A pandemic, especially when caused by a novel virus, induces tremendous uncertainty, fear, and anxiety. To mitigate panic and encourage appropriate behavioral action, communication is critical. The US Centers for Disease Control and Prevention's Crisis and Emergency Risk Communication (CERC) guidance is designed to assist public health authorities, government officials, and other stakeholders in using risk communication during an emergency. For each of the 6 core communication principles outlined in the CERC guidance, we describe the use or nonuse of these principles at critical points during the coronavirus disease 2019 (COVID-19) pandemic by US public health and government officials. With the knowledge that the pandemic will continue to rage for some time and that new communication challenges will arise, including issues related to vaccination and treatment options, many lessons are to be learned and shared. To reduce fear and uncertainty among those living in the United States, COVID-19 communication should be rapid and accurate, while building credibility and trust and showcasing empathy—all with a unified voice.

Introduction: Vaccine hesitancy, defined as a delay in the acceptance or the refusal of vaccines despite their availability, is a growing global threat. More individuals are turning to social media for health information, including vaccine information. As such, there is an opportunity to leverage online platforms as a means to disseminate and persuade individuals toward vaccine acceptance. We sought to review literature focused on the influence of exposure to social media content on vaccine acceptance or hesitancy. Areas covered: This review focused on social networking sites (e.g. Facebook) and content communities (e.g. YouTube), to understand how exposure to vaccine information affected vaccine knowledge, attitudes, and intentions/behaviors. We searched PubMed, CINAHL, Scopus, and Inspec. We included English-language materials published from 2004 to 2020 and included interventional studies, observational studies, and impacts of policies. We excluded systematic reviews, protocols, editorials, letters, case reports, case studies, commentaries, opinion pieces, narrative reviews, and clinical guidelines. Expert opinion: Social media interventions to affect vaccine acceptance is a new but growing area of study. How a communication message is framed, who delivers the message, and network structure are critical for affecting the vaccine decision-making process. Social media should be leveraged to impact vaccine uptake.

Adherence to public health recommendations is critical for public safety and well-being. Effective and appropriate communication plays an important role in whether populations trust government and public health authorities, and the extent to which people follow public health recommendations. Poor trust in communication from public health authorities can pose significant challenges for mitigating public health emergencies and maintaining health security. This study aimed to explore the importance of trust in and understanding of communication from public health authorities in improving adherence to public health recommendations, and how that communication can be improved to develop and maintain public trust, particularly in the context of public health emergencies. To understand which factors are important for public trust in communication from public health authorities, we conducted in-depth interviews ( n = 25) with a racially and demographically diverse group of individuals living in Baltimore. We found that communication source and communication transparency, such as timeliness, completeness, and clarity of information, were critical constructs of trust in communication from public health authorities. We also found that many participants misunderstood the flow of information from public health authorities to news media, and many were unaware that public health authorities provide the most reliable source of health information and recommendations during a public health emergency. To ensure adherence to public health recommendations, the public needs to trust that public health authorities are providing accurate, practical, and prudent recommendations. Drawing on these results, we provide several recommendations for developing and optimizing communication from various public health authorities.

Infectious disease outbreaks highlight the importance of trust in public health authorities to avoid fear and improve adherence to recommendations. There is currently no established and validated measure for trust in public health authorities. We aimed to develop and validate an instrument that measures trust in public health authorities and to assess the association between trust in public health authorities and vaccine attitudes. We developed 20 items to measure trust in public health authorities. After implementing a survey in January 2020, we investigated relationships between the items, reduced the number of items, and identified latent constructs of the scale. We assessed variability in trust and how trust was associated with vaccine attitudes, beliefs, and self-reported vaccine acceptance. The pool was reduced to a 14-item trust in public health authorities scale and we found that this trust model was strongly associated with acceptance of vaccines. Our scale can be used to examine the relationship between trust in public health authorities and adherence to public health recommendations. The measure needs to be validated in other settings to determine whether they are associated with other areas where the public question public health authority recommendations.