Covid – 'behaviour matters, Psychology matters'

Playing our proper part

Via a recorded video, Stephen Reicher, Wardlaw Professor of Psychology at the University of St Andrews, spoke to the British Psychological Society's Senate on what Covid reveals about the policy potential of Psychology.

My message today is extremely simple. It's that we have, as psychologists, a remarkable if brief window of opportunity. Because virtually for the first time in my lifetime, in my academic career, I think there is a general appreciation that psychology matters, that behaviour matters. And not only on a personal and interpersonal level, which is the way in which people normally conceptualise it; it matters at a systemic and policy level. 

During Covid, for instance, it was quite clear that the fate of the pandemic – in many ways, the fate of the world – depended upon behaviour. It was dependent upon getting people to behave in a very difficult way, given that we are a social animal – to keep separate from each other. At the beginning, many people said that until we get a vaccine, behaviour will be critical. But we were wrong. Because a vaccine in and of itself actually solves nothing. A vaccine in the bottle doesn't achieve anything. It's getting people getting vaccinated that makes a difference. And so when vaccines came along, they didn't substitute for the behavioural dimension. They simply added a new behavioural dimension, the question of what would get people to get vaccinated? How do we deal with vaccinate vaccine hesitancy? How do we deal with the fact that certain groups, certain populations, especially marginal populations, were less likely to get vaccinated? 

So in many ways, what we saw was not that there is a zero sum game between the life sciences, the physical sciences, and the behavioural sciences and psychology. Rather, the two complemented each other. The life sciences set up questions for the behavioural sciences. The life sciences could tell us how the virus transmits, but then it was up to us to understand how to change the behaviour in order to limit that process or propagation. There was an interdependence, a much more positive interrelationship between epidemiologists, public health experts and psychologists than I've ever seen before. That's something to cherish, and to hold onto alongside that recognition of the importance of psychology. 

The fragile rationalist, and collective resilience

However, there is a cost. As long as we are irrelevant, actually, we're not very accountable. Sometimes it's a consolation that what we say doesn't matter! But once we are centrally involved in the issue, then whether we get the psychology right or wrong matters. 

Let me give you an example. All of us, I think, remember the claim about behavioural fatigue – the idea that people are so psychologically frail, so unable to deal with the rigours of those measures that were necessary to contain Covid, that we wouldn't abide by them. That argument was taken into government very clearly – people like Matt Hancock and Michael Gove stated how it delayed the imposition of Covid measures in March 2020. Counterfactual modelling studies have suggested that had we locked down a week earlier – on the 16th instead of the 23rd of March 2020 – it would have reduced infections by in the region of 70 per cent, and therefore reduce deaths by something like 34,000. Had we taken measures at the same time as Italy two weeks earlier, we would have reduced infections by 92 per centd and saved 43,000 lives. Getting the psychology right or wrong, then, becomes a matter literally of life and death of tens of thousands of people. Psychology matters.

Now in many ways, when measures were introduced, and when levels of adherence were extremely high – according to early surveys, over 90 per cent, even though about half of those were suffering from the psychological and material consequences of the measures – that didn't come to a surprise to those who study crises and disasters. We generally find that what happens is that a sense of common fate leads people to come together as a community to support each other. And it's that support that makes people resilient. Resilience isn't something within the individual which individuals have, or rather which according to many assumptions they lack. Resilience is something that happens between people. It's a collective phenomenon. And the creation of collectivity is a key resource in dealing with a pandemic. 

So it's not about cognitive frailty. It's much more about developing social relationships between people in order to give them the support that they need. And in many ways that development of a sense of shared identity of community awareness was one of the key factors which underpinned adherence during the pandemic. A series of studies, some of them very large and multinational, showed that a sense of national identity – not a sense of jingoism, of 'my country, right or wrong', but simply a sense of belonging, of being concerned for the nation – was critical. 

Equally, the impact of the local community was critical. And that sense of community wasn't only important in the sense of creating adherence. It also enabled people to abide by the hardships the rigours of Covid. People began to support each other, informally through street level WhatsApp groups or more formally through mutual aid groups, of which some 8000 were formed. In the first wave, some 12 to 14 million people were involved. And one of the things you discover in the nationwide crisis is a state can't look after us. There are too many people to be looked after. There aren't enough state functions. The state can't look after everybody in the homes, it can't deliver food to everybody, it can't make sure they're all okay, it can't walk their dogs and so on. All it can do is help people to help each other: to support us forming those groups through which we help each other.

