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Pandemic fatigue Reinvigorating the public to prevent COVID-19 Policy framework for supporting pandemic prevention and management
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4 Pandemic fatigue
Executive summary
Despite documented public support for pandemic strategies to maintain and reinvigorate public support to
response strategies across the WHO European Region, prevent COVID-19.
Member States are reporting signs of pandemic fatigue in
their populations – here defined as demotivation to follow Pandemic fatigue is an expected and natural response
recommended protective behaviours, emerging gradually to a prolonged public health crisis – not least because
over time and affected by a number of emotions, the severity and scale of the COVID-19 pandemic have
experiences and perceptions. called for the implementation of invasive measures with
unprecedented impacts on the daily lives of everyone,
Responding to a request from Member States for support including those who have not been directly affected by
in this field, this document provides a framework for the the virus itself.
planning and implementation of national and subnational
Protective
Opportunity Capability
behaviours
Motivation
Fatigue
The framework is intended to We propose four key strategies for governments to
support pandemic prevention and maintain and reinvigorate public support for protective
management. behaviours.
Given the complex nature of
pandemic fatigue, a multifactorial
action plan is needed. Actions must
be based on the barriers and drivers Understand people. Collect and use Engage people as part of the
experienced by people, and must be evidence for targeted, tailored and solution. Find ways to meaningfully
implemented in an integrated way effective policies, interventions and involve individuals and communities
across all levels of society. communication. at every
level.
Strategies to maintain and
reinvigorate public support must
be informed by public health,
societal, cultural and economic Acknowledge and address the
Allow people to live their lives,
considerations, and must ensure hardship people experience and the
but reduce risk. Wide-ranging
that no one is left behind. profound impact the pandemic has
restrictions may not be feasible for
everyone in the long run. had on their lives.Pandemic fatigue 5
For any initiative, policy or communication aiming to maintain and reinvigorate public
support for protective behaviours, we propose five cross-cutting principles.
Be transparent by sharing reasons Be as consistent as possible in Strive for predictability in
behind restrictions and any messages and actions, and avoid unpredictable circumstances, for
changes made to them, and by conflicting measures. example, by using objective criteria
acknowledging the limits of science for restrictions and any changes
and government. made to them.
Coordinate to avoid mixed
messages across experts and
Strive for the highest possible level spokespeople.
of fairness in recommendations and
restrictions.
As a quick list of concrete actions, we propose the following.
Think local. Reach out to civil Prepare safe solutions for Appeal to people rather than
society groups and ask them to find upcoming national celebrations blame, scare or threaten them.
creative ways of motivating their where people gather across Recognize that everyone is
members and peers. geographies and generations. Engage contributing.
individuals, workplaces, public
transportation systems, the retail
sector, retirement homes and more in
In every workplace, school, discussions about ways to reduce risk. Be clear, precise and predictable.
university, youth club and Provide clear recommendations. Use simple and digestible info
more, talk to users. Ask them graphics as an effective way of
how they would like to implement communicating restrictions and risks –
recommended behaviours. Ask them and how they are related.
what support they need from you. Understand which measures may
be unbearable in the long term.
Amend or balance such restrictions
with other measures (economic,
Conduct regular qualitative and
Develop guidance on living life while social, psychological), taking into
quantitative population studies.
reducing risk. Find creative ways of account the epidemiological risk.
Take the findings seriously. Use them
communicating such guidance, and to inform action.
avoid constant changes.
Make recommended behaviours
easy and inexpensive. This can
Tailor communication to specific
involve the provision of fast and
groups that experience demotivation.
cheap internet connections, free
Test messages and visuals with
masks and hand sanitizers, accessible
sample populations before launching
hand-washing areas, spaces for
them.
social interaction, opportunities for
teleworking, and more.6 Pandemic fatigue
Introduction
Behavioural insights surveys consistently confirm It provides a framework for Member States to help
that the majority of people generally support them plan and implement national and subnational
national COVID-19 response strategies, uphold high strategies in this field. It draws on the results of
knowledge levels and wish to follow recommended behavioural insights surveys conducted across the
behaviours (1). This is notable after half a year of European Region, including those based on a WHO
lockdowns, restrictions and significant impacts on tool (2), as well as pre-COVID-19 literature related
all of our everyday lives. to public health, health crises, resilience, trust, risk
perception, cultural contexts, communication and
Still, Member States across the WHO European more. It has been reviewed by a range of Member
Region are reporting emerging pandemic fatigue State representatives and topic experts.
in their populations. We consider pandemic
fatigue as an expected and natural reaction to the This framework is intended to support pandemic
prolonged nature of this crisis and the associated prevention and management. It should be read
inconvenience and hardship. However, it poses a in conjunction with other key WHO resources, in
serious threat to efforts to control the spread of the particular Risk communication and community
virus. Until a vaccine or effective treatments are engagement readiness and initial response for novel
available, public support and protective behaviours coronaviruses: interim guidance (3),
remain critical for containing the virus. The gains and the Risk communication and community
that each nation collectively achieved through engagement strategy for COVID-19 template (4),
lockdowns and other measures – sometimes at high which supports countries to tailor their own strategies.
social and economic costs – must be safeguarded.
