Writing in The Lancet on lessons from Hong Kong, Singapore, and Japan, researchers from Singapore have highlighted the importance of “timely, accurate, and transparent risk communication” in determining whether the public will trust authorities more than rumours and misinformation.
The paper finds that while Singapore health authorities successfully engineered trust through a range of measures — daily information on mainstream media, websites debunking circulated misinformations, and dedicated Telegram and WhatsApp groups for sharing clinical and logistics information between public and private doctors set up by Ministry of Health — Hong Kong and Japan were let down, respectively, by recent social unrest and sudden school closures/anxiety over the Princess Diamond cruise ship; for more on Japan’s lack of early leadership, see The Strategist’s pre-spike warning.
With these case studies in mind, The Mandarin has compiled some of the best and worst examples of health communication, either from or between government agencies, throughout the pandemic.
China: censorship, control and propaganda
China has both demonstrated multiple examples of government control over health information and the first, and possibly best, examples of scientists breaking rank in the name of accurate science communication.
As The Diplomat recounts, the government infamously issued a statement early in the outbreak asserting that “the disease is preventable and controllable;” claimed the Wuhan seafood market was ground zero for the virus; and sent announcements to the World Health Organisation that there was no evidence of human-to-human transfer. This was shortly disputed by a clinical Chinese scientist writing in medical journal The Lancet, who revealed that some of the first clinical cases had no links to the Wuhan seafood market.
In likely the most significant case, SBS reports that police directly threatened whistleblower scientist Dr. Li Wenliang for “disrupting social order” after he warned other medical professionals on WeChat of a patient testing positive to a new “SARs-like” coronavirus. Dr Li was also told to sign a letter accusing him of “making false comments”, before becoming infected by the virus itself and dying February 7; calls for freedom of speech and government apology shortly trended on Weibo, before being deleted by censors.
A study by research group Citizen Lab found that targeted censorship of messaging services started even earlier than that; as The Verge’s wrap explains, since as early as January 1st Tencent-owned messaging app WeChat and live-streaming platform YY censored keywords ranging from factual information to references to China’s epidemic policies to mentions of Dr Li.
Following a brief respite in the face of public backlash following Dr Li’s death, the government stepped up censorship and propaganda measures:
- two Chinese citizen journalists disappeared after breaking stories of the outbreak (BBC), and three Wall Street Journal reporters were expelled from the country following accusations of racism over headline ‘Sick Man of Asia’ (KHFP);
- China’s top cyber regulator required online technology companies to “create a good online atmosphere” for fighting the virus (Reuters);
- the Chinese propaganda department sent journalists to Wuhan to report on crisis relief by Chinese authorities;
- the country’s push for an appearance of recovery saw China’s foreign affairs minister claim in early March that it’s not clear that the virus originated in the country, which follows circulated (i.e. not censored) online claims that the US was originally responsible (Foreign Policy); and
- a Caixan investigation found the government has, through local companies and officials, fraudulently boosted electricity consumption to provide an appearance of recovery.
Finally, China even attempted to block Taiwan from accessing World Health Organization information — the Chinese government has for years successfully kept Taiwan out of the WHO itself — an act that, as Foreign Policy explains, the WHO yet again went along with.
US: authoritarianism, denial and confusion
America has, much like China, adopted an authoritarian-style of communication over the virus, complicated further by some dangerous policy failures.
As the New York Times wrote, vice-president Mike Pence was given control over vetting and even censoring communication from the Centers for Disease Control and Prevention in late February, while a Slate report examines the legal opinion underpinning the White House’s censorship decision, and argues the government might, coincidentally, be relying on the precedent set by the Reagan administration’s censorship of AIDS information in the 1980s.
The government also attempted to remove coronavirus posters at immigration courts, a move the Miami Herald says has since been recanted, and censored report by the Director of National Intelligence that, according to Time, warned the country is not ready for a global pandemic.
????The White House is currently walking back *three* false policy announcements Trump made during his nationally televised address. pic.twitter.com/W1WbWCygGI
— Corey Ciorciari (@CoreyCiorciari) March 12, 2020
There’s also obviously the rhetoric, which ranges from Trump’s early dismissal of the disease to false claims everyone would be tested and treated for free (only the former was, at the time, true) to false information on Google’s testing website, all the way up to openly racist attempts to characterise the disease as ‘the China virus’. Trump also claimed that he had no idea his government had disbanded the White House’s pandemic team two years ago — claim The Intercept, in reference to similar behind-the-scenes work, posits could be true.
