Democratic Health Communications during Covid-19: A RAPID Response Professor Heidi Tworek Dr. Ian Beacock Eseohe Ojo Table of Contents Acknowledgements 4 Biographies 5 Executive Summary 7 Introduction 10 What Are Democratic Health Communications? 13 Overview of Case Study Countries 16 The RAPID Principles of Democratic Public Health Communications 23 Rely on Autonomy, Not Orders 25 Attend to Values, Emotions, and Stories 31 Pull in Citizens and Civil Society 37 Institutionalize Communications 41 Describe It Democratically 46 Conclusion 52 Appendix of Case Studies 54 Canada 55 British Columbia 59 Ontario 63 Denmark 68 Germany 72 New Zealand 77 Norway 82 Senegal 86 South Korea 90 Sweden 94 Taiwan 99 Endnotes 104 Democratic Health Communications 3 Acknowledgements It would have been impossible to research and write an interdisciplinary, comparative report like this one without the support of generous collaborators and colleagues. For impeccable research support and essential insights, we would like to thank Sudha David-Wilp, Victoria Ker, Yoojung Lee, David Metzger, and Sean Wu. For kindly reading a draft of the report and providing us with helpful suggestions, we wish to thank Travis Salway, Yves Tiberghien, and Alexandre White. Chelsea Chou provided further context on Taiwan and initial discussion with Hans Kundnani proved useful. We are indebted to Sean Wu for design- ing the clear and elegant print layout of this report. We are profoundly grateful for the financial support of the Peter Wall Institute for Advanced Studies, the Institute for European Studies, and the School of Public Policy and Global Affairs at the University of British Columbia (UBC). Invaluable production support was provided by the Centre for the Study of Democratic Institutions at UBC. Citation Heidi Tworek, Ian Beacock, and Eseohe Ojo, “Democratic Health Communications during Covid-19: A RAPID Response,” (Vancouver: UBC Centre for the Study of Democratic Institutions, September 2020). 4 Acknowledgements Author Biographies Dr. Heidi Tworek is Associate Professor of History and Public Policy at the Uni- versity of British Columbia, Vancouver. She is a non-resident fellow at the Ger- man Marshall Fund of the United States and the Canadian Global Affairs Institute. She is the author or co-editor of three books as well as over 30 journal articles and book chapters. Her latest book is the prizewinning News from Germany: The Competition to Control World Communications, 1900-1945 (Harvard University Press, 2019). Her current work examines the history and policy around health communications. She has testified before and advised governments around the world on social media, hate speech, and disinformation. Alongside regular ap- pearances on radio and TV, her writing in English and German has appeared in media outlets including The Atlantic, Foreign Affairs, Washington Post, Columbia Journalism Review, The Independent, and Süddeutsche Zeitung. She is a contribut- ing editor to the Brookings Institution TechStream. Dr. Ian Beacock is a prizewinning historian and journalist. He holds a PhD in History from Stanford University, where he specialized in modern Europe, mod- ern Germany, and the history of democracy. His work has been supported by major research fellowships from the Stanford Humanities Center, the German Historical Institute in Washington, DC, the Hoover Institution Library and Ar- chives, the Europe Center at Stanford University, and elsewhere. His reporting and analysis on contemporary politics, as well as his criticism, has appeared in publications including The New Republic, The Atlantic, Aeon, and The Walrus. He is currently working on a book about democratic feelings in modern history. Eseohe Ojo holds a BSc in International Relations from Lead City University, Nigeria and a Master of Public Policy and Global Affairs (MPPGA) from the Uni- versity of British Columbia where she studied as an African Leader of Tomorrow (ALT) Scholar and a R. Howard Webster Foundation Fellow. Her work focuses on policy, advocacy and communications around gender, youth inclusion, and human rights, particularly freedom of expression, access to information, digital rights and Internet freedoms. She also works on civic engagement, transparen- cy and other good governance issues globally and on the African continent. Her most recent publication is “Redefining Policy and Practice: Unraveling Defini- tions of Sexual Violence Through a Survivor Centered Approach,” a report on the impact, limitations, and approaches to improving current definitions of sex- ual violence. Democratic Health Communications 5 Researcher Biographies Sudha David-Wilp is a Senior Transatlantic Fellow and Deputy Director of the Berlin Office of the German Marshall Fund of the United