Tackling Covid-19: The Role of Behavioural Science

Prof Susan Michie is not only Professor of Health Psychology at UCL and Director of the UCL Centre for Behaviour Change, she is also a member of the UK Government’s behavioural science advisory group to SAGE, a member of Independent SAGE (established to complement the work of SAGE), and served as a Covid-19 consultant advisor to the WHO Behavioural Insights Team. Prof Michie was therefore an excellent choice of keynote speaker to start this session, to provide insight on the role of behavioural science in tackling arguably the most significant global public health crisis of the twenty first century; the Covid-19 pandemic.

Prof Michie began by outlining a number of key research contributions made by behavioural scientists. These included a weekly survey instigated early in the pandemic, measuring adherence to the Test, Trace and Isolate system by approximately 2000 people per week. Prof Michie and colleagues were able to rapidly mobilise this study due to their previous work on, and some legacy funding from, the 2009 swine flu pandemic (H1N1). At the time of the conference the Government had just agreed to allow publication of the survey data, which revealed less than 30% of people with symptoms were staying at home for the required period. Prof Michie commented that this why herself and her colleagues had been “banging on” in the news media about the problems with the Test, Trace and Isolate system, as the point of it was to separate infected people from the rest of the population. These findings suggested this was not happening effectively enough.

Prof Michie also highlighted the BPS Behavioural Science and Disease Prevention Taskforce and the Health Psychology Exchange (HPX) collaborative as “fantastic policy-oriented evidence synthesis factories” that had been established to support public health efforts.

Prof Michie continued by summarising the role of behavioural scientists in communicating with other scientists and professionals about Covid-19. Prof Michie highlighted the breadth of talent and expertise within the membership of SPI-B, who advise SAGE, which includes anthropologists, sociologists, social & health psychologists, and communication and implementation specialists. Prof Michie described some of the work the SPI-B group had done in response to requests from the Government, via SAGE, such as assessing the likely impact on adherence to personal protective behaviours of the vaccine rollout. Prof Michie described evidence from Israel which showed spikes in transmission immediately after vaccination, potentially due to changes in these behaviours, and the subsequent production of an animation, scripts and posters for the Department of Health to promote continued adherence to these behaviours after vaccination.

Prof Michie continued by discussing differences in opinion on how politicians/policymakers and scientific advisors perceive the division of their roles. This included highlighting occasions when politicians do not ‘follow the science’ when other agendas are perceived as equally or more important than public health, and the challenge to scientific advisors of dealing with unclear, partial or even contradictory evidence when formulating their advice to policy makers. Prof Michie offered her own view that as behavioural and social scientists, there cannot be complete separation between scientists and policymakers. Prof Michie described it as a pathway from evidence into policy and practice and argued that this pathway was the aim of scientific inquiry, and therefore we must be prepared to get involved with the “messy business of engaging with real-life decision making.”

Prof Michie explained the rationale behind setting up ‘Independent SAGE’, which she described as “Founded with the intention of putting scientific facts and debate into the public domain”, on the basis that as “behaviour is at the heart of pandemic control”, it is the responsibility of scientists to engage with the public to ensure that science benefits all of society. Prof Michie also argued that openness and transparency results in better understanding and decision making. Indie SAGE benefits from being a small and therefore agile group, which has produced over 50 reports, had over 20,000 viewers of its briefings, and from working in a consultative and iterative way, making it both “engaged, and engaging.”

Prof Michie concluded her talk by posing the question: “Should behavioural and public health scientists be part of, rather than just advising, the policy debate?” Prof Michie herself argued that as behavioural scientists we need to be more explicit about our values, for example, most of us believe that social and health equality is a good thing, and that these values drive us towards implementation science. As such we have more to offer than just advising others.

Following this the Chair, Dr Jeanelle de Gruchy, asked about the role of Directors of Public Health (DPH). Prof Michie argued that local public health structures are key, and used the example of Test, Trace and Isolate, which she argued had been inappropriately given to large national third parties to operate, instead of utilising the local knowledge and expertise at local and regional level.

Prof Jim McManus, outgoing Chair of the BSPHN and Vice President of the Association of Directors of Public Health, was then invited to talk about his experience as DPH for Hertfordshire, and the journey he had been on over the last six or seven years. Prof McManus described the progression from “Then”: being a lone DPH who was also a Chartered Psychologist, with an “obsession” with psychology and working with a small group of like-minded people to form the BSPHN, to “Now”: having an established Behaviour Change Unit, multiple qualified social scientists, and psychologists, dual-qualified in public health, and great partnerships with UCL and University of Hertfordshire. Prof McManus also excitedly described how public health and psychology had helped to design a Recycling Centre and highlighted how recent discussions about vaccine uptake in black and minority ethnic communities (BAME) communities were being led by health psychologists. He believed this was significant progress, as doctors were listening and engaging in real dialogue.

Prof McManus went on to outline a wide range of examples of work he was involved in around the pandemic, which he argued were “all things that are better done at local level, with partnerships with experts,” including:

• ADPH Guidance Preventing communities
• Vaccine Uptake Work
• Coping with lockdown
• Self-isolation compliance
• Vaccine hesitancy
• Compliance with combination prevention
• Free evaluation service for voluntary sector
• Internal consultancy

Prof McManus recalled how HIV had highlighted the necessity of social science in improving health and argued that we are in danger of being drawn back towards to the clinical approach to public health that was prevalent in the 1970s. He went on to call for a social science-informed approach to public health, arguing that if the pandemic had not taught us how much we need social sciences at local level, nothing will! Prof McManus moved on to describe the challenge of the increased vulnerability of BAME populations to Covid-19, combined with lower levels of vaccine update in these communities, and insisted that this must be a social sciences challenge, as well as a biomedical one. Prof McManus referred to the World Health Organisation’s (WHO) six tests for exiting lockdown and highlighted the local work ongoing in Hertfordshire relating to these. These include “knocking on 10,000 doors” and an exercise that revealed that the vast majority of those who don’t self-isolate either don’t know how to, can’t afford to, or need some support.

Prof McManus finished his talk by suggesting we should view the current pandemic through a “syndemic” lens, arguing that it has much in common with the HIV pandemic, in that it is the combination of Covid, plus mental health, plus lack of income, plus injustice, plus inequality. He argues that social scientists have so much to offer, to add to what is already there in public health. Prof McManus concluded by imploring us to work together towards “changing the system” to improve health for all across the life course.

Personal reflection: Having listened to both speakers in this session, I was left feeling very proud of the role that behavioural and social science has played in tackling the pandemic to date. I was also inspired by the calls to action from both speakers, to continue the work on the pandemic and beyond, to create a fairer and more equitable society, for the improvement of public health for the whole of our society.