People shop in a market after the government relaxed the weeks-long lockdown in Peshawar, May 11. — AP

How our government's communication on Covid-19 has done more harm than good

Investing in a cohesive, localised public health communication strategy will be essential in the coming months.

Updated May 28, 2020 04:27pm

The Pakistani government’s decision to all but lift a lockdown on May 9 coincided with the country entering a period of acceleration in Covid-19 infections. Since then, all caution has been thrown to the wind — malls bustle with shoppers, roads are jammed with traffic, mosques remain filled with worshippers with little to no adherence to physical distancing, and large social gatherings are commonplace.

Pakistan’s cases have increased five-fold since April 25, with 48% of total deaths happening in the last 15 days, on a 90-day scale since Case 0. Its per-capita indicators are the worst among all South Asian countries — cases per million for instance are 2.5 times higher than neighbouring India’s. For two consecutive weeks, it has been among the top 10-12 countries for daily new cases, despite a testing rate that is in decline, with an average daily negative growth of 1.41% in the same period. Multiple large hospitals are at capacity, and countless health workers are infected.

It is in this backdrop that Prime Minister Imran Khan told Pakistanis that they must live with the virus, the Supreme Court ruled that Covid-19 is 'not a pandemic' and ordered the reopening of shopping malls, and ulema urged the faithful to fill up mosques for Eid prayers.

Covid-19 is the first pandemic of the information age. Never before have as many people relied on the words of leaders and experts to make critical health decisions. This outbreak is not only a public health crisis, but also a public communication crisis. At the same time, it's clear that transmission is dictated by human behaviour and not policy measures, with the trajectory of the disease mirroring the public's perception of the risk involved.

Also read: With Covid-19, hope cannot be a strategy

On this front, the deny-and-censor strategy of the government has caused irreparable damage — both to its credibility and to the country’s Covid-19 outcomes. For over two months now, even as health experts cautioned the public, politicians have played down the risks posed by the virus. Their false bravado and reassurances have sent a lethal message to citizens, with commentary ranging from trivialising the threat with false and insincere messaging, such as 'the disease is slowing down', 'more people die from traffic accidents', 'we are doing better than other countries', to propagating misinformation straight up, such as 'summer temperatures will curb the spread' to abdication on the pretext that 'countries with lockdowns have also failed at containment, so let us learn to live with it'.

The prime minister has made no secret of his opposition to any flavour of lockdowns, strict or loose, from the start. Every decision made by his government — asking provinces to resume public transport, lamenting the strictness in enforcement of safety protocols for small businesses — has sent a signal to Pakistanis about the severity of Covid-19’s spread. Statements from his top deputies framing the country’s outbreak as mild, and its mortality as unusually low, have provided validation for undeterred socialising. Divisions between federal and provincial governments along familiar party lines have caused widespread confusion about the need for mitigation.

The complacency and denial that unites a vast majority of the public — from every class and education level — is neither a coincidence nor an inevitability of the country’s low literacy. The government’s "pro-poor" easing of the lockdown has been accompanied by muddled communication that has misled the very public that it claims to be protecting. Pakistanis no longer consider the virus a grave threat; many do not believe it exists at all.

Pakistan’s literacy rate has frequently been brought up to explain non-compliance. But low literacy is more reason — not less — for our leaders to engage and prioritise effective public health communication. Gaining citizens’ cooperation to reduce transmission requires ensuring that they understand the risks they are taking. Creating reliable channels for scientifically accurate information that is readily accessible, frequently repeated, and is shared in an easily understandable form for the average person is crucial for less educated populations. The absence of this has left millions of Pakistanis vulnerable to misinformation and conspiracy theories.

More on this: The Covid-19 emergency and prioritising public health in Pakistan

In stark contrast to Pakistan, world leaders at the helm of successful Covid-19 responses have used every tool in their arsenal and every opportunity at their disposal to persuade the public to adopt new behaviours and adhere to new rules. Engaged and visible throughout the crisis, they have explained the 'why' behind their decisions, linking them convincingly to favourable outcomes.

