health crises faced by WHO makes it more difficult. However, the current study results with earlier studies applying the SCCT model can be contemplated. The study results indicated that nearly half of the survey participants attributed the current crisis to WHO. Such attribution has harmed WHO's reputation, and the results confirm the earlier experiences in crisis management research (Schwarz, 2012; Šontaitơ‐Petkeviþienơ, 2014). Organizational reputation has a positive impact on behavioral intentions in the current study. Earlier research also has indicated such a relation between the two variables. As corporate reputation is a stakeholder assessment of the organization's ability to serve them, a higher organizational reputation will increase stakeholder engagement with the firm (Keh & Xie, 2009; Zarandi et al., 2017).

The applied crisis response strategy is one of the most critical factors in crisis management and reputation protection. SCCT model help organizations match the crisis response strategies with the crisis response types, thereby reducing the reputational impact of the crisis (Coombs, 1995). However, considering the complexity of the current pandemic and the necessity of multiple crisis management strategies—the present study measured the participants' perceptions about the appropriateness of the response strategies adopted by WHO. Crisis response perception negatively influenced the attribution of the pandemic to deliberate or negligent actions of WHO and confirmed earlier research results on the subject (Gwebu et al., 2018; Kiambi & Shafer, 2016). The relation between crisis response perception and corporate reputation was positive. PHP's positive perception of the crisis response improved the organization's reputation. Such a relationship is in line with earlier research results showing suitable crisis responses to reduce reputational loss during a crisis (Crijns et al., 2017; Effiong, 2014). In the current study, crisis response perception positively correlates with stakeholder emotions. As the stakeholder's perception of crisis response by the organization improved, their emotional reaction to the organization improved. Such a result is an endorsement of earlier research results (Claeys & Cauberghe, 2014). Emotions are also positively correlated with behavioral intentions in the current study. As the PHP's emotional appraisal of WHO improved, they exhibited higher intentions to engage with the organization. Such a result conforms to earlier research results where crisis‐induced emotions have been demonstrated to impact stakeholder engagement with the organization (Jin et al., 2016; McDonald et al., 2010).

The moderating effects of prior reputation and crisis history returned no statistically significant results in the current study. Though crisis history correlated negatively with crisis responsibility and positively with organizational reputation, the same was not statistically significant. The results contradict earlier research findings where a good prior reputation significantly modifies responsibility attribution and organizational reputation during a crisis (Coombs & Holladay, 2006; Kiambi & Shafer, 2016). Crisis history—an organization's liaison with a similar crisis in the past is posited to moderate crisis responsibility and organizational reputation, according to the SCCT model. A firm with a similar past crisis will be attributed higher crisis responsibility on recurrences. The recurrent crisis also will have a higher impact on the organizational reputation—with each repetition eroding more reputation. The current study showed no statistically significant relationship between crisis history and crisis responsibility or organizational reputation and is a deviation from the earlier studies (Comyns & Franklin‐Johnson, 2018; Coombs, 2004).

Lack of accountability to stakeholders can damage an organizational reputation (Harris, 2011). The consequences can be severe when the reputation loss involves a multi‐lateral organization mandated with global healthcare coordination. The mean crisis responsibility score of 3.29 indicates that the Indian PHPs attribute the crisis responsibility to WHO, at least partly. Under such circumstances, WHO might do well to audit the reason for such crisis attribution by the constituents and adopt ingenious response to correct such perception, rather than sweep the problem under the carpet, which shall only exacerbate the reputational damage (Grebe, 2013). Though the crisis responsibility was attributed to WHO, the PHPs' Perception of Crisis Response was also positive. A post‐survey interview with two senior PHPs indicated that the responsibility attribution comes from the slow and partisan actions (favoring China) during the critical early stage of the pandemic. However, they also opined that WHO's crisis response actions, like providing pandemic control and treatment guidelines, were satisfactory considering the poor understanding of the virus strain (Appendix).

The current pandemic has had its paradoxical effects on organizational reputations. Whereas private businesses have used their associations with the brand Covid‐19 to improve their reputations (Mogaji & Nguyen, 2020), organizations at the forefront of managing the pandemic, like WHO, have taken a hit on their reputation. The current study results indicate that the pandemic has adversely affected WHO's reputation as a harbinger of universal health, which is also reflected in the stakeholder's declared behavioral intention concerning the organization. Under such circumstances, WHO should consider suitable strategies to reconstruct its reputation among its primary constituents (Mahon & Mitnick, 2010) through appropriate reputational repair mechanisms. One possibility is using the behavioral theory of reputation repair (Rhee & Kim, 2012). WHO has to become more transparent and decisive in its pandemic management and investigation efforts. The agency is accused of lacking transparency in pandemic management (the main accusation against WHO in the current pandemic). Such a behavior change will reassure the stakeholders about its legitimacy as a universal primary health provider and global health crisis manager.

5. LIMITATIONS

The primary limitation of the current study is that it studies the subject from an Indian perspective and may not hold in another country's context. Due to differences in countries' cultural and developmental contexts, the generalizability of the results may be limited. For example, PHPs from smaller countries with poorer health infrastructure may still exhibit higher behavioral intentions for continued engagement with WHO, irrespective of their crisis attribution. Similarly, the perception of WHO's crisis response strategies may vary due to the political and cultural context. For example, the prevailing political narratives may prompt the PHPs from western nations to rate the WHO crisis response strategy as poor. Another limitation is the sampling used in the study. The study uses convenience sampling due to the prevailing restrictions in applying a random sampling method, and such sampling methods might bias the study results. Though statistically significant for the analytical techniques, the sample size is relatively small and restricted to PHPs, thus making the study results more idiographic than nomothetic. The geographical scope of the study is yet another limitation. The survey is conducted in six states with the highest infections, where the PHPs might be more prone to negative responses than those with lower infection rates.

