Analysis of Public Perception of the Israeli Government's Early Emergency Instructions Regarding COVID-19: Online Survey Study

"The higher the public trust and evaluation of crisis management, the greater the compliance of the public with guidelines."

Studies have indicated that mistrust in authorities, lack of information transparency, and failure to customise information to different subpopulations are central reasons for the failures of emerging infectious disease communication over the years, such as in the Ebola case in the United States (US) and the polio crisis in Israel. Conveying information and communicating risk to the public during the COVID-19 pandemic has been complicated by ongoing uncertainty surrounding the source and spread of the virus and the absence of a vaccine. Further exacerbating the situation in Israel is a constitutional crisis that has resulted in management of the COVID-19 response by an interim government. In this context, the objective of the paper was to examine the response of the Israeli public to the government's emergency instructions regarding the COVID-19 pandemic using an online questionnaire.

The article provides background: Israel's parliament stopped functioning normally after 3 election cycles in which there was no clear victor in the General Election. Israeli Prime Minister Benjamin Netanyahu made critical decisions during the COVID-19 crisis without bringing his decisions to the cabinet. Some critics argue that some of these decisions were motivated by political considerations (including the decision to delay the lockdown of centers of contagion, such as ultra-Orthodox communities). Among members of a team established by Prime Minister Netanyahu is Health Minister Yaakov Litzman (not a health professional), who reportedly refrained from taking measures against the ultra-Orthodox community, which is his constituency. In short, during the crisis, hospital directors, physicians, and scientists criticised COVID-19 management in Israel.

The survey was distributed in March 2020 to the public in Israel using Facebook, WhatsApp, and Instagram. In the first stage, intensive sampling was accomplished through social networks and social media platforms. In the second stage, snowball sampling was performed to reach broader circles in the Jewish and Arab communities. In the third stage, after it emerged that the number of participants from the Arab community was higher than that from the Jewish community, efforts focused on dissemination through diverse circles in the Jewish community, such as community forums, official community Facebook pages, and internal diffusion circles that expanded to broader circles. In the end, 1,056 people aged 18 years and older answered the survey, 40.29% of whom were Jewish and 627 (59.71%) of whom were Arab. Because the ethnicity distribution of the sample was not proportional to the general population distribution, a weighting index was calculated. After weighting the data, the ethnicity distribution was 19% Arab and 81% Jewish, according to the distribution of people aged 18 years of age or older in the general population in Israel.

The study found:

• Participants aged 65 years and older perceived higher personal risk compared to those aged 18-30 years (mean difference 0.33, 95% confidence interval (CI) 0.04-0.61) and those aged 46-64 years (mean difference 0.38, 95% CI 0.12-0.64). This finding is consistent with scientific facts indicating that older people are at higher risk due to the severity of the illness and the fatality rate.
• Significant correlations were found between overall risk perception and attitudes toward crisis management (r=0.19, P<.001), overall risk perception and economic threat perception (r=0.22, P<.001), attitudes toward crisis management and compliance with behavioural guidelines (r=0.15, P<.001), and attitudes toward crisis management and economic threat perception (r = -0.15, P<.001).
• Participants who perceived that the prime minister was the most credible spokesperson evaluated the crisis management significantly higher than all other groups. Meanwhile, the COVID-19 crisis management was evaluated significantly lower by participants who stated that infectious disease specialists were the most credible spokespersons. Participants for whom journalists were the most credible spokespersons evaluated the crisis management significantly lower than those who believed that the director general of the Ministry of Health or the head of Public Health Services was the most credible.
• Participants for whom the Ministry of Health website was the most credible source of information evaluated the crisis management higher than all other groups. Participants for whom scientific articles were the most credible source of information evaluated the crisis management lower than those who perceived that the World Health Organization (WHO)/Centers for Disease Control and Prevention (CDC) websites or Ministry of Health/hospital websites and healthcare workers were the most credible.

Reflecting on the findings, one suggestion the researchers advance is that participants who viewed Prime Minister Netanyahu as the most credible spokesperson might have given high marks to the crisis management because he performs two functions: manager and spokesperson of the crisis. Throughout the crisis, Prime Minister Netanyahu appeared at dozens of press conferences and delivered the guidelines to the public himself. Conversely, participants who viewed infectious disease specialists as the most credible spokespersons provided a lower evaluation of the crisis management perhaps because the crisis was managed by a narrow, centralised team that some said featured an insufficient number of public health and medical experts.

Some of the takeaways beyond the Israeli context:

• Trust in the healthcare system is particularly important during a crisis such as the COVID-19 pandemic, when the public is asked to change its routine behaviours and habits.
• Selecting appropriate spokespersons to communicate with the public during and after a health crisis is a strategic decision that can have far-reaching results; the higher the credibility of the spokesperson, the greater the chance the audience will be open to receiving the messages and complying with the guidelines.
• In epidemic/pandemic crises in the age of new media, it is especially critical that both spokespersons and information sources be perceived by the public as credible.
• Decision-makers must address and communicate the risks differently to different subpopulations that have different risk perceptions and different levels of health literacy.
• Unlike other epidemic crises, the COVID-19 crisis has widespread economic and social consequences; therefore, communication must focus not only on the health risk but on the economic and social risks as well.
• Follow-up studies could examine the association between the phenomenon of vacccine hesitancy and how hesitant groups perceive the management of the COVID-19 crisis.