Communicating with the public

For several years, pathogen genomics has informed public health responses to infectious diseases, as well as the global health response to disease outbreaks and epidemics. The COVID-19 pandemic has highlighted not only the importance of pathogen genomics in epidemics but also that there is need to focus on effective communication of pathogen genomic data. This information must be properly communicated by healthcare professionals, scientists, policymakers and the media, and it should consider the current context and happenings.

In most cases of infectious disease control, communication strategies have mainly focused on the individual and involve one-to-one communication between the healthcare provider and the individual about the diagnosis and treatment plan. However, with advances in genomics sequencing, it is likely that diagnosis for an infectious disease that may have genomic information of the infectious agent (pathogen) will be available as part of the diagnosis. How the healthcare provider communicates this information to their client may have an impact not only on the individual (e.g. their privacy) but also on their community. For example, take the case where HIV testing and surveillance also reveal hotspot areas. This could lead to stigmatisation and discrimination of people in that community, which is likely to be worse for those who are already part of stigmatised or marginalised groups.

Public engagement and communication of pathogen genomic information during disease outbreaks is key to the public health response. Generally, the public health responses to disease outbreaks are aimed at effective containment of the outbreak through:

• Bringing it to an end as soon as possible.
• Taking care of those affected by the outbreak.
• Contact tracing and surveillance to identify new cases or disease hotspots.
• Taking care of people who have become ill from the infectious agent and preventing new cases of the disease.

Information about these public health measures should therefore be included in messages to the public. More recently, genomic information about the causative pathogen may be included in the first announcements of an outbreak or a new strain of concern.

Public communication and engagement strategies during an outbreak response would ideally involve a mix of media approaches (e.g. print media, radio, TV, social media, press releases from various stakeholders, announcements in community and religious gatherings), seek to engage diverse stakeholders, and be tailored to each stakeholder group (e.g. children of school going age, healthcare workers, policymakers). It is also worth noting that social media has transformed public engagement and communication in science, as well as how people consume information. Irrespective of the engagement and communication strategy that will be used, it must be designed and implemented following good practices.

Best practices for public engagement and communication during outbreaks

• Have a pre-existing public engagement and communication plan; identify key stakeholders, and define the role and responsibilities of each stakeholder.
• Build public trust in the public health system; empathic messaging and communicating style, including honesty in situational reports and the expertise of the messenger, are key.
• Be transparent about outbreak origins, new strains, progress and uncertainties, what is known and unknown, public health measures that will be used and why, and the different methods public officials will use for communication.
• Respect public concerns about the outbreak.
• Be sensitive to local practices and culture.
• Consider the unpredictability of outbreaks.

Furthermore, communication of pathogen genomic information will be shaped by a variety of factors, including but not limited to:

• Political climate (democratic vs authoritative governments) will determine the flow and depth of information that can be covered during public engagement and communication.
• Economic resources where there are fewer resources to support outbreak response, national governments may want to limit media coverage for fear of raising public anxiety or causing economic disruption by being forced to adopt certain measures, such as lockdowns.
• International diplomacy may influence reporting of new outbreaks and or new strains of concern. Some countries may fear discrimination of citizens at the global level or that reporting of genomic information may easily link them to the origins, thereby leading to discrimination.
• Availability of public health authorities and scientists to communicate and respond to public concerns without heightening anxiety.
• Cultural context and behavioural patterns of communities.
• Public literacy/knowledge about the infectious agent or disease. For example, the communication strategy for Ebola in many west African countries today would be very different from that of a new emerging infectious disease.

It is worth noting that whilst public communication of pathogen genomic information during disease outbreaks is key to the global health response, it can fuel public anxiety and lead to the stigmatisation of certain groups. It also needs to be recognised that competition amongst scientists, media houses and institutions to be the first to report on an outbreak or a new strain can lead to exaggeration of the outbreak and control measures, perpetuate discrimination, increase public anxiety, and lead to a breakdown of public trust in science.

To conclude, it is important for scientists, public health officials and media personnel to have some understanding of how their communities or the public perceive risks during disease outbreaks, and to frame their messages with these perceptions in mind.

What was your experience of public engagement during the pandemic? As a member of the public, how do you feel about the way the public health emergency was communicated, both through official channels and from independent sources? Share with us in the comments.