This document includes the following sections.
Very limited experience exists on how to best
maintain or reinvigorate public support during What is pandemic fatigue?
a global health crisis that expands over months National plans of action
(potentially years) and that affects every member – Key strategy: Understand people
of every society in every country. – Key strategy: Engage people as part of the solution
– Key strategy: Allow people to live their lives, but
This document was prepared in response to reduce risk
requests from Member States for guidance – Key strategy: Acknowledge the hardship people
on responding to pandemic fatigue and experience
reinvigorating public support for protective – Checklist: Cross-cutting principles
behaviours. 10 suggested actionsPandemic fatigue 7
What is pandemic
fatigue?
What do we mean by pandemic
fatigue?
– A natural and expected reaction to
sustained and unresolved adversity in
Pandemic fatigue is understood in this document people’s lives.
as demotivation to follow recommended protective – Expresses itself as emerging demotivation
behaviours, emerging gradually over time and to engage in protection behaviours and
affected by a number of emotions, experiences and seek COVID-19-related information
perceptions (5,6).1 and as complacency, alienation and
hopelessness.
The pandemic fatigue reported from countries – Evolving gradually over time and affected
is expressed through an increasing number of by a number of emotions, experiences
people not sufficiently following recommendations and perceptions as well as the cultural,
and restrictions, decreasing their effort to keep social, structural and legislative
themselves informed about the pandemic and environment.
having lower risk perceptions related to COVID-19.
Previously effective core messages regarding
washing hands, wearing face masks, and practising
proper hygiene etiquette and physical distancing
may seem less effective, and many countries have Several components related to individual motivation
identified a need for reinvigorating approaches. have been strongly impacted by the longevity of
the pandemic situation. First, the perceived threat
Such demotivation is natural and expected at this of the virus may decrease as people become used
stage of a crisis. At the beginning of a crisis, most to its existence – even if the epidemiological data
people are able to tap into their surge capacity – show that the risk may, in fact, be increasing. At
a collection of mental and physical adaptive the same time, the perceived loss resulting from
systems that humans draw on for short-term the pandemic response (lockdowns, restrictions) is
survival in acutely stressful situations. However, likely to increase over time as people experience the
when dire circumstances drag on, they have to long-term personal, social and potentially economic
adopt a different style of coping, and fatigue and consequences of restrictions. For some people, the
demotivation may be the result (7,8). balance may shift, and the perceived costs of the
response may start to outweigh the perceived risks
This demotivation is part of a complex interplay related to the virus.
of many factors that affect protective behaviours.
These relate to individual motivation and capability Second, an ingrown urge for self-determination and
as well as to opportunities offered by the cultural, freedom may grow as restrictions continue for a
social, structural and legislative environment (see long time, impose inconveniences in everyday life, or
Fig. 1) (9). Each of these factors can be barriers to continuously change in ways people feel they have
and/or drivers of protective behaviours. little control over.
1
Here the word fatigue is used not in any clinical or diagnostic sense, but rather as it is used in everyday language to refer to exhaustion, tiredness, a feeling of being
worn out. Our use of the word pandemic indicates that we are focusing on fatigue related specifically to the COVID-19 pandemic and the restrictions imposed
to contain it. For a discussion of fatigue related to climate change perceptions and behaviours, refer to Increasing belief but issue fatigue: changes in Australian
Household Climate Change Segments between 2011 and 2016 (5).8 Pandemic fatigue
Third, even the most outrageous circumstances All of these factors are part of the demotivation
become normal when experienced over longer and pandemic fatigue addressed in this document.
periods of time. People may become used to the
pandemic and the threat it poses, and complacency
may result.
