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JSOCM
13,1 Timeless principles of social
marketing communication: a
comparison of the Spanish flu and
82 COVID-19 pandemic
Received 21 March 2022
Revised 15 September 2022
communication in South Korea
Accepted 17 September 2022
Seongwon Choi
Department of Management, California State University Los Angeles,
Los Angeles, California, USA, and
Thomas Powers
Department of Marketing, Industrial Distribution and Economics,
The University of Alabama at Birmingham, Birmingham, Alabama, USA

Abstract
Purpose – The purpose of this paper is to highlight the core tenets of social marketing communications in
managing acute infectious disease outbreaks based on a historical review of two major pandemics in South Korea.
Design/methodology/approach – Two researchers reviewed newspapers, journal papers, archived
documents and other historical materials to examine social marketing communications used in both Spanish
flu and COVID-19 pandemics by South Koreans.
Findings – Despite two events being a century apart and the social context of two eras being starkly
different, behavioral recommendations for both pandemics were nearly identical. Two major lessons arose
from the review. First, a full disclosure of the pandemic-related information is important. Second, proper
management of conflicting information is highly desired as an integral part of pandemic social marketing
communication campaigns.
Originality/value – Understanding the importance of social marketing in raising public awareness, this
paper provides a historical comparison between the 1918–1919 Spanish flu and COVID-19, focusing on the
social communications used during these two pandemics. The paper contributes to the health marketing
literature as well as to practice by drawing implications relevant to social marketing communication used in
disease pandemics.
Keywords COVID-19, Spanish flu, Marketing history, Pandemic, Social marketing,
Health communication
Paper type General review

Introduction
Journal of Social Marketing
Vol. 13 No. 1, 2023
pp. 82-99
© Emerald Publishing Limited
2042-6763
DOI 10.1108/JSOCM-03-2022-0059
It was about the beginning of September, 1664, that I, among the rest of my neighbours, heard
in ordinary discourse that the plague was returned again in Holland; for it had been very violent
there, and particularly at Amsterdam and Rotterdam, in the year 1663, whither, they say, it was
brought, some said from Italy, others from the Levant, among some goods which were brought
home by their Turkey fleet; others said it was brought from Candia; others from Cyprus. We
had no such thing as printed newspapers in those days to spread rumours and reports of things,
and to improve them by the invention of men, as I have lived to see practised since. But such
things as these were gathered from the letters of merchants and others who corresponded
 abroad, and from them was handed about by word of mouth only; so that things did not spread Social
instantly over the whole nation, as they do now. But it seems that the Government had a true
account of it, and several councils were held about ways to prevent its coming over; but all was marketing
kept very private “A Journal of the Plague Year” – Daniel Defoe. communication
As seen above, the issue of communications during a pandemic has existed throughout
history. During a health crisis such as a disease pandemic, public awareness and
communication efforts are needed and this importance was even noted in the distant past 83
(Defoe, 1990). The quote from the time of the bubonic plague in 1600s illustrates the role of
social marketing communication, with its opportunities and difficulties, which is the focus of
this paper. The COVID-19 outbreak reminded the world of the importance of well-planned
pandemic communications in mitigating and preventing the spread of disease. The
communications process used during a disease crisis underscores the necessity of public
engagement in the success of an overall mitigation effort (Glik, 2007; Jones et al., 2010;
Guidry et al., 2017; Savoia et al., 2015). For this very reason, communication strategies used
in health crises such as pandemics and epidemics have often been examined and designed
based on a social marketing perspective (Jones et al., 2010). Social marketing has been
conceived as an application of marketing principles to social phenomena to influence how
related ideas are accepted by the targeted audience (Kotler and Zaltman, 1971). Disease
pandemics is an archetypal example where social marketing communication is used to
influence an individual’s risk perception and subsequent health behaviors (Malecki et al.,
2021). The purpose of this paper is to review social marketing communications used in
South Korea to mitigate the Spanish flu in 1918–1919 and COVID-19 in 2019–2021.
Applying a social marketing perspective, this paper provides a historical review of two
pandemics and seeks to understand what transpired in 1918–1919 compared to the
2019–2021 event. This perspective can also provide keys for the success of future social
marketing endeavors.
The COVID-19 pandemic resembles the Spanish flu during the years 1918–1919 for its
magnitude of impact on the world. The so-called “Spanish Flu” pandemic is estimated to
have infected one-third of the world population and killed nearly 50 million people
worldwide in two years. In the USA alone, 675,000 people are estimated to have died from
the disease. Unlike other previous infectious disease outbreaks, the Spanish flu was
detrimental to young and healthy adults leaving experts baffled (Jordan et al., 2019). The
fatality rate of the Spanish flu is estimated to range between 15 and 53% of people infected,
and one example reported that a rural town in Alaska was virtually destroyed by the
pandemic killing 72 of its 80 residents (Jordan et al., 2019). To combat the Spanish flu, many
communication initiatives were used to influence public perception and awareness toward
the disease when and where possible (Kamradt-Scott, 2012). Although not referred to at the
time, these efforts represent social marketing programs taken from the perspective of 100
years later during the COVID-19 pandemic (Choi and Powers, 2020).
Nearly 100 years later, the world was shaken once again by the COVID-19 pandemic. The
impact of the COVID-19 pandemic has been far-reaching, leaving virtually no one
unaffected, revealing numerous implications for social marketing communication and social
policy worldwide (Scott et al., 2020). In this paper, a historical comparison is made between
the 1918–1919 Spanish flu and 2019–2021 COVID-19 pandemics focusing on the
communications used during these pandemics. In addition to the historical perspective used
in this paper, a social marketing framework is used to draw a meaningful comparison
between the two pandemics that occurred a century apart. This includes the relative
effectiveness of the communications used in these two pandemic periods as well as the
challenges that both communication programs faced. Although the two events took place in
JSOCM distinct eras and where the socioeconomic contexts were different, the historical review
13,1 illustrates both the commonality and differences in social marketing practices. The paper
contributes to the marketing history literature by examining social marketing
communications from a historical perspective during the event of the Spanish flu and
COVID-19 in South Korea and making this information available for the first time. This
research also identifies key characteristics of successful communication efforts in managing
84 a major disease outbreak. The historical comparison of two major pandemic events in Korea
advances the marketing literature as well as informs practitioners on making social
marketing communication more salient during a crisis such as a global disease pandemic.

Background
Understanding social marketing communication efforts made in Spanish flu and COVID-19
pandemics through a historical lens is important to expand our knowledge on core tenets of
successful public health communications. Despite 100 years of differences between the onset
of two pandemics, they share lessons pertinent to salient communications with the public. In
comparing these two historical pandemics, this paper adopts social marketing concepts that
provide useful theoretical underpinnings in exploring communications during disease
pandemics. Social marketing “seeks to develop and integrate marketing concepts with other
approaches to influence behaviors that benefit individuals and communities for the greater
social good” (iSMA, 2020). By definition, social marketing is concerned with bringing about
a change across different levels of society (individual, community and system as a whole),
resulting in a holistic systemic change (Kennedy, 2016; Kemper and Ballantine, 2017). The
usefulness of social marketing in examining a wide range of public health issues has been
well documented in previous research (Kotler et al., 2002; Kemper and Ballantine, 2017;
Kennedy, 2016). In the context of health, public health research has explored the use of social
marketing based on the understanding that a knowledge–behavior gap often deters
behavioral changes of targeted individuals, compromising the optimal outcome of the public
health programs (Dahl et al., 2015). Mounting evidence highlights results of social marketing
in a wide variety of health behaviors, including smoking, healthy eating and exercising
(Kotler et al., 2002).
The central premise of social marketing is a voluntary exchange (Jones et al., 2010).
People, without being forced, would willingly accept products, services, ideas and behaviors
that they believe are worthy and beneficial for them. Just as in commercial marketing in
which people are willing to pay for products or services they find worthwhile, social
marketing notes that the public would willingly adopt behavioral changes without being
forced if they believe that the benefits of a set of new behaviors outweigh inconveniences
caused by giving up their old behaviors (Grier and Bryant, 2005). Another essential concept
of social marketing is customer orientation. As with traditional marketing, understanding a
target customer’s characteristics such as beliefs, behaviors and attitudes is a prerequisite of
effective social marketing (Jones et al., 2010; Longest and Rohrer, 2005). The marketing mix
(product, price, place, promotion) framework has been useful for designing and
implementing social marketing initiatives. From a social marketing perspective, the
marketing mix framework can be used to delineate a social initiative in the following
manner: product (including services), representing a set of behaviors and policy changes.
Price, representing what the consumer sacrifices to change behaviors. Place, representing
the context in which consumer decisions and behavioral changes may occur. Promotion,
representing the dissemination of information to educate or appeal to customers to make
them voluntarily engage in new behaviors (Daniel et al., 2009). Previous researchers have
used social marketing concepts to design and analyze different communication strategies for
global pandemics, including bird flu (Jones et al., 2010) and COVID-19 (Choi and Powers, Social
2020), to improve public awareness making it one of the most critical elements in a marketing
successful pandemic mitigation effort (Jones et al., 2010; Choi and Powers, 2020).
Salient social marketing communication is characterized by its ability to deliver intended
communication
messages to the audience effectively. Henry (2018) describes transparency as a key factor in
establishing trust in public health authorities and messages. According to the risk
communication theory, the types, amount and accuracy of the information influence one’s
perception of risk (Henry, 2018). The available information is processed and structured 85
based on one’s existing beliefs and values, resulting in the formation of an image or
perception specific to the person. These perceptions are persistent and unlikely to change
once formed (Henry, 2018). Hence, transparency in communication early on is key to forming
proper perceptions by the public toward a disease. The acute nature of pandemics further
attenuates the importance of public awareness of the disease (Henry, 2018). Effective
communication during a pandemic enables people to form a well-informed perception of the
disease and the desired quality of life. This in turn increases the likelihood of people taking
the right actions voluntarily to lower the risk of contracting and spreading the disease
(Skevington, 2002; Jones et al., 2010). Besides increasing public awareness, clear
communication strengthens the legitimacy of leadership during the pandemic management,
while inconsistencies in message delivery result in a loss of trust in the message as well as in
leadership (Jones et al., 2010). Therefore, designing and executing salient communication
strategies is a critical task for the government, public health authorities and other related
organizations to best educate and engage the public in the disease mitigation effort (Jones
et al., 2010).
Another attribute is integrated communication that focuses on delivering coherent
messages. Dresler-Hawke and Veer (2006) posited that social marketing should consider
vertical as well as horizontal integration when delivering social marketing messages.
Vertical integration of social marketing communication entails harmonizing communication
strategies between different levels of senders within the society (socio-cultural level,
community level, local level and individual level). This encompasses:
 crafting targeted messages specific to each level of society while keeping core
messages coherent that apply to all levels of society; and
 circulating the messages to the target audience effectively at each level for a holistic
societal change to take place.

On the other hand, horizontal integration of social marketing emphasizes the orchestrated
use of various communication channels to reach a wider audience. The use of limited
communication channels may result in messages disseminated only to a limited pool of
people undermining the goal of approaching the most people possible (Dresler-Hawke and
Veer, 2006). Therefore, a communication campaign during a pandemic necessitates a high
degree of integration both vertically and horizontally to ensure that the core message is
effectively delivered throughout different senders or methods by which the message is
transmitted (Jones et al., 2010; Henry, 2018).

Social marketing communication and historical analyses

The COVID-19 pandemic underscores the importance of well-planned communications to
alleviate public anxiety, facilitate public buy-in to public health guidelines and thus improve
the overall outcome of public health interventions (Glik, 2007). During the Spanish flu and
COVID-19 pandemics, people were expected to comply with behavioral guidelines, including
social distancing, self-isolation and practicing personal hygiene. These recommendations
JSOCM called for the public to accept a new behavior, reject a potential behavior and modify a
13,1 current behavior (World Health Organization, 2020; Rice and Palmer, 1993; Unknown, 2020;
Jones et al., 2010).
Motivated by this common thread across pandemics in different eras and contexts, this
research recognizes the value of historical comparison in advancing our knowledge of
marketing history, especially of social marketing communications. In studying social
86 marketing communication used for mitigating disease pandemics, Korea as a country
provides an interesting study context. During 100 years between the two events, Korea has
transformed from an agricultural low-income country to an industrialized high-income
country. With this transition, the country has also experienced notable growth in its health
and public health capacity.

Method and approach

In the development of this research, with help of librarians of the researchers’ affiliated
academic institutions as well as the Korean National Assembly Library, the authors of this
study accessed newspapers, academic journal papers, archived documents, internet sources
and other historical materials to examine how social marketing communications were
conducted during these pandemics. Additionally, the authors used search terms, including
“Spanish Flu in Korea,” “infectious disease in Korea,” “plague in Korea,” “disease history in
Korea,” “COVID-19 in Korea” and “public health campaign in Korea” both in Korean and
English. Based on prior knowledge, the authors also accessed and reviewed the Korean
Center for Diseases Control website materials for COVID-19 social marketing
communications.
Our research on the Spanish flu in colonial Korea was somewhat constrained by the
limited availability of historical research published in peer-reviewed academic journals.
Therefore, the review of Spanish flu-related materials heavily relied on an analysis of
historical narratives. During the years of the Spanish flu, Korea was under Japanese ruling
(which lasted between the years 1910 and 1945), and it was before the country was divided
into two Koreas. Korea (“colonial Korea” hereafter used to refer to Korea during Spanish flu)
during this time consisted of areas currently in territories of South Korea and North Korea.
Given the geopolitical circumstances and that the Japanese authorities were responsible for
instituting public health guidelines for colonial Koreans during this time, the review also
used archived Japanese governmental documents and historical materials such as
newspapers to explore communications used by the Japanese authorities. Based on an
exhaustive review of materials obtained, the authors identified materials that included
images, texts and narratives explicitly depicting behavioral guidelines as a response to the
Spanish flu as well as COVID-19.
In the following sections, we provide a historical review of communication used in
colonial Korea for the Spanish flu in 1918–1919 and discuss relevant success factors. Then,
we examine South Korean contemporary social marketing efforts during the COVID-19
pandemic as well as success factors. By doing so, we highlight common historical threads
that may make communications more effective.

The Spanish flu in colonial Korea: 1918–1919

Socioeconomic context
Prior to examining the social marketing communication strategies used for the Spanish flu in
Korea, it is important to review the socioeconomic context of Korea between the years 1918 and
1919. Korea was under Japanese ruling when the Spanish flu first was believed to arrive on the
peninsula. A predecessor of colonial Korea was the Chosun dynasty that had existed for
500 years. The last years of the Chosun dynasty were marked by a period of turbulent social Social
unrest due to a widening inequality between social classes raising discontent among citizens. marketing
Imperial Japan invaded the peninsula amid this increasing turbulence and annexed Korea in communication
1905, through the Eulsa Unwilling Treaty that resulted in the Chosun dynasty becoming a
protectorate of Imperial Japan. In 1910, the Japanese annexation of Korea was made official.
The population in colonial Korea around this time is estimated to be anywhere between 13 and
19 million people, and the economy was largely driven by agriculture (Chang, 1971). The 87
country lacked robust social infrastructures such as railway systems and healthcare systems
(Park, 2008). Under the “modernizing” mission of the Japanese government, which was used to
legitimize control, colonial Korea underwent large-scale social changes that targeted
assimilating Japanese culture and regulations and modernizing infrastructure. These changes
included the rezoning of public space, instituting a Japanese language-based curriculum in
schools and modernization of social infrastructures such as public transportation and public
health care. These attempts, however, faced consistent and long-term resistance from colonial
Koreans making the assimilation efforts fall far short of what had originally been planned by
the Japanese (Henry, 2016).

Spanish flu and social marketing

Based on social marketing premises, a historical review of how Korea responded to the
Spanish flu is now provided. Given its easy access to water and other countries, colonial
Korea served as a place for international traders from the neighboring countries as well as
from America (Neff, 2018). Although the world might not have been as globalized as it is
now, the virus was still potent and effectively spread throughout the world. Colonial Korea
was not free from the deadly impact of the outbreak, which is speculated to have landed in
the Korean peninsula as early as in the fall of 1918 (Schofield and Cynn, 1919). During the
years the Spanish flu spreading across colonial Korea, people freely traveled within the
peninsula and neighboring countries, including mainland China, Russia and Imperial Japan.
In addition to ships and railroads that presumably transported the virus quickly throughout
the interior, crowded local markets, inns and unsanitary conditions further worsened the
consequences of the disease (Schofield and Cynn, 1919; Neff, 2018).
As a response to the Spanish flu, Japanese citizens (colonial Koreans as well) were asked
to follow guidelines devised and enforced by the Japanese Central Sanitary Bureau and
police department. In Japan, in an effort to increase public awareness, the Central Sanitary
Bureau circulated five million copies of printed materials that laid out a set of behavioral
guidelines when the spread of “flu” was first suspected starting late 1918. In later 1919, the
Central Sanitary Bureau started using posters that contained descriptive images to better
orient the citizens regarding desired behaviors to mitigate the spread of the disease (Kang,
2018). These communication materials were put up in public places such as theaters,
cinemas and railway waiting rooms (Figures 1–3). One poster portrayed the importance of
covering one’s mouth especially in public (Figure 1), and the other poster urged
quarantining an individual when the infection is suspected (Figure 2). There were also text-
based posters distributed reiterating the “four rules” for the flu that were:
(1) stay away;
(2) cover your mouth and nose;
(3) get vaccinated; and
(4) gargle (Figure 3).
JSOCM
13,1

88

Figure 1.
A poster from the
Taisho Era urging
the public to wear
masks after the
Spanish flu pandemic

