How researchers get heard

Fear of Fear of COVID-19

Fear appeals to change pandemic behavior seem irresistible. They might also be irresponsible.

Bluntly put: Should health and research communicators try to scare the crap out of people who don’t comply with COVID-19 restrictions?

Elizabeth Rosenthal, a former physician and now contributing opinion writer for The New York Times, thinks so, arguing that if it worked for smoking, it’ll work for COVID. Rosenthal dismisses public health announcements on the pandemic to date, calling them “a mix of clever catchphrases, scientific information and calls to civic duty” that are “virtuous and profoundly dull.”

“Mister Rogers-type nice isn’t working in many parts of the country,” she writes. “It’s time to make people scared and uncomfortable. It’s time for some sharp, focused terrifying realism.”

The closest example out now Rosenthal could find: this pro-mask PSA video put out by the State of California of a patient on a ventilator. Yet according to a USC survey cited by the LA Times, only 55% of LA residents are complying with travel restrictions against all but essential activities — a figure that has stayed constant throughout the pandemic. And California is seeing waves of unrest against its latest lockdown, led by business owners, workers and parents who feel they’ve done everything to comply with previous restrictions and are now being driven out of business (and out of playgrounds) while state, Los Angeles and San Francisco officials dined out and flew to Hawaii to meet interest groups. The time for fear appeals in California is probably past.

Do fear appeals ever work? The literature (which is decades old) is torn. For instance, this 2015 meta-analysis concludes yes. But this 2020 commentary cites numerous papers saying no and going further — that fear appeals often prompt numerous downsides, including “denial, backlash, avoidance, defensiveness, stigmatization, depression, anxiety, increased risk behavior, and a feeling of lack of control.” Now I’m afraid.

Two things now seem clear.

The first: If leaders don’t signal that they’re in this with us, no amount of messaging will work. In these cases, a meta-study out earlier this year in Nature Human Behavior found, “Leaders who threaten people with sanctions as a way to deter undesired behaviour may make people feel distrusted and paradoxically reduce their willingness to do as they are told.”

The second: All-or-nothing approaches are destined to backfire at this point in a prolonged pandemic. Fatigue is rising. People are going to socialize. People are going to choose their own risk-tolerance levels. Given these truths, a harm-reduction approach — one that clearly and consistently outlines what we know about the spectrum of risk, advocates for low-risk activities to satisfy human yearnings and needs, and outlaws only the most dangerous scenarios — is probably the shortest route to durable, widespread risk reduction.

“It’s not because the public is irresponsible; it’s because they are losing trust in public health officials who put out arbitrary restrictions,” Monica Gandhi, an infectious-disease specialist at UC San Francisco, told the LA Times. “We are failing in our public health messaging.”

I found this piece by NYU doctor Eric Kutscher useful, comparing harm-reduction approaches during the early years of the HIV-AIDS epidemic to this stage of the COVID-19 pandemic. He concludes:

To be clear, we must do everything possible to protect populations at risk. However, we must also learn to live our lives in the age of COVID-19. We must create a new normal that allows us to evolve our behaviors based on evidence. We must create a world where those with privilege do not stigmatize others for seeking meaningful interactions. As we move beyond social abstinence, we must accept the new realities of our changed lives and modify our behaviors to keep ourselves and others safe.

But naturally, there are already calls on Twitter to apply Rosenthal’s argument to climate change messaging (sigh).

The role of research communications is to be clear, consistent and loud about what the evidence is, as well as about the uncertainties that remain. But successful COVID-19 messaging is about the supporting context, not just about the evidence. In a hyperpolarized cultural climate, no message will overcome the leadership failure of politicians and elites eating at The French Laundry or flying to Hawaii while telling others they can’t see loved ones over holidays.

Photo by Nick Bolton on Unsplash