By Karina Toledo | Agência FAPESP – In coping with a disease as highly transmissible as COVID-19, human behavior can be part of the problem and part of the solution, according to experts in social and behavioral sciences. Until a vaccine or effective treatment becomes available, compliance with measures such as social distancing, mask-wearing, frequent hand hygiene, and disinfecting of surfaces and objects continues to be the main way to stop the disease from spreading. Why are some countries dealing with this challenge so much more successfully than others?
Scientists from Brazil and several other countries shared their findings on this topic on November 4 in an online seminar entitled “Values-Based Behavior under COVID-19”. The event was part of FAPESP’s series of COVID-19 Research Webinars.
For Jay Van Bavel, Associate Professor of Psychology and Neural Science at New York University in the United States, national leadership is a key factor in determining the quality of the response to the pandemic, which involves nationwide measures such as border closure, travel bans, public policy development, and the deployment of national medical and scientific resources. Countries with what he called “identity leaders”, who inspire trust, promote cooperation and instill a shared sense of identity, enjoy an advantage, he said, citing as an example the leadership of New Zealand Prime Minister Jacinda Ardern.
“Jacinda Ardern may be the most effective leader on the planet, especially in the way she has handled COVID-19,” Bavel noted. “She has become famous for using identity leadership, referring to New Zealanders as her ‘team of 5 million people’. In the early stages, once they had gotten the pandemic under control, she wanted to show it was safe and went out for brunch, but there wasn’t enough space at the restaurant because of distancing, so she left and waited. She didn’t just take a table and do a photo op. Other leaders do photo ops in crowded places or behave in risky ways that clearly violate good identity leadership, signaling that they can play by different rules. They set a different behavioral model.”
An example is the United States, which has more COVID-19 cases and deaths than any other country. “By many accounts, we have amazing research teams, world-class universities, leaders in vaccination, and pharmaceuticals. Yet we have failed catastrophically,” he said. “Why are we seeing these differences?”
To answer this question, his research group tracked 15 million people in 3,000 counties across the US using smartphones, every day for several weeks, to see how they were moving. Compliance with the social distancing guidelines was higher in parts of the country where Democrat presidential candidate Hillary Clinton won more votes in 2016 than in those favoring Republican candidate Donald Trump. What they saw was a consistent pattern: Democrats were engaging more in social distancing than Republicans from late April onward. It was a “partisan gap” between “two identity groups”, Bavel said.
“Counties that voted for Trump over Clinton in 2016 exhibited 14% less social distancing on average,” he stressed. “These same counties were the ones that had the highest spikes in infection and mortality ten days to two weeks later.”
To look at social behavior relating to the pandemic on a broader scale, in April-May Bavel led an online survey involving 46,500 volunteers around the world designed and conducted in collaboration with researchers at 170 institutions. Among them was Paulo Boggio, a professor at Mackenzie Presbyterian University’s Center for Biological and Health Sciences (CCPS-UPM) in São Paulo, Brazil. Boggio also presented to the webinar organized by FAPESP.
The survey was designed to find out, via a questionnaire translated and administered in 67 countries, what led people to comply with health guidelines and support restrictive measures such as closure of bars, restaurants, and schools. The conclusions were that people who identify with their nation and are concerned about its problems are more likely to accept restrictions on their freedom and support measures designed to keep them safe.
“National identity was shown to be a robust predictor of all the health behaviors associated with combating the pandemic,” Bavel said. “We took care to distinguish between national identification in a positive sense [most of the public identifying with their nation and its leadership rather than polarization and conflict] and national narcissism, or what some call populism, where people have an inflated view of their country, often aggressively believing it’s better than every other country. Such people feel threatened by the notion that the pandemic is out of control in their country, so narcissistic nationalism wasn’t such a good predictor of compliance with health measures. In fact, in some cases, such as the US, it was associated with risky behavior.”
The designers of the questionnaire also decided to measure the influence of political ideology. “We wanted to see if this was a conservative or liberal issue or neither,” Bavel said. “Globally speaking, respondents who self-identified as liberals or progressives tended to be slightly more supportive of policies to prevent the spread of the disease than conservatives. It’s different from the effect of national identity and much smaller.”
The complete results of the survey are published on PsyArXiv, a preprint platform for articles on psychological sciences that have not yet been peer-reviewed. The authors note that prior research has shown national identity to play an important role in motivating people to engage in behavior that is costly but benefits other members of the community.
Understanding this relationship between individual and collective gains and losses is crucial if the goal is to promote cooperation and a global effort, Boggio stressed at the start of his talk.
“It’s often thought that one person’s loss entails another person’s gain. That’s what we call zero-sum thinking,” Boggio said. “But how does this thinking help us solve global problems like pandemics or climate change? In such cases, the sum is evidently different from zero. Infection is a threat to the infected individual and everyone around them, so one person’s loss is another person’s loss and the sum is negative. The reverse is also true: if I gain by complying with public health measures, you and many others do too, so the sum is positive.”
According to Boggio, when individual behavior affects collective health, the decision-making process takes place in the sphere of morality. In the case of COVID-19, however, there is the extra ingredient of uncertainty about the risks associated with certain kinds of behavior, such as not wearing a mask in public spaces, for example.
“Evidence from the scientific literature suggests people are less willing to make sacrifices when the benefits to others are uncertain, so how we inform people about risks and offer guidance on handling the problem makes a big difference,” he said. “It’s really important for political leaders and the media to promote cooperation by highlighting pro-social behavior. Studies have shown that valuing people who cooperate increases the likelihood of their continuing to cooperate and also acts as an incentive for others to cooperate. On the other hand, the existence of free riders and lack of sanctions for anti-social behavior may reduce cooperation even among those who are already engaged.”
