March 25, 2020

We need to change our thinking and communication, urgently, to beat COVID-19

In the situation of pandemic, the values that are important in public health ethics really come into play.

This article was first published by Croakey on 23 March, 2020. Read the original article.

Ethics considers what actions and ways of being are right or wrong, good or bad, and what values and principles should guide us. Values are what matters to people. As public health ethicists, we have a critical message for government, for managers in organisations, for community leaders, and for all Australians, about the values that are important in our response to COVID-19.

Pandemics show that we are all connected: we connect with people who connect with other people who connect with yet more people. This means we are all both a potential link in a complex chain of transmission, and a person who has moral responsibilities towards others. In the situation of pandemic, the values that are important in public health ethics really come into play. These include solidarity (a collective commitment to do things to assist others even though that may be a cost to us), reciprocity (returning the good someone does, or responding to the harms or burdens we expect them to bear), and prioritising the common good, even though that might mean we can’t satisfy our individual preferences.

In our view, we urgently need to start emphasising these public values. We need to show people how to change their behaviour to reflect these values, and tell them why they should do this.

Crocodile Dundee and fearful preparation

We are worried about two responses to the pandemic, which we’ll call ‘Crocodile Dundee’ and ‘fearful preparation’ respectively. We emphasise that this is anecdotal – these patterns are what we are seeing around us, and we don’t know their prevalence.

The ‘Crocodile Dundee’ response includes a ‘she’ll be right’ shrugging off of personal risk, scornful dismissal of others’ risk reduction efforts (or even anger towards friends who request social distancing), and sometimes claims that COVID-19 is a beat up or conspiracy. This could be explained as a result of optimism bias (believing one is less likely to experience a bad outcome, and thus precaution is unnecessary), ignorance or misunderstanding about how COVID-19 spreads, or perhaps in a few, not caring about other people.

The ‘fearful preparation’ response can be seen on every empty supermarket shelf. It has, unfortunately, also been a feature of news reporting. Repeated stories of over-purchasing of consumer goods seem likely to be modelling over-purchasing, feeding social contagion and increasing a sense of scarcity. Fearful preparation has escalated into a Tragedy of the Commons, where an essential resource that could readily support everyone’s needs is overused, and so collapses. Fearful preparation is an intense pandemic response, but not a helpful one.

Prioritising individualistic values

In purely psychological terms, these are two ends of a spectrum of reaction to psychological stressors – denial of risk on one end, intense anxiety or fear about threat on the other. But we can also think of these responses as having an ethical dimension, and prioritising certain values. Both, in fact, prioritise a particular kind of individualism: a selfish individualism where my interests, freedoms and rights come first, despite potential harm to others. It’s unlikely that Crocodile Dundees and fearful preparers are setting out to harm others. But they are focused only on maintaining their own interests and freedoms.

Given much Australian pandemic communication, this is not so surprising. The messaging has focused on risk to individuals. We have been urged to ‘help stop the spread and stay healthy’ without much explanation of ‘the spread’. We have been told ‘the risk to you is low’, but we should ‘do what we can’ to protect the ‘vulnerable’ and save lives, making a strong distinction between ‘us’ (‘the risk to you is low’) and ‘the vulnerable’ (who are not spoken to as the audience of public communication). Here’s how communications could improve.

A pandemic cannot be about isolated individuals maximising their preferences. It shows us that we are who we are only in our connection with others. Neglect those connections, and everything we value as an individual is at risk. We can each create or break branching chains of transmission and so protect or harm many. And we can each support or abandon one another. This is our power and our responsibility, as always-connected individuals.

Solidarity and reciprocity

Solidarity demands that we commit, together, to engage in practices that will protect ourselves and others, even though this may cause personal inconvenience or unwanted costs. We all need to do this, and if we all do it, we can make a difference. It includes not just social distancing, but support for those stuck at home, such as making more regular phone calls, or delivering food when needed. Stories of everyday support and care are already circulating on social media.

Reciprocity demands two things. We owe a reciprocal debt to health workers. They face difficult days to come: we owe it to them to slow down the flow of cases. And we owe a reciprocal debt to our fellow Australians who will lose income by complying with health directives. Society must adequately support them to do what we expect.

And all of this is for a common-good goal of minimising deaths and preventing an overwhelmed healthcare system, a threat that might need to be made more concrete to motivate people’s actions. To quote a frontline Italian doctor: ‘The citizens won’t accept the restrictions… unless you tell them the truth.’ Leaders need to admit uncertainty, explain what we know and how, emphasise shared vulnerability rather than using us vs them framing, and explain community transmission and exponential spread clearly and often. They need to explain the how and the why of their demands over and over.

Good examples to follow

There are good examples to follow. This includes The Baltimore City Health Department’s ‘Stay home to save a life’ campaign (#stayhomeheroes),  Angela Merkel’s model televised national address (if you click only one link, click that one),  and New Zealand’s campaign, ‘Unite against COVID-19: Together we can slow the spread’.  

Australians showed repeatedly in the all too recent drought and fires that we can take serious risks seriously, and we understand solidarity, reciprocity and the common good. We saved water even though it was inconvenient. We evacuated and volunteered and self-organised into incredible community networks to donate money and accommodation and food. We can do it again.  

But first we need to inculcate in Australians a deep and concrete understanding that, in a pandemic, we can save those Australians connected to us, and the many more connected to them, or we can infect them, harm them, and potentially even cause their death. It is in our power, and is our responsibility, to do what we can.

Professor Stacy Carter, Professor Annette Braunack-Mayer and Dr Chris Degeling are from the Australian Centre for Health Engagement, Evidence and Values