We Need to Focus on the Science of Human Behavior to End COVID Pandemic

 A person walks by a sign that reads "One small ask, please wear a mask." New York City, May 27, 2020.   Image: Rob Kim/Getty
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 A person walks by a sign that reads "One small ask, please wear a mask." New York City, May 27, 2020.   Image: Rob Kim/Getty

What a relief to see the resumes of President-elect Joe Biden’s COVID-19 advisory board, a cross section of well-respected experts in infectious diseases, epidemiology, vaccines and more with experience in patient care, ethics, logistics, policy and even national security.

The list, however, contains a glaring omission: A behavioral scientist, someone versed in human behavior and how it can be influenced.

Throughout this pandemic, without preventive treatments or vaccines, the only tool to avoid the spread of COVID-19 has been changing how we behave: Wearing masks, socially distancing, reducing the size of indoor gatherings, washing our hands, avoiding unnecessary travel. Some of these shifts have come through a top-down approach of policies and mandates, while others have relied solely on individuals taking individual responsibility.

The verdict is in: While in some places we have seen some success, overall, this has been a spectacular failure. Instead of just a small number of cases and deaths, the US leads the world in both with 17 million cases and more than 310,000 deaths.  

We know that good, high-quality information shared by trusted sources is a huge first step toward getting people to change their behavior—for mask wearing to become a social norm, for example. The CDC’s current guidelines implore everyone over the age of 2 to wear a mask when in public or around anyone who isn’t part of their immediate household. But the current president, who as the nation’s leader holds great sway, has refused to wear a mask himself or give a real endorsement of the behavior.

North Dakota, where the death rate per capita made it one of the most dangerous places in the world in November, saw its case rates halved after the governor finally mandated masks and reduced capacity at businesses.

To change behavior, we need to make it easier for people to do what we ask of them. Conflicting messages from the highest levels has made every COVID-related decision more difficult for individuals to make.

Now, as we enter the vaccination phase of this pandemic, communication around vaccine policy and roll-out and to build confidence in and acceptance of the vaccine will be paramount, especially in this era of wavering trust in science. With significant populations clearly hesitant to accept the vaccine, it is at least as important now as in previous phases of the epidemic.

It’s time to put science behind our communication, just as we have put science behind tackling this devastating disease. Developing a vaccine and a logistical plan for dissemination won’t have the desired impact if we don’t use all that we know about behavioral science to convince the public to choose vaccination for themselves and their families.

For their part, former presidents from both parties—Bill Clinton, George W. Bush and Barack Obama—have volunteered to be publicly vaccinated to show that these new vaccines are safe, with the message that you, too, can protect yourself from a devastating disease. This show of leadership and solidarity is a great start.

But that is just one step. Behavioral science helps us understand what motivates people and how their social circles influence their behavior. We know many people will not just jump at the chance to be vaccinated because we ask them to, as the recent history of vaccine hesitancy in the US demonstrates.

We are starting from behind. A recent survey of New York City firefighters—whose infection rate from COVID-19 has been 15 times the general public—found that just 45% would get the vaccine. Likewise, only 47%  of adults in the US said they would definitely opt to get the vaccine in another recent AP survey. Experts estimate at least 70% of the US population needs to be vaccinated to hold the virus in check. A vaccine only works at the population level if people are willing to receive it.

Whose voices will they listen to? Scientists and government do have a role to play. But as we have learned in the Johns Hopkins Center for Communication Programs’ work across the world, local information and context are key. That means engaging local leaders, religious organizations and community groups hoping they can bring the messages into even smaller social circles where people can positively influence those they are closest to.

This kind of massive behavior change is possible. Take truth®, a national smoking prevention campaign for youth from the early 2000s. By highlighting deceptive tobacco industry marketing tactics and stark facts about the deadly nature of cigarette smoking, researchers estimate that after seeing the campaign nearly half a million fewer teens took up smoking. There are many other examples as well.

One of the things we have lacked from the beginning of this pandemic is a coherent communication strategy for COVID-19. If anything, it has felt like a chaotic disinformation strategy. Now is the time for a national, coordinated strategic approach, a transparent approach that makes clear what the science tells us, that the science will continue to evolve and helps people understand how crucial it is for everyone to be vaccinated. And that won’t happen unless the president-elect is listening to experts in how to change behavior on a massive scale.

 

Susan Krenn is executive director of the Johns Hopkins Center for Communication Programs, which focuses on social and behavior change approaches in health.

For the latest, most reliable COVID-19 insights from some of the world’s most respected global health experts, see Global Health NOW’s COVID-19 Expert Reality Check.

 

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