We were part of a group of public health experts appointed to a task force by then-President-elect Biden to advise on the pandemic during the 2020 post-election transition. The pandemic was about to enter its second year at that point. We have been continuously involved in the public health response. In this light, we offer 13 lessons, many of which are not yet well understood and incorporated into planning for the next dangerous epidemic. An infection that most of us will likely encounter in our lifetimes.
1) Human tolerance for lifestyle changes is limited.
Americans generally endured significant changes and restrictions in their daily routines and social interactions, including taking special precautions such as wearing masks, minimizing interactions, and lifestyle modifications. But my patience has reached its limit. By September 2022, 30 months after the pandemic began, 46 percent of Americans had returned to their pre-pandemic lives, according to a study by Axios Ipsos. This was despite an average of 90,000 new infections and more than 500 deaths per day as of September 1, 2019. Patience seems to have been even shorter during the 1918 flu pandemic. Your patience may run out faster if the next public health emergency hits soon. Policy makers need to recognize the limits of human endurance and prepare accordingly.
2) Incentives can change behavior. Social norms can enforce it.
Habits are hard to change. But with the right incentives, such as higher taxes on cigarettes and sugary drinks to reduce unhealthy behavior, people change. Mandatory workplace vaccinations have been effective in increasing vaccination rates during the COVID-19 pandemic. More creative uses of incentives and sensible obligations that do not provoke substantive resistance should be considered.
People also tend to follow social norms, the unspoken rules and conventions among peers that govern behavior in society. That is why masking was easier in East Asia than in the United States. During the SARS epidemic of 2002-2003, masks became common in East Asia and were often worn to prevent transmission and infection of the infectious disease. In the absence of such norms, persuasion from officials, celebrities, and other social influencers may need to be used. Policy makers must strive to implement public health measures that are translatable into social norms.
3) Trust is very important.
Public trust in governments and health institutions can reduce infections and deaths. Already bitterly politically divided, the United States has failed in this key element of the response. According to Gallup, as of 2021, only 39 percent of Americans have a lot or a fair amount of trust in the federal government in handling domestic or international affairs. And a 2022 Pew survey found that less than half said the country “appropriately prioritizes the needs, public health and quality of life of K-12 students.” . Trust is easy to lose, but very hard to regain. It requires honesty and transparency. Future policies, especially those based on uncertain or incomplete information, such as whether COVID-19 vaccination mandates should continue, need to be weighed in part by their impact on public confidence.