Fig. 1. The interplay of factors affecting COVID-19 protective behaviours
Peers’
expectations
and
behaviours
Cultural
norms, Rights and Self-efficacy Awareness
values regulations
Protective
Access
behaviours
(water,
sanitizer,
Workplace/
school Mental (Health)
non-public ability literacy
transportation) support
Income
Opportunity: Capability:
Social and physical Physical and psychological
Experienced
Contextutual hardship Individual
Values and
Intentions
beliefs
Perceptions Emotions
Fatigue
Perceived Risk
inconvenience perceptions
Boredom Complacency
Trust
Motivation:
Automatic and reflective
Individual
Fig 1. draws on the COM-B model, a widely used theoretical model to understand the factors affecting
behaviours (9). It proposes three overall factors that need to be in place for any behaviour to take place:
individual motivation (automatic and reflective), individual capability (physical and psychological) and
contextual opportunity (social and physical). The subcomponents of each factor can function as barriers
to and/or drivers of the behaviour.Pandemic fatigue 9
National plans of
action
Both before and during the COVID-19 pandemic, cutting principles for any policy, intervention or
considerable research has been conducted on fatigue communication that aims to reinvigorate public
and factors such as trust, risk perception, social and support for protective behaviours (see Fig. 2).
cultural norms, and structural opportunity (10–16).
Drawing on this research and on the complex nature Surveys across countries show that most people
of pandemic fatigue, we propose a multifactorial have a high level of knowledge related to COVID-19
plan of action. protective behaviours and are mostly able to find
the information they need. Yet emotions and
Overall, we recommend understanding people by contextual factors can have a greater impact on
drawing on evidence from epidemiological data and behaviours than knowledge (17), which means
population research. More specifically, we recommend that a strategy aiming to provide information
focusing on engagement, harm reduction and and public health advice alone may not be
recognition of hardship. We also propose five cross- the most effective. Rather, strategies should
Fig. 2. Four strategies and five cross cutting principles
Key strategies
in policies, Acknowledge
Engage people Allow people
interventions and Understand and address the
as part of the to live their lives,
people hardship people
communication solution but reduce risk
experience
Cross-cutting
principles
Transparency Fairness Consistency Coordination Predictability10 Pandemic fatigue
focus on policies and interventions as well as Supporting documents
communication. Their planning and implementation As noted above, this document should be read
should always be based on the current in conjunction with other key WHO resources, in
epidemiological situation, on behavioural insights, particular Risk communication and community
and on appropriate societal, cultural and economic engagement readiness and initial response for
considerations to ensure that no one is left behind. novel coronaviruses: interim guidance (3), and the
Risk communication and community engagement
strategy for COVID-19 template (4), which supports
countries to tailor their own strategies.Pandemic fatigue 11
Key strategy /
Understand
people
Background Strategic considerations
Pandemic fatigue results from various barriers that – Identify priority population groups – those
people experience across cultural and national that show signs of demotivation and those with
contexts, and that require different kinds of support, increasing transmission. Use population surveys
structures and communication. and surveillance data.
Understanding who is experiencing demotivation – Understand what motivates them; understand
and the barriers and drivers impacting their ability the barriers they face. Use qualitative and
or willingness to take up protective behaviours quantitative population studies, media
allows decision-makers to segment and tailor monitoring and hotline feedback.
actions to their particular needs. Barriers and
drivers can exist within various areas (see – Use what you learn. Use it to identify emerging
Fig. 1), and may relate to individual capability or perceptions and needs. Use it to inform pandemic
motivation, or to the social, cultural, structural or policies, communication and other interventions.
legislative environment. Careful consideration of Behavioural insights are only valuable if they
these elements leads to more successful and cost- inform action.
effective policies, interventions and communication.
– Test new initiatives, messages and
For communication in particular, quality over communication with the people whose
quantity should be the credo at this stage of behaviours you wish to change. Use (online) focus
the pandemic. High-quality, evidence-informed, groups or other research approaches.
tailored communication should be directed
to key population groups. Many people now – Communicate government needs, priorities
have high knowledge levels, particularly of and knowledge gaps to the research community
protective measures (1). At the same time, the to ensure that the research agenda is relevant
so-called COVID-19 infodemic has resulted in an and timely.
overwhelming amount of available information and
doubt about which sources are trustworthy (17). For
these reasons, less may be more.12 Pandemic fatigue Case examplesPandemic
for inspiration
fatigue 12
France Germany Romania Ukraine
Documenting personal Engaging experts from Using a behavioural Tailoring health
experiences using the health humanities insights survey to inform messages to target
creative and innovative in discussions of a strategy for reopening groups
methods restrictions schools
Researchers at the Ministry Discussions of pandemic Reopening schools Behavioural insights
of Health of France restrictions naturally after the lockdown surveys in Ukraine
learned more about involve virologists and posed important policy identified men with low
people’s experience of the medical specialists. challenges for authorities education as a group with
pandemic and related In Germany, however, across the Region. Not low adherence and low
restrictions through a other voices were being able to offer risk perception related
weekly questionnaire, and engaged to help balance education in a safe to COVID-19. To tailor
asked them to document ethical, cultural and environment could quickly communication to this
their life through behavioural aspects lead to public distrust critical group and enhance
creative tasks such as while safeguarding public and demotivation. The impact and relevance,
filming themselves while health – all critical aspects Government of Romania new COVID-19 messages
washing their hands. The of maintaining public used findings from a and visuals were tested
study concluded with support and preventing behavioural insights in focus groups. Tailoring
exit interviews with all demotivation. The Federal survey conducted in health messages to
participants. Notably, over Government consulted the country to inform specific population groups
16 weeks and with more philosophers, historians their strategy. The study can enhance impact and
than 60 participants, the of science, theologians, confirmed high support relevance. Focus groups
retention rate of the study pedagogical experts for reopening schools for can also be used to
was remarkably high. and jurists who provided both younger and older revitalize health messages,
Using qualitative methods valuable input, including children. Such studies which is important given
and creative approaches on the educational can help governments to that sustained exposure
may uncover new types of progress of children from identify developments over renders messaging less
insights that can provide disadvantages families, the time, new issues as they effective over time.
valuable information to legitimacy of restrictions of emerge, and the positive
inform policy (18). freedom, and the balance and negative effects of
between public support restrictions, messages or
and moral norms versus actions.
coercive state action (19).
Please note disclaimers on page 2Pandemic fatigue 13
Key strategy /
Engage people
as part of the
solution
Background Listening to people, understanding their needs, and
Humans have an essential need to feel in control planning policies that are responsive to those needs
of their own lives, and when this autonomy and that reflect people’s sense of self-identity all
is threatened, motivation is easily lost (20). promote feelings of engagement. Stories are also
Reinvigorating public support thus involves powerful motivators: research shows that people
engaging people as part of the solution (21,22). are more likely to follow actions if information is
Above all, engagement should give people a sense presented in a way that matters to them (24).
that recommended behaviours are not a matter of
capitulation to authority or a reflection of despair, For specific communities and population groups,
but a part of something positive, hopeful and (if at engaging trusted voices in promoting protective
all possible) fun (16,23). Such engagement can take behaviours as a social norm is likely to increase
many forms on national, community and individual support (25–27). During the Ebola crisis, enlisting
levels. the faith-based sector and trusted community
members was seen as a turning point in the
Promoting self-efficacy and positive majority epidemic response (28,29). Experience from the
behaviours can be a cornerstone in national COVID-19 pandemic also demonstrates that
strategies and communication. Rather than community cultural resources, norms and values
focusing on those who do not follow behaviours, it offer vital resources for building and maintaining
may be more effective to highlight the many who prevention efforts (16).
do, as well as positive majority norms and the public
health gains achieved through collective effort. On an individual level, people can be engaged locally
in workplaces, schools, sports clubs and more.14 Pandemic fatigue
Strategic considerations – Use commitment contracts. Encourage local
– Pass the baton on to others. Consider civil initiatives to engage people in setting goals and
society groups and leaders who could be pledging to follow behaviours.
engaged to take on leadership roles in enabling
and promoting protective behaviours: consider – Enlist trusted voices in health messaging, and
national youth organizations, local and national showcase those who have tackled COVID-19 in a
housing associations, religious leaders, sports positive way or those taking a lead in volunteering
clubs and scouting organizations, and business or to help others.
community organizations.
– Focus messages on strengthening self-
– Learn from civil society and actively engage efficacy, shifting from “the pandemic controls
them in developing scenarios for future local/ our behaviours” to “we control the pandemic with
national lockdowns. our behaviours”. Highlight the tremendous public
health gains achieved through collective effort.
– Ask civil society to find creative ways of
motivating their members and peers. Ask them – Seek to inspire as well as inform. Tap into
what support they need from you. Engage the power of stories and those who tell them
volunteers. Involve them in the design and well. Find creative ways or new opportunities to
delivery of COVID-19 policies, interventions and reiterate messages that engage people. Work
messaging. They can all play an active role. with professional writers, journalists, artists, and
other types of storytellers to create narratives
– In every workplace, school, university, youth based on the insights gathered from working with
club and more, ask users to discuss how they communities.