Disturbingly, a secret recording leaked to NPR of senator Richard Burr found the Senate Intelligence Committee chair warned a small group of “well-connected constituents three weeks ago to prepare for dire economic and societal effects of the coronavirus,” in direct contrast to anything the party had put at publicly at that stage.
Finally, the CDC is also responsible for some of these communication failures, due largely to delaying access to crucial tests for a full month. As ProPublica explains, the CDC basically rejected WHO testing data and tried and failed to go it alone; this in turn created an early reliance on private clinics and, apparently due to confusion, a temporary halt on reporting testing numbers.
BREAKING: The CDC has stopped disclosing the number of Americans tested for coronavirus.
On the left is how the website looked last night. On the right is what it looks like now, with the testing info removed.
The lack of testing is a scandal.
This is the coverup. pic.twitter.com/za5w9dkEKq
— Judd Legum (@JuddLegum) March 2, 2020
Great Britain: a 180 on ‘herd immunity’
Up until last week, Great Britain effectively rejected WHO advice and opted for a “mitigation” strategy over “suppression”; The Sydney Morning Herald reported just Sunday 15 March that the Johnson government aimed to quarantine elderly and vulnerable people, implement much more staggered social distancing measures, and then more or less let things run as usual to create herd immunity amongst 60-70% of the population.
At the time, officials were forced to both ramp up ‘wartime’ quarantine rhetoric for people over 70 and come just short of declaring herd immunity their official strategy:
“Herd immunity is not our goal or policy. It is a scientific concept” — Health Secretary Matt Hancock.
“We think this virus is likely to be one that comes year on year… like a seasonal virus. Communities will become immune to it and that’s going to be an important part of controlling this longer term.” — Boris Johnson’s chief scientific adviser, Sir Patrick Vallance.
Again, advocating for herd immunity as even an underpinning strategy was both dangerous and, whether politically or logistically, never really sustainable. Not only does ‘herd immunity’ generally relate to the desired outcome of a national immunisation programs — not new, infectious diseases — but it has yet to be demonstrated that people who have recovered from strains of the virus cannot be infected again, and the plan would require an impossible level of distancing between vulnerable and not-vulnerable populations.
As The Guardian reports, the government’s early ‘go it alone’ mitigation strategies were rejected in favour of unilateral social-distancing measures by groups such as aged care homes, sporting bodies, the Queen, and, ultimately, the government itself; over the past week, the Johnson government has effectively done a 180 on mass gatherings, non-essential travel and school closures.
This includes a new Coronavirus Bill, aimed at:
- Increasing the available health and social care workforce — for example, by removing barriers to allow recently retired NHS staff and social workers to return to work (and in Scotland, in addition to retired people, allowing those who are on a career break or are social worker students to become temporary social workers).
- Easing the burden on frontline staff — by reducing the number of administrative tasks they have to perform, enabling local authorities to prioritise care for people with the most pressing needs, allowing key workers to perform more tasks remotely and with less paperwork, and taking the power to suspend individual port operations.
- Containing and slowing the virus — by reducing unnecessary social contacts, for example through powers over events and gatherings, and strengthening the quarantine powers of police and immigration officers.
- Managing the deceased with respect and dignity — by enabling the death management system to deal with increased demand for its services.
- Supporting people — by allowing them to claim Statutory Sick Pay from day one, and by supporting the food industry to maintain supplies
As journalist Carole Cadwalladr notes below, Number 3 completes that policy u-turn with some new, draconian powers of digital surveillance, detention, and arrest.
Why is it for 2 years? The government is not revealing information suggesting it believes this crisis will last 2 years. Why the discrepancy? And if it's not telling us stuff now, this bill will give it powers to tell us not much more stuff in the future.
— Carole Cadwalladr (@carolecadwalla) March 19, 2020
Transparency in Taiwan
In contrast with China, the US, and the UK’s mix of authoritarianism and denialism, Taiwan was lauded in The Diplomat for encouraging a free-flow of information, including daily briefings, real-time apps for face mask availability, and fact-checking websites — that, as UN researcher Roy Ngerng details on Twitter, engineers public trust that proved crucial to a) avoiding panic situations and b) prioritising effective mask-use and resource allocation.
