From Alfred Fournier to Anthony Fauci: Targeting Public Health Messages to Teens

Communication about the causes, effects, and prevention of COVID-19 is plentiful in the United States. Press briefings and congressional testimony have aired live; news stories offer highlights and guidance to the public. An increasing number of resources help parents talk with their young children about the pandemic, too. None of the media discussing COVID-19, however, talks directly to young adults. Historic health messages about sexually transmitted infection, though, signal the importance of speaking directly to, and with, adolescent and young adult audiences.

The Paris physician, Alfred Fournier. (Courtesy Wikimedia)

In the late nineteenth century, when Dr. Alfred Fournier understood that sexually transmitted infections were difficult if not impossible to cure, he created an information campaign that targeted teens. A Parisian physician, Fournier developed a career that advanced both medical discoveries and public health initiatives. His reasoning was simple: if the consequences of a disease were harmful and lasting, disabling if not outright fatal, then physicians and others in positions of responsibility must share their knowledge in order to encourage young adults to act in ways that prevented the spread of infection. For Fournier and the organization he formed, “the first questions … were relative to youth. Ought one enlighten students in the higher classes at teaching centers” and other young people, whether in the workforce or in the military?1 The answer then was yes.

Today, there is virtually no targeted public health messaging for US adolescents and young adults about their roles in preventing COVID-19, although some organizations have begun to articulate the need to reach teens.2 Where Fournier and his colleagues recognized and responded to the sexual, social, and relational impulses they saw at work in teens’ lives, we have yet to develop messages about preventing the spread of the novel coronavirus that address this cohort. It is a shortcoming in our prevention efforts, particularly as schools begin planning on-campus instruction in the fall, which some administrators and agencies see as a necessary element of the future.

Fournier urged people in medicine and education to think about where teens were in their lives, the messages that they had received about cultural and social norms, their desires, and their aspirations. He talked about love and flirtation, and the popular poetry that idealized them. Later, his granddaughter recalled, “He loved young people, and he knew how to put up with them; he was quite interested in us. … He wanted us to read, asked about our lessons and demanded endlessly if we were in the middle of a book.”3 In his writing about sexually transmitted infections, then, he outlined extant medical knowledge as plainly as possible, describing careers and dreams of the future that might be ruined by incurable illness. He unflinchingly characterized the harm that could come to one’s beloved or future children by failing to protect themselves against disease. His message focused on both the self and the family, encouraging young people to understand that their restraint protected others as well as themselves.

Fournier advocated for information sharing that recognized teens’ changing lives and roles, but today we see a focus on logistics and statistics. As people in leadership and decision-making roles assess the possibilities of reopening college campuses, where teens and young adults learn, work, and enjoy the freedoms of adulthood, some presume their invulnerability. Mitch Daniels, former Indiana governor turned president of Purdue University, has argued that “All data to date tell us that the COVID-19 virus, while it transmits rapidly in this age group, poses close to zero lethal threat to them.” Similarly, in North Dakota, Governor Doug Burgum expressed a determination to see the state’s public universities reopen with residential fall classes, “given the population of the typical age of a college student is at less risk.” These statements reflect, presumably, Centers for Disease Control and Prevention statistics that show only 59 of the more than 100,000 US deaths attributed to COVID-19 occurred in the 15–24-year-old age group. This stance has also been reflected in earlier statements by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who told one interviewer that “for reasons that we still don’t understand, children, young adults do very well.”4

Yet public health experts, Fauci among them, have observed that even if young adults themselves may have an enviable resistance to the disease’s worst outcomes, they are not the only ones affected if they contract the virus. As Fauci explained in March, “one of the things, when you have infection control, that you have to be careful of is that children may get infected and do well and not feel sick at all and then inadvertently, perhaps, infect someone … who is vulnerable.” Spring break news coverage portrayed college students as alternately carefree and careless, defying social distancing and related means of checking the spread of the novel coronavirus.

As the weeks of lockdown and infection statistics continue, we have seen a growing number of publications and video presentations that help parents explain the virus to younger children, taking into account their vocabularies and reading preferences, their knowledge of science and world events, and their developmental stages. Some outlets have begun to advise parents on how to talk to teens, but we see few COVID-19 specific information resources developed for teens themselves.

Building on the work of early twentieth-century psychologists and physicians like Fournier, publishers and librarians in the mid-twentieth century recognized that teens and young adults differed both from children and from adults. They urged their professional peers to meet teens’ needs for information and books with contemporary, age-and-stage appropriate materials; they wanted to address teens as maturing and capable individuals.5 Since then, numerous information campaigns and nonfiction resources have provided young people with information that recognized them as a distinctive demographic cohort, particularly with regard to crucial and sensitive matters of health. While these efforts sometimes meet with resistance, they have formed part of a strong market for media for young people, including books.

As reopening schools and universities becomes an increasingly pressing and even contentious concern, instead of lamenting young people’s seeming ignorance of the virus’s consequences for others around them, we should take cues from history. We should be advised by the doctors, publishers, and librarians around the world who, starting in 1901, presented health information and other content directly to adolescents, with messages and metaphors that teens and young adults could see as authentic. Although our cultural norms and sense of what young adults may do have changed, we might still take note of the way professionals in the past created resources that recognized teens’ desires for independence and autonomy, even as their actions held consequences for others. Although the nature of the illness and times have changed, we need to talk to teens, rather than about them, to ensure a healthy future for everyone.

Notes

  1. Jennifer Burek Pierce, What Adolescents Ought to Know: Sexual Health Texts in Early Twentieth-Century America (University of Massachusetts Press, 2011). Return to text.
  2. In contrast, French President Emmanuel Macron used his Instagram account to promote the @lettre_1sourire campaign, which encouraged writing letters to the elderly in order to reduce their loneliness during the country’s lockdown. The campaign’s frequently asked questions and related social media indicate that adolescents are among the groups encouraged to participate in ensuring older people’s health during pandemic-induced restrictions. The campaign constructs young people as responsible for the health and well-being of their elders. Return to text.
  3. Burek Pierce, What Adolescents Ought to Know, 44. Return to text.
  4. Since then, recent research has shown that some children diagnosed with COVID-19 have developed pediatric multi-system inflammatory syndrome or PMIS. In early May, the New York state Department of Health issued a statement warning care providers of the appearance of this syndrome in pediatric patients; the phenomenon has been detailed in the New York Times. Return to text.
  5. See, for example, a discussion of Margaret Edwards, author of The Fair Garden and the Swarm of Beasts (1969), and her philosophy of youth services. Return to text.

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