{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T16:25:52Z","timestamp":1793982352299,"version":"4.8.0"},"reference-count":66,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"University of Maryland","award":["Grand Challenges Pandemic Readiness Initiative"],"award-info":[{"award-number":["Grand Challenges Pandemic Readiness Initiative"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Security"],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:p>Despite the availability of crisis and risk communication best practices, scholars have analyzed and described the global COVID-19 pandemic communication failures that led to mass confusion about disease dynamics and appropriate protective behaviors. In this study, we sought to understand the alignment of crisis and risk communication best practices with national and international organizational lessons learned from COVID-19 pandemic responses. Our study design was a summative content analysis of a purposeful sample of COVID-19 lessons learned and recommendations reports published by US or international organizations between March 2020 and June 2024. Forty-four organizations published 61 reports, with 331 recommendations (24%) aligned with communication strategies, practices, behaviors, or actions. We identified 612 full or partial statements that aligned with at least 1 of 12 crisis and risk communication best practices. Alignment between the 12 crisis and risk communication best practices and report recommendations varied by best practice. \u201cTake a process approach\u201d was the best practice that aligned most frequently with recommendations and \u201cexplain risk in plain language\u201d and show \u201can ethic of care\u201d were the least frequently aligned with recommendations. Word cloud analyses showed alignment between best practice definitions and report recommendations. Our findings indicate that despite the critical nature of the work to inform the public, there is little international consensus on the use of 12 crisis and risk communication best practices that represent consolidated evidence about what works. Organizations\u2019 own reports and our analysis provide the blueprint for future robust crisis and risk communication emergency responses, if the organizations heed their own advice. We recommend that in advance of the next pandemic, organizations at all levels prioritize building awareness of and planning with these 12 best practices so they are prepared to fully listen to and respond to public\u2019s information needs.<\/jats:p>","DOI":"10.1177\/23265094261488796","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:26:12Z","timestamp":1791433572000},"page":"385-399","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Influence of Crisis and Risk Communication Best Practices on COVID-19 Communication: A Content Analysis of Lessons Learned and Recommendations"],"prefix":"10.1177","volume":"24","author":[{"given":"Cynthia","family":"Baur","sequence":"first","affiliation":[{"name":"Cynthia Baur, PhD, is Endowed Chair and Director, Horowitz Center for Health Literacy; Katherine F. Raymond, MSW, PhD, is a Postdoctoral Fellow, Horowitz Center for Health Literacy; and Brooke Fisher Liu, MA, PhD, is a Professor and Distinguished Scholar-Teacher, Department of Communication; all at the University of Maryland, College Park, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine F.","family":"Raymond","sequence":"additional","affiliation":[{"name":"Cynthia Baur, PhD, is Endowed Chair and Director, Horowitz Center for Health Literacy; Katherine F. Raymond, MSW, PhD, is a Postdoctoral Fellow, Horowitz Center for Health Literacy; and Brooke Fisher Liu, MA, PhD, is a Professor and Distinguished Scholar-Teacher, Department of Communication; all at the University of Maryland, College Park, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke Fisher","family":"Liu","sequence":"additional","affiliation":[{"name":"Cynthia Baur, PhD, is Endowed Chair and Director, Horowitz Center for Health Literacy; Katherine F. Raymond, MSW, PhD, is a Postdoctoral Fellow, Horowitz Center for Health Literacy; and Brooke Fisher Liu, MA, PhD, is a Professor and Distinguished Scholar-Teacher, Department of Communication; all at the University of Maryland, College Park, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/713851971"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.30658\/jicrcr.4.3.1"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/10810730590904571"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/00909880600771619"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/00909880600769944"},{"key":"e_1_3_2_7_1","unstructured":"6.US