Among the challenges we currently face, he continued, is the signal-to-noise ratio in communication about the pandemic. It is vital to make sure that the message, or signal, gets through despite the noise from fake news and conspiracy theories. “It’s become hard to identify the signal, as so many conspiracy theories are accepted as fact,” he said. “Some are simply silly, but others fuel prejudice and polarization, or can have damaging consequences for public health, as exemplified by anti-vaccination messages.”
In addition to fighting noise by “breaking up these echo chambers”, as he calls the networks that spread misinformation, Boggio advocated “improving signal quality by increasing the persuasiveness of the message. The first step is to have trustworthy leaders and credible figures to convey the message to the public.”
The extent to which people comply with public health guidelines and pandemic control measures varies hugely not only from one country to another but also among different groups or regions within the same country. For Ortwin Renn, Scientific Director of the International Institute for Advanced Sustainability Studies (IASS) in Potsdam and Chair of Environmental Sociology and Technology Assessment at the University of Stuttgart in Germany, psychological, socio-political and cultural factors explain this variability.
Starting with psychology, Renn said there is evidence that a third to 40% of people tend to prefer flight over fighting when faced by a major threat, even if this behavior is physically risky, entailing dehydration, say, or malnutrition for fear of leaving a place chosen as a refuge, for example. Between 10% and 15%, on the other hand, prefer to fight the threat.
In the case of COVID-19, they cannot fight the virus directly because it is so small and they are not scientists, so they look for scapegoats to attack, such as foreigners or people with a different ideological position, be it to the left or right. A third group consists of people who try to ignore the threat and behave as if the threat did not exist. They include so-called “superspreaders”, who believe they are invulnerable to the novel coronavirus and contribute to rising contagion.
“Any kind of government action or communication needs to take these three basic response patterns into account,” Renn said. “People who prefer to flee, to go somewhere remote or shut themselves up at home, for example, need encouragement to go out to buy food and medicine, see a doctor, and so on. In the case of those who prefer to fight, you have to see if they’re actually attacking things that have nothing to do with the virus, while the third group should be strongly warned that even if they feel invulnerable they can still be carriers of the disease and responsible for contagion.”
Stark social and political polarization in the United States and Brazil, as well as other countries, is one of the factors that undermine compliance with health guidelines, he continued. “In these countries, the debate focuses not on the effectiveness of the measures but on the virus itself, on whether it’s a threat at all,” he said. “There’s a social division between those who advocate a return to business as usual and those who believe in the need to take preventive action. We see echo chambers and other phenomena in the social media, where some groups claim the pandemic isn’t a threat and isn’t important, while others insist that it is, or espouse conspiracy theories because they can’t live with the uncertainty.”
Turning to cultural factors, Renn argued that countries could be considered more collectivistic or more individualistic in terms of mentality. In his view, most East Asian countries had very little difficulty in containing the pandemic after the first wave, “whether they are democratic like Japan, South Korea, and Taiwan, or autocratic” like China.
“What they all have in common is that the collective good is paramount. They have a culture that encourages citizens to behave in the public interest. That includes both mask-wearing or distancing, and accepting all kinds of electronic devices that detect possible contamination,” he said. “In countries like mine [Germany], this isn’t acceptable. Even in the face of a threat like COVID-19, this is considered a violation of privacy and freedom.”
Also in connection with cultural differences, Renn noted that in countries like Sweden, Norway, and Denmark the public basically trust the government, and this contributes to voluntary compliance with health measures. In France, Italy, Germany, and the United Kingdom, the government is trusted by most people, but more effort is required to persuade citizens that preventive measures are effective, proportional to the threat, and fair.
“In Europe generally, 70% to 80% of people believe the measures are effective, proportional, and fair. Some 20% have doubts, with 5% to 6% of this group thinking they’re not fair or effective and opposing them,” he said.
Renn also stressed that people become accustomed to the crisis as time passes and tend to stop complying with restrictive measures. “We call this ‘the recalibration of normality’: it becomes normal to live with the virus all around us and it becomes harder to make a judgment about the proportionality of the preventive measures,” he said. “My view of the future is basically that unless we have a very effective vaccine forthcoming, in which case things will change dramatically and we can go back to what we consider normal before the pandemic, compliance rates will gradually fall even if there is a third or fourth wave.”
To understand individual variations in responses to the pandemic, Martha Hubner, a professor at the University of São Paulo (USP) who specializes in behavior analysis, invoked a formula known as three-term contingency (antecedent stimulus, response, and consequence), noting that the “behavior we’re analyzing here is a natural phenomenon and is selected by its consequences”.
Turning to COVID-19, she said “the problem is that the consequences of people’s behavior – the most important part of the three-term contingency – don’t appear obvious or immediate. If a person wearing a mask asks you to wear a mask, you can comply, but the consequence of your compliance isn’t right there. You’re not sure the natural consequence is that you’ll be protected, for example”.
Hubner also noted that dealing with the pandemic requires the assimilation of many new responses, and simply transmitting information is not enough. The new forms of behavior need to be trained, shaped, and socially stimulated. She stressed the need for positive reinforcement to show that the right behavior has desirable consequences.
“Responses may prompt incongruous or undesirable feelings. Having to stay away from your loved ones, for example, is hard to assimilate. These are all measures that take time to become stable. People have to be constantly trained. The rules have to be simple and uncontradictory, and they have to be communicated in familiar language that people can trust. Science needs to talk to the public all the time,” she said.
The webinar was moderated by Deisy Souza, a professor at the Federal University of São Carlos (UFSCar). The event opened with a welcome address by Luiz Eugênio Mello, FAPESP’s Scientific Director. The complete webinar can be watched at: www.youtube.com/watch?v=VgnF-wkPguI&t=6185s.