This article was written by Bruce Y. Lee for Forbes.
The key to having any effective relationship is open honest communication. Love songs don’t tend to say, “you’re still the one I run to, the one that I belong to, even though I have no idea what you are actually doing,” or “something in the way that our conversations are so one-sided attracts me like no other lover.” Open honest bilateral communication is especially important when there is a common enemy like the COVID-19 causing coronavirus (SARS-CoV2) that calls for a properly coordinated response.
As an example, take a look at an evaluation recently published in the journal Comparative Political Studies. This evaluation showed how efforts to increase communication between the government and the people helped in the battle against the deadly Ebola virus. In the publication, Lily L. Tsai, PhD, Ford Professor of Political Science, and Benjamin S. Morse, a PhD candidate at the Massachusetts Institute of Technology (MIT) and Robert A. Blair, PhD, the Joukowsky Family Assistant Professor of Political Science and International and Public Affairs at Brown University described how many Liberians already didn’t trust their government prior to the 2014–2015 Ebola outbreak. According to the authors, this mistrust arose from a history of government corruption, abuse, autocratic rule, and repression. Being fooled before don’t exactly make you want to sing Al Green songs the next time around. After all, didn’t former U.S. President George W. Bush once said, “fool me once, shame on, shame on you. Fool me, you can’t get fooled again”?
In fact, as the authors stated, many Liberians actually believed that “Ebola was a ploy by the government to generate more aid funding.” Yes, apparently people were saying that the whole Ebola outbreak was a political hoax and that “many citizens believed authorities were willing to harm and even kill their own citizens for personal gain.” Gee, people calling a real infectious disease outbreak a hoax for ulterior motives? Can’t imagine that happening in the U.S., right?
Mistrust of the government is very problematic because during an infectious disease outbreak, epidemic, or pandemic, coordination across the population is needed. And such coordination is not going to come from Netflix or some other source besides the government. Coordination is important because like it or not you are connected to not only Kevin Bacon but to everyone else in your country in some way or another. What other people do will affect your likelihood of catching the virus and vice-versa. Viruses like the Ebola virus or the SARS-CoV2 then are counting on lack of action or lack of coordination. They want people to panic and do silly things. They want people to continue to contact each other without taking proper precautions. Thus, with a major infectious disease threat, it is important to remember what the movie High School Musical, told us: “we’re all in this together.”
The key then is to have as many people as possible follow scientifically-backed infection control recommendations such washing your hands frequently and thoroughly, avoiding gatherings when told to do so by health officials, and making sure that health care professionals are adequately protected. Not complying with such preventive measures would be a nice gift for the viruses.
So how then did the Liberian government overcome the cone of mistrust that was already in place? How did they then convince people to comply with recommended preventive measures? Well, ordering people to do so alone was not going to work. That would be like ordering people to love you or commanding people to believe that you are the best. They may pretend to listen but when eyes are not on them they may just not comply. So something else was needed.
The government’s first attempt was a mass media campaign along with government representatives visiting different communities. But in the words of Dire Straits, the government soon realized, “that ain’t working,” as mistrust was already too high for the government alone to overcome. They needed help.
So the government then tried “mediated outreach.” That meant recruiting intermediaries to interact directly with the communities. This included intermediaries who actually lived in the same villages as the people they were trying to reach. Yes, you can say that the government got help from the village people.
These intermediaries then disseminated information, answered questions, and, in many cases, went door-to-door to try to directly engage every citizen. These volunteers even wore T-shirts, vests, bibs, and badges to clearly identify themselves as part of the government’s outreach campaign. After all, how can you ignore someone wearing a bib?
This was a considerable undertaking so the obvious question is: was all of this worth it? Well, from 2014 to 2015, the research team surveyed and interviewed citizens in Monrovia, Liberia, and found that after the mediated outreach, residents were:
- 15% more likely to support disease control policies
- 10% less likely to violate bans on public gatherings,
- 26% more likely to support government workers burying those who passed away from Ebola, because improper burial techniques could lead to the spread of Ebola
- 10% more likely to use hand sanitizer
- 9% more likely to trust Liberia’s Ministry of Health.
Such differences could definitely make a difference in the control of a virus.
So what does this mean for the COVID-19 causing coronavirus outbreak or epidemic? Governments should be maintaining open and honest communication with their citizens and other residents. This is not the time for politics and agendas to take precedence. That would be like worrying about your political future while trying to put out a raging fire.
Governments need to go out of their way to keep the public apprised of plans and the scientific rationale behind them. They need to make it clear through concrete actions that science and not politics are driving decision making and action. Otherwise, people may be slow to comply with necessary requests if they suspect ulterior motives, if they have to take those extra steps to ponder, “hmmm, what’s the real reason for this request?” Everyone has to remember that trust doesn’t occur overnight, and simply commanding people to do something doesn’t tend to work.
What happened in Liberia also highlights the importance of governments supporting networks of qualified intermediaries that are trusted by the public. For the SARS-CoV2 and any other health-related issue for that matter, real doctors, nurses, and other legitimate health professionals could serve as important intermediaries to directly engage with the public. If, for example, you have a longstanding good relationship with a doctor, you may be more likely to trust what your doctor says than a government announcement or even a hospital announcement. Community leaders can serve as intermediaries too but they need to coordinate with the real experts, the health professionals and the scientists, to get the right information out there.
When there isn’t a health emergency, you may not necessarily immediately see the damage of spewing anti-science rhetoric, neglecting the value of real health professionals, and eroding relationships between health professionals and patients. But as with all relationships, stress and crisis have a way of making you pay for everything that you didn’t do to positively grow the relationship all along.
Header image of the James S Brady Press Briefing Room by Rob Pegoraro on Flickr.