Clear health guidelines tailored to vaccinated people could help maintain the social norms around important public-health behaviour, writes Brooke Struck.
This column is an opinion by Brooke Struck, research director at The Decision Lab. Before joining TDL he consulted in evidence-based policy and data-driven decisions, advising clients including the European Commission, the U.S. National Science Foundation, and the Government of Canada. He worked on the COVI contact-tracing project, and with Montreal Public Health to develop COVID-related decision-support tools around compliance and vaccination. For more information about CBC’s Opinion section, please see the FAQ.
Wear a mask. Stay home. Wash your hands. Over the past year, we’ve all generally abided by these rules, even with fairly minimal risk of punishment for breaking them. Though coercive measures — such as fines or imprisonment — have technically been on the table, it’s social norms that have helped us to adopt and maintain these crucial behaviours.
But with vaccination ramping up, the situation is going to become much more complex.
Vaccinations create a challenge in terms of how to keep these important COVID-curbing behaviours working. Those behaviours are especially important right now, with case counts surging and the variants getting a foothold in Canada even as our vaccination campaign builds momentum.
Social norms are basically the standards of what people consider to be appropriate social behaviour. As articulated by Erez Yoeli, a leading behavioural researcher at the Massachusetts Institute of Technology (MIT), there are three key ingredients that give a social norm its power.
The first is that the social norm needs to be clear and explicit. We all need to know what the rules are.
The second is that the act of abiding by the rules has to be visible. We have to be able to tell when people are following the rules and when they’re not.
And the third is that there can’t be plausible deniability. If it’s too easy for me to talk my way out of something — to others or even to myself — I’ll find loopholes to avoid the rules. This often happens subconsciously through what’s known as motivated reasoning.
In this third area, vaccination creates an important challenge.
Up until now, only a small fraction of the population has tested positive for COVID-19. However, given the possibility of asymptomatic illness, nearly everybody had to live as though we, and all those around us, might be sick and not know it yet.
Widespread vaccination will change that.
WATCH | 10 million vaccine doses have now been delivered to the provinces and territories:
As of Monday, 10 million COVID-19 vaccines were delivered to provinces and territories, says Health Minister Patty Hajdu, and nearly 2.2 million more doses are expected to arrive this week. 4:29
Over the next few months, more and more of the Canadian population will be vaccinated. That’s going to create a plausible deniability problem that could have a huge impact on social norms.
To illustrate, suppose I’m waiting at a bus stop and not wearing a mask. What reaction should I expect from my fellow passengers? In January, when next to nobody had been vaccinated, I’d expect them to stare daggers at me.
By summer, with a substantial number of Canadians vaccinated (and hopefully lower case counts), I’d expect a more muted reaction. There will be uncertainty: “Maybe this person hasn’t had a vaccine and they’re irresponsible. Or maybe they have had a vaccine and their behaviour is therefore perhaps reasonable.” For a casual observer, there’s just no way to know.
This doubt — this plausible deniability about someone’s behaviour and whether the same rules apply to them — can undermine social norms in powerful ways.
As more people are vaccinated, it will provide an increasingly easy route for those who wish to flout the rules without incurring the judgment of others, eroding the behavioural norms that have been prompting us all to wear masks and physically distance for the past year.
At the same time, guidelines from federal and provincial governments on how to behave after getting the long-awaited jab have struck a dour and uncertain tone. Vaccinated people are advised to behave exactly as they were before.
So after being told for a year that the vaccine is our saving grace, we’re now being told that nothing changes once we’ve had it (at least for now). This not only removes part of the incentive to get the vaccine, it also creates frustration towards public health authorities and erodes credibility: How could vaccination be both essential and inconsequential?
To sum up, social norms have been key to encouraging compliance for the past year, but vaccines could undermine their effectiveness. Meanwhile, the motivation to get vaccinated comes from wanting to get out of this mess of a pandemic, but we’re still told to stay masked and in full physical distancing mode after getting the shot — with no defined end date.
As the weather warms up and the prospect of summer fun beckons, this set of conflicting policies could easily lead some people to give up on preventative measures and vaccines — both of which are crucial to maintaining public health while COVID-19 is circulating.
WATCH | Canada’s deputy chief public health officer discusses how life might change for Canadians post-vaccination:
Dr. Howard Njoo, Canada’s deputy chief public health officer, responds to questions about how life might change for Canadians post-vaccination. 4:32
How do we avoid this erosion of social norms that have helped protect us so far? There are two straightforward strategies that health authorities should consider.
First, outline a clear plan for how lockdown measures will be eased. Of course there will be uncertainty around these things. Of course we’re going to revise our plan as we learn more. Nevertheless, people still need to see a plan, even if they know it’ll change along the way.
Paul Dolan, a world-leading behavioural scientist at the London School of Economics, put it frankly: “Uncertainty is bad for mental health.” Seeing the checkpoints and the finish line helps us a lot, both with mental health and with supporting the current set of rules. “Nothing changes when you get the vaccine” is a very different message from, say, “Nothing changes until we reach 30 per cent of the population,” with defined changes at that moment, along with further changes when we reach 50 per cent, and so forth.
Second, in addition to the rules we already have in place for unvaccinated people, create a reasonable set of rules for vaccinated people, as the CDC has recently done in the United States (though whether those rules are too lax is a different question). That allows the social norms to keep doing their invaluable work by eliminating the plausible deniability problem. When one set of social norms doesn’t apply, there’s a second set of norms that kicks in, as opposed to defaulting to doing nothing.
Suppose, for example, that there were a clear norm in place that people do not need to wear masks in private gatherings of under 15 people if all of them have been vaccinated, but they must continue to wear masks in enclosed public spaces. In that situation there would still be an obvious benefit to being vaccinated, but that benefit is clearly defined. Meanwhile, the norm of public masking stays firmly in place, which is important given the uncertainty around COVID-19 variants and whether vaccinated people can still transmit the virus.
These two strategies should be used in concert. Lay out a plan for how COVID-19 restrictions will gradually be eased, including a set of guidelines tailored to vaccinated people that still support necessary ongoing public health measures.
We haven’t needed a two-speed system over the past year when nobody was vaccinated, and if all goes well, we won’t need a two-speed system a year from now when herd immunity helps all of us to enjoy at least a common baseline of protection. But there will be months of difficult transition between those two situations, and we’ll need a two-speed system based on a good transition plan to see us through.
Social norms are essential to our COVID-19 response, because it’s impossible to police the whole population into compliance. But those social norms need to be explicit, and we need the ability to see when people are complying and when they aren’t.