If people are to act responsibly they need their government to fulfil its own responsibilities to make safe behaviour possible, argue these authors
As formal restrictions on activity are lifted as part of the so-called “roadmap” out of “lockdown,” and as the new health secretary Sajid Javid vows that there will be no return to such restrictions after 19 July 2021, increasing emphasis has been laid on the need for people to be able to identify covid-19 risks and take measures to mitigate against them. [1,2]
The government has framed this shift in terms of exercising responsibility and demonstrating common sense. In his statement of 14 May 2021, the UK prime minister, Boris Johnson stressed that “it is more vital than ever that you play your part in stopping the spread.” [3] And he spelt out what this means in practice: “please get tested twice a week for free, get a jab if you are eligible; remember hands, face, space, and fresh air; observe social distancing from those you do not know; and if you are seeing loved ones think really carefully about the risk to them.”
This singular emphasis on the responsibility of the individual to act has two dangerous consequences. The first is that it suggests that problems with the pandemic derive from lack of responsibility and common sense on behalf of the public. [4] If people are infected, it is because of their own choices—to ignore mitigations, to socialise, to have parties. Hence, the narrative of blame which has persisted throughout the pandemic from the early concern about “covidiots,” to ex-health secretary Matt Hancock’s warning to students and young people not to do things that would “kill your gran” to his more recent explanation of the upsurge of infections in Bolton as due to patients who had “chosen not yet to get (vaccinated).” [5-7]
The second consequence of placing the emphasis entirely on what the public must do is that it takes the emphasis away from what the government must do. Indeed, in equating a sense of individual responsibility with doing the right thing, the prime minister implies that the things he asks for—getting vaccinated, getting tested, social distancing, getting fresh air—are all a matter of individual choice. This goes against what we know in general about health behaviours which are about having the necessary information, resources, and opportunities as much as the motivation to act in ways that keep oneself, ones family, and ones community safe. [8] It goes against the evidence from this pandemic which shows that differences in adherence to “lockdown” were more about being able to afford to stay at home than about personal choice to stay at home, and that the failure to self-isolate—or even to get tested—was more about the practical ability than the psychological will to do so. [9-11] That is why both SPI-B (the behavioural science sub-group of SAGE) and SAGE itself both called for enhanced support for self-isolation. [12,13]
Consequently, while it is quite right to propose that people should get vaccinated, tested, and observe covid safeguards, it is unhelpful to suggest that it is their responsibility to do so on their own. While the lifting of restrictions may lead to an increased emphasis on the public assessing and responding to risks to themselves and others, this cannot work if the UK government fails to provide (or worse, removes) the forms of support which are necessary for members of the public to act safely.
Let us illustrate this using two specific examples which relate to two key things we need to continue doing in the future. The first is the need to avoid stuffy indoor spaces and to improve ventilation. The second is the need to make sure that we get tested as soon as we develop symptoms and to self-isolate if infected.
As we learn more about the airborne transmission of the virus, so ventilation becomes an ever more important mitigation. [14] We must all relearn the importance of fresh air, to do things outside if possible and to allow air in through windows and doors when we have to be indoors. However, it is no good telling people to open windows if windows don’t open, as is the case in many public and private buildings—hence the need for ventilation grants for existing properties and ventilation standards for new builds ( New York, for instance, is planning to put two air purifiers in every school classroom). [15] It is no good telling people to avoid “stuffy” spaces if you can’t determine what is stuffy (Belgium, for instance, has made CO2 monitors mandatory in some public spaces). [16] It is no good ensuring public spaces are well-aired if people don’t know which spaces are well-aired (in New York, you can look online to see the ventilation status of every single classroom in the state). [17] And it is no good having information on which spaces meet ventilation standards unless you have regular inspections to ensure the information is and remains accurate. Equally, such inspections should include the space allowed for each person. All in all, there is much more to mitigating against airborne transmission than simply instructing individuals to ventilate the spaces they occupy.
