Introduction Clear, engaging, and actionable risk communications can save lives in a health crisis, such as a pandemic, as well as bring people together and inspire change. In the coronavirus disease (COVID-19) crisis, effective communications proved critical in mitigating health and other impacts and in reaching vulnerable groups during emergency response, re-opening of borders and economies toward recovery, and the rollout of vaccines. This article is adapted from a playbook that explores promising communication campaigns and practices implemented at various stages of the pandemic to address specific challenges or goals. These practices were chosen because of their diversity, innovation, availability, and results. Prepared by the Asian Development Bank (ADB) and McCann Global Health, the playbook is designed to help governments, health communications partners, and community leaders develop and evaluate effective COVID-19 risk communications plans. The Role of Risk Communications Communication activities can range from a press briefing to a creative campaign and can be used to establish public trust in government response, information, and support by building and maintaining credibility, integrity, and reliability of key decision makers and stakeholders; build public awareness and knowledge of COVID-19 and response efforts; increase public motivation to participate in response efforts; and facilitate coordination by increasing alignment and collaboration between and within the public and the private sector in implementing measures to prevent the spread of the disease (e.g., mobility restrictions). It becomes more effective when the message of government agencies, nongovernmental organizations (NGOs), community-based organizations (CBOs), and private companies are aligned or coordinated. This requires a diverse team of community leaders and communications specialists from the different public and private partners involved. Four Stages of COVID-19 Communications COVID-19 outbreak response can have four stages that are not always linear. These are the emergency stage, education and reopening, recovery and maintenance, and vaccine rollout. Risk communications must be able to dynamically respond to the progression of the pandemic. Emergency When an outbreak occurs and full lockdown measures are required, communications should focus on crisis response to get the cooperation of the public and to prevent disorder. Promising practices include the following: Deliver direct, clear, credible, and consistent guidance across spokespeople and channels. Have public health and issue area experts provide information (what is known and unknown) for transparency and to build trust and mitigate potential political assumptions. Generate a sense of community by assigning citizens a role to play in addressing the pandemic and making these roles the “norm.” Implement monitoring and evaluation systems to track conversation and attitudinal shifts. Use data to prepare for future communications and re-entry milestones. For example, using social media, including Facebook Live, New Zealand Prime Minister Jacinda Arden communicated simple, clear, and unifying messages. Through this transparent and consistent channel, Arden answered questions from citizens and sustained trust through a kind and empathetic response delivery. In Singapore, the government uses a multi-platform, multi-language, and multiformat approach to disseminates daily updates on COVID-19 through its Telegram, Twitter, WhatsApp, Facebook, and Instagram channels. Information is disseminated effectively and efficiently through familiar and frequently used channels that reach users where they are. To manage panic and fear, Ohio state in the United States positioned its Department of Health Director Amy Acton as the lead voice on COVID-19. Acton communicated vulnerably and honestly, focusing on collective empowerment and social connection in her daily press briefings. Education and reopening When the incidence rate declines and lockdown begins to be lifted, communications should focus on education about continued risk, sustained behavior change, and reopening guidelines. Promising practices include the following: Communicate to inspire simple actions that—when taken together—can have an impact. Create targeted communications based on the needs of specific groups. Leverage audience-specific channels, keeping in mind that different groups will need to be met across a variety of avenues. Consider the literacy level of target audiences when designing communications. For example, England’s National Health Service launched the “We Are the NHS” campaign to encourage young adults to join the health care profession by capitalizing on the long-term impact the virus is likely to have on the livelihoods of the “COVID Generation.” In addition to emphasizing the positivity of public service, the government is providing grants of up to £8,000 (more than $11,000) for those pursuing nursing degrees. In India, the city of Bangalore created an interactive and up-to-date epidemiological dashboard that displays the total number of cases, deaths, hospital bed availability, and other critical