The chapter provides recommendations for key communicators’ social media use during pandemic threats. Recommendations are based on findings from two sets of case studies during the 2014–2015 outbreak of Ebola in West Africa: the use by authorities in UK and Norway during the 2014–2015 West African Ebola outbreak; and the use by established media in the UK.
The risks from disease outbreaks and the threat of pandemics based on highly pathogenic influenza strains have risen significantly on the agendas of high income countries (HICs), such as Norway and the UK, over the past decade (
Such crises provide a challenge for health authorities, crisis communicators and news reporters’ use of social media because, whereas the attention span of social media tends to be short, pandemics are extended crises – what are sometimes termed ‘long wave events’. This offers particular challenges compared to a shorter term crisis in terms of maintaining interest, but also opportunities in allowing procedures to be put in place to meet the specific needs of the event (e.g. health authorities may introduce pre-authorised messages tailored to the specific disease; established media may embed reporters or hire expert commentators). Messages on social media are often short (especially micro-blogging sites such as Twitter), whereas accurate advice – and news reporting – may require detail. Whereas diagnostic testing to provide up-to-date advice may be slow, response time on social media is fast, something that leads to rumour (
In 2014, the outbreak of Ebola in West Africa became one of the most significant news items for both social media and more traditional media (print, radio, TV) in the UK and Norway, both because of the growing scale of the crisis in West Africa, and because both Norway and the UK received citizens with Ebola that were medically evacuated from the region. In particular, the emergence of Ebola cases in the US and Europe prompted a widespread sense of risk among Western populations late in 2014, seen not least in the massive spike in social media interest (
Our focus here is to provide recommendations for key communicators in health crisis management and established journalistic media regarding their use of social media during health risks such as pandemic threats. We base our recommendations on, on the one hand, analysis of how Norwegian and UK authorities had planned for social media use in health risks and crises, and then how they actually used social media (particularly Twitter) during the 2014–2015 Ebola outbreak (
The paper is framed by an understanding of social media as communication channels in which users can and often do bypass traditional gatekeepers, such as government authorities and established news media. Crisis communicators therefore need to adjust their traditional dissemination practices if they are to communicate effectively (
Health authorities have traditionally pursued a vertically integrated model of crisis communication, gathering epidemiological data and using it to provide health professionals and the public with information in a coordinated and coherent way (
We build on Valentini and Kruckeberg’s observation that social media have raised questions over the ability of organisations to respond to the nature of the medium in their crisis communications. According to them, social media’s potential for real-time interactions, short response time and user-generated contents have raised questions about ‘how organisations can prepare for critical situations, managing and even exploiting the internet’s capabilities for dialog in crisis communication’ (
The long-wave event we chose was that of a disease outbreak/pandemic and specifically the 2014–2015 outbreak of Ebola in West Africa. Unlike a terrorist incident or flood, which may be over in days or even hours, disease outbreaks last weeks and conceivably months. In the case of the Ebola outbreak we study here, the World Health Organisation (WHO) publicly announced the outbreak in March 2014 and, although the worst phase was effectively over a year later, nevertheless maintained their highest level of alert (a PHEIC, or Public Health Emergency of International Concern) into 2016. There were peaks of media interest surrounding specific events such as the meeting of the UN Security Council which declared the outbreak a risk to international peace and stability, the medical evacuation of aid workers from West Africa infected with the disease, and the transmission of the disease to health workers in the US and Europe.
In the case study of key health communicators’ social media use, the focus on Norway and the UK offered a comparative element. Both are HICs for whom outbreaks of deadly diseases are novel risks; both are liberal democracies, with well-established traditions of freedom of expression reflected in their use of social media, and both countries had nationals medically evacuated home from West Africa infected with Ebola. By comparing similar countries, we may speculate more freely about whether the approaches to and problems with social media are specific to Norway or UK or perhaps more generic to HICs. We focus on Twitter as (with Facebook) one of the two most popular social media platforms at the time of Ebola. We use the West African Ebola outbreak as our test because by 2014 social media use by the general public was significant, and risk/crisis communication plans for social media were in place in both countries.
In Norway, we focused on the plans and practices of two key governmental agencies – the Norwegian Directorate of Health (NDH,
In examining the policy and strategy adopted by Norway and the UK for the use of social media in health emergencies at the time of Ebola, we asked: What importance was attached by public health authorities to social media? What importance did public health authorities in the countries attach to gaining trust in their social media posts and how did they attempt to generate this trust? How did the authorities address the interactive nature of social media?
