Nearly a month ago, I called for an urgent 24-day full national lockdown, arguing that the restrictions were unlikely to make a significant difference in reducing transmission. If we had acted strongly and decisively then, and implemented a circuit-breaker lockdown — as we now know that the government's scientific advisory group Sage also wanted — we would be in a much stronger position today.
Many readers considered it a controversial and unwise strategy. The government agreed, declining Sage's advice and instead announcing the eventual rollout of a three-tier system covering areas of ‘medium’, ‘high’ and ‘very high’ risk, each with their own restrictions. Yet case rates, hospitalisations and deaths continue to increase across the country.
This prompted Sir Keir Starmer to — finally — call for a national two to three week circuit break. The Labour leader has correctly recognised that the current mixture of restrictions and pseudo-mini-lockdowns — which have no clear end or exit-strategy — are likely to yield an even greater negative economic impact than a national, brief and finite circuit break after which we could fully reopen the economy.
So why isn’t the government’s strategy working? After all, the central premise of the restrictions makes sense: if we reduce people’s contact with others in areas of particularly high prevalence, then the virus will struggle to infect new hosts.
It has failed because this isn’t a chess game. People aren’t pawns that can be moved about without ever objecting to whatever strategy the player is employing in each move. Managing pandemics is instead much more like managing a football team. You can have the best players who in theory should always win you the game, but football, like epidemic management, isn’t as simple as that.
What is needed in epidemics, like in a successful football team, is collective harmony. The majority of people need to be on board with a particular strategy. This will depend on them clearly understanding what’s required of them, that everyone else is putting in a fair and equal effort and, crucially, a belief that their collective adherence to the strategy will make a significant difference. This is what happened during the first lockdown in March and why it was so strongly adhered to.
These principles align with what we know about health behaviour science, an important toolkit that I believe the government has crucially failed to effectively leverage. Most health behavioural models emphasise the importance of motivation. Simply put, if people are motivated enough, they will at least try to adhere to actions designed to protect their health. Behavioural science also highlights how fragile motivation can be and how perception underpins it.
It is clear that today we do not, as a nation, have collective harmony or motivation. This is because of many factors but an important one is perception. Many people simply do not perceive the government’s restrictions as making sense because, frankly, many of them do not. Consider those people living under the ‘very high’ tier whose motivation is likely to be particularly fragile given the sacrifices they are being asked to make.
To protect their motivation to adhere, these people will need clarity on why their particular area is classified as ‘very high’ while a neighbouring area is not. They will question why their local gyms are closed but restaurants can remain open. Some will question whether a local lockdown is really a lockdown when schools and some workplaces remain open. Many will also question why we are making such sacrifices for a virus perceived to be of little threat to public health. Crucially, they will question the overall strategy — as well as asking when this will all end and what happens after the second wave is over.
This is why a finite, national and even approach is much more likely to be effective than a fragmented locally targeted one. A collective national approach will mean people are much more likely to perceive the measures as fair. With just one set of clear rules, the confusion over different restrictions for neighbouring areas will be eliminated and there will be unified clarity on what is expected. Most importantly, there will be a sense of optimism given that a circuit breaker has a finite end followed by the full re-opening the economy.
The post-second wave strategy should also be made clear now. People need to know what the government is planning for the long-term. It should be made clear that case rates are likely to increase again but that they will do so at a much slower rate. This should allow our weapons — widespread testing and track and trace — to increase their effectiveness. And when the second wave does indeed pass, the government must value the expert advice of Sage — including their health behaviour scientists — and stop viewing the public as willing pawns in a game of chess.