“We want to go back to living, presenting it in the simplest, most basic form, that’s going to get the most people to do the recommended health behavior now,” Wilkin said. “We believe that it’s going to have the biggest impact if we get more people vaccinated now.”
As I began writing this article in March, the virus was surging again in parts of Europe, where for mainly logistical reasons the vaccination rate was much lower than here. I saw a headline about intubations in a packed hospital parking lot in Greece.
Here in the states more recently, the experts have been worrying that not enough people will get the shot for true herd immunity. Demand has waned.
So Wilkin does have a point.
The fear appeal
Wilkin trains future public health officials. It occurred to me that I didn’t really know anything about them, or about their jobs, pre-pandemic. I had been thinking of public health as a kind of objective scientific organ: Data and science tell us this and that — and, on such and such basis, we’re now telling you this.
Can you really blame me? They’re always saying they’re following the science, and that the data is making the decisions.
But Wilkin said it’s always been more complicated than that. Like Sandman, she explained with a smoking example.
“So we think of something like smoking, and most people think, ‘Oh, well, everybody knows that it’s bad for you,’” she said. “Well, at what point in your life did you figure out that it was bad for you? And had they successively already convinced you to try smoking before then?
“They” being Big Tobacco.
“They’re out there using persuasive messages, and they have big marketing budgets,” she said. “And so, with very considerably smaller budgets, public health people have to figure out, OK, how do we counter those arguments that are out there.”
To essentially punch above its weight class, public health has to arm itself with more than just the plain and whole truth. It has to use what Holley calls “appeals.” Precisely speaking, she means emotional appeals. They can be to sadness, to empathy, to guilt, but most often they’ve been appeals to fear.
A classic example is the old your brain on drugs ad, where a matter-of-fact-looking guy pulls out an egg.
“THIS IS YOUR BRAIN,”
And a hot pan …
“THIS IS DRUGS … ”
And combines the two:
“THIS IS YOUR BRAIN ON DRUGS,
He fries the egg, your brains.
The ad doesn’t really tell you anything about addiction, how it develops, or how drugs work or that they can be pretty fun, at least for a while. It just tells you drugs will destroy you.
Fear can be very persuasive.
“I had a doctor once tell me that, you know, communicating with patients isn’t difficult at all. ‘I just tell them they’re going to die if they don’t take these meds, and they do it,’” Wilkin said.
The fear appeal can work quickly, but Wilkin thinks public health has leaned on it too much for too long during the pandemic.
She discourages the fear appeal in general, she said, because studies have found it unpredictable: You never know how it’s going to break, who it will work on, and for how long.
Some people get scared and stay scared; some people get defiant. You end up with the battle cry of the anti-masker, which isn’t “I don’t care about Grandma.” It is, quite tellingly, “I refuse to live in fear.”
“We have what we call … a third-person effect, where you don’t necessarily believe the media is impacting you, but you believe other people would be impacted by particularly things that they see or they hear in the media,” Wilkin said. “The fear appeal is very much like that.”
Fear also appeals to news organizations. If it bleeds it leads, and Wilkin said public health officials understand this. A fear appeal may get you headlines, while another kind of appeal won’t.
“People might not be tuning into the press conferences anymore,” she said. “At a certain point, I think people no longer start to see the human element, that they start to see you just having these increasing numbers.”
I mentioned the Philadelphia press conference I had covered — the one about the second wave hitting, and that a lot of media outlets ran that. What would the headlines have been if the health commissioner had just said a slight rise in cases, keep an eye out? Would there have even been any headlines?
At that summer press conference, Farley didn’t announce any new public health measures to go with the second wave announcement, but he also didn’t remove any. Some restrictions were slated to be relaxed the next week, and they were extended.
Wilkin, however, said that just talking about a second wave was an active public health measure in and of itself. Just saying those words on TV, that can save lives.
“What we’re seeing now is this is really being spread, within families and in social events,” Farley had said later in that July summer second-wave press conference. “And so we’re making a recommendation today to try to limit exposure, then to families and social events.”
What public health measure gets people to stop seeing their own families, especially during beautiful summer days, and after months apart? Maybe it’s pulling the trigger on a fear appeal, a big one, like a second wave.
Mount St. Helens never blows
To help me better understand Farley’s situation, Wilkin gave me an example from when she was a kid.
“When I was in middle school, we had to do a game in our science class where each day we got to check the seismic readings around Mount St. Helens and had to make a decision on whether or not you’re going to evacuate the town or not,” she said.