A few examples of effective public messaging for Covid-19 from around the world stand out in particular. With 326 cases and 0 deaths, Vietnam has among the most successful Covid-19 responses in the world — despite having one of the highest population densities in Southeast Asia, a shared border with China, an under-resourced health system, and limited testing infrastructure.

To alert citizens to the urgency of the situation, it declared SARS-CoV2 a pandemic before WHO did. Its government-citizen cooperation owes itself to a mass public awareness campaign, and organised debunking of fake news through scientific journalism. The country's health ministry website provides a constant stream of information about latest outbreaks and exposure risks, videos from the Deputy Prime Minister, and infographics to reduce Covid-19 stigma. Creative state-led campaigns increased awareness, such as partnering with a pop singer to produce "Ghen Co Vy" — a song that went viral and was promoted by Unicef — and commissioning young influencers to broadcast messages of optimism and solidarity for quarantined populations. Patients were encouraged to share their experiences at isolation centres on social media, bolstering trust in the conditions at these facilities.

Vietnam also made mistakes in managing risk perception that highlight the balance between over-assurance and under-assurance that risk communication must achieve. The country’s tourism agency attempted to promote "Vietnam — Safe Haven", a campaign to inform foreigners that the country had successfully managed the crisis, while the spread was still in its early stages. Due to this premature positive messaging, 41% of the cases in Vietnam's second outbreak cluster were tourists.

In New Zealand, which has one of the flattest epidemic curves in the world, Prime Minister Jacinda Ardern's message to citizens was this: life as they knew it was temporarily over, and everyone must start "acting as though you already have Covid- 19". Germany’s success seems unsurprising when one watches Angela Merkel's press conferences. In language accessible to the average German, she spoke about the sensitivity of the country’s health systems to R0 or the virus’ reproduction number. If our R0 goes from 1.1 to 1.2, so everyone infects 20% more people, our hospitals will get overwhelmed three months sooner, she explained. And while the American pandemic response is certainly not one to aspire to, New York governor Andrew Cuomo’s proactive and transparent communication made headlines for providing clarity to millions of residents as their state became the global epicentre of the pandemic. His daily, televised briefings displayed graphs on hospitalisation, ICU and intubation rates, motivating New Yorkers to continue slowing the spread by staying home, and providing a window into what was coming up ahead.

By emphasising the magnitude of the crisis instead of concealing it, these leaders created leverage for harsh policies that caused unprecedented disruption to lives and livelihoods. They paved the way for local bodies to enforce these policies. They set and re-set expectations about lengths of lockdowns, spikes in infections, and what life would look like once measures were relaxed. They continued to advise and demonstrate hyper vigilance long after community transmission had been eliminated. Above all, they did not peddle misinformation. The ones who did — such as federal leadership in the UK, United States and Brazil — are still paying a hefty price.

The Kerala model, already hailed for its preparedness in testing, tracing and isolation, is also a case study in public communication. It utilised both traditional and new media to communicate in several local languages, with a focus on migrant-dominated areas. The government’s 'Break the Chain' campaign and Corona Literacy Mission reached out aggressively and proactively to families with educational content, including a coordinated effort from the Kerala Police’s Media Center to produce localised videos, poems and dances. It is no coincidence that the Kerala Police’s Facebook page is one of the most popular police department pages in the world, with 1.4 million followers. A mobile app called GoK Direct regularly checked the spread of misinformation.

Read further: Rethinking Pakistan’s welfare systems after Covid-19

Kerala’s communication strategy boasted the additional element of political unity. Not only did the state's chief minister build faith in the state’s response by speaking to the people of Kerala for an hour every evening, he also jointly addressed local body representatives with the opposition leader by his side. "We must close down all our doors before the enemy enters" was their common message of caution.

These communication strategies owed their success to a few common elements, each of which built trust. They were: (1) early and proactive, (2) honest and transparent in disclosure, even when numbers painted a dark or uncertain picture, (3) careful in putting facts before politics, creating a common national narrative (4) frequent, ongoing, and evolving with the pandemic, (5) erring on the side of over-caution instead of over-confidence, (6) simple, clear, and unambiguous, breaking complex topics into bite-sizes.

