While the world awaits with bated breath the arrival of a safe and effective vaccine for Covid-19, we have to make do with an alternative approach, a “behavioural vaccine”. The only key available to us right now to slow the spread of Covid-19 is widespread public adherence to behaviour-based public health policies being implemented around the world.
As Ireland moved last week to Level-5 restrictions, we are being asked again to engage with behaviours which come at a significant personal, social and economic cost. We know from data provided by the Amárach Public Opinion Tracker that people in Ireland have consistently reported high levels of compliance with, and support for, restrictions since the outset of the pandemic. However, we also know that public patience for more restrictions is being tested. An Amárach poll for RTÉ’s Claire Byrne Live last week showed that about 20 per cent of people claim they are less willing to go along with restrictions during this second lockdown. It also showed a significant proportion of people, as high as 50 per cent among younger adults, who are concerned about their ability to cope psychologically this time around.
Hospital Report
Behavioural science has much to contribute to informing the public health response to Covid-19. Behavioural science seeks to understand the factors that influence behaviour, with the goal of developing evidence-based interventions and policies. One of the great strengths of behavioural science is that it uses evidence and a scientific approach to challenge some of the “common sense” beliefs we have about how to change human behaviour.
Counterproductive messages
A good example of such a common sense claim is that threatening people with punishment will increase adherence to public health guidance. Evidence from both psychology and economics suggests that authoritative and punitive approaches in this context are at best ineffective – and at worst counterproductive.
Imposing fines may aggravate existing inequalities by unfairly targeting those least able to pay
An international study, called iCare, has surveyed Covid-19-related attitudes, concerns and behaviours since the outset of the pandemic among 65,000 people living in 140 countries, including Ireland. When asked which measures convince them to adhere to public health restrictions, people consistently say that threats of fines and arrest are the least persuasive.
This has crucial implications for government policy and communications strategies. Not only are penalties not likely to be effective, they may have unintended consequences of damaging social cohesion and collective willingness to engage with the restrictions. For example, imposing fines may aggravate existing inequalities by unfairly targeting those least able to pay. There is also evidence that the requirement of policing fines increases antagonistic interactions between police and citizens. This has the potential to provoke social disorder and conflict.
Motivation is probably the most important factor in determining whether people are likely to adhere to guidance
So what measures will maintain high levels of adherence to public health guidance at this time? In behavioural science, we know that to change any behaviour, a person needs to have the capability, opportunity and motivation to do so.
Capability involves having the knowledge and skills to do what is needed. For example, clear and specific guidance on what exactly people need to do in relation to Covid-19 testing and self-isolation is an essential prerequisite to following the guidance.
However, information alone is rarely enough. People’s physical and social environments need to provide the opportunity to adhere to restrictions. For example, employers need to facilitate employees to seek Covid-19 testing when necessary and self-isolate when required.
Powerful motivators
Motivation is probably the most important factor in determining whether people are likely to adhere to guidance. Approaches which promote solidarity, trust and a sense of a shared goal are highly motivating. “Protect each other” messages, stressing how adhering to guidance benefits society and protects its most vulnerable members, schools and the health services, are very compelling. People living in Ireland reported high levels of solidarity during the initial response to Covid-19 back in March. Eight months later, these are still powerful motivators.
Providing a convincing longer-term strategy is critical to sustain motivation. The narrative matters. We know from national and international surveys that large proportions of the public are willing to adhere to restrictions, as long as they remain convinced by the strategy which underpins the guidance. Back in March, we aimed for and achieved the goal of “flattening the curve”. However, this time round, the goal is murkier. The Government’s Living with Covid-19 plan proposes a strategy where we raise the levels of restrictions when transmission of the virus is high and out of control, to bring infection levels down again at which point we can ease restrictions.
The 'we are all in this together' message becomes vacuous if we're not really all in this together
Currently, our tantalising promise after six weeks at Level 5 is to buy ourselves time to enjoy more normality over the Christmas season. This may well be motivating enough for many people. However, if the next year holds a cycle of oscillating between high and low levels of Covid-19 infection and resulting changes to restriction levels, it will become more challenging to get people to buy in to the goal. We need to encourage discussion and debate about our strategy. Is it really so unfeasible to aim for aggressive suppression of the virus with the ultimate goal of elimination of Covid-19 in Ireland? The answer to this question is likely to shift over the coming months, as priorities and attitudes evolve in response to the reality in which we find ourselves.
Finally, the process which governments use to decide, communicate and support public health restrictions is critical to their success. The “we are all in this together” message becomes vacuous if we’re not really all in this together. That means men and women, members of marginalised groups in society, people of all ages, people with disabilities and those with mental health problems. We need to hear diverse voices in the Covid-19-related debate and policy. We know from behaviour change research that engagement with key stakeholders in a meaningful way to develop and implement interventions means they will be more effective. Establishing processes which enable leadership from all sectors of civil society will serve us well into 2021.