Failure To Communicate: State Struggled To Warn Young People About COVID, Efforts Aim To Fix It

Sep 2, 2020

The state Department of Health continues to record a dramatic rise in COVID-19 cases among young people. One key reason may be that public messages to avoid the virus haven't yet effectively reached them.


  At the start of the pandemic, the health department ran messages that targeted the general public. The ads featured local celebrities like 71-year-old comedian Frank DeLima. 

However, East-West Center infectious disease expert Tim Brown said those early ads were not reaching young people.

“If the messaging aspect was being dealt with appropriately, young people would not be behaving the way they are right now.”

Hawaii has spent about $152,000 in state funds and $250,000 from the federal government on public communication efforts -- all aimed at stopping the spread of COVID-19.

What's not clear is how effective that spending has been.

Case numbers showed that those between 18- and 29-years-old continue to catch the virus more often than any other age group. They do not regularly require hospitalizations or die at the same high rate as the elderly, but they can spread the virus whether or not they show symptoms.

The health department’s Disease and Outbreak Control Division has had a history of communication issues. A 2017 audit of the department said it “experienced communication breakdowns with other DOH divisions, State and County response representatives, and the general public.”

A recent 2020 audit by the State Auditor also critiqued the department’s communication efforts and lack of transparency.

DOH’s early advertising efforts raised enough concerns that others felt compelled to step in.

The state House of Representatives COVID-19 started a communications subcommittee to develop its own campaign to help stop the spread of the virus. The effort, named “COVID Pau,” is set to launch next week. 

The campaign includes a social media strategy, a key component that the state initially lacked to reach young audiences, as well as video advertisements and a website. The campaign is designed to last a year, perhaps even two.

“This is about compelling people through them being able to see themselves in some of these stories,” said Na'alehu Anthony, one of the project leaders and former executive director of Oiwi Television.

One advertisement features a young, active fitness instructor who fell ill with COVID-19 and had to be hospitalized.

Beyond needing to make sense, the commercials need to touch people emotionally, Anthony explained.

“Make it personal. It's like, these people were from my neighborhood, or they went to the same restaurants I went to, or they are grandparents or kids or moms and dads just like me,” he said. 

“The storytelling, to me, makes it real. Obviously, this is deadly, and it is very real. But how do we make sure that people know it's real?”

Since mid-August, well into the pandemic, the state health department began running advertisements aimed at younger people.

A spokeswoman said by email that the department hired Anthology Group to research and produce the ads targeting young people.

One survey conducted between April and June and showed messages such as “protecting our kupuna,” “the call for Hawai‘i to come together,” and the need “to get back to work” resonated most with younger people.

While it’s too soon to tell if these new messages are working, the state may at last be on the right track.

Alice Payne Merritt, team leader for the breakthrough action project on COVID-19 at Johns Hopkins University School of Public Health, said one campaign that works well with young people in Baltimore and other countries is an appeal to “be a hero.” 

“It takes you from your everyday life, you know? I'm just a teacher. I'm just a student. I'm just a day laborer. But even though we're all just regular people in our regular lives, we can be more than regular, we can be a hero,” she said. 

“So a call to action to be a hero kind of calls upon each of us to be our best self. I mean, who doesn't want to be a hero? I think that's very culturally dependent, too. And it happens to resonate very well in the Philippines.”

Merritt explained that her team works with youth groups and social media influencers to make sure the messages about COVID-19 targeting younger demographics aren’t boring.

She noted a key behavior changing communication strategy for COVID-19 is called the extended parallel processing model. It’s also referred to as threat management.

“You describe very clearly what the risk or the threat is. And at the same time, you elevate the people's self efficacy or ability to manage that threat,” she said.

“We've seen that people don't feel at risk, and so they're not protecting themselves. We’ve as a result of that COVID-19 has increased not just for those individuals, but for the community at large around them. So we need people to feel personally that they are at risk, or their families or the people around them are at risk, but at the very same time, we want to elevate their skills, and their feeling of confidence in addressing that risk.”

One main challenge Merritt said health departments will have to face is after changing people’s behaviors to wear a mask, keep a six-feet distance and wash their hands is sustaining it for long periods of time.

A comparative threat that departments can look to that required long-term behavior change is childhood vaccinations.

“It is sort of an ever-present threat. If we stopped taking preventative actions against measles, to the very effect of vaccination, it comes back,” Merritt said.

The health department also launched a new campaign on Tuesday called, “Live with No Regrets.” It highlights stories from COVID-19 patients in Hawaii describing how the sickness affected them. DOH said in a statement that it is meant to appeal emotionally to residents.

Part 2: HPR examines  the state's communications on COVID-19 for Pacific Islanders.