If the government fails to earn back citizens' buy-in and trust, measures to track and isolate will also fail. Contact tracing only works when individuals understand the urgent need for it, and provide honest, detailed accounts of their interactions. Acceptance for antibody testing or isolation requires confidence that those testing positive will not be maligned or mistreated. Higher social disparities across the developing world require communication strategies that account for various capacities for scientific concepts and difference in risk tolerance.

Of all the tools leaders and governments have at their disposal in crisis management, public communication preparedness has the highest impact on transmission reduction, for the lowest cost. Investing in a cohesive, localised public health communication strategy will be essential in the coming months if we have any hope of mitigating the spread of Covid-19.


Author Image

The author is a technologist working in public health. She tweets @sabagl

The views expressed by this writer and commenters below do not necessarily reflect the views and policies of the Dawn Media Group.

Comments (30) Closed

May 27, 2020 06:56pm
Good luck, disciples of IK
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M. Saeed
May 27, 2020 07:13pm
Today after 92 days of home confinement, I went out for a drive in the personal car with all door glasses fully closed and air circulation kept to the indoor only. I was baffled to see that, all roods were full of traffic, public parks were congested, walking tracks were brimming and street vendors were having fields day. No visible social distancing and hardly a few face masks on the visible faces which were plenty. Nobody appeared in the least worried about the pandemic and many people I know, are calling this whole lock-down exercise, a hoax.
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May 27, 2020 07:21pm
Though options were limited for the federal government, they should have a uniform strategy aligned with steps taken by the provincial government, that did not happened, resulting in a confused message.
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May 27, 2020 07:27pm
Nicely written and presented case with examples. Keep writing, I hope one of aids of PM is reading it and planning to implement these examples in policies and implementations.
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May 27, 2020 08:01pm
People of Pakistan have inbuilt resistance
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May 27, 2020 08:21pm
....and what about the stand taken by our Chief justice ?
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Jehengir khan
May 27, 2020 09:50pm
Government failed on all front giving up ....
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May 27, 2020 09:58pm
@M. Saeed, This shows lack of education and illiteracy amongst the masses. Secondly lawlessness and corruption amongst the agency who are suppose enforce law.
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May 27, 2020 10:00pm
The only way Government can control the masses is by enforcing heavy fines between Rs10,000 to Rs20,000 otherwise there is no way to control unlawfulness
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May 27, 2020 10:13pm
Pakistan is doing much better than the neighbouring country whose people once used to boast here tirelessly.
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May 27, 2020 10:36pm
Totally Agreed
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Lahori Kid
May 27, 2020 11:12pm
The government knew it before lifting the lockdown, how can 230 million people keep social distance? whose going to ensure people are wearing masks, keeping distance, not allowing more than a certain number of people to gather in one place? No country in the world have the man power or resources to ensure that, that responsibility belongs to the people, and our people, educated or not, will never follow simplest and basic rules, people act like they have been deprived of their rights, socializing, forgetting that its for their own health and safety, no government wants to shut down the economy, but here we are.
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May 27, 2020 11:17pm
It’s a horrible account of Corona in Pakistan. I stay in Western Canada where the Corona is not that serious. But still the norms are very strict. I saw in the news two days back a gentleman was given $1200.00 ticket for not maintaining a safe distance with his friend inside a state park. I understand this is a dacronian rule but needed to save life & states money. Pakistan must follow the same to survive.
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May 27, 2020 11:46pm
@Thomas, pakistan must provide expertise to US as to how to control coronavirus and which medicines to be given to corona+ patients so that they can recover fast.
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May 27, 2020 11:49pm
We underestimate the challenges that the govt. is facing in Pakistan. PM IK is not incompetent, it is the country he is running that is full of corruption. Most political parties are simply not with the govt. Even the supreme court judges focused more on criticizing federal and provincial governments than on working WITH the govt(s). The court should have imposed emergency and give full powers to army and federal govt. to implement precautionary measures. Hope PM IK eliminates corruption ASAP.