In addition to these poster materials, Rice and Palmer (1993) reported that in some
prefectures, health officials appeared during intermissions of films to give talks and present
posters that focused on a theme of “self-help.”
In both Japan and colonial Korea, areas where outbreaks were reported, the authority
ordered a ban on large gatherings. The ban includes the closure of schools as well as a
community gathering for religious or entertainment purposes. However, this ban was more
strictly enforced in colonial Korea than in Japan (Rice and Palmer, 1993; Neff, 2018; Kang,
2018). Symptomatic individuals were advised to seek care from doctors and were not
allowed to leave the medical precinct unless they were free of symptoms. The Japanese local
authorities fervently recommended the use of masks, basic hygiene, vaccination and
frequent gargling to prevent the “flu” (Rice and Palmer, 1993; Unknown, 2020). These were
the equivalent measures that many individuals in western countries used. However, in
Japan, these public health campaigns fell short and obsolete recommendations such as
gargling were strongly supported by official and medical sources (Rice and Palmer, 1993).
Public health surveillance led by the police force was another characteristic of the Japanese
flu mitigation effort during this time. The police went around towns and inspected
private households, building rampant fear among the people, who as a result, disguised the
presence of the disease by hiding symptoms when the police inspected individual houses to
 Social
marketing
communication

89

Figure 2.
A poster advising
symptomatic patients
to be quarantined

trace the ill people (Kang, 2018). Compared to Japan, this surveillance led by police was even
more stringent in colonial Korea where police forcefully disaggregated crowds and
mandated closure of schools. As Rice and Palmer (1993, p. 402) report, Tokyo’s Metropolitan
Public Health Bureau head is said to have remarked “We can’t do this in Japan.”
A recent analysis indicated the cumulative mortality rate in colonial Korea from the
Spanish flu was 1.38%, whereas it was 0.52 and 0.96% for the USA and Japan, respectively
(Barro et al., 2020), indicating that colonial Korea suffered even harsher consequences of the
outbreak. This notable disparity in the mortality rates between colonial Korea and Japan
during the Spanish flu pandemic raises a question as it relates to the importance of public
awareness in addition to the health-care infrastructure in combating a pandemic. Lim (2011)
and Park (2008) noted that the Japanese authorities failed to respond to the outbreak in a
timely manner in colonial Korea. This, coupled with the Japanese ruling body’s
underplaying of the fatality rate of the Spanish Flu being similar to the fatality rate of
seasonal flu, contributed to a higher number of deaths of colonial Koreans during the
Spanish flu (Hong and Yun, 2017). At the beginning of the outbreak, the Japanese mitigation
efforts in colonial Korea heavily relied on the use of the police coercing compliance with
public health measures, including a ban on large gatherings for religious or entertainment
purposes instead of an emphasis on social marketing communication to raise awareness
among colonial Koreans (Kim, 2017). There are archived materials written by reporters in a
widely circulated newspaper “Maeil Sinbo” urging readers to practice self-quarantine and
JSOCM
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90

Figure 3.
The poster entailing
the four rules of
preventing the
Spanish flu

self-hygiene sporadically (Song, 2020). We were not able to obtain any further
communication materials officially distributed by the Japanese authorities in colonial Korea,
perhaps indicating an insufficient investment in social marketing communication by the
Japanese authorities during the peak of the Spanish flu.
The Spanish flu in colonial Korea between 1918 and 1919 devastated the country,
infecting nearly half of the population and killing approximately 140,000 individuals
(Hong and Yun, 2017). Our review indicates that the governing Japanese authority failed to
execute effective communications targeting the education of the colonial Koreans on
behavioral guidelines that they could adopt (Lim, 2011; Park, 2008). Rather, the pandemic- Social
related initiatives focused on heavy policing, increasing the fear and confusion among the marketing
public, leading to delayed reporting of symptoms by the potentially infected and subsequent
treatment (Kang, 2018; Lim, 2011). This absence of targeted communication efforts, coupled
communication
with inadequate public health infrastructure in colonial Korea (Schofield and Cynn, 1919;
Park, 2008), resulted in mass casualties from the Spanish flu outbreak. Colonial Korea’s
Spanish flu case highlights that failure to raise public awareness is even more detrimental to
the more vulnerable, resulting in disproportionate deaths of citizens who are more 91
socioeconomically disadvantaged, as in the case of colonial Koreans during this time (Barro
et al., 2020; Ohmi and Suzuki, 2018).