We also analysed tweets produced by the UK and Norwegian authorities to determine how social media were used. We focused upon the nature of the content, who the tweets were directed at, the discourse form and dominant speech act, and use of proxy measures (‘likes’ and re-tweets) to infer impact and effectiveness.
Our study of the established media’s use of social media focused on the use of Twitter across four key moments in 2014. The announcement of an outbreak of Ebola Virus Disease in West Africa by the WHO in March 2014; The declaration by the WHO of a PHEIC in early August 2014; The evacuation of British nurse William Pooley from Sierra Leone on 25 August 2014; and The announcement on 29 December 2014 that the Scottish nurse Pauline Cafferkey had been diagnosed with Ebola in the UK. The nature of comments on social media, especially the balance between factual reporting and opinion or comment. The sensitivity the established media’s social media use had to distinct events within the wider narrative. In particular, the degree to which their social media use maintained its focus on the long wave event – the crisis in West Africa – and the degree to which it shifted attention to other events within the context of the outbreak. The use of social media as a dialogical medium, including both replies to posts and responses to these from the originating source. Bloggers in particular have exploited the dialogical potential of social media in reporting and commenting on news stories, whereas established media would historically differentiate between their role as reporters commenting on events and authorities who have a responsibility to respond to queries. The degree to which the established media’s use of social media acts as a signpost to more detailed information or reports elsewhere, either on their own website or others’. The established media’s reporting on the use of social media during the outbreak – what this chapter terms ‘social media-reflexivity’. This includes both the degree to which it reports on Ebola-related stories appearing in social media as well as reporting on the use (or abuse) of social media during the outbreak.
We have deliberately chosen two events of international concern or interest, and two of more specific concern and interest to the UK to offer some variation allowing comparison. It is structured by addressing five areas:
Finally, we chose three different sources in the UK, deliberately attempting to introduce some variety. The first was the national broadcaster, the BBC (@BBCNews); second, we chose a ‘quality’ broadsheet,
We acquired data for health authorities’ use through a mixed-methods approach combining semi-structured interviews, document analysis and speech act analysis of the tweets they produced during the outbreak. We obtained data from primary source documents from governmental health agencies, for example, a national contingency plan against Ebola and advice on social use in NDH and NIPH, and strategies for general health emergencies and guidance for communication during epidemics in DoH and PHE. Data were furthermore obtained from key informant interviews (e.g. with the communications directors at NHD and NIPH) and the Twitter archive. For media use, we examined tweets sent from the source’s main Twitter feed, using a structured-focused approach (
The following Norwegian and UK Health Authorities’ Strategies and Policies for the Use of Social Media During Risk and Crises.NOR NDH By accessible, coordinated, updated info, tailored to target audience Use population surveys to monitor risk perceptions and to build communication on. Monitor messages on own account NIPH Be honest and accessible on what they know. Inform on uncertainty Create informative context if legacy media overdramatise threats UK DoH Coordinate messages with other bodies. Use trusted health professionals Monitor social media to gauge public attitude and engagement with messages Use message maps for audiences, including risk groups PHE Consistent messaging including shared content with DoH Social media part of ‘business as usual’ allowing build-up of user base which trusts organisation’s content NOR NDH By using messengers with local authority to give advice on preventive measures via social media to local communities Comm. officers actively present in social media, answer direct questions NIPH ‘Correct misconceptions’, ‘inform about current knowledge’ through SoMe Respond to questions (through signposting Q and A page). Questions generate more knowledge dissemination UK DoH Two-way communication strategy, ‘positively engaging’ with key groups Track public awareness through monitoring social media PHE Monitor social media through regular ad hoc ‘social/online listening’ Listening will lead to understanding concerns and creation of relevant online content
Our analysis displayed some clear differences between Norwegian and UK authorities in terms of the policies and strategies they adopted. Norwegian authorities emphasised social media’s importance in swiftly providing people with information, whereas UK authorities paid limited strategic attention to social media. Norwegian authorities recognised Twitter’s potential as a professional network, whereas UK authorities saw it as most useful for communicating with the general public. Strategy documents and interview sources in both countries emphasised the bi-directionality of social media and the importance of
Nevertheless, our analysis of the authorities’ Twitter postings during Ebola (and of users’ response patterns to tweets with different content topics), led us to question the degree to which authorities understood and were willing to explore social media’s interactive communication features. In our analyses, speech acts in each tweet collected in our material were determined according to whether they were dominated by:
Constative and directive speech acts, rather than expressives and commissives, characterised the authorities’ messages. The dominance of such speech acts in their tweets, supplemented by links to own Q and A pages, testified to a detached position and a strategy of directing users to a website where approved content existed. This may partly reflect a lack of capacity to engage in the dialogical potential of social media, but we question the effectiveness of authorities’ use of social media in that reaction to authorities’ tweets (measured by number of likes and re-tweets) was surprisingly low.
