The trouble with transparency: How pandemic is challenging the CDC
| WASHINGTON
Credibility, transparency, and trust.聽
Ask public health experts about their field鈥檚 guiding principles for communication, and those three words come up over and over.
鈥淓specially when you are communicating under very difficult circumstances, these are the three essential ingredients,鈥� says Vish Viswanath, a professor of health communication at the Harvard T.H. Chan School of Public Health.
Why We Wrote This
Pandemic messaging is a difficult balancing act. Leaders must project authority and try to combat spread, while being transparent and admitting unknowns. At stake are their own credibility and public trust.
But it鈥檚 precisely the toughest of circumstances 鈥� such as an unpredictable virus 鈥� that can make it most difficult to uphold the ideals of effective communication. And there鈥檚 little doubt that recent days and weeks have tested those principles, as a COVID-19-weary nation has gone from a growing sense of optimism and even normality to, once again, rising caseloads, mask mandates, and confusion.
A big jolt came last week, when the Centers for Disease Control and Prevention urged fully vaccinated Americans to resume wearing masks indoors in regions with high viral spread. The CDC also toughened its guidance for schools, recommending that all teachers, staff, and students wear masks, regardless of vaccination status 鈥� setting off across the country.聽
But the 聽鈥� based on an outbreak in Massachusetts involving mostly vaccinated people 鈥� wasn鈥檛 released for three days.聽
Experts say that the CDC is, at times, in a no-win situation. By announcing the new mask guidance without simultaneously releasing the data, the agency came across as less than transparent. But if it had waited to issue new mask guidance until it was ready to release the data, it could have been accused of delaying important public health advice.
鈥淧aradox of expertise鈥�
This conundrum demonstrates a 鈥減aradox of expertise鈥�: Public health officials need to speak with authority, so people will pay attention and feel reassured. But in an emergency, officials are learning new information in real time and thus can鈥檛 claim to have all the answers.聽
鈥淭ransparency has to be balanced by things that build confidence,鈥� says Marsha Vanderford, a former communications official at the World Health Organization and the CDC. 鈥淪o if you say, 鈥業 don鈥檛 know,鈥� people think you鈥檙e transparent, but they might also think that you don鈥檛 know what you鈥檙e doing. It鈥檚 a two-edged sword.鈥�
In an emergency, changes to public guidance are inevitable. Expert advice one day 鈥� such as the early pandemic advice that masks weren鈥檛 necessary, as Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, had said 鈥� can be reversed the next.聽
The key, say communication experts, is to qualify statements with phrases such as 鈥渢o the best of our knowledge鈥� and 鈥渁s of now.鈥� That signals to the public that the guidance could change, as new information is assessed.聽
If caveats and qualifications are left out, 鈥渋t makes the public health message susceptible to conspiracy theories or to the assumption of incompetence,鈥� says Kathleen Hall Jamieson, a professor of communication and director of the Annenberg Public Policy Center in Philadelphia.聽
鈥淭hat鈥檚 not fair to the scientists or to public health experts. But the messaging failure is that they haven鈥檛 clearly marked their messages as provisional, subject to updating, and what we know now, which could change.鈥澛�
As for the safety of the vaccines, experts say it鈥檚 accurate to describe them as very safe. But that doesn鈥檛 mean health authorities shouldn鈥檛 acknowledge and discuss the possibility of rare side effects 鈥� and in fact, doing so is helpful in maintaining trust, since those side effects can make headlines and often dominate on social media.聽Coursing through the conversation, since vaccines became available, is an effort by public officials to avoid sowing fear of the vaccines and to persuade the hesitant to get vaccinated.
The 鈥渂reakthrough鈥� challenge
Another point of contention now centers on the use of the word 鈥渞are鈥� when describing 鈥渂reakthrough infections鈥� 鈥� that is, COVID-19 diagnoses in people who have been fully vaccinated 鈥� even as news reports and anecdotal evidence increasingly suggest they may be more common than that.
At a virtual briefing with reporters Thursday, CDC Director Rochelle Walensky sought to correct a commonly cited statistic from her agency 鈥� that nearly all hospitalizations and deaths from COVID-19 are among the unvaccinated. The data, she noted, was from January to June, and did not reflect more up-to-date data that includes the rise of the delta variant.
Some are criticizing the CDC for halting the tracking, as of May 1, of breakthrough infections among the vaccinated unless they are hospitalized or die.聽
鈥淭he question is, is it worth the time and expense of setting up a system to track breakthrough cases when they don鈥檛 result in hospitalization?鈥� says Professor Jamieson. 鈥淭here are those who argue persuasively that it is.鈥�
Ms. Vanderford, the former CDC communications official, expresses sympathy for public health officials in the COVID-19 era.聽
鈥淭hey鈥檝e never dealt with anything that has so defied expectations over such a long period of time,鈥� she says. 鈥淎ll agencies in times of uncertainty draw lessons from the past. But in this case, there aren鈥檛 a lot of plays in the playbook to draw from.鈥澛�
Then there are the self-inflicted wounds, such as misstatements by top officials 鈥� including the person with the biggest megaphone, President Joe Biden 鈥� that can knock the government off-message.
In a July 22 CNN town hall, President Biden that since the vaccines 鈥渃over鈥� the delta variant of the virus, 鈥測ou鈥檙e not going to get COVID if you have these vaccinations.鈥� The White House later clarified his statement, noting that 鈥�97% of hospitalizations are people who were unvaccinated.鈥�
On July 30, the CDC鈥檚 Dr. Walensky stated in a Fox News interview that the federal government was 鈥渓ooking into鈥� a federal vaccine mandate. She soon : 鈥淭here will be no nationwide mandate.鈥澛�
On Tuesday, the director of the National Institutes of Health, Francis Collins, recommended on CNN that parents of unvaccinated children wear masks at home, .
Overwhelmed with information
A recent by the Annenberg Public Policy Center shows that trust in public health authorities 鈥撀爄ncluding the CDC, Food and Drug Administration, and Dr. Fauci 鈥� remains high. Other polling shows in public trust, in part a reflection of distrust in government in general.聽
Professor Viswanath of the Harvard Chan School favorably contrasts the Biden administration with its predecessor, in what he calls the current team鈥檚 鈥渟ignificant efforts in letting science make most of the decisions, and not undercutting scientists and public health experts.鈥澛�
But he identifies multiple challenges that contribute to the burden on today鈥檚 health communicators. First, he says, 鈥渢he pathogen has surprised us at every turn.鈥� Then there鈥檚 the challenge of processing all the pandemic-related information, including empirical, data-based studies too numerous to count.
鈥淭hat is like drinking from a fire hose; people are just overwhelmed with information,鈥� Professor Viswanath says.
Add to that the rise of social media, which can be a source of misinformation, disinformation, and conspiracy theories 鈥� as well as a source of accurate information 鈥� and the politicization of just about everything.
鈥淣ever,鈥� he says, 鈥渉ave our lives been upended the way this has happened in the last 17 months.鈥澛�
