The Psychology of Pandemics: Preparing for the Next Global Outbreak of Infectious Disease

This book is astounding in that although it was written in 2019, before the current Covid-19 pandemic, in describing human actions during previous pandemics, it predicts so many of the attitudes of those who disbelieve in the Covid-19 vaccine and Covid itself.

After describing irrational actions during the last pandemics, it urges public health to address issues and increase public trust before the next pandemic, since once misinformation is reported and believed it is very hard to eradicate.

It’s hard to choose a quote or two to encompass the book since every paragraph seemed relevant. Since it’s a very short, 116 pages plus another 45 plus pages of references, you can read it quickly.

It does read like a dissertation with numerous show more footnotes on every page and an extensive bibliography. But while some may find the format distracting, I found it utterly fascinating.

“ Things are likely to be complicated , unpredictable , and turbulent . There will be widespread prosocial behavior but also incidents of civil unrest and even rioting . Other fallouts will include a rise of xenophobia and discrimination . Ethnic minority groups and HCWs will likely be targets of discrimination . We will see a proliferation of conspiracy theories . Someone or some organization or agency will be blamed , rightly or wrongly . The news media will sensationalize the pandemic , despite admonishments to engage in more balanced reporting . Unfounded rumors and fake news will spread rapidly throughout the Internet . Heath authorities will struggle to contain rumors and to debunk conspiracy theories . Many people will dutifully conform to the advice of health authorities . Such people will get vaccinated , cover their coughs , and comply with social distancing mandates . But many other people will fail to adhere to the recommendations of health authorities . These people will engage in seeming self - defeating behaviors such as refusing to get vaccinated , if a vaccine is available . These people will refuse to stay home when they are sick . They will spread infection to other people ." p 113.

“There will be a rise of quack cures and folk remedies . Charlatans will seize the opportunity to capitalize on mass fears .

“To think of all conspiracy theorists as cranks is not helpful — there are just too many” p 70

"Conspiracy theories , as promulgated on social media ( e.g . , Twitter , Facebook , YouTube ) and through other avenues , have several common features : ( 1 ) The proponents typically go to great efforts to cite supposedly authoritative sources to support their claims , even if such claims might be vague ( e.g . , “ Research at Harvard has shown that … ” ) ; ( 2 ) the theories themselves are often vague ; and ( 3 ) the proponents frequently use leading questions ; a “ just asking ” style in which they raise rhetorical questions to challenge mainstream". p 72. show less

This book was long on the "what" and short on the "so what". It was a set of definitions and observations rather than a guide to preparing for the next global pandemic. It does a good job of covering, as the main title promises, the psychology of pandemics. It just doesn't deliver on the promise of the subtitle: preparing for the next global outbreak of infectious disease.

The first two chapters are a review for anyone living through this age of COVID-19. Superspreaders, social distancing, hygiene: these are familiar topics by now. Chapter three is also fairly familiar, although the chapter has some good insights, such as the idea that in uncertain times many of the negative behaviors people engage in, such as hoarding or promoting show more quack medicine, comes from a desire to recover some sense of control and certainty.

Chapter four goes into individual psychological factors that influence how people react to pandemics. The specifics are interesting, but the challenge from a societal perspective is that some people are prone to overreacting to the threat of disease while others are prone to underreacting. This makes it a challenge to come up with effective methods for encouraging adherence to public health guidelines. Digging into this further, chapter five discusses health anxiety. Some people overreact to a degree that it becomes both an individual and public health issue. While it is obvious that underreaction can become a public health issue, overreaction can put increasing burdens on the healthcare system (getting unnecessary tests) or the supply chain for essential goods (hoarding).

Chapter six discusses the behavioral immune system. Since we cannot see germs, humans have evolved to react to the visible signals associated with disease. This includes people who appear sick, of course, but it can also expand to those who are associated with sickness (e.g., healthcare workers) or who are stigmatized because of association with the disease (e.g., COVID-19 coming from China leading to discrimination against Chinese). The behavioral immune system is powerful, but an overactive system can lead to problematic discrimination.

Chapter seven discusses conspiracy theories. Conspiracy theories offer people a feeling of understanding, safety, and control. They claim to make clear why something happened, who benefits from it, and who should be blamed. Since pandemics are often times of great uncertainty, conspiracy theories can be an attractive way to avoid the reality's lack of legibility. Conspiracy theories are hard to dislodge although there is some evidence that people can be "innoculated" against them if they are exposed to the fact that would refute the theories before they are exposed to the conspiracy theory.

Chapter eight discusses the spread of belief, rumors, misinformation, and fear. These spread through direct information transmission, of course. They also spread via observational learning. If people see others being worried about a disease, they will become more worried, even when no specific factual information is conveyed. Media coverage tends to reflect and reinforce the concerns of the community, but with an overemphasis on the negative. During pandemic times, media has a responsibility to counter its negativity bias and to also emphasize what people can do to control the spread, protect their mental and physical health, etc.

Chapter nine is about risk communication. As noted above, one of the challenges is that people will react to a pandemic differently. Emotional appeal may appeal to some people but may push others to underreact. Logical appeals are received more consistently, but they are not as memorable and are less likely to motivate action. Communication about effective health measures will likely need to take multiple approaches.

One particularly useful concept from this chapter is the idea of psychological distance. Essentially, the shorter the perceived psychological distance between a person and a risk, the more likely they are to take actions to avoid that risk. This is a function of physical distance (is the disease here?), temporal distance (how quickly might it get here?), social distance (do I know anyone affected?), and probability distance (how likely am I to be exposed?). Shrinking the perceived psychological distance can help people take the risk more seriously, but only as long as the risks are not perceived as exaggerated.

Chapter ten is about adherence to vaccination recommendations. It mostly does not address conspiracy theory related reasons that people might avoid vaccines. Instead, it addresses the more mundane -- and therefore more prevalent -- reasons people do not get recommended vaccinations. People don't get vaccinated if they believe they are unlikely to be exposed, if they see themselves as unlikely to be infected, if they do not think the disease as serious, if they see the vaccines as hard to get (either logistically or because of fear of injection), or if they have misgivings about the safety or efficacy of the vaccine. This variety of reasons means that merely stressing the importance of vaccination is not enough. Instead, vaccination campaigns should target the specific reasons people avoid vaccines.

Chapter 11 covers the importance of treating pandemic related mental health problems. The chapter recommends a screen-and-treat approach where easy to administer screenings are deployed as widely as possible (e.g., mental health questionnaires at all medical exams). Those at risk are then funneled into further screenings (e.g., phone screens). Those who need additional health are then connected with qualified mental healthcare providers. This approach addresses two problems. First, those who need help may not proactively reach out for it. Second, by starting out lightweight, the process can aim to be less of a burden on an already stressed healthcare system.

The final chapter briefly notes some key things to do to prepare for the future.

Overall, lots of good information even if the book did not live up to its initial promise. show less

This is a brief, clear, straightforward summary of the psychological effects of pandemics on populations and individuals. While there is nothing particularly earth-shattering, it outlines a sensible way of mentally dealing with pandemics and is prescient with respect to the way the responses to COVID-19 appear to be shaping up.

Very good book. Easy to read with minimal jargon. Oddly comforting to know they people react the same regardless of the pandemic!