In all, both Norwegian and UK authorities largely saw social media in terms of a traditional paradigm of risk and crisis communication usage, namely that such communication is to provide the public with the information which is deemed necessary by the authorities. Our analyses broadly support
With regard to the established media’s use of social media, our findings identified areas of consistency across three different sources, but also some differences in approach. Overall, there was an inclination towards constative rather than expressive forms. Even with
Using likes/re-tweets/comments as a proxy for impact, the numbers across all three sources was consistently low in comparison with other major stories, especially those concerning celebrities; it was nevertheless broadly consistent with results from our study concerning tweets from authorities on Ebola (
Tweets very obviously acted as signposts for stories elsewhere, but it is unclear the extent to which this was because established media saw the character limits of Twitter as problematic and wanted readers to engage in more detail with stories on websites, or whether they simply saw tweets as a means of advertising their online presence.
Comparing the use of social media by authorities and established media, a number of common findings present themselves. Both preferred constative forms rather than expressive, using Twitter more often than not to make factual statements about the outbreak. Both used Twitter extensively to signpost stories elsewhere, and there is a more than a suspicion that Twitter was seen less as a means of communication in itself, than as a platform to draw attention to other forms of communication. Neither authorities nor established media engaged with comments from followers. The point was made to us on a number of occasions that this was because of a lack of capacity, but also from the authorities’ perspective because of the delays in getting approved content for what would be authoritative statements on an issue. We also hypothesise that this was a cognitive problem – that social media, and especially Twitter, were seen within a vertical communications’ paradigm which was well understood by both authorities and the established media, rather than within a new horizontally networked paradigm. Neither authorities nor established media appeared to monitor their own social media, but authorities did monitor social media more generally to help them in determining the public mood. That the media did not do this may be because they did not see social media in general as a trustworthy source – a point which was made to us on several occasions by journalists and editors.
Finally, the impact of stories on social media posted by both authorities and established media appears to have been limited. This is a surprising finding since much of the narrative concerning social media relates to their growing significance, both generally as means of communication and in communicating news. We considered whether this was because Ebola was a long wave event, but events within this narrative which may be considered individually likewise had little impact. That the Ebola crisis was hardest felt in Africa, not Norway or the UK, may be a partial explanation; there is also a suspicion that the stories which attract most attention on social media concern celebrities rather than ‘hard’ news. But we also hypothesise that the manner in which both authorities and established media used social media – within existing communications paradigms rather than as a new medium requiring new techniques to be effective – was a contributory factor, together with their low presence in social media (especially authorities).
Based on case study findings, we provide recommendations ( Recommendations for Health Authorities’ Use of Social Media During Epidemic Risks/Crises. In all phases of an epidemic threat or crisis, also when there is little new to say Presence also important in non-crisis or non-threatening situations Regular updates in social media required News briefs on different health risks on own accounts without unnecessary sounding of alarms Strengthen/maintain user engagement and improve conditions for dialogue More effective communication of advice Monitor the wider social media conversations, e.g. on Twitter. Use tools in monitoring of users’ response to a crisis To get a grip of moods, questions, claims, rumours and myths A prerequisite for maintaining trust and dealing with moods and myths that may develop Engage in two-way communication with users on own social media pages Set up accounts for experts where they can answer questions about health risks from the public directly Use language that not only includes constatives/directives, but also expressives /commissives when appropriate Show that one takes users seriously, develop trust through active presence and engagement in users’ concerns Humanising risk/crisis communication through positive engagement Act as opinion leaders and offer advice to people in affected regions Use an appropriate tone of voice to target groups in affected countries Add links in tweets with brief information/advice Avoid constatives such as ‘Information on Ebola can be found on our web page’; that is, tweets without a vital news pegWhen? How? Why? Develop strong social media presence Develop network of trusted sources Continuously engage in development to ensure strong network Find trusted users with a significant base of followers to pass on advice from authorities Enhanced implementation of measures Listen In all phases of an epidemic crisis or threat Engage in direct dialogue When asked directly by users in social media about risks/crisis Use messengers with local authority When urgent measures need to be taken to prevent spread of disease in outbreak regions In order to establish the trust needed so that people act to avoid infection and reduce spread of infection in outbreak regions Signpost websites When public demand for information is strong: typically when authorities raise the level of health risk alert or when people/users experience situations as threatening Users will be led to additional and valuable research-based information/advice, if web page is frequently updated
We emphasise the need to have a strong and continuous presence on social media during a crisis: attention needs to be given to social media communication at all phases of the disaster, crisis or emergency. The dynamic, bi-directional characteristics of social media require continuous presence if one is to respond in a timely and meaningful way in the different phases. Low levels of public reaction to the authorities’ tweets in our material (measured by the numbers of posted links and re-tweets) suggested that the authorities had not developed a strong presence among Twitter users. To be present in non-crisis situations is all-important for people to realise that the authorities are actually there, actively communicating. This can, for example, be done by providing news briefs, linking to different health risks, in this way branding oneself as an authoritative communicator, someone one can look to and rely on when crises emerge.
