COVID-19 has shocked the world and requires constant vigilance; but until the roll-out of safe and effective vaccines (of high-uptake), we should not easily revert to life prior to the pandemic. Public support for mitigation measures have been remarkable; still, as expected, signs of pandemic fatigue are reported throughout the world. Published and unpublished in-country population surveys show that the degree of individual vigilance, among those that previously adhered to protective behaviours and stayed informed of COVID-19, is waning.
As the pandemic continues to threaten local and global health, novel strategies and efforts by governments are necessary to invigorate public vigilance. This is crucial now, as fast spreading mutations have been identified and countries are experiencing resurgence of cases during the unpredictable winter season. The implications of people meeting across generations and geographical distances for year-end holidays have still not been fully revealed, and it is not yet known if the introduction of vaccines will lead to complacency and reduced adherence to recommended behaviours.
While a few countries have been able to introduce a vaccine, the prospects of a world with sufficient immunity are still likely many months away.
From the onset of the pandemic, the WHO Regional Office for Europe (WHO Europe) has initiated work on behavioural and cultural insights related to COVID-19, such as publishing a WHO Tool for Behavioural Insights on COVID-19 used by 29 countries and areas in the Region to understand public perceptions, behaviours and wellbeing and to inform their pandemic response strategies.
To address this need, the WHO Europe released a framework with considerations for governments to invigorate public support, drawing on behavioral insights survey data as well as pre-COVID-19 literature related to public health, health crises, resilience, trust, risk perception, cultural contexts, communication and more. The framework has been reviewed by 20+ peers, including Member State representatives and topic experts.
Pandemic fatigue is not well-defined in literature. In the framework we define it as distress as a reaction to sustained and unresolved adversity which may lead to complacency, alienation and hopelessness. We say that it emerges gradually over time and is affected by a number of emotions, experiences and perceptions.1,2,3,4
Given this complex nature of pandemic fatigue, a multifactorial action plan is needed in each country with tailored interventions to the unique context, taking into account the epidemiological as well as public health, societal, cultural and economic situation. Actions must be based on the barriers and drivers experienced by various population groups. The intention is not to place the responsibility to contain the virus on populations alone, nor to refrain from national or regional pandemic control measures when they are called for. On the contrary it is for governments to alleviate the adverse impacts of these measures through careful planning, implementation and communication and through additional social protection measures and policies to ensure that no one is left behind.
Supporting the development of such action plans, the framework proposes four key strategies:
- Understand people: Collect and use evidence for targeted, tailored and effective policies, interventions and communication.
- Engage people as part of the solution: Find ways to meaningfully involve individuals and communities at every level.
- Allow people to live their lives, but reduce risk: Wide-ranging restrictions may not be feasible for everyone in the long run.
- Acknowledge and address hardship: Find ways to recognize and alleviate the profound impact the pandemic has had on their lives.
The framework also identified five cross-cutting principles that strengthen trust:
23 country case examples are included as inspiration and to illustrate the concepts. Based on the four key strategies and five cutting principles outlined above, the following 10 suggested actions are available to decision-makers:
Table 1: Ten suggested actions for decision-makers on addressing COVID-19 pandemic fatigue
Only when translated into action, at regional, national and local levels, will the good intentions make a difference. Since the launch of the framework, several actions have been taken to follow up. WHO Member States at a meeting in October agreed to establish a policy forum for cross-country collaboration on this topic, facilitated by WHO and with the participation of key partners. The European Commission recommended the WHO pandemic fatigue measures and recommendations to all EU Member States in their communication on ‘Staying safe from COVID-19 during winter’. WHO Europe followed up with several activities to support Member States in this field, including the development of an evaluation framework for assessing the impact of interventions that aim to address signs of pandemic fatigue and a forthcoming online repository with evidence in the field.
For further information, please visit the WHO Regional Office for Europe’s Behavioural and Cultural Insights for Health website and COVID-19 Risk Communication and Community Engagement website.
About the authors:
All authors work at the WHO Regional Office for Europe
Katrine Bach Habersaat1, Andrea Elisabeth Scheel1, Omid Fekri2, Cristiana Salvi3, Nino Berdzuli4, Dorit Nitzan3, Nils Fietje1, Anastasia Koylyu1, Robb Butler2
1 Insights Unit, Division of Country Health Programmes
2 Regional Director’s Division
3 Health Emergencies
4 Division of Country Health Programmes
Acknowledgements: Many people have contributed to the considerations WHO Regional Office for Europe developed for Member States and should be acknowledged: Elena Altieri, Cornelia Betsch, Dan Chisholm, Caroline Francoise Clarinval, Frederick Cooper, Mohan Dutta, Daisy Fancourt, Nils Fietje, Edward Fischer, Miljana Grbic, Zoe Heritage, Petra Hongell, Olha Izhyk, Andriana Johnson, Anastasia Koylyu, Robert Mooney, Melita Murko, Saad Omer, Martha Scherzer, Cass Sunstein and Felicity Thomas
Handling Editor: Neha Faruqui