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Top Pandemic-themed Public Health Media Bites of 2021, Metaphor Edition

PHI’s Berkeley Media Studies Group rounds up their top ten pandemic-related media bites from the last year.

  • Heather Gehlert
    Katherine Schaff
two teens wearing masks staring at tablet

During the early days of the pandemic, we read news coverage about the virus obsessively. No story was too small. We also paid close attention to behind-the-scenes conversations happening on public health listservs, and an overwhelming number of threads pointed to the need for one thing: more robust infrastructure and funding. Without it, experts warned, the pandemic would rage on, and, even more troubling, may not be the only pandemic we experience in our lifetimes.

It was clear that communicating the need for public health infrastructure was critically important to prevention, now and in the future, but how could we convey such an abstract concept in a clear, compelling way?

Then, we saw it: a beautifully — and simply — stated metaphor. Matt McKillop, senior health policy researcher and analyst at Trust for America’s Health (TFAH), and Dara Alpert Lieberman, TFAH’s director of government relations, co-authored a report that made a compelling case for why we must proactively prepare for threats like COVID-19 by investing in our public health workforce and infrastructure. “Not doing so is akin to hiring firefighters and purchasing hoses and protective equipment amid a five-alarm fire,” they wrote.

We’re reminded of that metaphor every time we read a new article or blog about infrastructure. McKillop and Lieberman gave us a new lens to look through. They shaped not only our understanding of their article but our understanding of all future communication about the subject.

We love metaphors at BMSG. Metaphors, which are prevalent but often overlooked in everyday language, carry many functions and benefits: They allow us to make strong arguments about complex or abstract ideas without relying on jargon; they can help us illuminate social problems — and how to solve them; they can even help us bridge ideological gaps. Researchers have found that exposure to a single metaphor can result in substantial differences in opinions — differences that can help disparate groups, such as opposing political parties, come together and see issues from a similar perspective.

Metaphors, then, can lead people to logical conclusions that may be harder to reach in other ways. For example, according to a study published in PLOS One, participants who read language portraying crime as a virus “were more likely to propose treating the crime problem by investigating the root causes of the issue and instituting social reforms” than participants who read language that likened crime to a beast lurking around every corner. Those participants were more likely to propose punitive approaches to fighting crime, such as “hiring police officers and building jails — to catch and cage the criminals.”

When it comes to communicating about COVID, we’ve seen many outstanding metaphors in the news. Public health practitioners, advocates, and researchers have used analogies to explain everything from the need for vaccines to the importance of masks to the way vaccines work. Many of these metaphors have been so memorable that we’ve decided to dedicate this year’s annual media bites blog to the creative comparisons.

Of course, no communication, no matter how clever or compelling, is a substitute for equitable access to vaccines, housing, job safety, and other conditions that shape our health. Words cannot replace these supports — but they can reinforce them. Cognitive linguist George Lakoff has explained that metaphors play a key role in defining our daily realities. And we at BMSG have no doubt that they have been instrumental in shaping narratives about the pandemic. Here are some of our favorite metaphors from this past year’s news and social media, as well our own resources, grouped by topic. Please sit back, enjoy, and if you have seen other metaphors that you think should be on our radar (metaphor intended!), share your top picks with us at info@bmsg.org or @BMSG.

Using fire safety to convey the effectiveness of vaccines, important caveats about breakthrough infections, and more

One of the most common and effective metaphors we’ve seen characterizes the virus as a fire. If the virus is a fire, then it becomes easier for readers to imagine how public health tools like masks and vaccines compare to common elements of fire safety, from fire extinguishers to flame retardants. Fire safety metaphors can help us communicate the following:

How vaccines slow the spread of infection:

“The vaccines have begun to quench the pandemic inferno, but the remaining flames are still burning through the same communities that have already been disproportionately scorched by COVID-19 — and by a much older legacy of poor health care.”

-Ed Yong. Appeared June 9, 2021 in The Atlantic.

Why breakthrough infections are expected, “unextraordinary,” and have been “no cause for alarm”:

“[T]he protection that vaccines offer is more like a coat of flame retardant than an impenetrable firewall. … The people who experience [breakthroughs] are getting less sick, for shorter periods of time; they are harboring less of the coronavirus, and spreading fewer particles to others. …

“Stopping a small fire from spreading is far easier than erasing the damage a conflagration has left — but we’re still figuring out how many stray sparks we’ll need to track…. Certain people have naturally different susceptibility to infection, in the same way that certain types of bark catch fire more easily…. Some of the same vaccine attributes that make breakthroughs rare also make them difficult to unearth and sequence. When sparks of virus do take hold in a vaccinated person, their fire still seems to burn extremely low — though infected, these people simply don’t carry much virus.”

-Katherine J. Wu. Appeared May 27, 2021 in The Atlantic.

