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Editorials Democracy and Health

Preparing democracies for pandemics

BMJ 2020; 371 doi: (Published 23 October 2020) Cite this as: BMJ 2020;371:m4088

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Rapid Response:

Follow the Science, but Lead the Psychology

Dear Editor,

The recent experience of the evolving pandemic for the first time in our generation has exposed us to some clear weaknesses in our society. This is particularly obvious in many health systems where democracy and autonomy are paramount virtues.

“Follow the science” is a regular comment heard from politicians. Do they realise that science is not a straight and narrow stream that flows steadily in one particular direction. It often meanders along taking the occasional wrong turn and gets held up trying to course around areas of resistance, eventually to find a way through when the strength of science overcomes the forces of resistance to change. We scientists are all taught about historical characters, ridiculed at their time, only to be later recognised as visionaries. We are very good at celebrating historical figures but need to develop a better system to recognise and identify these visionaries while they are still alive and struggling while trying to push science in the right direction.

Throughout history science on occasion, has been on a wrong trajectory, only to arc back towards the correct one over time. It is very likely that politicians today could find the science that conveniently suits their beliefs for that has been the case in the past. We need to be wary of the term “follow the science” because in many instances, and particularly in a pandemic, we are developing the science as we learn more. Politicians and the public need to understand that the science can change and we need to be agile in responding to it rather than see every potential scientific correction as evidence of incompetence, to be viewed with distrust.

The job of scientists and politicians today is to win the population’s “hearts and minds” This is best done by involving more psychologically minded individuals in order to best understand how to communicate complex ideas while collecting the evolving science. A few decades ago there was a virus that could be stopped if individuals would wear a condom during sex. This HIV, coronavirus, was much more lethal than the virus of today. Despite that simple instruction, many people were unwilling to take or practise this advice much to their own detriment. Similarly, we have struggled for years to try and curb the number of individuals using tobacco and other recreational drugs. Every individual using these drugs understands the negative health implications of doing so. Despite that, large numbers continue to use them. Similarly, despite examples of good practice and many people following the advice of the scientists in protecting themselves and others from the coronavirus, yet again, there have been unfortunate examples of citizens not taking heed of scientific advice in democratic countries.

Why don’t people follow the science? Why is so it so difficult to win hearts and minds of autonomous people?

We need to accept that the countries that are failing to control the spread of the current virus are countries where the communication has not been coherent and clear and where there seems to be a lesser recognition and understanding of public psychology. Mixed messages are the worst form of communication and the resulting confusion is magnified when people are frightened and anxious. Politicians of all parties need to sit behind closed doors and come to an agreement on what the strategy for the country is going to look like. They must be advised by scientists and once a decision is agreed upon the strategy the advice needs to be communicated. This is best done with a mixture of humility and empathy and advised by psychologists who are able to offer help on the language and body language that encourages public confidence in our leadership that should be both persuasive and sympathetic.

Finally we need to understand that despite the best science and intentions there will be a group of autonomous individuals that will not follow the recommended path and these people should not be punished but used as a source for testing an alternative hypothesis with regular feedback of the implications of their choices.

We do need to accept that the human race does not always do what is in its own best interest and make more people aware of clear examples of this, of which we have many. We need to understand that with democracy and freedom come choices and consequences and that people need to accept responsibility. It’s better to offer incentives to nudge people towards “good” behaviour than to punish. Psychologists have worked out long ago that most people, like lab animals, respond to sticks and carrots. In the middle of a pandemic we urge the government to use the carrots wisely to reward what is considered appropriate behaviour and hope the majority will follow the science, with appropriate incentives. Despite our best attempts lets be accepting and empathise with those who will not come on board but use them as our control group in order to create the science for future generations to follow!

Competing interests: No competing interests

24 October 2020
Joseph Zacharias
Consultant Cardiothoracic Surgeon
Megan Joffe
Blackpool Victoria Hospital