- With prior disease outbreaks, there's typically been a prominent scientist who becomes the "public face."
- That involves regular briefings with the press to share the latest scientific developments, and a clear set of recommendations. They must have the trust of the public, and feel confident that they can speak the truth.
- That person has been noticeably absent, with the CDC maintaining an unusually low profile during the crisis.
When the U.S. experiences sudden outbreaks of disease, the federal government typically appoints a spokesperson. That person communicates the latest data, issues recommendations to keep people as safe as possible, and provides a calm and reassuring voice until the storm passes.
Most health communication experts agree that person should be a scientist -- not a politician. That's particularly the case for a politically polarized country like the United States.
"It is crucial that the public face for health information on the coronavirus should be a highly respected public health figure," said Lawrence Gostin, a professor of global health law and director of the O'Neill Institute for National and Global Health Law at Georgetown University. "The public must have trust in that person to provide unbiased, science-based information."
When politicians overstep, he explained, that can add a layer of politics to a science-based recommendation. Already, that seems to be happening during the Covid-19 crisis. The population is deeply divided about issues ranging from vaccines to wearing masks in public. Wearing a mask -- which is now the recommendation from the CDC, particularly in areas where it's challenging to meet social distancing guidelines -- has increasingly become a political statement.
Communicating with the public is so important that the CDC's Field Epidemiology Manual dedicates an entire chapter to the subject.
The recommendations say the spokesperson should have a consistent message (a "SOCO" or "single overriding communication objective"), which might be a specific health recommendation, like "wear a mask" or "stay six feet away from strangers." Their tone is vitally important, the manual stipulates, and they should be empathetic but clear about the challenges we face, whether that's a shortage of tests or delays in producing a vaccine.
While serving as the director of the U.S. Centers for Disease Control from 2009 to 2017, Dr. Tom Frieden stepped into that spokesperson role.
"During Zika, H1N1, Ebola, we usually had daily briefings with every major media outlet covering them," said Frieden, who's now the president and CEO of Resolve to Save Lives, an advocacy group.
"I would feel safer and we would all be safer if we were hearing from the CDC regularly," he said.
In the United States, President Trump asked the public to tune into regular briefings from the White House for updates on the coronavirus. Local officials like New York governor Andrew Cuomo and California governor Gavin Newsom followed suit, leaving doctors and scientists mostly on the sidelines.
Dr. Anthony Fauci has emerged as the most prominent scientist speaking about the coronavirus, but his appearances next to the president have been inconsistent, often leading to speculation about why he's missing.
Frieden has known Fauci for years and says he's a "brilliant science communicator and researcher." But, Frieden says, he's not a foremost specialist in the control of respiratory diseases. Those experts at the CDC include Dr. Nancy Messonnier, who reportedly drew ire in the early months of the pandemic for issuing urgent warnings to the public, and Dr. Anne Schuchat, the agency's number two. Both have given a few comments to the press, but neither has emerged as a public face for the pandemic response.
Meanwhile, Fauci, who has advised six presidents and plays a central role in the White House's coronavirus task force, has acknowledged that he's not always in a position to correct falsehoods he hears from President Trump during the press conferences, including exaggerations about the number of tests available. "I can't jump in front of the microphone and push him down," he told CNN.
At this point, it would be a challenge for any public health official to breed consensus. Some are having success on a local level, such as in states like California and Washington, but there's a lack of consistent understanding across the country.
"Dr. Fauci is among the best health communicators in America. His authoritative and reassuring voice is highly respected by the public. Yet he is operating during a period of politicization of science in ways never seen before in modern America," said Gostin. "Health information should not be seen through a political lens but through the lens of science."
Experts outside of the federal government are doing their best to fill the void, answering questions about whether it's safe to travel, go to the park, or to send kids back to school.
On the medical side, providers treating Covid-19 patients like Brigham and Women's Hospital's Dr. Jeremy Faust, Rhode Island Hospital's Dr. Megan Ranney and Oregon Health & Science University's Dr. Esther Choo are frequent voices on the air, speaking out about life inside the hospital during a pandemic.
Dr. Ashish Jha, the director of the Harvard Global Health Institute, has also emerged as a leading voice on public health.
Jha, who has urged the CDC to speak out at a time when its experts are most needed, says he's willing to keep communicating with the public -- but he recognizes that he's not the national spokesperson that Americans need.
"I don't have the data that [CDC director] Robert Redfield has," he said by phone. "We are all using publicly available data and doing our best with what we have."
Jha said it's unfortunate that Fauci does not appear to have the freedom to take the helm during this crisis. He describes Fauci's role as "not full Fauci but half Fauci," because he appears "constrained and he can't contradict the president."
Jha said he's now doing four to six television appearances per day, in addition to his day job, to provide guidance on how to safely reopen the economy. He'd be willing to step back if and when a true spokesperson emerges. "I hear all the time from people that they don't know who to turn to or who to trust," he said. "There's no glory in it...we are filling in for the federal government's communication gap."
Dr. Ranney, the emergency medicine physician and public health expert, agrees.
"I will do my darndest to continue to disseminate science and to serve as a voice of public health reason," she said. "But good public health messaging requires trust and consistency (and) ideally that comes from our governmental leaders."