Centers for Disease Control and Prevention. Crisis and Emergency Risk Communication (CERC). Accessed August 16 2025. https:\/\/www.cdc.gov\/cerc\/php\/about\/index.html"},{"key":"e_1_3_2_8_1","unstructured":"7.World Health Organization. Coronavirus disease (COVID-19) pandemic. Accessed August 16 2025. https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019"},{"key":"e_1_3_2_9_1","unstructured":"8.Mueller B Lutz E. U.S. has far higher Covid death rate than other wealthy countries. New York Times. February 1 2022. Accessed August 18 2026. https:\/\/www.nytimes.com\/interactive\/2022\/02\/01\/science\/covid-deaths-united-states.html"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02796-3"},{"key":"e_1_3_2_11_1","unstructured":"10.Fischhoff B. The COVID communication breakdown: how to fix public health messaging. Foreign Affairs. October 4 2021. Accessed August 18 2026. https:\/\/www.foreignaffairs.com\/articles\/united-states\/2021-10-04\/covid-communication-breakdown"},{"key":"e_1_3_2_12_1","unstructured":"11.LaFraniere S Weiland N. Walensky citing botched pandemic response calls for C.D.C. reorganization. New York Times. August 17 2022. Accessed August 18 2026. https:\/\/www.nytimes.com\/2022\/08\/17\/us\/politics\/cdc-rochelle-walensky-covid.html"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-022-05398-2"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/10410236.2020.1838093"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781394180844.ch13"},{"key":"e_1_3_2_16_1","unstructured":"15.World Health Organization (WHO). Managing the COVID-19 Infodemic: Call for Action. Geneva: WHO; 2020. Accessed August 18 2026. https:\/\/iris.who.int\/bitstream\/handle\/10665\/334287\/9789240010314-eng.pdf"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1108\/14635779910289261"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/kpm.110"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1108\/13632541211217560"},{"key":"e_1_3_2_20_1","unstructured":"19.World Health Organization (WHO). Communicating Risk in Public Health Emergencies: A WHO Guideline for Emergency Risk Communication (ERC) Policy and Practice. Geneva: WHO; 2017. Accessed August 18 2026. https:\/\/www.who.int\/publications\/i\/item\/9789241550208"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732305276687"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.5688\/ajpe7113"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1622"},{"key":"e_1_3_2_24_1","unstructured":"23.US Centers for Disease Control and Prevention (CDC). CDC Museum COVID-19 timeline. Accessed August 16 2025. https:\/\/www.cdc.gov\/museum\/timeline\/covid19.html"},{"key":"e_1_3_2_25_1","volume-title":"Emerging Stronger From COVID-19: Priorities for Health System Transformation","author":"National Academy of Medicine","year":"2023","unstructured":"24.National Academy of Medicine. Emerging Stronger From COVID-19: Priorities for Health System Transformation. 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Lessons Learned From COVID-19 Pandemic: Virtual Regional Consultation with Informal Expert Group. New Delhi: WHO SEARO; 2021. Accessed August 18 2026. https:\/\/www.who.int\/publications\/i\/item\/sea-whe-6"},{"key":"e_1_3_2_32_1","unstructured":"31.US House of Representatives Select Subcommittee on the Coronavirus Crisis. Preparing for and Preventing the Next Public Health Emergency: Lessons Learned From the Coronavirus Crisis (Final Report). Washington DC: 2022. Accessed August 18 2026. https:\/\/coronavirus-democrats-oversight.house.gov\/sites\/evo-subsites\/coronavirus-democrats-oversight.house.gov\/files\/2022.12.09%20Preparing%20for%20and%20Preventing%20the%20Next%20Public%20Health%20Emergency.pdf"},{"key":"e_1_3_2_33_1","unstructured":"32.American Public Human Services Association (APHSA). COVID Response Project: Lessons Learned from State Adaptations and Federal Flexibilities. Washington DC: APHSA; 2021. 