would like to implement the recommended
behaviours. These discussions can reveal barriers,
inconveniences and misperceptions that can be
addressed while still maintaining restrictions.Case examples for inspiration Pandemic fatigue 15
Denmark Turkey Norway
Co-creating solutions: Engaging people to reflect on Engaging staff to plan
@hvemdelerduspytmed their own environment kindergarten reopening
[who do you share saliva with]
The Danish Lung Association co- The WHO Country Office in Turkey National strategies for the reopening
created a campaign with its target has carried out Twitter polls asking of kindergartens in Norway
group of young people, encouraging questions such as “What are you included a degree of flexibility. This
them to enter a competition to come doing to protect your health?”. way, communities and individual
up with ideas for how to spend time These types of low-cost engagement kindergartens could operationalize
together in a safe way during the activities may spur people to think restrictions and protection measures
pandemic. Actively involving target critically about their own behaviours in ways that were tailored to their
groups in the design and delivery of and social environments while context. Kindergarten staff in some
engagement activities can ensure serving as a reminder of the ongoing places convened to discuss and
that they are tailored and responsive pandemic. collectively agree on sustainable
to the perspectives and experiences of local solutions to meet national
the people they strive to reach (31). requirements. Recognizing that
West Africa people are experts of their own
Partnering with trusted voices environment, this approach
United States of demonstrates the importance of
America During the Ebola epidemic, Christian enabling local decision-making,
Sharing commitment contracts and Muslim faith leaders used ownership and autonomy in national
through grassroots movements passages from religious texts to show planning (30).
that modified burial rituals were
In Florida, two brothers launched the
still spiritually acceptable. In cases
“Promise to Humanity” campaign
where religious rituals are affected
with a single goal: to enlist people
by COVID-19 restrictions, engaging
in signing contracts pledging to
religious leaders may increase the
follow all guidelines in an effort to
acceptability of adapted ceremonies.
slow the spread of the virus. After
Community leaders often have
signing the pledge online, followers
a high level of trust and a good
could nominate three more people
understanding of the community
to do the same. Such commitment
norms and values, which can be of
contracts are known to influence
great value to decision-makers in
people’s behaviours and keep them
policy formulation (33).
dedicated for longer (32).
Please note disclaimers on page 216 Pandemic fatigue
Key strategy /
Allow people to
live their lives,
but reduce risk
Background
The demotivation reported among some people is This approach can also be applied at a national
in part a reaction to the longevity of the pandemic. level. Member States who have recently applied
While early strategies could draw on far-reaching new restrictions to address case resurgences have
interventions such national lockdowns, long- done so mostly locally by applying smart, time-
term strategies will need to go beyond a state of limited and risk-based measures rather than broad
emergency and allow people to return to something and extended restrictions. This targeted approach
that resembles normal life. can reduce COVID-19 spread and its impact on
society and the economy while allowing for the
Thinking in terms of harm reduction may be a way continuance of elements of normal life.
forward. When adopted to address issues such as
alcohol abuse and sexually transmitted infections,
including HIV, harm-reduction approaches have
lowered morbidity and mortality (34). As different
as this pandemic is, such approaches may
prove useful for those who struggle to abide by
restrictions.
A harm-reduction approach recognizes that stopping
behaviours entirely may be difficult, but reducing
the harms associated with these behaviours may
be possible. With this in mind, a harm-reduction
approach encourages a spectrum of acceptable
behaviours (35). When presented with all-or-nothing
scenarios and daunting standards of success, people
are more likely to give up easily and revert to very
risky behaviour. In the context of the COVID-19
pandemic, this may take the form of throwing a
large party because not being social at all has come
to feel unsustainable. While small-group socializing
may not be 100% ideal, it is preferable to a reactive
burst of large-group activities.Pandemic fatigue 17
Strategic considerations – Consider whether all cultural events need to
– Help the public differentiate between lower- be cancelled, or if they can be implemented in
risk and higher-risk activities, and ensure that safe ways, for example, through a combination
there are support mechanisms in place for the of online and physical events with mechanisms to
lower-risk options when sustained abstinence is ensure safe practices. Engage in a dialogue with
not an option. organizers and find creative solutions together.
– Develop guidance on how to carry on with life – Encourage individuals and communities to
while reducing the risk of transmission. Guidelines identify harm-reduction strategies that fit their
can offer options for safer dinner parties, needs.
children’s play dates, workplace interactions,
dates, funerals, weddings, travel, etc. Find – Shift messaging from “do not” to “do
creative ways of communicating these. Stick differently”.
with recommendations rather than constantly
changing them. – Avoid judgment and blame related to risky
behaviours, as this can contribute to shame
– Start preparing for end-of-year celebrations, and alienation more than engagement and
and think ahead to other large-scale motivation.
