This Covid-19 pandemic has not only created a massive body of research (more than 100,000 scientific articles in 2020), but has awakened the world to the importance of prevention and non-pharmaceutical interventions to halt or slow the spread of disease. Globally it has been known that providing clean water will prevent the spread of diarrhoea and other infectious diseases, we have known that vaccination has prevented more than 37 million deaths in the past 20 years in low- and middle-income countries alone.

What the Covid-19 pandemic has also created is a massive drive to improve communication globally about health issues; suddenly everyone knows about “vaccine hesitancy” and people talk about doubling times and variants of viruses in everyday conversations. There have been numerous webinars and discussions about how best to deal with the “infodemic”. The huge amount of information available to ordinary people (many who do not know how their bodies work and, like me, have only the vaguest idea about how the incredibly complex immune system works).

We have world-leading scientists and communicators, our social listening group is a world leader in this field, but we conflate the two. Being a world leader in virology does not mean that you understand social and behaviour change communication, in fact like many, the scientists believe that if you scare people enough it will ensure that they behave in a certain way to keep safe. The evidence from numerous studies and interventions (lessons we learnt from the HIV epidemic) shows otherwise.

There is a field of study which looks at social and behaviour change, another that looks at risk communication and community engagement. These fields of study have looked at not only the outputs of communication, but the impacts and there are a number of outcomes we look for. We want people to be:

• Informed
• Concerned
• Aware
• Calm

What we don’t want is for people to panic, not understand or not be able or willing to implement the important measures that need to be taken. What we don’t want is to victim blame or stigmatise people who are infected with the illness (all lessons learnt from the HIV epidemic).

So what should we do?

We should have a coherent strategy. We should ensure that important information about how people can protect themselves is known and emphasised. We should be listening carefully to why people are not protecting themselves and create an environment to make the healthy choice the easier choice. We should ensure that communicators understand that important issues such as ventilation are front and centre to communications. We should be measured in the information that is shared on platforms like television — dazzling people with graphs that even people with master’s degrees do not understand is not good communication. I am not saying that the information should not be available, but how it is presented is critical.

For example, last week we learnt that our scientists (world class) have uncovered a new viral variant that produces the Covid-19 illness. What do we need to know?

1. There is a new variant;
2. We don’t know much about it except that it seems to be spreading fairly rapidly;
3. We are carefully monitoring it;
4. We know that the preventive measures — ventilation, distancing, mask wearing and so on — help prevent the spread of this variant;
5. We are pretty sure that vaccination will protect us from serious illness (and death);
6. We have the world’s best scientists working day and night to find out more;
7. People need to protect themselves — the best ways known worldwide — through vaccination, distancing (especially not being in crowds), good ventilation and mask wearing; and
8. We will keep you informed.

This information needs to be in all languages so that everyone can understand it.

This kind of authoritative communication needs to come from the government and be consistent throughout. That means a comprehensive communication strategy (with money allocated to it). It will generate trust and help to counter the numerous “experts” spreading misinformation.

Finally, we need to think of the future — why does our population not know how the body works (even in the most rudimentary way)? How can we change this? In the Aids epidemic, the Treatment Action Campaign knew that building HIV literacy was critical to saving lives and helping people continue to take their medicines for the long haul. Now we have to build national health literacy so that when new variants arise, or another disease, we have a better base on which to build.

We also need to build our social networks to enable communication to not just be at a national level, but that the important information is available to numerous people who will spread it in their communities.

There is so much known about health communication, about how to communicate in a crisis — we just need to implement it. DM

Prof Susan Goldstein is deputy director and chief operating officer of the SAMRC Centre for Health Economics and Decision Science (PRICELESS SA) at the University of the Witwatersrand’s School of Public Health.

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