It should also be said that there are other ways in which collectivity was absolutely critical in dealing with the rigours of lockdown measures. For instance, the emergent 'social cure' research shows that being part of a group and feeling connected to others is a really powerful way of maintaining mental and physical health. 

So connectivity was critical, as well as the other things that go along with connectivity, such as trust. If government was seen as part of this collective, part of a community acting for the community, we were more likely to trust that government and go along with the measures that they were imposing. If we thought there was one rule for us and another rule for them, then that undermined that trust and it undermined that influence and our response. 

Building inclusive community

Community, and building community, are therefore absolutely key. But I say that with one key caveat. When we build community, it's really important that community is inclusive, that it includes everybody who lives in a particular area, or locality or a country. Because if we create an exclusive sense of community, of 'us' and 'them', and if we blame 'them' for what's happened to us, then instead of solidarity, we get conflict. Donald Trump talked about the 'Chinese virus', for example, and people from Asia were blamed for what was going on. We also see this when we look historically. For instance, in the Black Death, when Jewish people were blamed for the Black Death for poisoning the wells, then 1314, on one day in Strasbourg, it is estimated that 3000-6000 Jewish people were burned alive when they were blamed for the Black Death. 

The key psychological question becomes, how do we build inclusive community? And I want to argue that this is a key question for the future – that we need to inspire people, by treating them as part of the solution, not the problem. That we need to empower people, give them the resources to do the right things. We need to engage with people, we need co production of the response. And the next point I want to make is that this isn't just a matter of what we say. It's also a matter of creating the structures which enable these things to happen. 

The first thing we need are data systems. Not only data systems which give us advanced warning of levels of infection, which monitor wastewater and so on to tell us when a pandemic might be coming. We also need psychological data. We need to know the state of trust in the nation, the state of intra- and intergroup relations. We need to know what people think of what others thinks and the norms that govern our behaviour. 

So what social science data do we need to regularly collect? And what do our data infrastructure bodies like the Office of National Statistics need to be looking at? If we want to engage with people to make them feel part of a common community, how do we do that? How do we create engagement structures, which involve diverse communities? How do we ensure that people are enabled to go along with the measures we put in place, to understand the barriers to compliance in different communities and the types of resources we need to give to people? What structures do we create to make that possible? And finally, how do we scaffold? How do we support that self organisation I spoke about? How do we make sure that not only are people able to set up the mutual aid groups, but they have the resources to make them endure? Because we saw that during the second wave of Covid infection, people were burnt out, they didn't have the resources, they didn't have support, and therefore we didn't see that same wave of mutual support groups. We need the state to play a part, but in scaffolding and supporting our self organisation, not substituting for it. 

Playing our proper part

My take home message is really clear. If you look at the pandemic, then factors like community and trust were in many ways more important even than preparedness in infrastructure. They were absolutely critical to a positive response. So how do we act in a way as to recognise that, to understand it, and to create the structures through which we can influence it? Covid creates a brief window of opportunity to demonstrate how psychology – and particularly a psychology of community and social relations – is relevant not only to personal and interpersonal level, but also at systemic and policy levels. Moreover, this is of relevance not only for addressing future pandemics, or even future crises, but for all the challenges of society and its governance. We must act fast to make sure that psychology plays its proper part in dealing with the many crises that confront humanity. 

Collaborating with speed and agility across our Society

Dr Roman Raczka, President Elect of the British Psychological Society, spoke to Senate about the work of the BPS Covid Coordinating Group.

Our lives have changed in so many ways since those first reports came out of Wuhan in December 2019. From then until to the announcement of UK lockdown on 23 March 2020, little did we know the impact would be so significant across society and the whole globe. The belief in March that the UK government would be able to contain, delay, research and mitigate the impact was perhaps very ambitious, and clearly far from what has happened in reality. Reflecting back, one wonders how effective those early media messages were, when we were encouraged to 'Stay home, protect the NHS, save lives'.

