Sabrina Macpherson: We need to get better at communicating risk
Data is meaningless without human context
Editor’s Note: We received some constructive feedback about last week’s dispatch, which criticized the uselessness of one of the predictive COVID graphs released by the Ontario Science Table. The disagreement was twofold; firstly, even a graph with a wide predictive range provides valuable data to decision makers. Secondly, it wasn’t clear enough that we weren’t criticizing the scientific validity of the graph— which we don’t dispute — but rather its value as a communications tool to the general public. To that end, here is a column from a friend of The Line, who has some ideas about how modelling information can be better communicated in the future. Please enjoy.
By: Sabrina Macpherson
I tell stories for a living. This seems like a strange way to describe my job, considering that I work in product strategy on a technology team, but it's true. A significant part of my work is to gather important information and then communicate it to people who need it to make decisions and plans. A key thing I've learned is that data is great, but you don't get anywhere unless you've got a compelling story to go with it.
Last week, the Ontario Science Table released a chart predicting a range of possible scenarios as the province heads into its Delta-driven fourth wave. The chart, a highlight of a longer presentation, predicted anywhere from between 500 to 9,000 cases per day by next month, and it was presented with no supporting messaging explaining what everyday people could do with this information. I felt intense frustration. If I walked into a meeting with a huge range of potential outcomes and then said nothing about what it meant in practice, I would be hammered with questions. "What does this mean? What changes are more likely to move us towards the green? Which ones lead to red? What are the tangible things I need to know in order to make good choices?"
My problem isn't with the OST — not really. I think they're a dedicated group of experts that has had to add to their pandemic stress by doing volunteer work on top of their day jobs, suffering the slings and arrows of public life, and frequently having their efforts belittled by the muppets currently in residence at Queen's Park.
My real frustration is that you can't present this kind of data without practical messaging. To be clear, I don't mean the short notes they added about increasing vaccination rates or reducing interpersonal contacts to 70 per cent of pre-pandemic normals. Those are good things to know, but they don't answer the questions that people making personal choices need answered. Some might say that the OST's job is to inform policy makers, and that this isn't in their purview. However, these slides and presentations are being consumed by the general public. Real, worried people are looking to these experts for help making safe choices this fall. So why not provide more human guidance?
Ideally they'd release the chart and immediately talk about that range in very practical terms. Like, “This is the red zone: we get here if we all do things like X, Y and Z.” And, “This is the midrange, where we most likely end up if we follow current behaviours. That means expected outcomes of A, B and C.” And, “This is the ideal green line. If we tried to do 1, 2 and 3 things, we could get here. This is what trying those things would cost us.”
The OST did, eventually, communicate some of this context. But it was a day late and a dollar short: the chart made the rounds on social networks for many hours before any messaging came out from one of the Table members. In the gap, people added their own annotations and interpretations with predictably partisan results.
The average person draws conclusions very quickly, and they do so based on intuition and gut feelings. We love to think that we're rational creatures, but the truth is that most times our reason comes in post-hoc to justify the things we just felt were right.
Communicators often misunderstand this process. We put the data first, thinking that showing the numbers will be what it takes to convince people. For most people though, you have to first persuade the emotions. It might be slightly distasteful to those of us who appreciate the rational beauty of math, but psychology research shows that this is how human minds work. If you want to influence people, you've got to speak to their intuitions, their worries, and their impulses. This means sharing the facts and figures, of course, but doing so with meaningful context.
We are 18 months into this pandemic, and COVID is fast reaching an endemic state in Western countries. That means our communications strategy has to shift — away from panic and fear-based messaging, and into a framework that deals with risk management.
If you want an example of risk communication done well, take a look at the investment industry. If you want to invest your money, you're going to first have a conversation with someone about your risk tolerance. These conversations are designed to get you thinking about what outcomes you want, and what you're willing to risk losing in order to get them. What kind of retirement do you want? What activities will you want to pay for? Will you have a spouse? Kids?
It's all in service of creating a good understanding of what actions are most likely to lead to desired outcomes, so you can then think about the best choices for your needs. I'd argue that we need to start approaching our COVID messaging in the same way.
Pandemic communication has been driven by intense anxiety. Initially, COVID’s emergence required us to take fast, sweeping actions in order to minimize harm. Our public-health communicators rightly tapped into those feelings of fear and said, "These are the big broad policies that will keep everyone safe. Do these things now to reduce your risk." People responded, because they were worried, and these sweeping approaches worked to reduce spread and buy us time to get vaccinated.
But anxiety and fear are not sustainable emotions. Over time, they transform either into acceptance, indifference or anger. The tactics that were effective two years ago won't work for everyone forever. What's more, the risks are different at the endemic stage, and they're no longer the same risks for all people at all times. Endemic-risk communication needs to look something more like the risk communication between investors and advisors.
