"There's no question of heroism in all this. It's a matter of common decency. That's an idea which may make some people smile, but the only means of fighting a plague is — common decency." Albert Camus, The Plague.
Covid-19 is a human-centred crisis that demands a human-centred solution. As well as the heroes in the NHS and other frontline services, we also need a population-wide commitment to “common decency”, such as following government guidelines on keeping our distance.
So it seems fair to assume that a deeper understanding of human behaviour – via psychology and behavioural research – should play its part, alongside epidemiologists, virologists and others.
Evidence from the world of behavioural science can inform policy – and better public health communication strategies. “You can have all the physical science in the world but risk losing much of the value of that input if you don't actually understand how and why people are going to react to risks in their environment,” according to Brooke Rogers, Professor of Behavioural Science and Security at King’s College London, and Chair of the National Risk Assessment Behavioural Science Expert Group at the Cabinet Office.
For example, it’s important to understand how people responded to past pandemics such as swine or avian flu, the psychological impact of quarantine and how to reduce it, and the risk of rioting and public disorder. Studies on these topics have fed into the Scientific Advisory Group for Emergencies (SAGE), via the Independent Scientific Pandemic Influenza Group on Behaviours, with the ominous-sounding acronym of SPI-B. SPI-B provides advice aimed at “anticipating and helping people adhere” to interventions that are recommended by medical or epidemiological experts, and have published evidence on behavioural and social interventions that informs SAGE and an “evidence list” on behavioural science.
However, there has been criticism circulating around Twitter and the blogosphere, with headlines such as “Don’t trust the psychologists on coronavirus” or “Why is the government relying on nudge theory to fight coronavirus?”
An open letter from 600 behavioural scientists questioned evidence around so-called “behavioural fatigue" on social distancing in the early stages of the pandemic. “If you tell people to stay at home too early,” the government’s Chief Scientific Advisor Patrick Vallance said at a press conference on 12 March, “they get fed up with this at the very point where you need them to stay at home.”
But it was unclear exactly what the evidence or policy was around the delay of the lockdown. As the authors of the open letter admitted, their target was unclear: “a lack of transparency from the government has made it hard to discern what the official policy is”.
The real issue may be about transparency of evidence. The campaign group Sense about Science has called for a public website for evidence on the government’s evolving thinking around policies such as testing. Being upfront with the public is crucial to maintaining trust.
The lesson from psychologists reviewing avian and swine flu is that “communication strategies should maximise levels of trust amongst the public by being open and transparent in order to maintain the credibility of the information provided.”
But as anybody who has worked in government will tell you, it’s inevitable that some emergency policy thinking is done behind closed doors. Those involved right now will be struggling to find time to sleep, let alone have a protracted public dialogue over social media, as suggested in a Nature editorial. Time is of the essence, and history may show that countries like the UK, US and Sweden didn’t move fast enough.
However fast the high-quality evidence is created and curated, it counts for little if it is ignored. A big contribution from the sciences of the mind is how to communicate evidence. Online experiments by the Behavioural Insights Team, who have been part of the SAGE government advice, showed how bright infographics and minimal text helps make handwashing posters more effective. We also need to understand why some groups don’t follow advice, such as young men who are more likely to ignore public health guidance. Knowledge does not equal changed behaviour. Indeed, some studies on responses to avian flu in the Netherlands and Hong Kong found that ignorance was more highly correlated with good preventative behaviour.
The important point is to avoid just a dissemination model of pushing out guidance, through adverts, letters through doors, or press conferences. Our “Science of Using Science” project, funded by the Wellcome Trust, stressed the need for a cocktail of measures, working at different levels, from individual to society at large, and recommended the COM-B framework of behaviour change: where people need to have the requisite capability, opportunity and motivation (COM). Unless you can tick all three of those areas, the behaviour is not going to happen, according to psychologist Professor Susan Michie, who created the framework and is a member of the SPI-B behavioural science advisory committee. For example, if the policy is to make people stay at home, it means ensuring “capability”, such as providing Universal Credit for the newly-unemployed; “opportunity” might mean a roof over the head of the homeless; and “motivation” might mean nurturing a sense of common purpose to “flatten the epidemic curve”, and relieve the burden on the NHS.
Motivation is going to be crucial for the coming months. The public is, eventually, going to have to leave their homes, and go back to work. And the virus will still be among us. So, we are going to have to figure out how the public can still help. Collectivism, helping our neighbours, volunteering and appeals to the common good will be needed. Framing public messages that stress “empathy appeals”, and a community working together, can do something to mitigate the effects of a crisis.
Researchers working on human behaviour can be a part of understanding how we can create the best possible environment for common decency. They can point policymakers and public health officials in the right direction. But they can only give pointers. The rest is up to us.
Jonathan Breckon is Director of the Alliance for Useful Evidence at Nesta and a Visiting Senior Research Fellow at the Policy Institute, King’s College London.