The pandemic has had significant psychological and social effects on the global population. The impact has been greatest felt amongst the most vulnerable groups across society, including children, students, people from minoritised groups, people with pre-existing mental and physical health needs, people with disabilities, and also (significantly) health and social care workers. With the NHS wellbeing hubs campaign the BPS has been working on for the past year and a half, we've seen that Covid has had a massive impact on people's health and wellbeing, but that the wellbeing needs were there before the pandemic, and have continued after. The impact of living with Covid has become a part of our daily lives, a catalyst to make things that were an issue before even worse. 

The ongoing impact of Covid includes social isolation and loneliness, the impact on children's education of schools being closed, and learning from home at universities and colleges, and remote and hybrid working for people in workplaces. It is important to note the significant and scary numbers: 800 million confirmed cases worldwide, and 7 million deaths. Covid is still here, and it's not going away. We're still living with Covid, and the impact of Covid, long Covid, trauma and retraumatisation.

What did the BPS do?

By 25 March, the then President David Murphy had assembled a group of leads across the Divisions, Sections, and the senior leadership team to develop a coordinated response, with David as Chair and Daryl O'Connor a deputy chair. At that first meeting, we had initial wide representation, including from the Divisions of health, educational, clinical, occupational and counselling. I was there as a member of the Division of Clinical Psychology division, we also had members from across the Sections, including the Crisis, Disaster and Trauma Section, and the Cyberpsychology Section. We also had representation from across the four nations. 

The initial group was focused on issues that members agreed would have a significant contribution in the coordination and response made by the BPS. Over time, some people left, other people joined, subgroups were set up, and we had an even greater number of people who were involved and engaged. So whilst there was a core Coordinating Group, the number of people involved across the whole of the BPS was significant, including both volunteers, the senior leadership team, and other BPS staff.

At that initial meeting, we set up a number of workstreams covering what we felt were the key areas that we needed to take a position on in order to provide guidance and support to our members, to members of the public, and to other organisations, professionals and stakeholders. These were:

• Adaptation to work practices
• Behavioural science and disease prevention
• Bereavement and care of relatives
• Community action and resilience
• Effects of confinement
• Rehabilitation
• Research priorities in psychological science
• Staff wellbeing
• Working differently

I was Chair of the adaptation to work practices workstream. Each of the workstreams had a different chair and a membership drawn from the coordinating group and a number of other people from across the divisions, sections and nations, with support from BPS staff to make those groups really effective. 

In the adaptation to work practices group, we produced probably seven different publications and a number of webinars. In that group we had engagement from as many as 80 volunteers contributing to the documents. Across all of the workstreams, we had several hundred volunteers, collaborating and co-authoring the different papers, webinars and reports that were produced. 

The resources produced are all still available on the BPS website – more than 50 publications for professionals and practitioners, 30 for the general public, and 12 webinars and video resources. The earliest one was a report on providing video therapy to individuals, and that's interesting in terms of how we've changed our practice to work using video, both in terms of meeting and also in our therapeutic assessment and intervention as practitioners psychologists. Things have changed very significantly in that time.

Collaboration and engagement

The collaboration and engagement across divisions, sections, and nations, in a very rapid way, was really impressive. Having that wide engagement from different parts of the Society, bringing together staff and volunteers, really added to the value and impact of what we can actually do. Key was the rapid publication process. We managed to be very agile in that, with sign off by the leader of the workstream, which meant that we managed to get things out very quickly, and therefore have that influence and impact within psychology, but also for other stakeholders and across society. 

Recently, a survey was sent out to the Divisions and Sections to look at the lessons learned. We heard that the work of the coordinating group had been a great opportunity to use psychology, and that the public now seemed more willing to talk about emotions and wellbeing, allowing continuing work on aspects such as mental health stigma. 

Challenges identified included making sense of the knowledge we amassed during the pandemic, and translating that into accessible, impactful ways to shape policy. 

It's inevitable that there will be another major impact on society. What can we learn in order to make us more effective in what we do as psychologists, but also across society. Professional leadership at a governance strategy level is really important, as is organisations representing psychology and psychology professions coming together. Cross organisational collaboration gives us a greater voice. 

Comments in the survey also called for more research and teaching / dissemination on the psychology of pandemics, and better evidence for early interventions to support staff in occupations where they are at risk of trauma and moral injury. The impact on people from the minoritised communities is really important. We learned that kindness and a compassion-focused approach is key to supporting people, both during and after Covid.

