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Communicating risk around COVID-19: what can we learn from Taiwan’s Uncle Chen?

By 25th September 2020 No Comments

Leslie Mabon

Senior Lecturer in Social Science
Scottish Association for Marine Science

TL;DR: Taiwan has done very well in keeping COVID-19 under control.  We can learn a lot about effective health communication- especially in regard to managing risk- from their Central Epidemic Command Centre (CECC) and particularly from their Minister of Health and Welfare, Chen Shih-Chung.

Although the first peak of COVID-19 is behind us, it is clear that the virus won’t be going away any time soon. Sudden restrictions, local lockdowns, and periodic changes in the advice we should follow to reduce infection are fast becoming a fact of life as COVID-19 continues to circulate and our underpinning scientific knowledge of the virus develops. But for the societal response to COVID-19 to be effective, it is not enough to inform government policy and decision-making with the latest scientific evidence and the best expertise. There is also a need for governments and scientists to communicate this information effectively to the public.

The social sciences have long studied how best to communicate risk. And what comes across strongly in this extensive body of research is that effective risk communication means much more than bombarding the public with more and more science until they alter their behaviours and attitudes. In this post I’d like to look at one country which has done very well in keeping COVID-19 under control – Taiwan – and understand a little about how the Taiwanese authorities’ risk communication efforts have contributed to this success.

First, some context on what Taiwan has done well. As of 5 September 2020, Taiwan had only 492 laboratory-confirmed COVID-19 cases and 7 deaths, with only one of these cases having an unknown source of infection. Internationally, the Journal of the American Medical Association has pointed to Taiwan’s efforts to reassure and educate the public whilst fighting misinformation as a key component of the country’s successful COVID response, especially the daily briefings from Taiwan’s Central Epidemic Command Centre (CECC).

Let’s look at these briefings and what has made them effective. Decades of research tells us that trust is vital when we are dealing with new and unfamiliar risks. If we as citizens can’t assess the risk ourselves, we’ll decide how to act based on whether we trust the institution assessing the risk for us. There is ample evidence to suggest that if we believe the messenger is competent, knowledgeable and sincere, we are more likely to follow their advice. In the case of Taiwan, it is not so much an institution as a single individual that has brought the public on-side – Minister of Health and Welfare Chen Shih-Chung.

Every day from late January to early June, Chen led a daily CECC briefing (they have since switched to weekly) on the current COVID-19 status. The format is simple yet, crucially, consistent (check out an example here). At 2pm daily, a team of white-shirted, grey-vested officials (nearly always all men) line up to face the media, behind a green table and in front of a blue background, with Chen in the middle. As well as daily infection numbers, updates in advice and best practice are conveyed through big, simple sheets of printed paper held up to the cameras. A graduate of Taipei Medical College, the man known affectionately to the Taiwanese public as ‘Uncle Chen’ has the professional credentials to back up his words.

Taiwan’s Minister of Health and Welfare, Chen Shih-Chung
(Photo licensed under the Creative Commons Attribution 2.0 – Official Photo by Wang Yu Ching / Office of the President)

But what really makes the CECC briefings stand out to a risk communication expert like me is the way they blend this non-sensationalist and evidence-driven ethos with a slice of humour and compassion. Whilst the format is the same day in day out, the colour of Chen’s microphone changes daily. And when the CECC team heard reports in mid-April that young boys didn’t want to wear pink masks for fear of being bullied, the whole team donned pink masks for that day’s briefing. When combined with a consistent format, the clear presentation of up-to-date information, and a fronting figure with professional expertise in medical matters but also a touch of humanity, we can see how an effective risk communication approach removed an experts/public divide and helped the Taiwanese authorities maintain buy-in for COVID mitigation actions.