celebrations over the year. How can individuals,
workplaces, public transportation, the retail
sector and retirement homes, for example,
be engaged to reduce risk leading up to these
events where people meet across geographies
and generations? Ask for their input and
develop the guidance they need. Provide clear
recommendations.18 Pandemic fatigue Case examplesPandemic
for inspiration
fatigue 18
Netherlands Denmark Israel United States of
When abstinence is not A new format for Safe social interaction: America
an option: the “cuddle cultural events the floating cinema Keeping track with a
buddy” contact budget
Recognizing that people The annual Copenhagen In Israel, a local business An American
need physical contact, Pride festival is usually a opened a floating cinema epidemiologist suggested a
including during a large-scale public event where people can rent a basic method of reducing
crisis, authorities in with colourful parades in boat on a lake and enjoy harm in everyday life: the
the Netherlands issued the streets and widespread a movie while respecting use of a contact budget.
guidance to single people celebration. This year, rather physical distancing Just as a household budget
seeking intimacy during the than cancelling the event, requirements. Encouraging provides an overview of
pandemic. They advised organizers extensively and supporting start- where money is spent
them to find just one changed the format to ups and local businesses and where savings can be
cuddle buddy rather than include mainly online as to think creatively and made, a contact budget
being intimate with several well as physical activities. “do differently” is key to allows individuals to
partners. Similar guidance Engagement with a broad ensuring the provision keep track of exposure.
has been issued in several range of stakeholders and of social spaces and Recognizing that some
countries. Supporting national health authorities recreational opportunities – level of risk is unavoidable,
people to balance high- allowed for a safe event critical elements in methods and tools like
risk and low-risk activities and the continuation of an countering pandemic this may help people to
rather than issuing all-or- annual celebration that is fatigue (37). consciously and critically
nothing recommendations important to many people. examine their own habits
may help to prevent Similar harm-reduction and choices to minimize
demotivation (38). strategies and guidance risk (39).
can be tailored to rituals
and holidays of social and
cultural importance. With a
specific goal in mind – such
as meeting loved ones –
and with people involved
in setting the rules, the
motivation is likely to be
high (36).
Please note disclaimers on page 2Pandemic fatigue 19
Key strategy /
Acknowledge
and address the
hardship people
experience
Background Surveys show that the perceived loss related to
Pandemic restrictions have imposed both hardship pandemic restrictions can be higher than the
and inconvenience in everyday life, and everyone perceived loss related to the virus itself.
has experienced some kind of loss – of income or a Behavioural insights surveys often show, for
job, of educational progress, of being with friends example, that fewer people have a high perception
and family, of engaging in sports activities, or of the of risk related to the virus itself, and that more
chance to participate in important rituals such as people indicate stress caused by concerns related to
weddings, graduations, funerals and more.2 It is well the pandemic response, such as losing their job or
established that the pandemic and its restrictions income (1).
have led to stress, loneliness and boredom, and
have had a negative impact on well-being and Under such circumstances, it is not a small request
mental health among many (1,40,41). Those already to ask for continued population support. If this
experiencing disadvantages have been shown to be hardship is not well understood, acknowledged and
affected even more negatively (42–45). addressed by those asking for population support,
people may very well lose motivation and COVID-19
initiatives, policies or communication may become
unsuccessful. The fatigue resulting from hardship
can be addressed by building resilience and
alleviating difficulties where and when possible,
including through financial, social, cultural and
emotional support offered by the government and
civil society.
2
The greatest losses relate to the serious illness and death caused by COVID-19. Additional guidance is needed on providing support to those who have experienced
illness or lost loved ones.20 Pandemic fatigue
Strategic considerations – Explore if difficult-to-follow restrictions
– Identify and address the barriers and can be balanced with other measures to
hardships people face, and understand which alleviate negative impact. This could take the
measures may be difficult to follow in the long form of financial support schemes, or social,
run (for example, isolation that results in loss of psychological or mental health support such as
employment or income). free online services.
– Make new habits of protection behaviours less – Create opportunities for people to fill their
costly. In terms of money: how can protection time productively if isolated or unemployed due
behaviours be as inexpensive as possible? And in to the pandemic, such as training or employment
terms of effort: how can we make recommended programmes, employment subsidies, or start-up
behaviours as effortless as possible for people? incentives. Help them to build more structure
into everyday life and engage in activities that
– In all communication, acknowledge the have positive effects, such as being outdoors,
hardships that people face or fear, such as exercising and enjoying safe socializing.
loneliness or loss of income. Empathy, hope and
understanding above punishment, shame and – Avoid an economy-versus-health dichotomy.
blame. Personal economic hardship can result in
demotivation, and so pandemic response
– Explore how difficult-to-follow restrictions measures may include efforts to keep the
can be amended while taking into account the economy and businesses going.