We did manage to rapidly collate, share and disseminate information and guidance, and that's essential.  

We hope to do a project capturing and analysing all the learning about the Psychology response for future to show how the BPS responded and adapted in real time. We will continue to look at what wider lessons we've learned, what we should do to be better prepared, and what we should be doing now.  

Coaching Psychology, Covid and beyond

Dr Fiona Day learns from members of the Division of Coaching Psychology.

In March of this year, we asked 2,500 members of the Division of Coaching Psychology to look back on Covid. The response was 1 per cent, but it does begin to give us at least some insight into how their expertise was used during Covid.

There were four different themes:

• Developing and delivering pro-bono programmes at small and large scale: anything from a small workshop to coaching in the NHS with thousands of healthcare workers;
• Supporting managers, leaders and teams in health, education and other contexts, for example with directors of public health;
• Supporting front line staff; and
• Supporting and developing coaching psychologists

In terms of lessons learned, survey respondents said 'we were agile, adapting to new ways of working, using our psychological skills in new ways which have continued post-pandemic'. We also heard that the 'focus of coaching shifted during this time to become more attentive to wellbeing and resilience'. 

In terms of implications for the BPS, we did hear that 'the BPS could have been much more dynamic and proactive during the pandemic, doing more than just sharing research'. I knew all about the Covid Coordinating Group and its work, partly because of my own links with the Deputy Chair Daryl O'Connor. But not everybody seems to have been aware, perhaps just due to the volume of things that people were trying to keep on top of. One other comment spoke to the need for 'more integration across the BPS around responding to major emergencies or public health issues', and how this is then reflected in BPS strategy and operationalised. 

There was learning around how to scale that up, particularly from people who were doing large-scale pro bono support projects, and around supervision and governance as well. I feel it's also important to note one comment, that 'the psychological labour was very high'. We need to think about how we support members with their own wellbeing.

Long Covid is still an issue. I'm an Occupational Physician by background, now I'm working as a Chartered Coaching Psychologist, and supporting senior medical and public health leaders, getting them back into the workplace. They're all doing really well, but they have needed a lot of support to fully regain their function. The psychological trauma of Covid is still an issue: a senior doctor client told me only this morning about having called colleagues in London to get some advice, only to be told that all the consultants were on ventilators with Covid. That must have been so traumatic at the time, knowing that Covid was rapidly spreading, and for many people, it's still a live issue that needs expert clinical psychological help.

We need to be thinking about preparedness and preparation for future pandemics and health emergencies or other emergencies that we may need to face. We need a more joined up, cross-BPS approach around improving health in the population, and reducing health inequalities. There's so much that we can do here as psychologists in terms of influencing the public health agenda at local, national and international levels. 

'We have to be out there, engaging with people in high places and outside of psychology'

Professor Susan Michie had several roles during Covid, including on both the UK Government's advisory group SAGE, and Independent Sage. She was also an advisor to the World Health Organization, and on the Lancet Commission public health taskforce.

I'll be sharing with you my perspectives on the contributions of Psychology during Covid, in terms of process, content, impact, and next steps. Of those, impact is our greatest challenge as psychologists. Unless we can show impact, why should people invest in us? 

Process

The behavioural science group within SAGE (Scientific Advisory Group in Emergencies) was referred to as SPI-B, standing for Scientific Pandemic Insights, Behaviour. Within it, there were a large number of psychologists from many different backgrounds, including health, social, education, communications. It worked in a cross-disciplinary way, with psychologists bringing to the group psychological ways of thinking, theory and methods to inform and shape policy-relevant advice. There were also important contributions from sociology, anthropology, implementation science, communication science, and other domains, but I would say that the predominant disciplinary impact was from psychology.

There were a variety of types of activity to disseminate relevant evidence and scientific thinking, and a particularly important one for me was the public-facing work. Independent SAGE was an excellent initiative, set up by former Chief Scientific Adviser Sir David King, who firmly believed there needed to be ways in which scientists could directly speak to the public. The plan was for one or two broadcasts, but there was such a positive reaction that we a kept going for about three years via weekly YouTube broadcasts. We had politicians, city mayors, the press, the public, coming on to the channel asking questions. We were able to be very responsive and produce a large number of reports on the website, and gain a big Twitter following, alongside these weekly broadcasts. I and Steve Reicher were on the main group, but we also set up a behavioural group, with about half a dozen psychologists.

