Life in the Time of COVID: Planning for Non-Adherence

7 April 2021, 1115 EDT

One of the numerous ways in which the world’s response to COVID has been problematic involves border closures.  As the novel coronavirus spread in spring 2020, more than 130 countries restricted international travel and border-crossing.  Some prevented entry by foreigners from specific countries, or by foreigners generally.  Others used blanket policies, preventing entry even by a country’s own citizens or permanent residents.

The continued pandemic makes it difficult to obtain complete and precise results, but preliminary studies issue several warnings about border closures.  For one thing, they do provide relief, but also should be supplemented by measures such as early detection, handwashing, self-isolation, and household quarantine.  Furthermore, border closures are costly: lockdown and other drastic measures may have been effective from a public health standpoint, but they also hurt societies, economies, and the humanitarian response system. Moreover, border closures may be illegal.  The “right of return” to one’s home country is enshrined in at least four regional or global treaties.  These treaties do contain some language allowing exceptions – but states that closed their borders during the initial months of the COVID pandemic rarely followed the treaties’ procedures, and therefore they’ve opened themselves to litigation in human rights courts.

If border closures are stopgaps that are costly and potentially illegal, then countries must explore additional options for dealing with infectious diseases.  During the COVID pandemic, such exploration has included mask mandates, prohibitions on large gatherings, restrictions on refugee processing, mass vaccination, immunity passports, and others.  Despite the variety of measures, however, exploration for each distills to two steps: 1) determine the policy, and 2) persuade people to follow it. 

Lessons from Two Steps: Process and Persuasion

For both the “process” step and the “persuasion” step, policymakers have learned some lessons. 

For the process step, policymakers now incorporate a longer list of criteria when determining policies.  Certainly, measures dealing with disease ought to be efficacious from a public health standpoint – but ideally they also will be equitable, legal, privacy-protecting, and difficult to game.  As a result, expertise from public health officials is being augmented by expertise from economists, lawyers, ethicists, engineers, and many others.  For example, current debates over immunity passports involve discussions not only of efficacy in reducing disease transmission, but also of equity, legality, privacy, and integrity.

Lessons also have been learned for the step of persuading people to follow policies.  Policymakers are exhibiting greater appreciation of the importance of reaching out to the public proactively, with consistent messaging.  In addition, they’re experimenting with social or behavioral theories – for instance, by publicizing celebrities getting COVID shots or by sending people nudges about vaccination appointments that were scheduled for them.  Much of the focus has been on reducing any reluctance or inconvenience that stand in the way of people following the policy.

The Missing Third Step: Planning for Non-Adherence

But this focus downplays a crucial third step: responding when people, unintentionally or intentionally, do not adhere to the policy.  In other words, policymakers must have a plan not only for overcoming reluctance, but also for dealing with non-adherence.  Smart design isn’t just about choosing a compelling policy and persuasion tactics – it’s also about tackling uncomfortable questions concerning what happens when (not if) some people do not go along

What is the appropriate response, and who is the appropriate responder, when a patron refuses to wear a mask in the public library?  When a college student throws a large party in her apartment building?  When a senior citizen shows up at the airline counter without proper proof of a negative test?  When groups of unaccompanied children approach a border to seek asylum, and don’t have immunity passports?  The uncomfortable reality is that although government officials are developing policies and trying to persuade people to follow them, there will still be non-adherents.  Moreover, in many cases it won’t be government officials encountering them – rather, it will be library staff, building managers, airline employees, charity groups, and so forth. 

No policy developed in Step 1 will be without drawbacks.  No persuasion campaign devised in Step 2 will guarantee full compliance.  So, if policymakers are serious about dealing with this infectious disease (and future ones), they need a Step 3 that wrestles with two tough issues. 

The first is whether it’s okay for public officials to patrol an increasing variety of quasi-private spaces; the second is whether it’s okay for private actors to carry out more quasi-public functions.  For COVID, responding to non-adherence might take the form of government actors moving into previously private spheres, or private actors substituting for government enforcement, or some combination of the two.  Neither is without tensions.  Yet both possibilities need to be frankly discussed in planning how to respond to the inevitability of non-adherence.

We’ve all heard the adage that “failing to plan is planning to fail,” but my warning is slightly different: honest anticipation of failure needs to be part of the plan. 

This piece was made possible (in part) by a grant from Carnegie Corporation of New York to Perry World House at the University of Pennsylvania. The statements made and views expressed are solely the responsibility of the author.