information. The variety of formats and visualizations cater to different styles of learning and keeps visitors engaged. The campaign aims to satisfy the public’s need for information and prevent them from turning to less trustworthy sources. The Philippine Disaster Resilience Foundation (PDRF) launched the Synergizing Recovery Initiatives, Knowledge and Adaptation Practices (SIKAP) platform. It provides small and medium-sized ventures across the country access to business advice, programs, and loans to help them build back better from the crisis. Recovery and maintenance When a variety of organizations, businesses, and activities reopen in a phased approach, communications should focus on revitalizing the economy and maintaining reopening. Promising practices include the following: Ensure that messages about the rules for reopening are aligned. Indicate how safe situations or places are to empower the public to make decisions about their safety. Review and reassess pre-pandemic priorities to determine what issues need to be addressed in addition to COVID-19 (and those that have been worsened by COVID-19). For example, in Singapore, when an auditor determines that an establishment or public space has passed a health and safety compliance inspection, it will receive a widely visible “SG Clean” stamp or sticker, demonstrating to all that it is a safe, viable travel option. Likewise, the Japanese government launched the “Go To” travel campaign to restore local tourism and help the hospitality industry recover after lockdown. The campaign offers subsidies for up to 50% of domestic travel costs for residents to travel within the country. The discounts are being offered through the official Go To travel website and through Booking.com in a variety of languages to reach as many potential domestic travelers as possible. In the United States, the Cornell University COVID-19 Dashboard publicly displays information on the current number of positive student tests, the number of students being tested daily, and the capacity of the isolation dorms and local medical facilities. It also has a color-coded level system with explanations to help viewers understand how the campus is handling the virus. This transparency has succeeded in raising risk awareness and accountability. Vaccine rollout When vaccines are in development and nearing regulatory approval, communications should focus on vaccine education and demand generation. Promising practices include the following: Tailor communication strategies to the audiences that will receive the vaccine first. The experiences of these audiences can heavily shape broader confidence in the vaccine. Promote interpersonal discussions with health care practitioners and key community influencers about vaccines. Building their ability to have conversations conducive to vaccine uptake can have a substantial impact on coverage rates. Have a plan in place to manage misinformation. For example, the National Medical Association, which represents African American physicians and health professionals., has created a Vaccine Hesitancy Task Force focused on addressing the concerns of black and other communities of color. The task force will give its own recommendation regarding the safety of a COVID-19 vaccine. Suggestions from trusted individuals in communities of color could contribute to increased vaccine uptake in traditionally vaccine-hesitant groups. The existence of a distribution plan prior to governmental approval is necessary to smoothly roll out vaccines and ultimately save lives. As stated by the European Commission, “it is imperative that the Member States follow a common strategy for vaccine deployment and apply evidence-based and proportionate nonpharmaceutical measures to stem infection rates.” Key Imperatives Remember the following when developing COVID-19 risk communications: Behavioral determinants like knowledge of COVID-19 risks and prevention behaviors, perception of COVID-19 severity, perceptions of target behaviors, and perceived norms (i.e., perceived peer engagement in target behaviors). Use of diverse channels and tactics to reach audiences at different stages. Audience’s health literacy or ability to understand and act on medical or health information. Action plan that guides development and implementation. Resource Asian Development Bank. 2021. COVID-19 Risk Communications Promising Practices Playbook. Manila. Ask the Experts Patrick L. Osewe Chief of Health Sector Group, Sustainable Development and Climate Change Department, Asian Development Bank Patrick Osewe has been at the forefront of strengthening health systems against the threat of disease outbreaks and pandemics through innovative, multi-sector approaches for more than 25 years. Prior to ADB, he served as World Bank's global lead of healthy societies, senior health advisor for USAID, and senior epidemiologist at the United States Centers for Disease Control and Prevention. He received his medical degree from the University of Nairobi and holds a Master of Public Health from Harvard University. Follow Patrick L. Osewe on Leave your question or comment in the section below: View the discussion thread.