We not only had an impact on the public, we educated the other disciplines: virologists, immunologists, mathematical modellers, etc. Some of us – John Drury, Steve Reicher, Robert West, myself – were engaged in a lot of mainstream and social media, including radio, television and podcasts, with a wide reach.

Content

From a health psychology perspective, we enabled population, community and individual-level behaviours to assess and reduce risk of transmission. In terms of mental health, psychologists outlined possible consequences of different courses of action, and advised as to how to minimise harmful impacts of events and policies surrounding Covid, in particular how to reduce the widening inequalities, via policies to engage communities, and mutual aid work.

We also had the CORSAIR study, set up after the 2009 H1N1 (bird flu) pandemic to get better quality data from the public about their behaviour and influences on key behaviours. It was a 'sleeping' project, funded by NIHR so that as soon as the next pandemic arose, we had a weekly survey to 2000 people throughout the UK ready to go, commissioned by the Department of Health and Social Care. We were therefore able to directly inform its communications and some of its policies, including making a difference by providing the data that let to SAGE advising the Government to provide adequate financial resources to those having to self-isolate when symptomatic or testing positive with Covid19. Although the support was not adequate, it was at least something.

Impact

Did we have an impact on the course of disease? I think it's impossible to say, given the nature of the UK Government. Did we influence policy? On SPI-B, we published more than 100 papers, with absolutely first-class researchers producing really good reports. Not very many of those reports, I would say, did influence policy. But I mentioned the financial support, because we found out through the CORSAIR weekly survey, that the majority of people who should be isolating weren't, and that that was because of not having enough money or insecure employment .

We also think there may have been wider societal outcomes, such as raising the profile of psychology in government, amongst other sectors, and with the general population. Perhaps there is a better understanding of behaviour, its influences and its management. But, since there wasn't any evaluation or monitoring framework set up by SAGE or SPI-B of its advisory processes, it's hard to tell. There were certainly many new collaborations, and new research, such as ESRC's £20 million investment in behavioural research over the next five years, including the leadership hub, Behavioural Research-UK.

Next steps

My personal perspective is that UK psychology as a discipline needs to be much more outward-looking and proactive. An example of being proactive is how SPI-B was formed.  Before 2009, the government knew that pandemics were one of its big risks and set up a large committee to look at pandemic influenza. There were only two psychologists on that, myself and Lucy Yardley. At the lunch break of the first meeting, I went up to the Chief Scientific Adviser who chaired the committee, and said that most of what was being talked about was dependent in one way or another on behaviour; that changing behaviours can be absolutely key to pandemic management; and that I didn't think most people in the room knew that or knew anything about the science of behaviour and how to enable its change. I said I would be happy to give a 15-minute presentation at the next meeting, and he agreed to that. 

As a result of that conversation and presentation, when H1N1 did break out, and SAGE was set up, I was invited to participate – the only social or behavioural scientist on the committee. All of the rest of the participants were biomedical in various ways. I repeated my messages to the previous committee and added that I thought we needed a behavioural subgroup, and that I'd be willing to convene it. It was agreed and resourced, including a half-time researcher to help with key tasks such as rapid reviews to inform briefings for Government Ministers. When the Covid-19 broke out, the precedent of the behavioural group within SAGE was repeated, this time on a much bigger scale. 

This is an example of one small initiative of one person leading to a substantial system and impact. Taking initiatives and talking about them enables others to do likewise. So we have to be out there, engaging with people in high places and outside of psychology. We need to demonstrate the added value that psychology can bring – don't assume it's obvious. And don't assume that because we're doing lots of stuff, we're making a difference. We need data to show that. 

I also think we need to be more focused on multidisciplinary efforts in public health. Public health is intrinsically multidisciplinary, but psychology often isn't thought about as an essential part of it. The BPS should be looking at high profile partnerships around preparedness for future pandemics – worryingly, already in the United States we have had reports of humans contracting H5N1 (another form of bird flu).

