During this complex time you kept on working as an investigative journalist, trying to shed light on the hidden aspects of the pandemic. How do you think communication and the role of the scientific journalist changed, in relation to this and in recent years in general?
I believe that some of the chronic issues of this sector worsened in recent years. During this global crisis the elephant in the room was the lack of basic knowledge, not only in non-specific journalism but unfortunately also in the scientific one. I want to highlight that I have great sympathy for all the colleagues that had to improvise and turn into journalists working in the medicine and healthcare sector overnight, but it isn’t a job you can do without the adequate training. Unfortunately there is a lot of misinformation out there about what has been going on in the world for the past year now and I think this is really serious because we are not putting people in the condition to grasp what is happening.
During the COVID-19 period we saw virologists, scientists, epidemiologists, physicians- and other professional figures that the majority of citizens did not know about until last spring- suddenly become the spokespeople of the pandemic, probably much more than institutional and political figures. Allowing “experts” to cover science-related communications has its own advantages- but also has a significant list of disadvantages- and the emergency context showed some science figures that completely lacked public speaking skills. In light of this, should journalists choose the expert they refer to and speak with?
There is an underlying problem here, which is the so-called “white coat syndrome”, whereby most journalists feel a form of reverential awe towards any person that has a degree or title related to medicine, public healthcare or science. However, it’s important to remember that the opinion of the expert is not evidence in itself. Secondly, during this global crisis there was also a tragic misunderstanding, because these experts were somehow viewed as “stars”, but that’s not how science and medicine work. Media and journalists often mistook fireflies for lanterns. Even though the association between virus and virologist seems intuitive, the virologist actually isn’t the professional figure you should refer to in order to understand epidemics. Medicine and science branch out into countless different specialties for good reasons. The professional figure you should refer to right now is an epidemiologist (someone specialised in infectious disease epidemiology), not a virologist, who deals with basic science and data- the more theoretical side of the matter. It’s a shocking mistake that is repeated on a daily basis because nowadays every country seems to have its own virologist-stars. Moreover it makes things difficult for the population, as people do not have a way to understand what is happening. Many journalists do this with the best of intentions, but it’s still absurd to see a neurologist and a biologist discuss infectious diseases during prime time. I think people have the right to know the truth and to receive the right message. Another thing, that I think is particularly important and that I really miss seeing as part of communications, is the definition of what is “normal”. If you don’t explain it, how can citizens distinguish between what’s normal and what isn’t? Instead, we are bombarded with numbers, without any reference point- the reality is that numbers on their own are meaningless and they always need to be compared to a denominator- and often the tools that would allow readers to read these data are not provided. I also believe it is really wrong that certain matters are presented as absolutely unique even though we have been managing epidemics for hundreds of years. Any viral disease has the potential to drag on a bit but global communication to the masses is presenting a series of facts that we are quite familiar with as though they were unique, causing a compounding effect on collective fear which unfortunately leads to bad decision-making.
When communicating you should always think about customer satisfaction, especially when you are talking about an emergency. Communication is a form of marketing; in this case you are trying to obtain the citizens’ trust and you have to be reliable in order to get there. “Reliability” is a true keyword in communication and it can become a painful matter from the institutional point of view as it changes people’s willingness to adapt to a variety of things- from complying with facemask wearing to being vaccinated. Do you think the ongoing disagreements between these experts and their changes of direction impacted people’s willingness to adapt to the correct prevention measures for COVID-19 in any way?
We know well how complex and challenging it is to communicate about risks and benefits in the public healthcare sector; it makes communications a very delicate matter. There is a great difference between the communication of a public healthcare authority wanting to implement a certain measure and the communication of the best evidence-based scientific data. One critical issue- out of the many- is that in medicine and healthcare politics there are many things that we don’t know, and yet, despite this, the uncertainties aren’t discussed and you tend to just hear, “It’s that way”. That’s not a convincing message: given the great level of collective fear there is people will tend to follow the experts and believe media, but the risk is that they will completely lose their trust towards healthcare authorities and scientists. For example, we know that vaccines against COVID-19 were introduced in the market with accelerated procedures, hence why we do not use the word “approval” on its own but instead refer to “emergency authorisation” and “conditional authorisation”. Instead of telling people that everything is fine and that this vaccine is undoubtedly safe and effective we should explain that, in light of the current situation, the regulatory authorities deem its safety and efficacy profile to be satisfactory, which is exactly what the Food and Drug Administration and the European and Swiss authorities wrote. After all, regulators choose their words very carefully.
The uncertainties aren’t discussed and you tend to just hear, “It’s that way”.