Similar considerations apply to getting tested and self-isolating. People need to get tested at the first sign of symptoms. For that, they need to know the symptoms, listed on the NHS website as a high temperature, continuous cough and loss of smell/taste. [18] Only just over half of the population can name these, but to make matters worse, the symptoms of the now dominant Delta variant have changed, both excluding old criteria (loss of smell/taste) and including new ones (runny nose). [19] Without concerted information about what the symptoms are, how can one expect people to act on them? [20]
Provision of information must be complemented by provision of resources. You can’t expect people to self-isolate if they can’t afford to do so, you can’t expect people to provide contacts to tracers if they can’t afford to self-isolate, and you can’t expect people to get tested when a positive result traps them between the unaffordable costs if they do try to self-isolate and the unaffordable fines if they don’t. This goes a long way towards explaining the fact that less than a quarter (22%) of those who have symptoms request a test. [21]
If people are to act responsibly they need their government to fulfil its own responsibilities to make safe behaviour possible. A successful response has to be a partnership between government and the public. The fear is that when government talks about a “freedom day” when all restrictions are lifted, it doesn’t mean that the virus has gone away, and it doesn’t mean that measures are not needed to prevent a resurgence. Indeed, as Mariângela Simão of the World Health Organization (WHO) stressed at a 25 June press conference “vaccines alone won’t stop the community transmission and people need to continue to use masks consistently, be in ventilated spaces, hand hygiene, respiratory etiquette, the physical distance, avoid crowding.” [22] What it does mean is that the government is planning to withdraw all forms of support and abandon us to deal with the pandemic on our own.
Stephen Reicher, School of Psychology and Neuroscience, University of St. Andrews.
Susan Michie, Centre for Behaviour Change, University College London.
Ann Phoenix, Institute of Education, University College London.
Competing interests: SR and SM participate in the UK’s Scientific Advisory Group for Emergencies and its subgroups, and are members of Independent SAGE. SR participates in the advisory group to the Scottish chief medical officer. All are writing in a personal capacity.
References:
1. https://www.theguardian.com/world/2021/jun/28/sajid-javid-covid-restrictions-in-england-must-end-on-19-july
2. SPI-B paper, 25th June 2021 Sustaining behaviours to reduce SARS CoV-2 transmission
3. Retrieved from https://www.gov.uk/government/speeches/pm-statement-at-coronavirus-press-conference-14-may-2021
4. Williams, S. (2021) The UK’s coronavirus policy still places too much responsibility – and blame – on the public. British Medical Journal (Opinion). Retrieved from https://blogs.bmj.com/bmj/2021/05/26/the-uks-coronavirus-policy-still-places-too-much-responsibility-and-blame-in-the-hands-of-the-public/
5. https://www.theguardian.com/commentisfree/2020/sep/02/selfish-covidiots-blame-british-government-greek
6. https://www.bbc.co.uk/news/newsbeat-54056771
7. Retrieved from https://hansard.parliament.uk/commons/2021-05-17/debates/BEC589F3-7FE2-424E-A1ED-4BE5019D4F31/Covid-19Update
8. Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science, 6, 1-12.
9. Atchison, C. J., Bowman, L., Vrinten, C., Redd, R., Pristera, P., Eaton, J. W., & Ward, H. (2020). Perceptions and behavioural responses of the general public during the COVID-19 pandemic: A cross-sectional survey of UK Adults. medRxiv. https://www.medrxiv.org/content/medrxiv/early/2020/04/03/2020.04.01.20050039.full.pdf
10. Cevik, M., Baral, S.D. & Crozier, A. (2021) Support for self-isolation is critical in Covid-19 response. British Medical Journal, 372:n224. https://www.bmj.com/content/372/bmj.n224.full
11. Liverpool Covid-19 Commuity Testing Pilot: Interim Evaluation Report (2020)
https://www.liverpool.ac.uk/media/livacuk/coronavirus/Liverpool,Community,Testing,Pilot,Interim,Evaluation.pdf
12. SPI-B (2020) The impact of financial and other targeted support on rates of self-isolation or quarantine (16th September). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/925133/S0759_SPI-B__The_impact_of_financial_and_other_targeted_support_on_rates_of_self-isolation_or_quarantine_.pdf
13. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/931005/S0762_Fifty-seventh_SAGE_meeting_on_Covid-19.pdf
14. Tang, J.W., Marr, L.C., Li, Y. & Dancer, S.J. (2021) Covid-19 has redefined airborne transmission. British Medical Journal, 373, n913. https://www.bmj.com/content/373/bmj.n913
15.https://ny.chalkbeat.org/2021/6/23/22547814/all-classrooms-to-have-2-air-purifiers-next-year-new-york-city-officials-pledge
16. https://news.in-24.com/news/56243.html
17. https://www.schools.nyc.gov/about-us/reports/building-ventilation-status
18. https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms/main-symptoms/
19. https://news.sky.com/story/covid-19-only-half-of-people-know-the-main-symptoms-and-most-who-have-them-dont-get-tested-or-isolate-study-finds-12261819
20. https://www.bmj.com/content/373/bmj.n1596/rr-1
21. Smith LE, Potts HWW, Amlot R, Fear NT, Michie S, Rubin GJ. Adherence to the test, trace, and isolate system in the UK: results from 37 nationally representative surveys. BMJ. 2021;372:n608
22. https://www.who.int/publications/m/item/covid-19-virtual-press-conference-transcript—25-june-2021