Translating scientific expertise into policy and practice effectively requires forming ongoing and trusted relationships with key people. People in power need to trust that what you've got to offer will help them, and you're not acting out of self-interest – rather, your incentives are aligned. You've got a joint mission, and then you work together to achieve it. Get out there, and make a noise, and keep saying the same thing – 'we're here, we could help you achieve your goals'. No special bleating about Psychology being important. This is not what is going to move people at scale. Most people don't care about psychology per se, they care about what they want to get done in life. We have to get a lot better at pitching ourselves to people with power and influence who can make a difference. We will then get invited to events and activities through which psychology can embed itself to the fabric of society. But we can't wait to be approached – we should be proactively and strategically engaging and making our voices heard in ways that people want to listen to.

• Read more in Susan's article around lessons from the UK's handling of Covid.

Supporting collective resilience

Professor John Drury (University of Sussex) addressed the British Psychological Society Senate around his involvement in the Covid response.

During Covid, I was a member of both SPI-B and Independent SAGE, and involved in some of the BPS response. The advice we tried to give and the recommendations that many of us made, were based on the evidence we had that the public did have the capacity to respond effectively, if properly informed and supported. In many cases, the policy decisions were instead based on assumptions that the public would be mentally fragile and unable to cope.

One example of where that assumption of public mental fragility operated was in the delay to the start of some of the protective measures in March. A second comes with the emphasis, repeatedly across the first couple of years of the pandemic, on the need for punishment and coercion as almost a first choice by the government. That misunderstood the motives people had for adhering to things such as distancing. But not only did that misunderstand and stem from a poor understanding of the relationship between authority and the public, we argued that it also damaged the relationship with authority of public and became a kind of vicious circle. 

An inclusive approach

If those were the kinds of practices and policies that came out of a fundamental misunderstanding of the psychology, and if we assume instead, based on the evidence base, that the public can respond in an adaptive and resilient way, what kinds of practices and policies should we have going forward? 

One would be a more inclusive approach. Rather than the approach we saw at times, which is rather divisive, singling out some groups and blaming them, the premise should be to treat the public as part of the solution, not the problem. 

This inclusive approach already exists to some degree in government policy – the programme of community resilience is built on this assumption. The question is, how far is that actually being operated in practice. That would go hand in hand with a more engaged approach, whereby the public are involved in co-producing the response rather than the response being experienced as being imposed on them. That would empower the public, provide a sense of ownership and get more buy-in for policies.

Scaffolding and enabling

A second principle is that of scaffolding. This means supporting those autonomous independent initiatives that arose within the community and within the public, and helping them to exist and to practice. If you look at the different kinds of behaviours required of the public for protection during the height of the pandemic, there was a very striking contrast in the figures of people reliably adhering to practices such as physical distancing, hand washing, mask wearing, compared to self-isolation, where the figures were much lower. Some of the key predictors of that were financial (low-paid workers found it hard to self-isolate), and practical (e.g. 'I needed to go out for my shopping'). For a behaviour like self-isolation, you can't do it on your own, you need support. 

During the pandemic, such support came from family, friends, but also neighbours – the community, in the form of mutual aid groups. We wrote about these and other forms of volunteering in the SPI-B document on the role of Community Champions networks with SPI-B. When you look at the experience of participants, the volunteers in these mutual aid groups, they often talk about the benefits of being part of a group as important motivators and predictors for their continued participation. They felt there were risks, they felt a sense of duty, but they also got group-based benefits such as learning skills, a sense of fulfilment, a sense of wellbeing. But you talk to the organisers of those groups, and they're talking about the need for scaffolding to be put in place to enable those groups to continue. Motivation isn't enough. 

When we looked at mutual aid groups, we saw the same pattern that we see with community responses in emergencies – they tend to fizzle out. There were many fewer groups in the second wave of the pandemic. The groups that did continue tended to broaden their aims and purposes to all sorts of community projects such as shared gardens, homelessness etc. During Covid, to continue their work – which was often much more trusted in local communities than charities and established groups – they need practical support from government, local authority, and established charities. Simple things such as storage space, spaces to meet, transport, computing facilities, relationships with other groups that will enable them to have these things and so on. These are grassroots groups that don't have a formal constitution, membership, bank accounts. They support from groups and organizations that do have these things.