6. CONCLUSION

The current study makes two significant contributions to the study of crisis and its impact on reputation in the healthcare domain. First, the article assesses the impact of the pandemic and its management on WHO's reputation. Though WHO has seen many health crises previously, there has been no systematic academic attempt to investigate the impact of such crises on its reputation. The paper's second contribution is in empirically verifying the SCCT model in a health crisis setting. The use of the SCCT model in a health crisis setting has been restricted to a partial application (Sisco et al., 2010). Hence, the holistic application of the SCCT model in understanding the impact of the current pandemic management on WHO's reputation is a novel attempt.

It is evident from the current study results that the current pandemic has dented WHO's reputation among PHPs in India, its vital constituent in achieving the objective of delivering universal primary health and managing health crises. Such reputational loss may not auger well for managing global health emergencies—a rising phenomenon due to increasing globalization. Though the developed nations and some developing nations may have matured healthcare systems capable of managing internal health emergencies—it may be a different game in global health emergencies. We need a multi‐lateral global agency that can warn us of global healthcare emergencies and help coordinate international efforts in managing them. However, damaged reputations can prevent an organization from achieving its stated objectives and enlisting constituent contributions—in terms of mind, money, men, and material. Considering the circumstances, WHO should consider adopting suitable strategies to repair its reputational loss and rebuild it to continue its aim of “the attainment by all peoples of the highest possible level of health” (WHO, 2020).

Biographies

Suneel Gupta is professor and dean of Management Studies at SMS‐Lucknow, India. He teaches in the areas of economics and international business. He also chairs the corporate relations at the institute. His research interest encompasses international business, corporate relations, and corporate communication.

Neerja Pande is a professor in the Business Communication Area at the Indian Institute of Management, Lucknow. She has more than 27 years of rich academic, administrative, and research experience in premier national and international institutions. She established the communication area at IIM Lucknow in 1999.

Thangaraja Arumugam is from the field of marketing and analytics. His research and training programs encompass the use of analytics in various business areas, especially in understanding consumer behavior and its application in marketing planning. He works with VIT‐Business school, Chennai Campus.

M. A. Sanjeev is an associate professor of Management at SCMHRD‐SIU, Pune, India. He teaches in the areas of marketing and strategic management. Before his academic career, he spent a decade and a half in corporate. He functioned in various positions in the pharmaceutical and healthcare, and advertising industries. His research interest includes corporate communication, consumer behavior, and health‐seeking behavior.

CONCEPTUAL AND OPERATIONAL DEFINITIONS OF THE CONSTRUCTS

Functional definition (in the merged row at the beginning of each section)	Operational definition
Organizational reputation: The PHP's perception about WHO's credibility in serving the cause of public health currently.
“WHO” is concerned with the health of the general public	Score: Mean of the three items
“WHO” is not concerned with the health of the general public (reverse coded)
I do not trust WHO tell the truth about the Covid‐19 pandemic (reverse coded)
Crisis responsibility: The PHP's perception of whether the actions/inactions of WHO caused the Covid‐19 pandemic.
Circumstances, not “WHO,” are responsible for the Covid‐19 pandemic	Score: Mean of the two items
The blame for the Covid‐19 crisis lies in the circumstances and not with “WHO.”
Behavioral intention: The PHP's intention about accepting or recommending WHO guidelines about public health issues in the future.
I would recommend professional colleagues to follow “WHO” guidelines regarding public health issues in the future too	Score: Mean of the three items
I would follow “WHO” guidelines, for public health management, in the future also
Under most circumstances, I would like to believe what “WHO” says about public health issues
Emotions: The PHP's affective reaction (liking or disliking) to WHO'S handling of the crisis
I feel disappointed/angry at the way “WHO” is handling the Covid‐19 pandemic (reverse coded)	Score: Mean of the two items
I am happy that “WHO” is handling the Covid‐19 pandemic well
Perception about crisis response: PHP's assessment of whether WHO had responded to the crisis appropriately
“WHO” is exhibiting professionalism in the way it is responding to the Covid‐19 pandemic	Score: Mean of the two items
“WHO” is looking lost and unprofessional in the way it is responding to the Covid‐19 pandemic (reverse coded)
Crisis history: The PHP's assessment of WHO's handling of earlier medical crises.
History indicates that WHO has always been successful in handling public health crisis	Score: Mean of the two items
“WHO” has always been successful in handling public health crises in the past
Prior reputation: PHP's perception about how truthful and professional WHO was in the past
Five years ago, “WHO” was more honest	Score: Mean of the three items
Five years ago, I would have been more confident in believing what “WHO” said
Five years ago, “WHO” was more professionally managed.

Gupta, S. , Pande, N. , Arumugam, T. , & Sanjeev, M. A. (2022). Reputational impact of Covid‐19 pandemic management on World Health Organization among Indian public health professionals. Journal of Public Affairs, e2842. 10.1002/pa.2842

DATA AVAILABILITY STATEMENT

Data available on request from the authors.