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May 28, 2020 02:26am
Finally an article..wish it was published before..there are lot to write as i have been on comments what should be done but wonder hi ups read comments?? Because they are the only ones with brain.well forget whats done atleast gov should provide details on their covid gov pk on cases locality or area wise drilled down to streets. So that ppl avoid going there atleast..the portal has just graphs no info e.g. if i should avoid going to g6 area in isb or not..met a lower class guy a couplenof days back even he said nonone dies in 14 days if initially gov had imposed a 14 days strict lockdown it would have helped..well mr ik thats a poor guy giving the half cooked policies of you ppl will give strong beating to life and economy both..even i was following it since jan and u people wasted initial 1.5 months now handle.
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May 28, 2020 04:32am
Ik incompetence is now fully exposed for all to see
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May 28, 2020 05:36am
@AKL, On what evidence is that statement based?
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May 28, 2020 06:21am
First I consider you apostrophe is in the wrong place for Government's, instead it should be Governments'... "Divisions between federal and provincial governments along familiar party lines have caused widespread confusion about the need for mitigation." 18th Amendment has caused this disunity, whereas the PMIK has been consistent as the author acknowledges. "The prime minister has made no secret of his opposition to any flavour of lockdowns, strict or loose, from the start. " This indicates the weakness in the Pakistan's Governance System of Democracy, which must be plugged for better National Performance and in the National Interest, hence, a re-look at the 18th Amendment is needed without discarding it.
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May 28, 2020 06:24am
@NACParis, you pay bribe at every step in pakistsn. So nothing is going to work
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Sunil kore
May 28, 2020 06:37am
It's because of lack of education
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May 28, 2020 07:16am
Well writen. Nations who laid aggresive policies towards the Coronavirus saved their masses from death, while the leaders of USA, Brazil, UK, Pakistan and some others acted timidly, resulting in death to their citizens. In Pakistan, Imran Khan government failed miserably to contain the desiese due to their confused policies, which has resulted in large death, for which PTI government is fully responsible.
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May 28, 2020 08:30am
In some areas , like Pishin District, Pandemic is already wreaking havoc. There has been death in every street and people are openly discussing the lethal effects of this virus. Hope sanity prevails.
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May 28, 2020 08:36am
I think it was handled well,atleast the factories were no closed and there was no crisis because of migrant labour.
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May 28, 2020 09:05am
Pakistan is doing much better than the neighbouring country whose people once used to boast here tirelessly.
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Zeeshan Ramzan
May 28, 2020 11:06am
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May 28, 2020 01:46pm
When the PM of the country keeps doubting the benefit of lock down and refuses to wear masks during his meetings, no action by provincial government will be taken seriously by the people or even the bureaucracy
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May 28, 2020 03:06pm
The government has handled the pandemic, extremely well. Better than any country in the region.
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May 28, 2020 05:47pm
I live in Germany, which has one of the best health systems in the world. But middle class pay 40-45% of total income/earning in taxes, apart from 19% tax on any monetary transaction, including doing grocery. With 7,500 covid-19 deaths (4.4% death ratio) & 160,000 confirmed infections in a population of 80 million (equal to Pakistan' Punjab population) Germany is no success story! A second wave is expected as well. Pakistan's record is among the top few. Moreover, Angela Merkel was speaking to a population with 100% education, still communication gap was/is the worst ever during the last decade. Despite weak performance Germany is eyeing the Covid-19 market in terms of medicines, technology & services. Imran Khan has done a great job keeping in view the low education and high poverty level in his country. Please, kindly avoid comparison between the world 3rd largest economy having 80 million well-educated population with Pakistan, which has 220 million people swimming in debt.
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May 28, 2020 10:01pm
Look at communication from Pakistani PM FO and ISPR. Can you tell me one person of these who has benefited Pakistan on world forum? That sets the quality bar.
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