Too early and people lose confidence in you — we left and nothing happened. But make a move too late …
“And now you’re dealing with a bunch of people who have died as a result of you not acting soon enough,” she said. Either way, “Everybody who’s around knows you made the right call or you didn’t make the right call because an actual volcano explodes.”
With pandemic public health, if you do everything right, the volcano never goes off. All is quiet when a crisis is averted — which can make prevention measures seem like total overkill.
There is a possibility that Farley’s simply saying that there was a second wave last summer did something to stave one off. There really is no way to know.
Farley declined to be interviewed for this story, but I really wish he would have. I wrote to his spokesperson, saying that I wanted to know what I didn’t know, the factors he weighed behind closed doors before deciding to declare a second wave, the pressures he felt.
I don’t know what it’s like to be in his position, to make life-and-death decisions, even if indirectly, for an entire city. There’s a strong case he did gild the lily, but he definitely saved more lives than I have this past year.
The question then becomes at what cost.
Gilded lilies and who we believe
I live in a deep blue city, run in progressive circles, most people I know want to believe the Farleys of the world.
But what about others? People who don’t trust experts or officials, who believe COVID conspiracies, or think the virus is no worse than the flu, a ploy to control us?
Sandman, the expert on risk communication, said gilding the lily, overstating some things while keeping quiet about others, can become jet fuel for misinformation and conspiracy theories.
“Let’s take vaccination, for example. The easiest way to find out the small percentage of the truth that’s genuinely anti-vax is to read anti-vax websites, and you have to wade through a lot of falsehood, but you’ll also find the little pieces of truth that public health is pretending don’t exist,” he said.
What if, instead of Sandman telling you a clinical trial found no difference between the placebo and the vaccine in terms of COVID deaths, it’s someone ranting on YouTube. He’s red in the face, screaming all kinds of scary nonsense, but then he says something about Pfizer that a) is true, b) is kind of troubling, and c) that no mainstream authority has bothered telling you.
How does that change who you believe? And who you trust?
But that’s maybe a peacetime concern. We’re still in a war against this virus. It’s hard to know the right move, especially when dealing with imperfect, irrational humans.
Throughout this story, I’ve really been asking two questions: How much can we trust public health? And how much does public health trust the public, trust us?
But Wilkin brought up a third, harder question: How much trust does the public deserve?
We were talking about masks.
“I have friends that live in the U.S. but were born in China or in other places in Asia,” she said. “And they were all going, ‘Oh my God, why are they not telling us to wear face masks? Face masks help!”
She started to say the messaging should have been straightforward, no appeals at all, just the complicated reality. But then she remembered toilet paper. The way we all lost our minds scrambling for it, and cleaned out the store shelves.
“Was the rationale that they were afraid that people are going to hoard the face masks? Like they hoarding toilet paper?” she asked.
It’s nice to think we would have all banded together in a patriotic, scientifically informed fervor to protect our meager mask supply. But honestly I doubt we would have — we’re the country of Black Friday sale stampedes after all. Ammunition sales spiked right alongside toilet paper.
And Sandman said there is a hazard in trusting the public with too much science. They realize it’s imperfect. That it can be, and is wrong, all the time.
Still, he’s settled on honesty is the best policy — the whole truth, warts and all, as often as you can.
“It’s my argument in the longer term that the lives they saved by misleading us are not worth it because their credibility is at stake, and they should be honest, even at the cost of their campaigns being less effective,” he said. “That’s my opinion. I cannot prove it. I don’t have good data.”
If the COVID-19 pandemic truly is once in a century, maybe public health gets away with lily gilding and fear appeals stretched too far.
By the time the next pandemic comes along, maybe all anyone will remember is science saved everyone, and miracle vaccines in record time.
But if that’s not the case, as some epidemiologists predict, Sandman said that above honest public health, above trustworthy and transparent public health, what’s most important now is accountable public health.
“Don’t ask to be trusted. Don’t want to be trusted. What you should want to be is accountable, more than trust,” he said. “What we need is accountability.”
I am thankful for the efforts Farley and others in public health have made this past terrible year. They choose to serve, to try to protect the health of their communities — to protect me. I know that impulse is likely behind every decision, right or wrong.
But, as for me, I won’t believe or not believe everything Farley says.
I’ll treat him like a reporter should treat any city official talking from behind a podium. I’ll listen, but with a healthy dose of adversarial, respectful doubt.