Find the Trusted Messengers

H5N1 is a fantastic case study of some lessons I learned during Covid-19

There is no question that the information landscape has dramatically changed in the 21st century. Information is no longer dictated by authorities but networked by peers. This means the old-school approach to information diffusion—a top-down trickle from ivory towers—does not work with many groups. In fact, it sometimes backfires.

This cannot be more apparent than with bird flu (H5N1). Higher-risk people who need the information don’t trust the messenger (i.e., the government), and worse, the information is unresponsive to their needs on the ground.

There is really only one answer: Find, equip, partner with, and support trusted messengers. 

A new way of thinking

When I started this newsletter a few years ago, I naively thought I was talking to “Joe on the corner”— reaching directly into households. That was until I surveyed YLE readers and saw the audience was “trusted messengers.” These are readers directly involved with their communities—education boards, non-profits, teachers, physicians, businesses, hospitals, scientists, media, and religious leaders—craving actionable, understandable, and useful information quickly to curate further for their networks. Eventually, YLE information would reach “Joe on the corner” through key mediators.

In other words, YLE is simply a small node in a massive grassroots information diffusion network system.

While this network is largely invisible, it’s incredibly powerful. Trusted messengers are trusted precisely because they are in the community. They understand pain points, reality, and tradeoffs people must make daily. They refuse to be helicopters—swooping in when they need something and retreating quickly. Rather they are:

1. Believable—Genuine, transparent, and motives are clear.

2. Relatable—They can hang. Their background, skills, and experiences overlap with the target audience.

3. Credible—They bring useful knowledge and skills that others don’t have.

This is important to understand not only in relation to COVID-19 but also to literally all other public health topics today—whether it’s emergency response or “peacetime” public health challenges.

H5N1 couldn’t be a better example

I don’t consider H5N1 (bird flu) to be under control. We are flying blind: We don’t know how this virus is spreading, where it is spreading, and if it’s becoming better at infecting humans.

The major challenge is that those at risk, and with whom we need cooperation to stop H5N1 from becoming a pandemic, trust the government and institutions the least:

• Agriculture workers in rural areas

• Undocumented workers

• Health and wellness groups that drink raw milk

There are many reasons for lack of trust: Their values don’t align, there are language barriers, some have been burned before, public health leaders have vilified them, and some have legitimate concerns about their livelihood being impacted. It shouldn’t be shocking that few are volunteering to test for H5N1. Others are even actively going against advice, like buying more raw milk.

A core of the response should be finding, equipping, partnering with, and supporting the people they trust the most. This could be their physicians, places of worship, EMTs, unions, or migration centers. Unfortunately, this idea is largely put by the wayside in many conversations I’m a part of. Everyone’s focused on the science, which is important, but equally important is the behavioral aspect of information diffusion for effective public health implementation.

I’m afraid we are making the same mistakes we did during Covid-19. (Vaccines don’t equal vaccinations.)

The same can be said about really any “peacetime” topic in a world of misinformation

Misinformation was named the top global health threat in the coming years. Vaccines, climate change, women’s health, wellness—it’s everywhere.

But the solutions being proposed are underwhelming. For example, some suggest that all we need to do is find the magic wand—the perfect word or phrase for an awareness campaign—and everyone will suddenly trust the information and get their routine vaccinations. 

This line of thinking is a fantasy. We live in a new world where the information landscape has dramatically changed. The problem isn’t the information supply—there is way too much. We must work on the demand side—actively finding trusted nodes in communities, understanding how they get their health information, hearing their concerns from a place of empathy, communicating nuance, and 100% leaning into it.

This is hard, messy, complex work—and it’s not sexy to fund. But we will continue to spin our wheels until we find and support sustainable models for trusted messengers to translate and disseminate public health information.

Bottom line

It’s beyond time that we change our approach to public health information diffusion: Find, equip, partner with, and support trusted messengers. Not just as H5N1 may become an emergency and not just as an afterthought. But rather as a core part of our work every day. This is where and how public health will make an impact.

Love, YLE

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“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, data scientist, wife, and mom of two little girls. During the day, she is a senior scientific consultant to a number of organizations, including the CDC. At night, she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well-equipped to make evidence-based decisions. This newsletter is free, thanks to the generous support of fellow YLE community members. To support this effort, subscribe below: