‘All interventions must stand up to scientific scrutiny’

Professor of Behavioural Science and Security Brooke Rogers OBE (King's College London) is a social psychologist whose research explores risk communication, along with perceptions of, and responses to, risk and threat. She pointed out that the UK government has had pandemic diseases on their radar for many years. The UK National Risk Register identifies pandemic influenza as having the potential to have the most severe impact, and a high likelihood of occurring in the next five years. As such, the Civil Contingencies Act 2004 places duties on a range of organisations to establish and test plans for preparing for pandemic response. In spite of this forward planning, pandemic response is a significant challenge that can only be successful if government, science, industry, and communities work together.

Rogers told us she had been impressed with the evidence-based, transparent approach to communicating with the public in the UK and explained what changes in approach we might see in the coming months. 'At the moment we're in the containment phase and the decision to stay in this phase is influenced and informed by a scientific evidence base. If this situation starts evolving, which there's a high chance that it will, then they would have to consider implementing other interventions. All interventions must stand up to scientific scrutiny and be considered alongside a constantly evolving context.' Rogers pointed out that potential interventions are already being shared by Chief Medical Officer Professor Chris Whitty. He has suggested that certain measures may need to be taken to slow the spread of the virus, such as closing schools or cancelling large gatherings.

'Effective response will involve a combination of interventions and a combination of changes of behaviour,' Rogers said. 'If you're giving advice you need to let people know why you're giving that advice, give information on why that advice is relevant or effective and give them forward vision of what is likely to happen and what the response process is going to entail. At the moment, I think they've got the balance pretty much right because they're saying "these are some of the things that we're considering", but they're not making decisions without the evidence to support it.'

There is an important balance to maintain in this type of event between communicating in a way that makes the risk relevant and meaningful to the public in order to enable them to prepare if they wish to do so, or communicating in a manner that makes people feel anxious or frightened. Rogers said that in the past, there has been a widespread presumption that the public was prone to panic in the face of disasters – but behavioural science and psychology had shown this is not always the case. 'Yes, panic can happen, but we're much more likely to see prosocial behaviours across multiple types of disasters and extreme events. Response organisations must recognise that they have a role to play in informing public reactions. Public response can be impacted by the type of information that's available, the perception of the risk, and the levels of trust invested in each organisation. 

'Psychologists have also demonstrated that under-response can be as problematic as over-response. We saw that with the 2009 swine flu pandemic – this had the potential to be a major, major issue but the public really didn't see it as something they needed to pay attention to or do a lot about.' Dr James Rubin (King's College London) has researched the swine flu pandemic and found the uptake of simple changes in behaviour such as increased hand-washing or avoiding crowds and public transport was very low. 

Rogers argued that a step-change was needed: 'If people aren't willing to follow the guidance that is there to decrease the risk for them, they need to realise that messages such as "catch it, bin it, kill it", or messages about good hand hygiene are also about keeping the wider community safe. Catching your coughs and sneezes and washing your hands properly are actions that decrease the chances of other people being exposed to this as well, especially more vulnerable groups.'

Rogers and Professor Richard Amlôt (Public Health England) explored another interesting area of public response through a Deloitte-funded PhD undertaken by Dr Lorna Riddle. This project asked whether or not employees who work in critical infrastructure organisations such as financial services, energy and health, would be willing to come into work during a crisis if they were able to do so. It questioned an assumption made in many organisational crisis response plans – that a majority of employees would turn up to work in the face of a disaster or man-made incident. 

The project involved a literature review followed by interviews with more than 20 senior professionals in resilience and crisis management. The interviews were conducted in order to identify managerial expectations and assumptions about staff levels of ability and willingness to come to work during an extreme event. The interviews were followed by eight scenario-based focus groups involving an intentional release of pandemic influenza, and an online survey of over 300 UK employees exploring a range of scenarios including severe weather, pandemic, and chemical, biological, radiological or nuclear events.  

The focus group and survey data allowed them uncover whether the academic and managerial assumptions would hold true in the UK workforce. Out of those 300 employees surveyed 55 per cent said they would attend work in the face of a new strain of pandemic flu.

Rogers said that, given people over-report their intended behaviour in such surveys the number of people coming to work in that scenario would very likely be less than 55 per cent. But she added: 'There's a lot of evidence that people really do try and do their best. Employee willingness to report to work during an extreme event can be informed by a number of factors, including their perception of the risk, ability or willingness to find childcare if schools are closed, trust in their organisations, and recognition of the role that their organisation plays in keeping basic services such as gas, electricity, transport, healthcare, and more running. Most importantly, they must understand the role that they play in enabling this.' 

Rogers said evidence from psychology and behavioural science can help to make policy in this area much more realistic. She directed me to more of Rubin's work on presenteeism, or attending work when unwell, which can pose a real risk with any contagious disease. She added that it was a wonderful time to be a psychologist, with the government recognising a need for a more joined-up approach to incorporating evidence from behavioural science – highlighted last year in the Government Office for Science's review of government science capability. 

'My view is that we are world leaders when it comes to incorporating physical science into the world of emergency planning and response. However, you can have all the physical science in the world but risk losing much of the value of that input if you don't actually understand how and why people are going to react to risks in their environment. Basing decisions on and building communication upon evidence from the world of behavioural science improves our ability to protect public health across the board...'