Outside of the briefings and in response to the pressures of COVID-19, Taiwan has also passed new laws for the certification of public health experts. The Public Health Specialists Act allows those with degrees in public health, or those graduating in related subjects and with public health work experience, to become recognised public health experts who are able to propose plans to prevent health risks and diseases. These certified experts are assessed by exam, and bound to follow codes of professional ethics. Certified experts may also be called up by the Taiwanese government to assist with public health management in times of crisis, such as future pandemics. Not just in Taiwan but also globally, disinformation from purported medical ‘experts’ has been a major challenge. A certification scheme for medical experts is hence a useful step in helping publics know which experts to trust, and gives the Taiwanese authorities a bank of recognised public health experts they can call on if needed in the future. The Taiwanese government has also turned its strong interest in virtual and online citizen participation to the COVID-19 crisis, drawing on recently-established channels to empower citizens to interact with the government to propose solutions and response strategies. The vTaiwan platform[4] forms part of a blended online and offline process, whereby citizens work collaboratively with government ministries, elected officials, scholars, business leaders and civil society organisations to build consensus and agree on outcomes for societal challenges. vTaiwan follows a four-stage process spanning proposal, opinion, reflection and legislation, and allows citizen input right across the process. The value of vTaiwan in a pandemic was demonstrated when the system led to the development of an app showing availability of face masks.

There is of course much more to Taiwan’s COVID-19 response than risk communication, for instance a rapid and effective contact tracing system and the lessons learned from previous experience with SARS. But it is certainly true that trust in authorities and the messages they convey is vital in a public health crisis, where the public may be asked to keep up with ever-changing and potentially complex information. Indeed, Chen Shih-Chung was reported to have hit 94% approval at the height of the pandemic in May in comparison to approval ratings for the Taiwanese government as a whole of just under 70% prior to the outbreak of the pandemic, indicating the CECC’s risk communication efforts were well received by the Taiwanese public.

Under the principles I’ve outlined above, in my view Scotland has done pretty well on the risk communication front so far. The consistency of Nicola Sturgeon giving daily briefings and the utilisation of social media by public health experts such as Prof Devi Sridhar, an adviser to the Scottish Government, stand out especially. Indeed, it is notable how many people have taken to social media to lament the end of the live broadcasting of the First Minister’s daily briefings. In a uniquely Scottish twist, getting the Scottish Government’s National Clinical Director Prof Jason Leitch to come onto Scotland’s top football radio programme Off the Ball every Saturday is a brilliant way to reach a wide cross-section of the population. And whilst conceived as comedy rather than public health advice, comedian Janey Godley’s voiceovers of Nicola Sturgeon’s daily press briefings inadvertently stand as an excellent example of risk communication that condenses complex messages into a few key points, delivered with humanity and humour. The fact that the First Minister has retweeted a few of them would indicate she – or her advisors – agree with this assessment.

As we now prepare for the long-haul of containing COVID-19, Scotland and the wider UK would do well to understand the mechanisms which countries like Taiwan have used to sustain public support for public health measures. From the government and policy side, consistency, credibility and compassion in the institution and the individuals representing them are key. This means having people conveying the message who are viewed as competent and relatable, and in a format that as far as possible stays the same day-to-day. It is of course easier to do this if you are starting from a position of public trust in the authorities, which is the case in Taiwan and to a certain extent Scotland. If not, it may be better to have someone delivering public health updates who is perceived as non-partisan and distant from ‘politics.’ In fact, this is exactly why former Health Minister Andy Burnham decided to take himself out of risk communication duties at the peak of the the H1N1 swine flu outbreak.

Equally, as members of the public, all of us will have to make decisions about responding to information and managing risks during the pandemic. We may even have to communicate COVID-19 risk ourselves to colleagues and family. In this regard, we too can learn from the professionals. Because if we look at the leaders of countries such as New Zealand and Taiwan that have been praised for their response to the pandemic, two characteristics stand out. One is a steadfast reliance on the underpinning science to guide their responses, and a second is compassion. Both of these are things we can practice in our daily lives. We can learn to be cautious about what we read and share on social media, and ensure our actions are guided first and foremost by official public health channels. And, perhaps more importantly, we can learn to be compassionate. These are confusing and stressful times, and emotions do drive our decision-making. This doesn’t mean we have to give airtime to wild conspiracy theories, but when we are talking with others about responding to risks, it is worth remembering that people have legitimate concerns that go right to the heart of things that matter to them in their lives. A little understanding and compassion, and making others feel their concerns are being taken seriously, can go a long way in bringing others to adapt their behaviours and manage the risk we face from COVID-19.