The coronavirus pandemic in South Korea: 2019–2021

Socioeconomic context
The contemporary pandemic response by South Korea is now examined. At the time of the
outbreak of the COVID-19, South Korea was a sovereign country with a thriving economy.
Following the declaration of independence from Japan in 1945, the peninsula was separated
into two Koreas (South and North Korea). South Korea experienced rapid economic progress
throughout the 1960 and the 1970s, and urbanization buttressed by the strong performance
of construction and chemical sectors. In more recent years, the country has become a leader
in technology sectors such as information technologies (IT), appliances and consumer
electronics (Eichengreen et al., 2020). The population of South Korea is now estimated to be
52 million, and its size of the economy (US$2.03 trillion) and gross domestic product (GDP)
per capita (US$39,500) make the country one of the wealthiest today (Central Intelligence
Agency, 2019).
The health-care infrastructure in South Korea has also evolved as the country has grown
into a leading high-income country. The South Korean health-care system encompasses a
nationalized insurance arm, private health services providers, consumer groups and
regional/local governments. Koreans receive universal health-care coverage under a self-
payer system, National Health Insurance Services. Central public health programs such as
vaccination, food and drug safety assurance, health promotion and environmental
protection are also designed and executed by governmental entities – the Korea Advisory
Committee on Immunization Practices, the Ministry of Food and Drug Safety, the Korea
Health Promotion Institute and the Environmental Health Bureau in the Ministry of
Environment, respectively. The Korean Center for Disease Control is a key entity that is
involved with public health emergency response. Focused on research, surveillance and
monitoring, the Korean Center for Disease Control plays a central role in developing
responses to existing and emerging infectious diseases. As the country has undergone
economic growth, the overall health status of Koreans has improved. At birth, an average
South Korean is expected to live 82.7 years in 2017, which is higher than the average of
80.8 years by other OECD countries (OECD, 2020).

COVID-19 and social marketing

In 2019, the world faced the COVID-19 pandemic. Since the origin of COVID-19, South Korea
received increasing recognition for being able to contain the outbreak successfully while
minimizing the mortality rates as well as detrimental economic consequences (Sachs et al.,
2020; Huang et al., 2020). During the first wave of the pandemic (early 2020), while the rest of
the world struggled to suppress the spread of the virus, South Korea was able to manage (i.e.
“flatten the curve”) the spread without having to impose mandatory lockdowns (Sachs et al.,
2020). Rather, based on its robust surveillance and testing capacity, South Korea
JSOCM demonstrated an ability to control the number of newly infected cases and death rate at a
13,1 relatively lower rate compared to other high-income countries (Central Defense
Countermeasure Headquarters, 2020). The South Korean COVID-19 response was also
characterized by high public compliance with the guidelines imposed by the Korean public
health authorities (Sachs et al., 2020). This exceptionally high compliance can be partially
explained by increased public awareness enabled by extensive communication strategies
92 that focused on educating, thus engaging the public in pandemic mitigation efforts.
Surprisingly, behavioral recommendations for the COVID-19 were very similar to what
they were for the Spanish flu and other previous infectious disease outbreaks. People were
asked to practice personal hygiene, cover mouth and nose (wear a face covering), avoid
contact with symptomatic individuals and avoid large crowds. These guidelines have been
constantly promoted as general behavioral guidelines (Figure 4), while tailored behavioral
guidelines were communicated with the particular population segments such as those who
work in a restaurant industry (Figure 5) and those whose first language is not Korean
(Figure 6).
Notable attributes of South Korean COVID-19 communication strategies were
transparency and coherence (Choi and Powers, 2020). Since the beginning phase of the
COVID-19 pandemic, the South Korean government has prioritized transparency, fully
disclosing pandemic-related information to the public (Central Defense Countermeasure
Headquarters, 2020). South Korean pandemic mitigation efforts, including social marketing
communication, were led by the central government entity – the Central Disaster and Safety
Countermeasure Headquarters that was formed based on the collaboration between the

Figure 4.
A poster by the
Korean Center for
Diseases Control
outlining behavioral
guidelines to be
followed by
asymptomatic people
as well as by the
symptomatic people
 Social
marketing
communication

93

Figure 5.
A poster by the
Korean Center for
Diseases Control
outlining behavioral
guidelines to be
followed by workers
in the restaurant
industry