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Brighton UK: Institute of Development Studies and Partner Organisations; 2023. Accessed August 18 2026. https:\/\/opendocs.ids.ac.uk\/ndownloader\/files\/48185602","DOI":"10.19088\/CC.2023.004"},{"key":"e_1_3_2_37_1","unstructured":"36.The White House. National Strategy for the COVID-19 Response and Pandemic Preparedness. Washington DC: The White House; 2021. Accessed August 18 2026. https:\/\/bidenwhitehouse.archives.gov\/wp-content\/uploads\/2021\/01\/National-Strategy-for-the-COVID-19-Response-and-Pandemic-Preparedness.pdf"},{"key":"e_1_3_2_38_1","unstructured":"37.District of Columbia Department of Health (DC Health). COVID-19 Pandemic Health and Healthcare Recovery Report. Washington DC: DC Health; 2021. Accessed August 18 2026. https:\/\/dchealth.dc.gov\/sites\/default\/files\/dc\/sites\/doh\/page_content\/attachments\/Pandemic-Recovery-Report_May-2021.pdf"},{"key":"e_1_3_2_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01585-9"},{"key":"e_1_3_2_40_1","unstructured":"39.Government of the Northwest Territories (GNWT). Learning From the Response to Covid-19: Report and Recommendations. Yellow Knife Canada: GNWT; 2023. Accessed August 18 2026. https:\/\/www.fin.gov.nt.ca\/sites\/fin\/files\/resources\/learning_from_the_response_to_covid-19-report_and_recommendations.pdf"},{"key":"e_1_3_2_41_1","unstructured":"40.Public Health Advisory Council. Creating a Blueprint for the Future: Lessons Learned From the Covid-19 Pandemic in Michigan. Lansing: Michigan Department of Health and Human Services; 2021. Accessed August 18 2026. https:\/\/www.michigan.gov\/-\/media\/Project\/Websites\/mdhhs\/Folder2\/Folder34\/Folder1\/Folder134\/Public_Health_Advisory_Council_COVID-19_Mid_Action_Report.pdf"},{"key":"e_1_3_2_42_1","unstructured":"41.The White House Lander ES Sullivan JJ. American Pandemic Preparedness: Transforming Our Capabilities. Washington DC: The White House; 2021. Accessed August 18 2026. https:\/\/bidenwhitehouse.archives.gov\/wp-content\/uploads\/2021\/09\/American-Pandemic-Preparedness-Transforming-Our-Capabilities-Final-For-Web.pdf?page=29"},{"key":"e_1_3_2_43_1","unstructured":"42.Hawai\u2032i State Department of Health. COVID-19 in Hawai\u2032i: Addressing Health Equity in Diverse Populations. Honolulu: Hawai\u2019i DOH; 2021. Accessed August 18 2026. https:\/\/health.hawaii.gov\/news\/newsroom\/department-of-health-community-partners-take-action-to-address-covid-19-race-ethnic-disparities\/"},{"key":"e_1_3_2_44_1","volume-title":"OECD Science, Technology and Innovation Outlook 2023: Enabling Transitions in Times of Disruption","author":"Organization for Economic Cooperation and Development (OECD)","year":"2023","unstructured":"43.Organization for Economic Cooperation and Development (OECD). Mobilising science in times of crisis: lessons learned from COVID-19. In: OECD. OECD Science, Technology and Innovation Outlook 2023: Enabling Transitions in Times of Disruption. Paris: OECD; 2023. Accessed August 18, 2026. https:\/\/www.oecd.org\/content\/dam\/oecd\/en\/publications\/reports\/2023\/03\/oecd-science-technology-and-innovation-outlook-2023_fb6e6c20\/0b55736e-en.pdf"},{"key":"e_1_3_2_45_1","unstructured":"44.US Centers for Disease Control and Prevention (CDC). CDC Moving Forward. Updated February 8 2024. Accessed August 18 2026. https:\/\/stacks.cdc.gov\/view\/cdc\/148653"},{"key":"e_1_3_2_46_1","unstructured":"45.Public Health Physicians of Canada (PHPC). Public Health Lessons Learned from the COVID-19 Pandemic. Ottawa: PHPC; 2022. Accessed August 18 2026. https:\/\/nlma.nl.ca\/site\/uploads\/2023\/01\/PHPC_Public-Health-Lessons-Learned-from-the-COVID-19-Pandemic.pdf"},{"key":"e_1_3_2_47_1","unstructured":"46.United States Federal Emergency Management Agency (FEMA). Pandemic Response to Coronavirus Disease 2019 (COVID-19): Initial Assessment Report. FEMA Operations January Through September 2020. Washington DC: FEMA; 2021. Accessed August 18 2026. https:\/\/www.fema.gov\/sites\/default\/files\/documents\/fema_covid-19-initial-assessment-report_2021.pdf"},{"key":"e_1_3_2_48_1","unstructured":"47.US Department of Veterans Affairs Veterans Health Administration (VHA). Veterans Health Administration (VHA) Coronavirus Disease 2019 (COVID-19) Response Report; Annex A; Annex B; and Annex C. 2020. https:\/\/www.va.gov\/HEALTHEQUITY\/docs\/VHA_OHE_COVID-19_Equity_Response_Final_508_February_2023.pdf"},{"key":"e_1_3_2_49_1","unstructured":"48.Wolfe LC Selekman J. COVID-19 resources for Missouri schools: lessons learned (2020-2021). Missouri Public Health Association Communiqu\u00e9. 