HEALTH COMMUNICATORS SHOULD FOLLOW TRUSTED METHODS TO IMPROVE RESPONSE TO PANDEMICS AND OTHER HAZARDS TO SAVE LIVES

By Ian Mannix

May 1, 2020

Article written for Croakey News

Australia is experiencing its worst natural hazard since Black Saturday in February 2009, with almost 7000 confirmed cases of COVID-19 and more than 80 deaths.

And yet there have been no warnings.

This is a failure of health departmental planning which may have led to unnecessary death and injury, and should not be repeated.

It is a particularly egregious error given Australia has very good warning procedures. Health authorities and political leaders know this and decided for reasons known only to them, to ignore Australia’s trusted hazard warning systems in favor of advertising, public and media relations  and marketing.

This statement is likely to irritate all those involved with the Federal and State government information campaigns, which cost the Feds alone $30m, but the reality is, if it’s not called a warning, and doesn’t immediately change attitudes and behaviours, it isn’t a warning.

And warnings save lives. The people on The Ruby Princess did not receive a warning.

The ”Australian Government ” campaign to keep people apart in public…Who? What? When? Where? Why? By whom?

Initially, although too late,  Australian health authorities provided information, education, feel good mental health campaigns and contemporary graphics which unfortunately at times were bewildering.

The advertisements did not mention the impact of the virus, or that it would kill people. Even now, three months after the outbreak, advice on TV says: “For most, the virus will be mild.’’ It’s the equivalent in a bushfire emergency warning which says: “In a bushfire, most people will be safe or suffer minor damage to their homes.”

The Covid19 information was issued by: ”The Australian Government’’ a somewhat nebulous entity  often associated with partisan politics (and used brilliantly by satirical producers ”The Juice,” which had the most effective anti-virus alerts of all https://www.youtube.com/watch?v=Hks6Nq7g6P4 )

Text Box: Figure 1: The Juice, brought to yu by the Australien Government
Messages brought to you by ”The Government.’

The subsequent images of thousands of people milling on Bondi and St Kilda beaches, showed the desired outcome of the messages – to share responsibility and get people to stay at home – did not work. This was not shocking. People were putting their own understanding on what they were being told – they were personalizing, localising and adding context.

When they sought  ‘validation’ they discovered the PM was going to the footy; some businesses were shut while others remained open, and authorities were specifically encouraging them to exercise in parks.

And they quickly discovered, because health authorities were telling them, there were no cases of localised transmission.

The powerful images which might have changed their attitudes were not in the advertising campaign, but in front of their eyes, in the behaviour of others.

The Prime Minister was furious – ‘’Stop it, just stop it,’’ he said, like a father trying to change the behaviour of an annoying child. That didn’t work either.

The failure to communicate effectively exasperated public health ethicists who wrote in Croakey “We need to change our thinking and communication, urgently .’’[1]

‘’In our view, we urgently need to start emphasising …‘’public’’ values. We need to show people ‘’how’’ to change their behaviour to reflect these values, and tell them ‘’why’’ they should do this.’’

They suggested ‘’solidarity and reciprocity’’ phrases and statements which I immediately took and placed in my new book,  The Principles of Effective Warnings,’’ where their insights added value to the theory and practice of effective communications around natural and man-made hazards.

The book provides a foundation for training people who have responsibility for keeping people safe and reducing economic loss –  health and education agencies, emergency responders, NGOs, local government and business.

The ‘’warnings process’’ is based on the work of well known trauma psychologist, Dr Rob Gordon, and two eminent US behavioural analysts – Dennis Mileti and John Sorenson.

It’s the first book of its kind, although The Australian Institute for Disaster Resilience last year issued ”Australian Warning Principles’’ to guide the development and use of warnings in Australia.

AIDR has done a great deal of work on warnings, often with the Bushfire and Natural Hazards CRC. The research into warnings has nearly 40 years behind it and started with Mileti and Sorensen. Dennis Mileti came to Australia in 1994 to talk to emergency agencies about their work and he told me he is bewildered by the fact that their work was then ignored.[2]

‘’The Principles of Effective Warnings’’ contains the best of the AIDR Principles and those from Sorenson and Mileti.

Among elements of warning which we know must be included to change attitudes and behaviours in  timely way are:

  • Personal (All people are at risk. You can get it from other people coughing or sneezing. You might die or get very sick, or you might pass it on to your family, including babies, children, the elderly and those on drugs.)
  • Local (Everyone in Australia including those coming from overseas).
  • Explain impact (Even in mild form the virus can choke, make breathing extremely difficult, and for people with existing illnesses like obesity, diabetes, heart and lung problems, it can affect all major internal organs. The virus is extremely contagious and can survive for hours where you can pick it up from things you touch like door handles, steering wheels, shop counters and coffee cups, shopping trolleys and bus seats. It will be worse than the worst flu you ever had, and last for two weeks or more.)
  • Provide context (This is the second virus pandemic in ten years, the first being H1NI virus, which in 2010 in Australia resulted in 37,537 confirmed cases and 191 deaths.[3])
  • Issued by a respected, independent authority: (Chief Medical Officer)
  • Call to action: (Assume that every person you come across has the virus, and stay two meters away, regularly use hand sanitiser, practice good health protocols and listen for more health warnings)
  • Advice for vulnerable communities: (Those with chronic illness, disabilities, migrants, single parents, women living in fear of domestic violence, the aged and infirm, and children.)
  • They should build trust in the issuer (Name the person, give their title and if they are unknown, provide a little background).
  • Integrated (Be part of health communications, school learning, engagement programs).

Australia does not have effective health warnings issued by health professionals in any jurisdiction although heat health warnings are distributed by The Bureau of Meteorology and The SES, where they are treated as ‘’warnings’’ not advice.

Instead subscribers to health departments get ‘advice and alerts,’ such as Legionnaires Poisonous mushrooms, Salmonella, Murray Valley Encephalitis .

It was heartening when the Emergency Commissioner in Victoria took control of Covid19 information flow in that state, but most states don’t have similar roles.

If health authorities followed the lead of emergency agencies, they would have well trained independent ‘’warnings experts’’ operating outside politics, who would issue warnings when they were needed, in all demographic groups, multiple languages, and repeatedly and for as long as required.

They would have feedback mechanisms to ensure the warnings were reaching their target audience, in a timely way, and with desired impact.

Imagine if each day during the bushfire crisis, we didn’t see warnings, but we only got news conferences with a multitude of mainly men fronting the TV cameras a couple of times a day? And then add to the wasted opportunity by ensuring the language of the health experts seems to have been developed by the Government’s political communication team.

Another significant advantage of the official emergency warnings process is that ‘’official warnings’’ issued by acknowledged agencies are carried on ABC radio and News 24 TV, commercial radio and online and Sky News for free. In the case of the ABC, it has an ‘’emergency broadcasting policy’’ which means it will issue all warnings, repeatedly and for as long as necessary, for free. It’s a massive cost saving which cuts through public relations noise and carries enormous respect.

Health authorities should follow the lead of the emergency agencies and create an independent well resourced warning capacity to save lives in future outbreaks and epidemics.


[1] https://croakey.org/we-need-to-change-our-thinking-and-communication-urgently-to-beat-covid-19/

[2] https://www.researchgate.net/publication/255056072_Communication_of_Emergency_Public_Warnings_A_Social_Science_Perspective_and_State-of-the-ART_Assessment

[3] https://en.wikipedia.org/wiki/2009_swine_flu_pandemic_in_Australia