COVID-19 is new, but the factors influencing our behavior during outbreaks are not

By Eric Nilles, MD
Director, Program on Infectious Diseases and Humanitarian Emergencies

It sometimes feels that we’re bombarded with a constant flow of media reports of outbreaks, epidemics and pandemics. But in this case, it’s not overdramatization. Serious outbreaks and epidemics are becoming more common: climate change, environmental degradation, and increasing population substantially increase the global risk of new outbreaks; and exponential international travel means that when they do occur these outbreaks can rapidly spread regionally or globally. These increased risks are exacerbated by weak health systems in many high risk (for outbreaks) countries which means that when they do occur they are less likely to be quickly identified and less likely to be effectively controlled. Despite major advances in our global epidemic preparedness since the large West Africa Ebola outbreak in 2013-15, there remain serious limitations in our global capacities. The challenges with the current novel coronavirus outbreak (recently renamed COVID-19 and likely to soon become a pandemic) is a case in point.

One specific area that we are just starting to better understand is the role of community trust towards government and international responders and how trust influences our ability to control outbreaks. Many factors that drive the transmission (spread) of outbreaks are influenced by our behaviors. For example, washing hands, avoiding contract with sick people, accepting vaccines when recommended, adhering to isolation measures, using mosquito repellent, etc. Because individual behaviors are complex and influenced by many factors, and because these behaviors can make the difference between effective outbreaks control and a major epidemic, my Harvard Humanitarian Initiative colleagues Patrick Vinck, Phuong Pham and I have worked to understand and describe if and how trust in authorities is linked to preventative behaviors in outbreaks settings.

We recently published the findings of one of our studies in the journal Lancet Infectious Diseases, based on research conducted during the ongoing Ebola outbreak in the Eastern Democratic Republic of the Congo. This is one of the few explorations of trust and how trust is linked to individual behaviors in epidemics and one key finding was that low trust in government institutions is linked to low likelihood of adhering to public health recommendations, such as accepting the ebolavirus vaccine, washing hands frequently, etc. Although these findings are, perhaps, not surprising, exploring, documenting and quantifying the influence of perceptions (of trust, etc) on behavior and epidemic transmission is critical to help develop effective control interventions to stop diseases from spreading and turning into global health threats.

The topic of serious disease outbreaks and how to control them is timely. The current COVID-19 outbreak, that started in December 2019 with a small cluster of severe pneumonia cases in Wuhan, China, is gaining steam and is rapidly turning into a global emergency. On January 30, the World Health Organization declared the outbreak a Public Health Emergency of International Concern, the highest-level alert for disease outbreaks -- and data from China and globally since that time has been progressively more concerning. The international response to this epidemic is complex and multipronged, but ensuring adequate focus and resources are invested in the socio-behavioral characterization of the outbreak is essential to ensure we mount a comprehensive epidemic response.