2022;June:8-12. https:\/\/mopha.org\/wp-content\/uploads\/2024\/12\/june-2022-newsletter_618.pdf"},{"key":"e_1_3_2_50_1","unstructured":"49.World Health Organization (WHO) Regional Office for Europe (EURO). Pandemic Fatigue: Reinvigorating the Public to Prevent COVID-19. Copenhagen: WHO EURO; 2020. Accessed August 18 2026. https:\/\/www.who.int\/europe\/publications\/i\/item\/WHO-EURO-2020-1573-41324-56242"},{"key":"e_1_3_2_51_1","unstructured":"50.United Nations Office for Disaster Risk Reduction (UNDRR). Increasing Global Resilience to Systemic Risk: Emerging Lessons from the COVID-19 Pandemic. Geneva: UNDRR; 2021. Accessed August 18 2026. https:\/\/www.undrr.org\/publication\/increasing-global-resilience-systemic-risk-emerging-lessons-covid-19-pandemic"},{"key":"e_1_3_2_52_1","unstructured":"51.Bollyky TJ Patrick SM. Improving Pandemic Preparedness: Lessons From COVID-19. Independent Task Force No. 78. New York: Council on Foreign Relations; 2020. Accessed August 18 2026. https:\/\/www.cfr.org\/task-force-report\/improving-pandemic-preparedness"},{"key":"e_1_3_2_53_1","unstructured":"52.Arizona Department of Health Services (ADHS). Arizona Health Improvement Plan: Summary Document 2021-2025. Phoenix: ADHS; 2021. Accessed August 18 2026. https:\/\/www.azdhs.gov\/documents\/operations\/strategic-initiatives\/azhip-2021-2025.pdf"},{"key":"e_1_3_2_54_1","unstructured":"53.JSI Research & Training Institute (JSI). Nutrition Programs Adapt to COVID-19: Lessons for Future Shocks. Baltimore MD: JSI; 2023. Accessed August 18 2026. https:\/\/www.advancingnutrition.org\/sites\/default\/files\/2023-04\/usaid_an_adapt_covid_2023.pdf"},{"key":"e_1_3_2_55_1","doi-asserted-by":"crossref","unstructured":"54.Organization for Economic Cooperation and Development (OECD). First Lessons From Government Evaluations of COVID-19 Responses: A Synthesis. Paris: OECD; 2022. Accessed August 18 2026. https:\/\/doi.org\/10.1787\/483507d6-en","DOI":"10.1787\/483507d6-en"},{"key":"e_1_3_2_56_1","doi-asserted-by":"crossref","unstructured":"55.Organization for Economic Cooperation and Development (OECD). Transparency Communication and Trust: The Role of Public Communication in Responding to the Wave of Disinformation About the New Coronavirus. Paris: OECD; 2020. Accessed August 18 2026. https:\/\/doi.org\/10.1787\/bef7ad6e-en","DOI":"10.1787\/bef7ad6e-en"},{"key":"e_1_3_2_57_1","unstructured":"56.American Public Health Association. COVID-19 and the education sector: early lessons from the pandemic. Published October 23 2020. Accessed August 18 2026. https:\/\/www.apha.org\/policies-and-advocacy\/public-health-policy-statements\/policy-database\/2021\/01\/14\/covid-19-and-the-education-sector"},{"key":"e_1_3_2_58_1","unstructured":"57.National Academies of Sciences Engineering and Medicine. Societal Experts Action Network (SEAN): facilitating rapid and actionable responses to social behavioral and economic-related questions. Accessed August 18 2026. https:\/\/www.nationalacademies.org\/our-work\/societal-experts-action-network"},{"key":"e_1_3_2_59_1","unstructured":"58.US Centers for Disease Control and Prevention (CDC). The CDC Clear Communication Index. Accessed August 18 2026. https:\/\/www.cdc.gov\/ccindex\/index.html"},{"key":"e_1_3_2_60_1","unstructured":"59.Edelman Trust Institute. 2025 Edelman Trust Barometer: Trust and the Crisis of Grievance. Chicago: Edelman Trust Institute; 2025. Accessed August 18 2026. https:\/\/www.edelman.com\/sites\/g\/files\/aatuss191\/files\/2025-01\/2025%20Edelman%20Trust%20Barometer%20Global%20Report_01.23.25.pdf"},{"key":"e_1_3_2_61_1","doi-asserted-by":"publisher","DOI":"10.4324\/9781003363330-26"},{"key":"e_1_3_2_62_1","doi-asserted-by":"publisher","DOI":"10.1080\/13669877.2020.1773516"},{"key":"e_1_3_2_63_1","doi-asserted-by":"crossref","unstructured":"62.National Academies of Sciences Engineering and Medicine. Effective Health Communication Within the Current Information Environment and the Role of the Federal Government: Proceedings of a Workshop. Washington DC: The National Academies Press; 2023. https:\/\/doi.org\/10.17226\/27210","DOI":"10.17226\/27210"},{"key":"e_1_3_2_64_1","unstructured":"63.Arria A Kennedy M McManus G Bugbee B Hawkins A. Maryland Commission on Public Health: Assessment Team Report. Baltimore MD: Maryland Commission on Public Health; 2025. https:\/\/health.maryland.gov\/coph\/Documents\/Reference\/2025-05_Final_Maryland%20CoPH%20Assessment%20Team%20Findings%20Report.pdf"},{"key":"e_1_3_2_65_1","unstructured":"64.Parkinson K Sandman PM. Top 12 barriers to effective outrage management. Posted July 22 2024. https:\/\/www.psandman.com\/col\/Barriers.htm"},{"key":"e_1_3_2_66_1","unstructured":"65.The White House. Withdrawing the United States from the World Health Organization. Published January 20 2025. https:\/\/www.whitehouse.gov\/presidential-actions\/2025\/01\/withdrawing-the-united-states-from-the-worldhealth-organization\/"},{"key":"e_1_3_2_67_1","unstructured":"66.US Department of Health and Human Services (HHS). HHS winds down mRNA vaccine development under BARDA. 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