President’s office and the central public health arm – the Korean Centers for Disease Control
and Prevention. This center served as a centralized communication outlet responsible for
delivering daily briefings via various channels, including major television stations and
online media platforms. The contents of daily updates included virus-related quantitative
measures such as the accumulated number of confirmed cases, the accumulated number of
cases tested negative, the number of individuals quarantined, the number of individuals
who completed 14-day self-quarantine, the number of community transmission cases and
the number of deaths. The briefing also highlighted contact tracing information of
confirmed cases such as times and places where individuals with confirmed positive testing
for infection had visited. This was to encourage people who had been in the vicinity of these
individuals to be tested voluntarily. In cases of major community spreads that resulted in
mass infections, targeted and detailed contract tracing information was made available to
the citizens via various communication outlets (Central Defense Countermeasure
Headquarters, 2020).
In conjunction with the central government’s daily briefing on the pandemic at the
national level, regional- and city-level offices disseminated updated virus information on the
aforementioned items. They also supplemented the information that residents received with
more local information including adjacent health-care facilities where patients with
confirmed infections could be admitted and effectively treated, the status of testing for
individuals with suspected infection, detailed contact tracing information for individuals
JSOCM
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94

Figure 6.
A poster by the
Korean Center for
Diseases Control
outlining behavioral
guidelines to be
followed by
asymptomatic as well
as symptomatic
people whose first
language is not
Korean
with confirmed and suspected infection and a list of public spaces that were sterilized by the Social
officials and safe to visit (Choi and Powers, 2020). marketing
The South Korean COVID-19 communication efforts were constantly challenged by a
flood of conflicting information accelerated by social media channels. For instance, at the
communication
onset of the pandemic, some individuals and news channels started to spread false
information about the COVID-19 mortality rate being higher than it was for the bird flu,
which only exacerbated public fear amid increasing uncertainty (Central Defense
Countermeasure Headquarters, 2020). To prevent the public from being misled by false
95
information, thereby undermining the mitigation efforts, two major tactics were
implemented by the South Korean public health officials. First, the leaders in the Korean
Centers for Disease Control and Prevention served as spokespersons and ensured the
legitimacy of information shared by the authorities through speaking through diverse
communication channels. Second, the Central Disaster and Safety Countermeasure
Headquarters operated an online forum where prevalent conflicting information was
identified and corrected (Central Defense Countermeasure Headquarters, 2020).
The COVID-19 pandemic response, bolstered by the evolution of technology and health
systems, demonstrated effective pandemic management capabilities. Under the strong
leadership of the central government as well as public health authorities, South Korea
effectively enacted public health interventions, including mass testing, contact tracing,
orchestration of a network of health-care organizations for treatment (Sachs et al., 2020). In
addition, large-scale communication campaigns to raise public awareness throughout the
COVID-19 pandemic were effectively used. Throughout the COVID-19 pandemic, South
Korea has been able to manage the COVID-related death rate far lower compared to other
high-income countries. Between March 2020 and February 2021, the country’s COVID-19-

Spanish flu COVID-19

Behavioral guidelines  Cover mouth and nose (wear
mask)
 Avoid large gatherings
 Stay away (especially when
you are sick)
 Gargle
 Cover mouth and nose (wear mask)
 Avoid large gatherings
 Stay away (especially avoid
contact with symptomatic
individuals)
 Practice personal hygiene
(handwashing)

