On Monday, FDA announced the approval of updated COVID vaccines. On Tuesday, the CDC announced its recommendations for who should get the shot. The announcements feel timely with the uptick in cases, but there continues to be one overarching problem facing disease prevention and control in the U.S.: confusion.
A lack of vaccines was the main issue 3.5 years ago. Now there are a lot of vaccines, but with them, a lot of confusion.
Over the last several years, we've heard multiple agencies offer advice and updates (CDC, NIH, HHS, FDA) on multiple vaccines (COVID, flu, RSV, and more), coming from the voices of multiple spokespersons (Anthony Fauci, MD, Rochelle Walensky, MD, MPH, and Ashish Jha, MD, MPH, just to name a few). Public confusion has led to a loss of trust in our leadership.
Now, into this cauldron steps the new CDC director, Mandy Cohen, MD, MPH. In an August 2 NPR interview she presented what she described as "three important steps" for restoring trust.
These include:
- Transparency: Clear communication that is simple and accurate, presenting "common sense solutions"
- Good performance: CDC "doing what we say we're going to do"
- Partnerships: "We can't do it alone from the CDC"
There is good news and bad news in the road ahead. The good news is that Cohen is clearly a good communicator. All you have to do is look at her "3 W's" campaign in North Carolina or listen to her affirmation of communication in general to know she has what can be called, "narrative intuition." She understands the tripartite nature of narrative structure, and I'd be willing to bet she can tell a good story. More to the point, the North Carolina governor called her "a problem solver." That's what narrative structure is about -- the problem-solution dynamic. She gets it.
But here is the bad news: What awaits her this fall is a new and foreboding landscape of an anti-science movement that has gone as far as to attack leading vaccine scientist Peter Hotez, MD, PhD, and to back anti-science presidential candidate Robert F. Kennedy, Jr. As noted by the Washington Post last year, the anti-vaccination movement, "... is now firmly entrenched among tens of millions of Americans."
What's worse is that any confusion in communication by the government works in the favor of the anti-vaccination movement. The more uncertain the public is about the recommendations of its leaders, the easier it is to undermine vaccination efforts.
So, while Cohen's tripartite list of actions is undoubtedly accurate in theory, regaining the public's trust will be tougher in practice.
Here are what I believe to be the three most important real-world challenges for Cohen to aspire to, both in the effort to encourage uptake of vaccines this fall as well as with broader public health efforts:
The Singular Narrative
The question, "Who's in charge," is central to leadership. This has been a problem from the very start of the pandemic. Michael Osterholm, PhD, MPH, director of University of Minnesota's Center for Infectious Disease Research and Policy, noted this as early as October 2020. On NBC's Meet the Press he said, "We don't have a consolidated one voice."
The power and importance of the singular voice of leadership cannot be understated. It was made clear in Nicholas Kristof's brilliant 2009 Outside Magazine essay titled, "Nicholas Kristof's Advice for Saving the World." He cites the work of social psychologist Paul Slovik, PhD, in showing how when the focus shifts from just one subject to two, the audience begins to disconnect. And yet, the Biden administration continually chose to address the pandemic with multiple voices (CDC, NIH, the White House).
A year ago, Hotez stated it clearly, "Put CDC back in charge of fighting COVID-19." He is absolutely right. There needs to be the one voice of leadership, and by consensus, it needs to be CDC (has there ever been a more fitting moment for Paul Simon's lyrics: "our nation turns its lonely eyes to you"). So, now that the CDC has provided its recommendation for who should get the updated COVID shot, all other government agencies must move forward with a unified front and adhere to CDC's messaging.
Consistency
There are three vaccines being recommended for fall (the COVID booster, the flu, RSV) for various groups. Already, the public is unsure about who should be getting which shots, and when, despite the fact that some of the vaccines are already available. Should they all be given together? Spaced apart? How far?
We need clear "talking points." The Republican party has known this for generations. Figure out the message, then equip team members with the facts in the form of simple, agreed upon items.
Furthermore, the message should have a structure and not just be a "shopping list" of everything everyone can think of. This is what narrative structure is about. Less is more, but it takes thought, time, and tough choices to distill a complex message down to an effective message.
Relatability
For many, the image of CDC is that of Big Brother talking down to the public it wants to control. This has to change.
In my first book, "Don't Be Such A Scientist: Talking Substance in an Age of Style," I shared what I learned in acting classes about the alienating power of "rising above." When an argument breaks out, nobody likes the voice that attempts to "rise above," whether through an information deluge or just through sheer assumption of authority with the attitude of, "We're your government, listen up."
"Never rise above," needs to be a central catch phrase for CDC this fall. This needs to be at the heart of efforts to do a better job of changing the perception of CDC as a friend of the public, rather than as an agency that wants to control it.
None of these elements are easy. All of them involve much more than just science. For any of them to work, the only hope is that there is "a problem solver" at the top.
Randy Olson, PhD, is the director of the ABT Framework Narrative Training program, author of "Houston, We Have A Narrative," and 2020 recipient of the John P. McGovern Award for Excellence in Biomedical Communication from the Southwest Chapter of the American Medical Writers Association.