States. Victoria Ker is pursuing her Master of Public Policy and Global Affairs (MPPGA) at the University of British Columbia, Vancouver. She holds a BSc in Microbiology and Pacific and Asian Studies from the University of Victoria. Yoojung Lee is a BA student majoring in International Relations and minoring in Law and Society at the University of British Columbia, Vancouver. David Metzger is a student assistant at the Berlin office of the German Marshall Fund of the United States and is currently pursuing a Master’s degree in International Relations at the joint study program of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Universität Potsdam. Sean Wu holds a Master of Public Policy and Global Affairs (MPPGA) and a BA in History and Political Science from the University of British Columbia, Vancouver. His research interests include policy commu- nications, the digitization of government, and digital diplomacy. 6 Biographies Executive Summary his report recommends how to put health during a public health emergency—in ways that T communications at the heart of democ- strengthen democratic norms and processes racies’ response to Covid-19. Communications rather than undermining them. are an effective non-pharmaceutical interven- We draw our recommendations from in-depth tion (NPI) for Covid-19; other NPIs include trav- studies of nine jurisdictions and two provinces el restrictions, physical distancing, or personal on five continents: Senegal, South Korea, Tai- protective equipment—each of which, in turn, wan, Germany, Norway, Sweden, Denmark, New requires clear, rapid communications. More ef- Zealand, and Canada (for which we also studied fective communications could save lives. two provinces, British Columbia and Ontario). Effective communications are essential in the Each of these cases managed relatively effec- short-term for uptake of public health measures tive responses on their own terms; each of them like face coverings. But they matter more over a also took democratic communications seriously. longer time horizon, whether to forestall com- Where appropriate, we compare with democ- pliance fatigue, lay the groundwork for vaccine racies that struggled to communicate around uptake, or encourage the public to engage pro- Covid-19, particularly the United Kingdom and actively with the healthcare system for concerns the United States. unrelated to Covid. They also matter for cultivat- This report proposes five broad principles that ing trust among citizens and their governments— can underpin any democratic public health com- trust that is critical for the future stability of dem- munications strategy. Our principles draw upon ocratic institutions. research from a range of disciplines, including If communications are a health intervention, political science, social epidemiology and pub- democratic communications can be a civic inter- lic health, behavioural science, sociology, media vention. Many democracies were already strug- and communications studies, history, and polit- gling with distrust before the pandemic: anti-vac- ical theory. We call them the RAPID principles, cination activism, conspiracy theories, sinking because rapidity is an essential element of an ef- faith in institutions, populism, rising inequality, fective response: the erosion of local journalism, and so on. This rolling democratic crisis is now interacting with Rely on Autonomy, Not Orders the pandemic. Our report lays out a framework Pandemic responses should emphasize auton- for how to communicate—even or especially omy where possible, in alignment with national Democratic Health Communications 7 traditions and local political cultures, support- and their needs from government. Officials ed by thoughtful and clear communications. We should also consider finding trusted local vali- identify two particularly salient forms of auton- dators to share health information with friends, omy: personal and institutional. This means de- families, and followers (e.g. young people, social veloping and repeatedly communicating a set of media influencers, celebrities, religious leaders). universal principles for making responsible and Encouraging participation and collaboration, es- safe decisions during a pandemic. Autonomy pecially on issues like public health, also reduces is not anarchy, but rather a policy that includes burdens on public-sector actors. Collaborating stakeholders, assumes good faith, and reinforces with citizens and civil society may create a more democratic self-understanding. robust response; in turn, listening and respond- ing to citizens’ concerns strengthens democratic Attend to Values, Emotions, values such as solidarity and collective responsi- and Stories bility. To complement autonomy, the most effective democratic