The last principle for supporting the public response, we would call enabling. This partly refers to the information we have about who needs support. There were demographic differences in who was able to participate in certain protective behaviours, just as there are clear demographic differences in who is taking up vaccination. So it's getting that information on who is not able to participate; what are the barriers to their participation that could be addressed? 

A note on 'conspiracies'

If you look at the history of conspiracy theories, one of the things you'll notice is the way they rise and fall with changing relationships with authority and with the state. As the state loses trust, they seem to rise. Those of us involved in the advisory groups were on the receiving end of all sorts of abuse, and one thing I noticed was that endorsement of conspiracy theories and those kinds of attacks rose towards the end of the response to the pandemic. This was just when the UK Government was saying, 'Let's drop all the measures now, because they're not needed'. 

For many, those announcements were like saying, 'We didn't need those in the first place'. It confirmed the suspicion some had that the whole thing was a hoax, or a way to control the public. And so some of the actions of this government – not at the height of the pandemic, but towards the end, when they seem to discount and to criticise their own measures – played into that conspiracy mindset.

Beyond crisis

Covid did bring this opportunity to demonstrate how psychology – and particularly a psychology of social relationships – is relevant at systemic and policy levels. It was a group memberships in different ways that were found to be important, and the psychology of that could be built upon: and not just for Covid, not just for crises, but for many challenges of society and its governance.

What needs to be happening now?

Jim McManus, National Director of Health and Wellbeing, Public Health Wales, and co-Deputy chair of the Pandemic Preparedness Group of the International Association of National Public Health Institutes (IANPHI) addressed the BPS Senate. 

I'm speaking here in a personal capacity as an ADPH Member, as someone who worked at local and national level in England during the pandemic, as well as working with colleagues across the UK and Europe.

From vaccination uptake, right through to helping people to navigate the uncertainty of Covid, I am absolutely convinced that psychology is essential to public health. As someone who's both a chartered psychologist and a public health professional, I have spent most of my time during Covid advocating for the use of psychology in a multidisciplinary approach to help navigate the pandemic well and ensure policies which support people .

Covid was not unprecedented. We were underprepared. I still remember sitting in Downing Street opposite Boris Johnson, a week before lockdown, and saying, 'we need a better plan than the one we've got'. And we will have more and further international epidemics. We still have significant numbers of emerging diseases, partly because of our encroachment on the environment, and they are coming at us more quickly. Some of us came straight out of responding to a wave of Covid, straight into responding to the multinational monkeypox outbreak. And in that, many of us felt we didn't learn the lessons of Covid – we made it very difficult for people to get vaccinations in the first part, rather than using community networks and solutions. And today, we're wondering how many of the pandemicity conditions H5N1 will meet? Will it spread, will it go international? So, we're going to go around this loop again at some point… the only issue is which infection it will be.

As a public health professional who has worked at international, national and local levels, there are a few key outcomes that we need. The first is that psychology, with all its contributions, is seen as vital to getting the public into the best possible health before a pandemic, in coping through it and in enabling people, organisations and systems to recover afterwards. If you don't have psychology embedded in a pandemic response, and all that psychology offers, it won't be effective. We need to do better at bringing together the various branches of psychology to bring to bear our expertise on public health and on pandemics. 

Psychology front and centre

Having said that, you could see from space the impact of psychology on the vaccine uptake policy, on providing support through self-isolation, on mobilising local communities and in responding to misinformation. Organisations learned a huge amount about psychology that wasn't necessarily applied by the official response. I presented and coordinated quite a lot of guidance for public health directors, and we put psychology and social and behavioural science front and centre. We talked about the importance of a covenant of trust between government and the people in order to really weather Covid. Some of the biggest mistakes made as a nation were in the way that leaders and governments did not keep faith with the public. For example, the doctrine was 'get people back into schools' and never mind about the impact of them on long Covid. We now have a generation of kids with long Covid, which could have been avoided. We also needed to do better on the fact Covid was and is airborne. There is much for psychology to do in understanding some of the decision making amongst policymakers and advisers, where some agencies stuck to ideas of droplet spread when airborne spread was clear. What is the psychology behind sticking to risk information which is not strictly accurate?