We need to encourage people to think in terms of what social outcomes they want, and what they're willing to risk to get them. What activities do you want to do right now? Do you have kids in school? Do you have elders or immunocompromised people in your life? Can you work remotely? How much risk can you afford, and how much can you tolerate?
I'd also suggest we need some communication that helps everyone understand that different risk calculations are expected and acceptable. I don't judge someone 20 years my junior doing very different things with their money, and I should probably have similar empathy for how they judge their risks when it comes to an endemic virus. We will need to have safety rules for our shared public spaces, but overall as long as their choices aren't harming others, they can do what they like.
We have now collectively been fighting a monster for almost two years. We're tired, the virus is not going away, and what we need now more than anything is good guidance on how to build a sustainable long-term approach to this battle. Communications must speak to the feelings of people who are weary, frustrated, and annoyed. Give them concrete examples that offer them help and hope. Let them know how they can fight COVID within their own boundaries of risk and comfort, with the tools that feel right to them. If we want to get out of this with our collective sanity intact, then what we need most are experts who can not only provide the data, but communicate it in a way that will make sense to ordinary people trying to live their lives.
Sabrina Macpherson is a product manager in the financial services industry. She lives in Ontario with her family.
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Yes. I agree wholeheartedly with this. I too have had a career in risk management and risk management processes, including safety-of-life risks, mission risks, project risks, business risks, financial risks.
One thing I would start with is the Government of Canada's own vaccine risk management plan, which is actually quite reasonable, if followed. The first thing about it to note is that the vaccines have not been approved due to proof of long-term safety, but rather an overall "accepted risk" based on the demonstrated efficacy of the vaccines. The GoC explanation is, "predicated on the Minister's determination that the evidence provided supports the conclusion that the benefits outweigh the risks associated with the drug, taking into account the uncertainties related to the benefits and risks, as well as the urgent public health need caused by COVID-19.”
That is, they are tentatively approved in an overall risk-benefit analysis so that people in general can use them, but the risks are not zero and this is not the same thing as a case-by-case analysis of whether any specific individual should use them.
For that, the GoC also has a risk mitigation plan. Each approved vaccine has a Health Canada analysis with stated risks and risk mitigation. They state, “One limitation of the data at this time is the lack of information on the long-term safety and efficacy of the vaccine. The identified limitations are managed through labelling and the Risk Management Plan. The Phase 3 Study is ongoing and will continue to collect information on the long-term safety and efficacy of the vaccine.”
"Labelling" means providing the risk information to medical professionals and patients for their informed consent. This approach mitigates risk by acknowledging the risks exist and allowing each person to decide for themselves, along with their doctor, on whether to take the vaccine based on their individual risk-benefit calculation. The Risk Management Plan describes monitoring public outcomes, after the fact, and keeping the vaccine monographs updated with known and unknown risks.
For example, the vaccine monographs, Section 7.1, state the following: "The safety and efficacy of [the vaccine] in pregnant women have not yet been established; It is unknown whether [the vaccine] is excreted in human milk. A risk to the newborns/infants cannot be excluded.”
They also list known risks in Section 7 and recommendations for who should probably not take the vaccines as decided between the patient and the doctor doing their own risk-benefit analysis.
The science is also clear that people with prior COVID-19 infection appear to as good or better immunity, meaning that vaccines still have the risks of unknowns but lack much benefit value for such people, and the known risks vary with age, probably the square of age given that the risks of COVID-19 are very low in the young and high in the old, and long-term unknown risk of vaccine are small for the old (who have less time left) than the young. This includes potential risks to reproductive processes such as described above, so there are also gender-specific risks.
This is why I am concerned about the emergence of vaccine mandates, coercion, and fear-mongering that undermines the well designed GoC risk mitigation plan, including coming from our own Prime Ministers and provincial leaders. What is their replacement for this risk mitigation plan if they are coercing people to get vaccinated and even chose between their jobs and health?
They seem to be making classic risk management mistakes of confusing the overall risk-benefit approval so that people can take the vaccines with individual risk-benefit calculations on whether an individual should, and confusing the absence of evidence of harm with evidence of evidence of harm. These mistakes destroyed two space shuttles, contributed to Chernobyl, and caused the Thalidomide tragedy.
This is why I sub-titled my own writing on this issue as "A lesson in how to learn nothing about risk management, ever.": https://adnausica.substack.com/p/a-canadian-behavioral-study-of-obedience
References to the GoC risk mitigation process mentioned above are available there as well.
So beautifully presented, thank you for this.