… and South Korea
As Croakey explores, Taiwan has also done a relatively excellent job of matching large, fully subsidised testing systems with honest communication and a clearly-defined national protocol; check out the Twitter thread below for a first-person POV from a news briefing.
Face masks were a prerequisite for journalists at the presser — no mask, no entry. pic.twitter.com/iAhuPCBFPF
— Victoria Kim (@vicjkim) March 9, 2020
Indonesia’s government has drawn plenty of criticism for its response to the virus — see, specifically, the health minister’s claim that “prayer” resulted in the country’s zero cases in mid-February — and, according to Science, even rejected an offer from scientists at the Eijkman Institute for Molecular Biology to help test more people.
The researchers, who said that the announcement of the country’s first two cases by 2 March was “statistically impossible”, also claimed the ministry’s “unclear and nontransparent” testing criteria has meant gaps in testing for Wuhan evacuees.
Jump forward a few weeks, and President Joko Widodo has failed to cancel large-scale religious events or communicate case information, admitting, according to The Jakarta Post last Saturday, that information was being withheld so as not to “stir panic”:
We will inform the public eventually. However, we have to think of the possibility that the public will react to it by panicking or worrying, as well as the effect on the recovered patients.
Now, as The Guardian reports, Widodo has acknowledged the need to immediately ramp up testing as the virus grows and confusion over cases continues: as of yesterday, 306 confirmed cases and 25 — not 19, as earlier reported — fatalities.
Spain: nationalised private health, potential bureaucratic failures
Finally, Spain — apart from being Europe’s second-worst hit country after Italy — is worth mentioning first for announcing nationalisation of private hospitals and insurers. Health minister Salvador Illa’s 15 March press release (translated from Spanish) listed the new measures as:
A. In the scope of the Spanish National Healthcare System reinforcement:
- The Ministry of Health makes available to the regional counsellors all the facilities and resources of private healthcare in their respective territories. Thus, they will have executive power over all means to protect health and the public interest.
- The contracts of the residents of the last years of training in the specialties that are necessary to attend to the situation caused by the coronavirus are extended. In addition, measures are taken to make these last-year MIRs available in areas that need reinforcement for care needs.
- Exceptionally and temporarily, it is allowed to hire people with a bachelor’s degree or degree in health professions, who do not yet have a specialty course, for different reasons, so that they can provide their services. Likewise, it is allowed to hire people who are in their last year of medicine and nursing degrees, for health support functions.
- Retired health professionals under the age of 70 should be available in the event that the Autonomous Communities need their services, taking all precautions to protect them, attending to their personal situation, as with other health personnel.
B. In the field of supply of goods and material,
- Within 48 hours, all companies or individuals that have products necessary for health protection, such as masks, must communicate their stock and their location to the Ministry of Health.
- Likewise, companies that have the productive capacity to manufacture them must also notify the Ministry.
- These provisions will be widely disseminated for your knowledge and their non-compliance or falsification of the data in this regard, will carry penalties provided for in the General Law of Public Health.
For more on the country’s health system, our increasingly-useful source of public health research The Lancet has just put out a report this week on ‘The resilience of the Spanish health system against the COVID-19 pandemic’.
First and foremost, the report found that the country’s Health Alert and Emergency Coordination Centre (Centro de Coordinación de Alertas y Emergencias Sanitarias in Spanish) provided an inadequate mechanism for coordinating between national and regional governments; for just one consequence, “the Basque Country declared a public health emergency before any other region, whereas Catalonia requested a complete shutdown of the region, including closure of air, sea, and land ports.”
However, in finding that information “is widely considered to have been provided by authorities at all levels in a timely manner via mainstream and social media,” researchers perhaps found a template for how government and media in Western countries — say, Australia — will experience, and possibly overcome, some of the outbreak’s social challenges:
The Spanish media has largely acted responsibly, disseminating accurate information and debunking fake news stories circulating on social media networks. These developments have coincided with changing attitudes among the Spanish population. Initially, the disease attracted little attention, but this calm soon gave way to panic and hoarding of key supplies once cases began to increase. However, many manifestations of solidarity have been seen, such as supporting health professionals, those who are most vulnerable, and voluntary social distancing, including greater home working.