Pandemic Ready: Safeguarding Our Future Through Preparedness

Recommendation 5: Integrating the behavioural sciences and a focus on inequalities

The Committee’s Interim Report noted the work done on behavioural interventions and community engagement. It concluded that “Responses to future threats should be designed and delivered in such a way as to consider knowledge, capabilities, attitudes and behaviours, and the environments and circumstances in which people live and the groups most likely to be affected. No amount of pandemic planning will succeed if interventions are not understood, accepted, and supported by the public.”^[24]

A clear lesson to come out of the COVID-19 pandemic concerns the importance of behaviour – and hence of behavioural science – at a systemic and policy level. Before vaccines were developed and rolled out, the primary means of limiting infection transmission was to limit close physical contacts between people. A clear priority was therefore to promote physical distancing whilst at the same time, understanding, limiting and mitigating against the harms of social isolation. Even after the vaccines were distributed, this did not end the contribution of behavioural science. On the one hand, vaccines were only beneficial if people were willing to get vaccinated. On the other, the benefits of vaccination, however substantial, did not remove the importance of getting tested, participating in contact tracing, and self- isolating if infected. The advent of the vaccines therefore emphasised rather than removed the need for behavioural science.

Critically then, the relationship between the contribution of behavioural sciences and the contribution of medical and life sciences to the pandemic response is not a zero-sum game. Rather, each raises and answers questions for the other. Medical understanding helps define the key behaviours which need to be addressed in order to reduce infections. Behavioural science helps identify the levers which can be used to maximise those behaviours. This relationship was recognised in the multi- disciplinary composition and functioning of the Scottish Government Covid Advisory Group (C19AG) during the pandemic. The effectiveness of these arrangements is, in itself, an important learning point for the future and should inform the workings of the Partnership. Building resilience to misinformation also forms a core part of this and the Committee has included this in its recommendation of key priorities for the Partnership.

During the initial COVID-19 response there were some concerns that the public would be the weak link in the pandemic response as individuals would be unable to comply with the stringent measures necessary to contain the spread of infection. In the event, levels of adherence were extremely high and, even if they declined a little over time, they remained high throughout the pandemic. The key determinant of resilience was not individual lack of capacities. Rather, it had to do with the nature of social relationships between people and the emergence of ‘community’ which impacted the motivation to adhere, combined with adequate information and resources which impacted the ability to adhere. A number of studies^[25] have pointed to the critical role of trust – both trust in Government and trust of the public in each other – in determining the effectiveness of pandemic responses. Some studies suggest that it played a greater role than medical preparedness.^[26] Trust itself derives from the sense that the other is acting with and for you – in other words, trust is a function of developing a sense of community.

The experience of the COVID-19 pandemic demonstrated a number of other benefits of community, including adherence, support for others and, not least, psychological resilience in the face of the effects of COVID-19 and COVID-19 protective measures. An example of the role of this could be seen in the emergence of mutual aid groups in which it is estimated some 12-14 million people participated across the UK and which performed many key roles which were beyond the capacity of Governments.

A key question for future preparedness should therefore be how to develop and sustain the sense of community and trust. There are multiple elements to the answer, but the core lies in a partnership approach in which Governments are aware of the issues and barriers facing diverse publics in adhering to crisis measures and take action to address these. In this way support serves both to enable and to motivate adherence. Moreover, support is critical both in terms of direct assistance to members of the public but also in terms of assistance which enables members of the public to help each-other. While mutual aid groups made a considerable impact in the first wave of the pandemic, the burden of keeping them going led to a sharp decline during the subsequent waves. In order to enable the creation and maintenance of mutual aid in a crisis, there is a need to provide advice, expertise and resources for groups to form quickly and function effectively. This process should work with and through existing community anchor groups. Alongside this, engagement processes should be developed which include all sections of the public including those who are most marginalised, and which is sufficiently flexible and fast-acting to feed into policy decisions in a fast-moving crisis.

A core mission of the Partnership should also be to build an understanding of the impact of inequalities to inform pandemic preparedness and response, including building on learnings from COVID-19 such as developing our understanding of drivers contributing to areas of enduring transmission. This ties to the necessary improvements in data which are dealt with under recommendation three in this report. This work should examine both the structural inequalities that influence vulnerability of certain individuals and groups to a pandemic and the inequalities that emerge during a pandemic. It is also important to expand the impact assessment process for scrutiny of crisis policies in order to go beyond the impact on diverse communities and vulnerable groups and identify the specific barriers to adherence for different groups amongst the public and the information and resources necessary to overcome those barriers. An overall process should ensure that this is done for relevant existing policies as well as for new proposals.

It will be essential for this work to be integrated with the other aspects of the Partnership.

5. Integrating the behavioural sciences and a focus on inequalities into future pandemic preparedness

We recommend that:

A. the SG develops a rapid assessment process which scrutinises crisis policies’ impacts on marginalised and vulnerable communities;

B. the Partnership work with the SG and PHS to create a rapid response mechanism to identify and address the cross-cutting challenges posed by misinformation around pandemics; and

C. the Partnership works with community anchor groups to provide advice, expertise and resources to enable the maintenance of mutual aid in a crisis and to develop a flexible and fast-acting engagement process which includes those who are most marginalised.