To be prepared for the next pandemic, we need an approach that is multi-strand and multidisciplinary, with a central focus on prevention, mitigation and recovery. We need psychology front and centre, and the only way we do that with governments is by building relationships with them long before a new emergent infection. The aim should be to prevent pandemics, and their consequences. We have to be in the conversations. We have to influence key national and international policymakers, which is one of the reasons why I'm engaged in the national and international work on pandemic preparedness.

Keeping faith with people, communities and systems and knowledge was one of the most important things in Covid. The contribution of leadership psychology has huge implications – how you do the least worst thing in the face of disagreement, disinformation, spin and harassment. These are the waymarkers for leadership in a sandstorm.

I also think we need to realise that actually Covid wasn't a pandemic, it was a syndemic – multiple waves of impact from health inequality, right through to misinformation and access to service, acting synergistically. That must have a multidisciplinary response, and a psychological one is core to this.

Some 'acid tests' for the next syndemic

We have to learn the lessons from Covid response, and one of these is that Public Health needs to renew its efforts on receiving and using psychological science. In light of this, I suggest there are eight 'acid tests' for knowing whether we have learnt from the pandemic, to give the Government and public health system the right questions to ask and reflect on as we prepare for the inevitable 'next time'. There are contributions from psychological science to each of these.

Do we have a well-funded, effective infrastructure of readiness and response? Do we have honesty and clarity about readiness and gaps, and about what we want to achieve? Do we understand the roles and functions of different parts of the system? Do we have a culture of collaboration? Do we have the public's trust? Will we fund the infrastructure to deliver better public health, and not just core services but a range of services, in particular to protect our 'most vulnerable'?

We need to look at how psychology can be used to protect and improve the health of the public at every stage, from policy analysis right through to individual work. If public health is the art and science of the organised efforts of society to protect and improve the health of the public, every discipline has to come into that, including psychology and a broad range of social sciences.

And yet, to give an example, NHS vaccination policy for decades has been surprisingly psychologically barren. It was before COVID, we learned lessons, and now it feels like we've gone backwards. Vaccine uptake in the UK is sliding, partly because of fear, partly because of misinformation, partly because actually, people that we sometimes brand 'anti-vaxxers' are people with genuine questions about vaccine efficacy. We have to take that seriously.

Next steps

The first thing we need to do is summarise and collate the learning we have. The second is to identify the critical components of success and what must be in future plans for the next global or international outbreak. We need to get that agreed through international Psychology bodies and begin to influence governments. Influence the four chief medical officers, and National Health Protection Agencies and other bodies. I'm a great believer in policy network theory – get a whole load of people saying similar things in order to influence governments saying similar things.

I know that many public health professionals, like me, don't believe UK public health legislation is fit for purpose, given the diversity of outbreaks. ADPH has called for a Public Health Act for England, for example. I think we had something like 27 sets of public health regulations in the first two years of the pandemic, and that created as many problems as solutions. Psychology can also have a lot to say around those structures and systems.

The next government that goes into a pandemic needs to build and maintain a covenant of respect and trust between government and citizens. Those nations who did better in terms of weathering the storm had better respect. I think we need citizens who know what to do and are motivated. The huge outpouring of help that came from Covid actually has been sustained in faith communities, and in a number of other groups, but a lot of it has fallen away and people are tired.

We also need to develop a OneHealth approach to emergent zoonosis – encroachment on the environment is a significant creator and generator of often novel infections that we are immunologically naive to. And we have a lot to contribute to biosecurity, but we also have to reduce inequalities. 

You can find more recommendations in the full presentation here and in our discussion paper for Senate, here. These include:

• agree to support a BPS-wide working group built upon the existing DCP Public Health and Prevention Group with clear governance arrangements and the opportunity to shape BPS Strategy; 
• reflect on how current BPS Strategy can be shaped to include a greater focus on improving public health (in particular, how we can do more to promote the value of Crowd, Crisis, Disaster and Trauma Psychology to population health); 
• sign up to the Climate and Health Scorecard initiative; 
• formally capture the learning from the Covid Pandemic for the BPS for the purposes of future emergency planning and preparedness;

• consider preparing a detailed analysis of the contribution and importance of psychology to the SARS-CoV-2 pandemic.

   

  - We are planning a special issue of The Psychologist, 'Covid, 5 years on – Lessons and lives'. If you think your work in Psychology could feed into a contribution that is personal, practical and persuasive, please get in touch on [email protected].