Strategy documents and interview sources in both countries emphasised the potential bi-directionality of social media and the importance of
Our interviews suggested that the bi-directionality of the health authorities’ social media use was mostly a question of obtaining the best possible basis for unidirectional, pandemic risk communication. Social media’s dialogical communication characteristics were viewed as something that enabled effective correction of the public’s misconceptions during the outbreak, preferably by directing users to their own Q&A pages. This strategy could be supplemented by more active and direct engagement with users, something authorities also express a wish to accomplish. One way of doing that is by setting up accounts for experts. In terms of the type of language used in Twitter, we identify a clear dominance of
Using messengers with local authority, was something that the Norwegian health directorate actually did during the Ebola crisis, when Facebook was an important instrument in their strategy. The directorate appointed people from Sierra Leone who were living in Norway to act as opinion leaders and offer advice to Facebook users in West Africa on preventing the spread of Ebola. The advice is in line with the so-called actionable risk communication model (
This is also a question of understanding different cultural contexts and how local knowledge, beliefs and communities must be taken into account and effective communication plans must be adapted to environments. For example, in the Ebola-struck West African countries it is not enough to communicate hard scientific facts alone, but to know how the information is perceived, which channels can be used effectively and who the different audiences are. Western authorities should also take into consideration how it is, from an African point of view, not irrational to be sceptical about advice coming from the so-called developed world. Accordingly, for health authorities’ communicators it is important to get in touch with citizens and professionals who can establish trustful relationships with local communities (see also
The last advice (signpost websites) should be treated with some caution, as it seems that authorities consider this as sufficient in their current practices. Admittedly, space is limited in a tweet and people can gather valuable advice by being directed to Q and A pages through tweets. However, one still needs to be creative and grab attention on Twitter, and we suggest that news pegs are used, followed by links to a website. An example: ‘How long can #Ebola survive outside the body? Light and air reduce the life cycle of the virus and reduce the risk for infection’. Such tweets can function as an interest-provoking alternative to the preferred directives that marked authorities’ tweets in our material, such as: ‘We remind you that we have a question and answer page about Ebola’, followed by a link.
Given the commonalities in our research findings between authorities and established media, it is perhaps unsurprising that our recommendations for established media are not dissimilar to those for authorities. We were surprised at the limited impact social media had, but were also struck by the manner in which it was used as a new technology within an existing paradigm rather than being thought of as a radical new medium requiring new working practices. There was no attempt to work with a community of followers to establish itself as a key part of a ‘social’ medium, in contrast to bloggers who often embrace the dialogical nature of the medium and thereby establish a strong community following their blogs. Instead, tweets appeared too often as advertising for content elsewhere, implicitly dismissing Twitter as an independent medium for disseminating news content. We would suggest that this strategy would not endear the established media to those who use Twitter (or other platforms) on a regular basis, and especially those for whom Twitter is the principal method of gaining information. Although content is limited by the number of characters available, the use of sequential tweets allows more space, while the essentials of a story can often be expressed in a limited space (as Donald Trump has shown to devastating effect). Nor is social media necessarily limited to statements of fact – indeed many use it effectively to state opinions or ask challenging questions. Although
We want to thank the Research Council of Norway (grant no. 233975/H20) and Oslo Metropolitan University for the funding that made this book and the research it is based on possible.