Major communication  Posters (in Japan)  Website

channels and success  Announcement in public  TV and social medial channels
factors spaces by prefatory officials  Detailed and structured
(in Japan) communication by public health
 Police officers (in Japan and authorities
colonial Korea) enforcing a  Coherent message delivery by
ban on large gatherings and different entities Table 1.
self-quarantining via home
visitations Comparison of
Spanish flu and
Barriers to public  Public fear caused by heavy  Spread of conflicting information COVID-19 social
awareness policing via social media platforms marketing
communication in
Korea
JSOCM related deaths per million population have been below 0.5 on average. Cumulatively, during
13,1 this period, South Korea has lost approximately 30 lives per million population, whereas
Japan has lost 56 lives per million population, and the USA has lost 1,480 lives per million
population (Roser et al., 2020). When compared to the devastation caused by the Spanish flu
a century ago, the deadly impact of the COVID-19 pandemic on the peninsula was better
mitigated (Table 1).
96
Discussion and conclusion
In this paper, actions taken in colonial Korea and contemporary South Korea regarding
social marketing communication strategies during the Spanish flu and COVID-19 were
reviewed based on a historical context and a social marketing basis. Social marketing has
been widely used to bolster engagement in public health interventions and policies (Kotler
et al., 2002) and bring about societal changes (Kennedy, 2016). An effective pandemic
response entails timely legislative actions, strong leadership, well-functioning health
systems and effective education and communication campaigns (Jones et al., 2010; Bedford
et al., 2020). This notion was largely evident in the historical review of the interventions
taken place for the Spanish flu and COVID-19 pandemics in Korea. Surprisingly, behavioral
recommendations for the two pandemics were nearly identical despite two events being a
century apart and the social context of two eras being starkly different. This was seen by the
promotion of almost identical behavioral guidelines, including social distancing, self-
quarantining, practicing personal hygiene and vaccinating during both Spanish flu and
COVID-19 pandemics in colonial Korea and contemporary Korea, respectively (World
Health Organization, 2020; Rice and Palmer, 1993).
The engagement of an informed public is an important antecedent to effective health
initiatives. The success of interventions targeted to lowering the mass infection rate and
subsequent deaths is largely dependent upon public compliance with the behavioral
modifications and guidelines suggested by health authorities (World Health Organization,
2020). Communication campaigns are a vital element of social marketing that contributes to
properly educating the public and increasing awareness (Jones et al., 2010; Dresler-Hawke
and Veer, 2006). The Spanish flu experience in colonial Korea highlights how the absence of
effective social marketing communication undermines public compliance with public health
guidelines and could potentially exacerbate the detrimental impacts of the outbreak. By
comparison, social marketing communication during COVID-19 in South Korea provides
clear evidence on social marketing communication’s critical role in informing the public
about the disease, thereby successfully engaging them in pandemic management.
After 100 years ago of the Spanish flu pandemic, evidence suggests that raising public
awareness was not a primary goal of the Japanese authorities in colonial Korea. Rather,
public health surveillance during this time was characterized by coercive police visitations
of individual homes to enforce the behavioral guidelines, instead of relying on a voluntary
change of behaviors enabled by increasing public awareness. In the contemporary
COVID-19 pandemic, on the other hand, the pandemic response included a heavy emphasis
on extensive social marketing communication centered around transparency and coherence
and enabled citizens to stay highly aware of the development of the outbreak, thus
motivating them to change behaviors voluntarily.
By historically comparing two global pandemics in Korea, this paper highlights two
major lessons for future pandemic social marketing communication that can bolster the
system-level success of pandemic responses. First, a full disclosure of the pandemic-related
information is important. From a social marketing perspective, conflicting information or
the absence of information often prevents individuals from voluntarily modifying their
existing behaviors (Grier and Bryant, 2005). The widespread uncertainty and conflicting Social
information among the public undermine the success of public health initiatives (Henry, marketing
2018). As demonstrated in the Spanish flu in colonial Korea, emphasis on policing the
communication
behavioral guidelines without sufficiently circulating disease-related information
heightened fear among colonial Koreans, resulting in disguising the existence of disease
symptoms by people, delaying treatment and resulting in excessive mortality. Whereas
during the management of the COVID-19 pandemic, South Korean authorities’ transparent 97
and coherent social marketing communication contributed to minimizing uncertainty and
fear among the public while building trust in leadership and public health authorities. This
trust resulted in South Koreans’ high degree of compliance with the policies and
interventions enacted by the authorities (Sachs et al., 2020).
Second, proper management of conflicting information is highly desired as an integral
part of pandemic social marketing communication campaigns. Heightened fear and
uncertainty attributable to the emerging nature are major characteristics of acute infectious
disease outbreaks (Jones et al., 2010). Amid soaring uncertainty, the circulation of conflicting
information also tends to increase. As it was evident during the Spanish flu pandemic in
colonial Korea, some behavioral guidelines without proven effectiveness were widely spread
(i.e. gargling). During the COVID-19 pandemic alike, incorrect information regarding the
disease (i.e. methods with which the virus is transmitted) was prevalent (Central Defense
Countermeasure Headquarters, 2020). The spread of conflicting information was accelerated
by the availability of various social medial platforms preventing conflicting information
from further spreading.
The Spanish flu and COVID-19 pandemics represent major historical events of the 20th
and 21st centuries, respectively. These two pandemics have revealed that the world should
continue learning and remain prepared for future outbreaks. Despite the 100 years between
two events, we can draw parallel implications relevant to these pandemic social marketing
communications. The historical comparison of the two pandemics in Korea provides a clear
lesson central to managing disease outbreaks is the importance of educating and engaging
the public through transparent and well-coordinated social marketing communications.
This research has shown that through a historical lens, we can better understand the present
by comparing it to related, but distant past events.

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Corresponding author
Seongwon Choi can be contacted at: schoi61@calstatela.edu

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