How public health measures have implications for entire communities, not just individuals:

“We live in the same house!” and it’s on fire. This short video uses metaphors and humor to show how hoarding vaccines in the U.S. will harm us all.

-Karan Menon. Appeared Dec. 3 on Instagram.

Why freedom — and opening things up — requires caution and responsibility:

“We’re permitting campfires and fireworks in the dry forest — freedom, you know — but we have some fire extinguishers ready to go.”

-Bob Wachter. Appeared Aug. 12, 2021 on Twitter.

Why hostility toward public health guidelines is self-destructive:

“Attacking proven tenets of public health, items like mask wearing, and improved building ventilation, to combat a respiratory virus, is on par with attacking a firefighter for saying the smoke alarms in our homes will help decrease incidents and the severity of fires. Please consider this analogy. If you use smoke alarms, you should be masking, and, if you’re medically able to, you should get the vaccine. Both could save yourself, your fellow citizens, and serve the public good.”

-Michael LaGier, a microbiologist. Published Sept. 10, 2021 in the Des Moines Register.

Using auto safety and drunk driving to communicate about prevention, freedom, social responsibility, etc.

Automobile safety is another compelling comparison that can help audiences to understand:

Why prevention is critical:

Pushing monoclonal antibody treatments while playing down vaccines, one doctor said, was “like investing in car insurance without investing in brakes.”
-Dr. Christian Ramers. Appeared Sept. 18, 2021 in The New York Times.

How wearing masks increases our freedom:

Not wearing a mask is like not using a blinker in traffic: “If one person does it, maybe no one will get hurt. Or maybe they will. It’s a gamble. But if huge numbers of people stop signaling, we will quickly have chaos. The roads will become significantly more dangerous, and everyone will lose the ability to enjoy road travel.”

-Heather Gehlert. Appeared Aug. 16, 2021 on Facebook.

How vaccines work — and why breakthroughs still speak to their effectiveness:

“Delta is vastly more contagious, so as it is spreading among the unvaccinated there is spillover into the vaccinated population. The unvaccinated are a big highway of transmission. The vaccinated are a little side street.”

-Dr. William Schaffner, professor of infectious disease at Vanderbilt. Appeared Aug. 26, 2021 in The New York Times, among other outlets.

Why we need multiple layers of protection:

“Using masks, vaccines, and social distancing is like wearing a seatbelt, having airbags, and driving the speed limit. All of those help keep you, and those around you, safer when you are driving.”

-BMSG. Appeared Aug. 11, 2021 on bmsg.org.

Driving metaphors are especially salient when combined with the dangers from drinking alcohol. In the following example, drunk driving helps show how the decision of whether to vaccinate has larger social consequences:

“To explain the risk they pose to themselves and others, we propose an analogy: The choice to remain unvaccinated is equivalent to driving while intoxicated.

“Some might balk at this comparison, but here are the similarities. Both causes of severe bodily harm are largely preventable — covid-19 through vaccination, and drunken driving by not driving after drinking alcohol. Both are individual decisions with societal consequences.

“Both can cause substantial mortality, though deaths due to coronavirus far outstrip those due to drunken driving. About 10,000 people die per year in impaired-driving accidents in the United States, less than the number who died from covid-19 last week alone. More than 650,000 Americans have succumbed to the virus thus far, which is more than all recorded intoxication-related fatalities in the last 40 years combined.”

-Leana Wen and Sam Wang. Appeared Sept. 15, 2021 in The Washington Post.

Using tobacco control to discuss interconnection

Although tobacco control took decades to gain widespread acceptance, anti-smoking efforts that were once controversial are now considered common sense. Now we can use tobacco control metaphors to demonstrate how our health outcomes are connected.

“It used to be that smoking was considered an individual decision, but people saw it differently when the science confirmed that secondhand smoke also kills people. We changed our behavior to protect everyone. Vaccination protects everyone, too — it protects the vaccinated person who is less likely to get sick, and it protects the whole community when more people are vaccinated because COVID will have less chance to spread.”

-BMSG. Published August 11, 2021 on bmsg.org.

Using hunger to highlight health equity

Equity is an abstract concept for many people, but the sensation of hunger is universal, making the two an especially powerful combination. In referencing vaccine equity across the world versus boosters for the U.S., Heather McGhee stated:

Using money metaphors to make the case for infrastructure support

Public health infrastructure and prevention are hard concepts to connect with, in part because they don’t make the news if they are fully funded and working well. Money metaphors can bring the hidden infrastructure to light and help demonstrate the need for more funding:

“That $65 billion should have been a down payment, not the entire program. It’s a rounding error for our federal budget, and yet our entire existence going forward depends on this.”

-Mike Osterholm, an epidemiologist at the University of Minnesota. Appeared Sept. 29, 2021 in The Atlantic.