I was going to ask you whether the procedures to improve the transparency and accessibility of data should be changed, but I think that the answer is obvious…
I believe that lack of transparency is one of the biggest issues we are facing in this historical time. We know there are many initiatives around the world asking for better and full access to data. The article I recently published on the BMJ pointed exactly towards this direction. We found that the percentage of mRNA integrity of these new vaccines is considered a trade secret and I don’t think that’s a good idea because that actually means cutting out the scientific community from a topic that is very relevant to the public interest. Data transparency is crucial or else we are just left with faith. Everything can go well but that might not always be the case. Lack of transparency and incoherent communications can only be counterproductive, especially in this time and age when access to information has changed radically.
Communication through social media platforms, and the web in general, is also changing. How was this aspect managed during the pandemic? For example, in Italy, the fact that the Ministry of Health did not provide clear communication guidelines allowed the Regions to organise independently in different ways and not always efficiently.
I am extremely worried about a new phenomenon that is taking a disturbing direction: the fact that social networks can determine what is evidence-based and what isn’t. Firstly, I think it’s not a good response. The right response to the citizens’ doubts should be empathy and a great effort to educate. Let’s not forget that science is all about asking questions; debates and discussions have always been at the core of scientific discourse and consensus often originates from there. In some cases there is no scientific consensus so the fact that social media now claim the right to determine what is true and what isn’t seems absurd to me. There were some really shocking cases, like Facebook censoring the Director of the University of Oxford’s Centre for Evidence-Based Medicine (CEBM), Carl Heneghan, who wrote an article for a British newspaper, with Tom Jefferson, about the results of a recent Danish randomised controlled study on the efficacy of wearing facemasks for the general population. Facebook labelled it as fake news and blocked the content so people could not read it. I don’t believe it’s right that YouTube, Facebook or Twitter are in charge of deciding what constitutes the scientific truth. It is fair and healthy for people to have questions and we cannot resolve the matter with a gag. Additionally, very often in science and medicine the things we don’t know are more than the things we know.
I believe that lack of transparency is one of the biggest issues we are facing in this historical time.
Furthermore, I understand that healthcare authorities should usually display certainty but they should talk about how there is also a degree of risk in life that needs to be accounted for. The fact that many scientists and researchers seem to have forgotten this worries me. The journalists who covered the pandemic did not help either; they would blurt out numbers and data, accompanied by the morbid use of images from intensive care units- on top of that, in our culture showing that type of image used to be taboo. Presenting unfiltered messages in a sensationalistic manner damages the public interest and is ultimately a disservice. Overall, there was great confusion, not just in Italy. One thing is to tell people that, “We are facing great uncertainties and we fear for the stability of the healthcare system so we ask you to stay at home for two weeks”, and another is to keep on changing the criteria all the time.
Anyways, putting everything else aside, perhaps one of the few positive aspects of the pandemic was the universal acknowledgment of how important communication is. The Centre for Employee Relations and Communications (CERC) of the IULM University in Milan conducted a study on a group of companies and communications managers from July to November 2020. In general the results showed how much the strategic role of internal communications of companies grew during the pandemic.
It certainly did, though we don’t yet know what consequences that entails. We know that a double-blinded randomised controlled trial can provide results that an observational study just can’t, but I did not see almost anyone making much of an effort to provide quality communications in this sense. As journalists we have the duty to nit-pick all communications but apparently it’s become normal to just copy and paste the press release of drug companies and public healthcare authorities. Worldwide, the message conveyed at government’s presser has become “the Truth”. That’s novel, and bizarre. Everyone started copying and pasting the press releases of companies, particularly in regards to vaccines against COVID-19, even though we know that drug companies write news releases that send a positive message about their products. What should normal citizens do then? Should they do our job and investigate in our stead?
Going back to our initial chat about the role of the scientific journalist, do you think there are widespread educational routes to train a new generation of “scientific communicators” in Italy?
To be honest I don’t have extremely accurate information on this. I generally believe that the most important need in Italy is to educate the population, especially journalists, and to provide basic knowledge so that people are able to hear the spot red flags. I hope that the healthcare authorities will put a hand on their heart and whenever they are about to deliver a message they will first think about, “What will a layperson without any specific knowledge of this sector get from this? What chain reaction will this trigger?”.
Edited by Tiziano Costantini
Investigating Health & Medicine
By Catherine Riva and Serena Tinari / Re-Check.ch*
Global Investigative Journalism Network
*Re-Check.ch is a Swiss non-profit organization that investigates issues relating to health and medicine.