epidemiological risk.Case examples for inspiration Pandemic fatigue 21 Norway Russian Federation Acknowledging hardship to motivate youth Tackling structural barriers The Norwegian Minister of Health gave a speech Tackling structural barriers is a prerequisite to any acknowledging the hardship experienced by young people sustained behaviour change. In the Russian Federation, and thanking them for their contributions to society. several measures have been put in place in this regard. Norway has also consulted with youth on safe solutions Lump-sum payments have been provided to families with for graduation celebrations and initiation ceremonies children, and financially vulnerable families with children at universities. This seems to have paid off: population aged 3 to 7 years are eligible for a monthly allowance. surveys in Norway show that youth are more adherent to Citizens who have lost their jobs can apply for this COVID-19 restrictions than those aged 50+, in contrast to allowance in 2020 independent of their financial status. many other countries. Even when hardship itself cannot In Moscow, older people have been supported to engage be alleviated, understanding and empathy can be strong in physical activities taking place outside and in a safe motivators for continued support (48,49). manner. Spain France Bulgaria Removing structural barriers Stepping up with timely responses Preventing domestic violence through social protection schemes to emerging challenges during the pandemic Many countries have implemented As in other countries, behavioural In response to increasing reports of social and economic supports for insights surveys documented that domestic violence since the beginning those most affected by pandemic the mental health of the French of the pandemic, the Government restrictions. Spain launched a population was severely affected by of Bulgaria adopted a national national Minimum Living Income the lockdown. In response to these programme to prevent violence and scheme. Offering monthly payments findings, health authorities rapidly protect women and children. It aims of up to US$ 1145 to the nation’s implemented a range of measures to maintain services and offer help to poorest families, the programme to promote good mental health those who need it. Such programmes will support 850 000 households. among citizens. This was done in have been initiated in many countries Eligibility is not contingent on close collaboration with health and may help to alleviate some of the unemployment or lack of income, professionals and the volunteer negative social consequences of the which allows people to continue a sector. Efforts included a free pandemic (47). level of employment. As such, they national telephone hotline and can meet basic needs while still information and referral lines for seeking to improve their situation those experiencing psychological through employment or vocational distress (41). training (46). Please note disclaimers on page 2
22 Pandemic fatigue
Checklist /
Cross-cutting
principles
The four key strategies for reinvigorating public perception, social and cultural norms, and structural
support for protective behaviours must be applied opportunity. These principles should be applied
based on the epidemiological situation and on across policies, interventions and communication,
societal and economic considerations to ensure and can be used as a checklist. They prompt
that no one is left behind. To support this process, decision-makers to ask: will people consider these
we propose five cross-cutting principles that draw actions to be appropriately transparent, fair,
on evidence relating to factors such as trust, risk consistent, coordinated and predictable?
Transparency Fairness Consistency
Knowing the rationale for decisions To trust authorities, people need Ensuring consistency in an ever-
increases motivation to follow to feel that all relevant opinions changing situation is next to
them (50). Be transparent in sharing the have been included (10,11) and impossible. Still, consistency can be
reasons behind recommendations that decisions have been based on pursued by making sure that the risk
and restrictions. Acknowledge the objective criteria, not on arbitrary being communicated in messages
limits of science and government in grounds or the interests of certain and restrictions is always in line with
terms of predicting the development groups. Strive for the highest possible the current epidemiological risk, and
of this pandemic and what level of fairness in recommendations that the actions of leaders are in
restrictions will be necessary at any and restrictions. All people have felt line with what is being recommended
later stage, share uncertainty and the consequences of the pandemic, for the public. Authorities should also
take responsibility for the decisions and catering only to the needs of avoid inconsistent responses, such
that need to be made on uncertain some will be perceived as unfair by as lifting restrictions in one sector (for
grounds. Making promises you cannot others. Creating structural conditions example, increasing the number of
keep or being unwilling to share for health equity is another critical spectators allowed at sports events)
reasons for actions leaves room for aspect, which involves clearly while tightening them in another (for
misperceptions, myths and even communicating the need for equity, example, imposing new restrictions
conspiracy theories. Clarity and for example, by compensating for or on restaurants), without providing
simplicity are key: messages that alleviating restrictions particularly for a clear rationale and explanation.
are not clear or simple enough to those who are suffering the most. Consistency may also be established
understand and act upon lead to through the regular use of specific
uncertainty and distrust. terms and numbers, such as
transmission rates, case rates and
fatality rates.Pandemic fatigue 23 Coordination Predictability Stakeholder coordination creates Predictability is a basic psychological trust (51). Maintain relations with need that prevents stress and stakeholders, strive for unity, and mental overload. This pandemic is avoid mixed messages from characterized by everything but experts, spokespeople, government predictability. Still, countries can representatives and health workers. strive for predictability by setting Everyone is entitled to their expert objective epidemiological criteria opinion; however, everyone also for restrictions (and their shifts needs to be aware that sharing early up or down) on, for example, travel, research results or their personal risk gatherings, educational institutions perceptions in the public debate may and workplaces. Countries can also affect trust in experts in general, communicate clearly the timelines particularly if these results and for restrictions and follow up on perceptions are not in line with those these so people know what to expect. of other experts.
