How do we communicate with the public in the next pandemic?

Regular listeners will know that Chris Smith was pretty busy at the start of 2020, when an unknown flu-like virus first emerged in the Chinese city of Wuhan. At that time, and over the course of the next few years, he was invited to appear on national and international networks with Linda Bauld, professor of public health at Edinburgh University. Chris has been catching up with Linda, and began by asking her at what stage the public should be told about the outbreak of a new pandemic...

Linda - I think that's a difficult decision, Chris, for any government or public health agency. I've been co-chairing the behavioural and community engagement group for the Scottish Standing Committee on pandemics. So here in Scotland we have our own pandemic preparedness that we're now engaging in looking ahead to future threats. I think it really depends. We don't know what the next pathogen will be, but the key principle for me is transparency. So once there is an outbreak, it could be localised. It could be something that people are concerned about and is picked up through health protection. It needs to start with engaging with the relevant authorities, others in the health service and the public health system. And then if we know that information needs to be communicated to the public because there is a potential risk, then I think it's important to do that early. Not to panic people, but to start that communication as quickly as possible. And I think that's one of the lessons that we've taken out of COVID that maybe that didn't happen at the pace it should have done.

Chris - On the flip side of that though, people have criticised us, not you and me, but the scientific, medical, and also political establishment because we said things that we thought were true, then we changed our minds. Now obviously it's reasonable to update your understanding and update your stance based on a changing situation and the acquisition of more knowledge. But people, it feels, want concrete information, not unreasonably. But that's not possible to supply all the time when you've got a dynamic and emerging situation going on.

Linda - No, I think transparency also needs to include uncertainty. So let's just use a couple of examples here. I mean, there can be e-coli outbreaks, or we saw concern about RSV, a respiratory virus recently. Or we had mpox in the UK that we know affected particular communities. It's about saying there's something that's arisen, there's action that the public can take or we just want to let you know about this, but actually we're unsure what the science is telling us. We're waiting for more surveillance, waiting for more testing until we can give you more accurate information. And in the meantime, these are the practical steps you can take. For example, engage in good hygiene practices. If it's something to do with food, tell people where you've been. Look for particular symptoms amongst the people that you live with or your community. Basic information and then say, we'll update you once we know more. And I think communicating that uncertainty is really difficult for decision makers and probably at those early stages it needs to be public health authorities that do that before we pass on to others.

Chris - Michael was saying, quite alarmingly, that he feels that trust has been dented quite significantly damaged because of COVID. Do you share that view?

Linda - I'm a bit more optimistic than Michael. I think there has been a lot of misinformation that has circulated. Anti-vaccine sentiment, questioning about the measures that were taken. And let's face it, there's inquiries now that will pour over all of that. But I think the public is better educated now, particularly about infectious disease and are asking more questions. I think if you look globally though, it's not always the case to say. It might be the case in the US and the Uk, but I wouldn't say in some of the countries that my colleagues work in, that COVID causes major distrust between the government and the public. I think that bond is still strong in many places and we probably need to learn internationally about how to manage that better.

Chris - So who do you think are the right sources? When there is a pandemic situation, who should be giving out that information? Because we are in our module two of the UK Covid inquiry and there's been some quite interesting speculation and comment around some of the opening hands that have been played in the inquiry. Including some of the things that Sir Patrick Vallance wrote in his diary, who was our Chief Scientific officer at the time of COVID, wasn't he? Saying that there was a sense that perhaps the scientists were being pushed out there in front of the government so the science could be blamed rather than the policy makers so much? Who is a good source for this sort of information? Should it come from the government? Should it come from scientists? Did we get that right during the pandemic?

Linda - Well, I think there's a lot there. The first thing I would say for any government, and I work with the Scottish government, is that this is a long running programme that needs to be in place in advance of any future health threats. The connection between authorities and the public, the connections and relationships amongst the public, inequalities between groups, capacity to communicate. We need to make sure we've got that in place and we maintain it in between health threats. In relation to who should communicate, the problem with politicians doing the communicating about health issues is they are not the experts. So I think it's important that we differentiate. So we have a communication function, for example, through public health agencies etc, where we say, this is what we're communicating about the science. But when it comes to this is what is happening to you, the public, and these are the bits of laws or decisions that are going to impose on your lives, and this is what we want you to do, that needs to come from the politicians because they're the decision makers. One thing I would say about pandemic communication, if I could have redesigned it, I would've separated out the scientific advisors and the public health experts in terms of their communication from the politicians. I don't think they should be communicating together because then it looks like science is essentially condoning all the decisions the politicians are making. And we know that politicians were faced with very difficult decisions, and it wasn't always about the scientific advice.

Chris - So the approach that was taken by Number 10, Downing Street, where they had that podium, prime minister in the middle usually. Or one of the senior cabinet ministers flanked by usually one of the senior medical officers, chief medical officer for example, and then one of the scientists to the other side would, would you say that was a bad mix? They shouldn't do that again.

Linda - I think if we could think about it differently, we might have press conferences with answering journalist questions where you have that combination. Not necessarily broadcast on television, but I think it would've been better actually if you could have taken the politicians out of the mix and have the briefing, just a basic scientific briefing. This is what happened today. This is what we think is going to happen tomorrow with just the scientific advisors, without the political decision making being rolled into it. And I think if you look at some of the approaches in other countries, it was primarily the public health agencies who communicated in a particular way and then the governments were also passing on other information. So I think we need to think about that really carefully during future public health threats. And then the final point for me on this is locally we mustn't forget the local context. So you have in the UK your director of public health or maybe community groups who are broadcasting through local radio. They need to get the information from the government and the public health agencies and share that with their listeners and their audience in a locally appropriate way. So it's a tiered approach.