The reporter of the same article drove home the point using some social math:

“The pandemic plan compares itself to the Apollo program, but the government spent four times as much, adjusted for inflation, to put astronauts on the Moon.”

-Ed Yong. Appeared Sept. 29, 2021 in The Atlantic.

Using a common sandwich ingredient to explain the complex concept of risk mitigation

This Swiss cheese metaphor is sophisticated yet surprisingly simple. (It’s from last December but is so useful, we had to include it!)

“Multiple layers of protection, imagined as cheese slices, block the spread of the new coronavirus, SARS-CoV-2, the virus that causes Covid-19. No one layer is perfect; each has holes, and when the holes align, the risk of infection increases. But several layers combined — social distancing, plus masks, plus hand-washing, plus testing and tracing, plus ventilation, plus government messaging — significantly reduce the overall risk. Vaccination will add one more protective layer.”

-Siobhan Roberts, paraphrasing multiple virology experts. Appeared Dec. 5, 2020 in The New York Times.

Multiple Layers Improve Success

Using training and preparation metaphors to demystify how vaccines function

When people say they “trust their immune system” and offer that as a rationale for not getting the vaccine, these metaphors that evoke training and instruction manuals can help:

“mRNA vaccines … give your immune system instructions for how to fend off Covid, then disappear like a Snapchat message.”
Dr. Tom Frieden. Appeared Aug. 16, 2021 on Twitter.

For an extended training metaphor that explains why the vaccine is still effective even though it does not offer 100% protection, watch this video (second clip in the thread):

Although training metaphors can be highly effective, they can also backfire if they cross a line into war or combat comparisons that view viruses as “enemies” that can be “conquered through the technological subjugation of nature,” Alex de Waal, of Tufts, explained. Then people may falsely conclude that “if we have just the right weapons, then just as an individual can recover from an illness and be the same again, so too can a society,” de Waal said. “We didn’t have to pay attention to the pesky details of the social world, or see ourselves as part of a continuum that includes the other life-forms or the natural environment.”

Using candy to explain correlation vs causation

The Vaccine Adverse Events Reporting System, which was created to provide transparency and to quickly address any adverse events, is commonly cited by those who are vaccine hesitant. Although the system contains unverified data, the adverse events have led to confusion, with many people raising concerns about what the database means for vaccine efficacy. To help people understand why the data should not be taken as gospel, this simple reference to candy may be useful:

“If you give everyone in the U.S. a lollipop and then publish data about how many of them die within 24 hours, you may create the false impression that lollipops are dangerous. The key thing to remember is that correlation does not mean causation, and until a link has been proven, such assumptions can be dangerous.”

-Appeared Aug. 13, 2021 in SF Gate. Cross-posted from Logically.

Using sports metaphors to show why COVID work must happen over the long haul

Too often, we see people inclined to celebrate victories and relax prevention practices, only to end up back in risky situations. COVID and our public health response continue to evolve. As such, it’s important to be cautious about using “finish line” metaphors. Suggesting that the pandemic may end soon and we are close to the finish line — and then moving that finish line — erodes trust in science and public health.

Instead, it’s helpful to recast metaphors in ways that effectively communicate the long game:

“With everyone masked, you learn to read the emotions in your co-workers’ eyes. They’re weary and they’re also disappointed that the country has started the end zone dance before we cross the goal line. The truth is we’re fumbling the ball before we even get there.”

-Dr. Terrence Coulter. Appeared July 1, 2021 in The New York Times.

Using disability to illustrate the realities of chronic illness

People who have never experienced disability or chronic illness may have difficulty conceiving of life with long COVID. This description helps to break up the false dichotomy between the infected and the recovered, revealing a middle ground between two extremes.

“Non-disabled people only saw the potential outcomes of the virus as either life or death — they didn’t account for the gray. Disabled people live in the gray. Even after the virus has left the system and patients are in ‘recovery,’ about one in three COVID-19 patients experience long-term symptoms and disability. They live in the gray now with us too.”
-Imani Barbarin. Appeared Aug. 30, 2021 in  Refinery 29.

At BMSG, we’d be happier than a flea on a dog if we were able to kick COVID to the curb tomorrow, but we know this is a marathon and not a sprint. We are grateful to be in the game with all of you and will continue to shine a spotlight on language that helps us all get to the light at the end of the tunnel.

But seriously, we are in a moment where the news media and the public are more focused on public health than perhaps at any point in most of our lives, and yet we know that there are many aspects of public health infrastructure, vaccines, and COVID that are hard to understand or that don’t get much news coverage. Metaphors can meet people where they are, break down complex topics, transform public health jargon into easy-to-understand ideas, and help us move forward together.

Originally published by Berkeley Media Studies Group


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