24 Pandemic fatigue Case examplesPandemic
for inspiration
fatigue 24
Norway Kazakhstan
Making decision-making processes transparent Showing empathy
Norway has upheld a high level of transparency in Recognizing the significant losses that people have
decision-making and the role of expert bodies. The experienced during the pandemic, the WHO Country
rationale for decisions has been clearly communicated to Office in Kazakhstan addressed the nation on social
the public, including instances where decisions departed media to remember the loss of health-care workers on the
from the recommendations made by expert bodies to the occasion of the national day of mourning for the victims
Government (55). of COVID-19. Providing space for grief and demonstrating
empathy for the considerable impact that the pandemic
has had on people are more important now than ever, as
trauma reactions are to be expected (52).
Ireland Germany Latvia
Tailoring easy-to-understand Leaders walking the talk Decision to be open and honest
messages for different audiences about the unknowns
In many countries, leaders have
Several countries have sought sought to lead by example, including In Latvia, a strategy of honesty was
to demonstrate the relationship through isolating themselves, agreed on as a fundamental political
between levels of risk and different wearing masks, and cancelling principle. When COVID-19 emerged,
behaviours in simple tables or personal events or celebrations. the authorities conducted daily press
infographics (53). Ireland prepared When quarantine was deemed conferences and answered each
an overview from which tailored necessary in Germany, Chancellor and every question. In cases where
infographics are selected and Angela Merkel self-isolated from they had no answer, they admitted
used individually for targeted 22 March to 2 April after her doctor this and promised to follow up
audiences (see https://assets.gov. tested positive for the virus. She with more information as soon as
ie/87604/405b1065-055a-4ca8-9513- recorded a podcast about her possible. Demonstrating honesty and
390ce5298b10.pdf) (54). quarantine experience, and shared transparency is essential to building
that she had been lonely. and maintaining trust.
Please note disclaimers on page 2Pandemic fatigue 25
10 suggested actions
We offer this list for decision-makers who are seeking recommendations for
concrete actions. All of these actions relate to the strategies and principles
outlined above.
01 04 07
Think local. Reach out to civil Start early to prepare safe Appeal to people rather than blame,
society groups and ask them to find solutions for upcoming national scare or threaten them. Recognize
creative ways of motivating their celebrations where people gather that everyone is contributing.
members and peers. Ask them what across geographies and generations.
support they need from you. Engage Engage individuals, workplaces, public
volunteers. Youth organizations, transportation systems, the retail
housing associations, religious sector, retirement homes and more in 08
leaders, sports clubs and scouting discussions about ways to reduce risk Be clear, precise and predictable.
organizations, and business and during the time leading up to these Use simple and digestible
community organizations can all play events. Ask for their input and develop infographics as an effective way
an active role. the guidance they need. Provide clear of communicating restrictions and
recommendations (56-58). epidemiological risks – and how they
are related.
02
In every workplace, school, university,
05
youth club and more, ask the Understand which measures may 09
users to discuss how they would like be unbearable in the long term – Conduct regular qualitative or
to implement the recommended for example, extended isolation qualitative population studies. Take
behaviours. These discussions may that results in loss of employment the findings seriously. Use them to
reveal barriers, inconveniences or income. Amend or balance inform action.
and misperceptions that can such restrictions with other
be addressed while maintaining measures (economic, social,
restrictions. psychological), taking into account
the epidemiological risk. 10
Tailor communication to specific
03 groups that experience demotivation.
Develop guidance on living life
06 Test messages and visuals with
sample populations before launching
while reducing risk. For example, Make recommended behaviours them.
make recommendations for safer easy and inexpensive. This can
dinner parties, children’s play dates, involve the provision of fast and
workplace interactions, dates, cheap internet connections, free
funerals, weddings and travel. Find masks and hand sanitizers, accessible
creative ways of communicating hand-washing areas, spaces for
such guidance. Avoid constant social interaction, opportunities for
changes. teleworking, and more.26 Pandemic fatigue
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