“Changing behaviours is complex and may not happen even when life is at stake – it requires more than clinical and epidemiological expertise,” so wrote one group of social and behavioral science experts convened by the World Health Organization to a new body also convened by the WHO to help create an international instrument on the pandemic.
The older group, the Technical Advisory Group on Behavioural Insights and Sciences for Health headed by American Cass Sunstein, penned an open letter to its younger cousin, known by the inelegant moniker Bureau of the Intergovernmental Negotiating Body (INB). This body was established in late December by the World Health Assembly “to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response.” The open letter, which appears below, urges the INB “to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response.”
The letter was made public on February 23, and the INB’s first meeting took place on February 24. That meeting, the next one on March 14, are focused on setting up the body and addressing the numerous bureaucratic concerns that attend to global diplomatic efforts. Nonetheless, by the end of this month actual subject-matter sessions and testimony are expected to begin. The letter calls for both actions by the INB include social and behavioral components and that social and behavioral experts – the word is underlined – be members of the panel or advisors to it.
The open letter, titled “Behavioural and social sciences are critical for pandemic prevention, preparedness and response,” appears in whole here, with its 20 signatories from around the world appear at the bottom.
Dear Bureau of the Intergovernmental Negotiating Body,
We, the members of the World Health Organization (WHO) Technical Advisory Group on Behavioural Insights and Sciences for Health, write to ask you to draft and negotiate a WHO convention, agreement or other international instrument on pandemic prevention, preparedness and response as they are critical for pandemic prevention, preparedness and response.
COVID-19 has confirmed that the behavioural and social sciences have guided our understanding of the drivers of transmission and how to design and deliver effective interventions. Changing behaviours is complex and may not happen even when life is at stake – it requires more than clinical and epidemiological expertise.
To ensure a robust international instrument, our first suggestion is that you consider including uses of behavioural and social sciences in pandemic prevention, preparedness and response at relevant places in the international instrument. This ranges from informed political and public health leadership, the choice of legislation for mandatory vaccination, financial measures to support self-isolation, guidance and scripts for contact tracing, and tailored communications for vulnerable communities to minimize health inequalities (explained well in this article).
Second, we propose the inclusion of at least one article focusing on critical behavioural and social actions for pandemic prevention, preparedness and response. One example of this is “intensify and target risk communication, strengthen community engagement, empowerment and support, addressing community concerns, combating misinformation and building trust” as highlighted by the WHO Director-General in his charge to countries at the World Health Assembly in 2021.
Finally, to facilitate the appropriate integration of behavioural and social sciences in the new international instrument, we propose that experts in behavioural and social sciences should be included as members of the Intergovernmental Negotiating Body or as advisors. We, together with WHO Headquarters’ behavioural sciences team, can help source these experts.
World Health Assembly resolutions related to COVID-19 that may be reflected in the new instrument, and which cannot be successfully implemented without the contribution of behavioural and social sciences, include:
- Community engagement, rapid investigation, risk assessment, rapid response and public information and risk communication: rapid and customized engagement and agile data collection with target audiences, synthesis and interpretation of their responses, and co-design of appropriate and acceptable responses from credible messengers, which can cause reactance and loss of trust in public health and government if poorly designed.
- Equitable access to healthcare services: explaining both public and healthcare professional barriers to equitable access and designing and evaluating solutions.
- International health regulations implementation/compliance and policies/norms/guidance: specification of behaviours for compliance; determining barriers to compliance through the science behind comprehension, intention and behaviour; and the expertise to optimize international health regulations and supportive resources for maximum impact.
Behavioural and social sciences use evidence, theory, frameworks, and methods drawn from anthropology, psychology, health promotion, behavioural economics, sociology, marketing, design thinking and more. These are used for the design, implementation and evaluation of policies and programmes for greater public health impact, reduced inequalities and greater value for the public purse. WHO needs to create mechanisms for capacity building in this area and for the rapid exchange of behavioural evidence and data and resources across countries.
The Intergovernmental Negotiating Body has a critical task ahead, with the responsibility of building on the lessons learned from the COVID-19 pandemic. One of the lessons learned is that we must improve how we use the behavioural and social sciences. We wish you the best as your work will help to enhance global health and protect lives and hope we can be of further assistance.
Professor Cass Sunstein, Harvard University, United States of America (USA) – Chair
Dr Maria Augusta Carrasco, Public Health Institute, USA
Dr Varun Gauri, Princeton University, USA
Dr Gavin George, University of KwaZulu-Natal, South Africa
Professor Ross Gordon, Queensland University of Technology, Australia;
Professor David Houeto, University of Parakou, Benin;
Professor Ruth Kutalek, Medical University of Vienna, Austria;
Dr Glenn Laverack, University of Trento, Italy;
Dr Fadi Makki, B4Development, Qatar;
Ms Ammaarah Martinus, South Africa;
Dr Shahinaz Ibrahim Mekheimar, Theodor Bilharz Research Institute, Egypt;
Professor Susan Michie, University College London, United Kingdom;
Dr Iveta Nagyova, Pavol Jozef Safarik University, Slovakia;
Professor Saad Omer, Yale University, USA;
Professor Rajiv Rimal, Johns Hopkins Bloomberg School of Public Health, USA;
Ms Jana Smith, ideas42, USA;
Dr Beena E. Thomas, National Institute for Research in Tuberculosis, India;
Dr Chiara Varazzani, Organisation for Economic Cooperation and Development, France;
Ms Archna Vyas, Bill & Melinda Gates Foundation, India; and
Dr Joyce Wamoyi, National Institute for Medical Research, United Republic of Tanzania