At a particularly crucial time in the pandemic, the Center for Disease Control and Prevention have a messaging problem.
The CDC and its director, Dr. Rochelle Walensky, has been the subject of growing criticism of statements and guidance that have been revised or retracted.
The United States is facing something of a mystery. Millions of Americans are vaccinated every day, and state and local governments are relaxing restrictions. Meanwhile, as the number of cases increases in parts of the country, public health experts are worried about the possibility of a fourth wave.
There are no easy answers.
“One of the most important things we say in public health is that you need to have a very simple message,”
The problems started last week with what were perceived as mixed messages about the state of the pandemic and what is safe for people who have been fully vaccinated.
Walensky warned on March 29 of “impending doom” due to the recent increase in the number of cases across the country. In an interview with MSNBC the same day, she raised eyebrows by suggesting that “vaccinated people do not carry the virus.” Many researchers criticized the comments, saying it was too early to know for sure what effect the vaccines might have on transmission. The CDC went back with its statement a few days later.
The agency then relaxed its travel guide for people who are fully vaccinated, but in light of the steady increase in the number of cases and the fact that the majority of the U.S. population is still unvaccinated, Walensky said, “I would advocate general travel in general. . “
The recent back and forth caused confusion and frustration, and the muddy messages of public health on what some experts say is an uncertain moment. The CDC is being criticized at a shocking time as it seeks to rebuild trust that has been eroded over the past year, largely due to political interference from the Trump administration.
“Whether you’re a public health agency or running a communications campaign of any kind, erosion of trust is incredibly harmful,” said Alison Buttenheim, associate professor of nursing and health policy at the University of Pennsylvania.
She said Walensky’s comments about vaccinated people and transmission were “not super-thought”, but she added that mistakes in public health messages can be saved if handled transparently.
Others have been less sympathetic.
“CDC announcements about restrictions on wax have been a mess,” tweeted Dr. Vinay Prasad, Associate Professor of Epidemiology and Biostatistics at the University of California, San Francisco.
The error steps highlight the enormous challenges associated with public health announcements during the pandemic when science unfolds in real time and development often takes place at a rapid pace. Designing public health guidance in such circumstances makes it difficult to tackle the nuances, especially as the pandemic develops and the situation changes.
“People want an answer that is black or white: Is this risky or not risky?” said Sandra Albrecht, assistant professor of epidemiology at Columbia University. “But risk is a spectrum – it depends on the context, the circumstances, the individual, the geography. There are so many factors that contribute to the risk that it’s really hard to deliver a series of public health messages to everyone.”
And conversations about risk become more challenging as “pandemic fatigue” begins. A recently released Gallup poll showed that concern about getting coronavirus has dropped to record lengths, with only 35 percent of Americans saying they are very concerned or somewhat concerned about catching the virus.
Albrecht and Buttenheim saw the difficulty in communicating risk and guidance early in the pandemic. Last year, they teamed up to create Dear Pandemic, an online project to answer questions from the public in an easily digestible way and help people navigate the onslaught of information about Covid-19.
One of the main goals of the project is to fill in the gaps between official guidance with facts and context.
“A lot of what we’ve done is discuss the causes and motives behind public health announcements coming from the CDC because the public is left confused,” Albrecht said. “Part of what we do is explain the rationale and evidence in support of a particular recommendation.”
Early in the pandemic, for example, Albrecht and Buttenheim tried to address why the CDC and the World Health Organization reversed the course of recommendations for people to wear masks in public.
“As researchers and public health professionals, we understood why this change happened and why it was necessary, but the reasons for that change were not adequately addressed to the public,” Albrecht said. “It caused a lot of confusion and provided fodder for conspiracy theorists.”
Loren Lipworth, an epidemiologist at Vanderbilt University Medical Center, said the events of the past year have revealed how important it is for the CDC and public health staff to be open about where science stands and to control people’s expectations of how things can change. .
“The CDC must be honest and transparent and share everything they can in terms of evaluating evidence, but they must also be appropriately careful when we are at a point where we can not yet say anything,” she said.
Balance is especially important now that increases in infections in some states threaten to erase hard-fought gains to stem the spread of the virus.
And as the number of cases increased and variants of the virus spread around the country, people and communities could respond in the coming weeks to change the course of the pandemic in the United States, Lipworth said.
“We are so fortunate to have these vaccines, and it is certainly our way out, so there is real reason for optimism ahead of us,” she said, “but it is certainly not the time to fail our guard.”