Communicate Hope to Motivate Action Against Highly Infectious SARS-CoV-2 Variants Michael Bang Petersen*a, Lasse Engbo Christiansenb, Alexander Bora, Marie Fly Lindholta, Frederik Jørgensena, Rebecca Adler-Nissenc, Andreas Roepstorffd, and Sune Lehmannb aDepartment of Political Science, Aarhus University, Aarhus, Denmark bDTU Compute, Technical University of Denmark, Kgs Lyngby, Denmark cDepartment of Political Science, University of Copenhagen, Copenhagen, Denmark dInteracting Minds Centre, Aarhus University, Aarhus, Denmark March 16, 2021 Abstract new variants, the B.1.1.7. variant, is now a global pres- ence and is expected to be the dominant strain in the The world is facing a race between controlling new and countries where it was first discovered within weeks [8]. more infectious variants of coronavirus and implement- These more infectious variants present a significant and ing vaccinations: How can health authorities and gov- new challenge. Because of higher infectiousness, new ernments most effectively communicate the need to en- variants strongly increase the risk of large outbreaks (wit- gage more strongly in protective behavior to avoid a col- nessed, e.g. in the United Kingdom and Ireland [7]), in- lapse of the healthcare system until vaccination programs tensifying the need for citizens to engage in protective are effective? In the first wave of the pandemic, citi- behavior [3], at a time where populations across the globe zens became engaged in ‘flattening the curve’ via pow- are strained with pandemic fatigue [4]. erful visualizations. Here, we use epidemiological mod- elling to develop a new visual communication aid, a This manuscript addresses the question of how health au- hopeful message of ‘buying time’, which reflects the pan- thorities and governments can most effectively commu- demic trade-offs currently facing governments, authori- nicate this new challenge to their citizens. ties and citizens. Using a population-based experiment In the spring of 2020, when the first wave of SARS-CoV-2 conducted in United States (N = 3, 022), we demon- spread across the globe, a figure illustrating the epidemi- strate that this hope-oriented visual communication aid, ological credo ‘flatten the curve’ became a global rallying depicting the competing effects on the epidemic curve of point. (1) more infectious variants and (2) vaccinations, moti- vates public action and communicates more effectively This illustration communicated the need for individual than fear-oriented visual communication, focusing exclu- and collective action within a conceptual framework of sively on the threat of the new variants. Finally, using epidemic modelling [1], in a way that resonated with a cross-national representative surveys from eight coun- large number of people. However, the ‘flatten the curve’ tries (N = 3, 995), we document the urgent need to mo- illustration, does not fit the current situation. Epidemi- tivate public action to halt the spread of the new, more ologically, the current goal is no longer to ‘flatten the infectious variants. These findings not only provide pub- curve’ in the sense of constantly keeping the number of lic health authorities globally with a validated blueprint hospitalized below the capacity of the health care system for health communication in a critical period of the pan- by moving infections from the present to the future. In- demic but also provide general insights into the impor- stead, there is a race between a variant-driven accelerated tance of hope as a health communication strategy. rate of infection versus vaccination-driven depletion of the pool of susceptibles. The goal of engaging in protec- After 10 months of the SARS-CoV-2 pandemic, the ar- tive behavior is, therefore, to decrease outbreak size (and rival of highly effective vaccines raised global expecta- associated hospitalizations and deaths) by buying time tions that a return to normal was within reach. As vac- until vaccines can take effect. Psychologically, research cines are rolled out, however, countries across the globe on health behavior prior to the pandemic has provided experienced the emergence of new, more infectious vari- increasing evidence that fear (e.g., fear of a collapse of ants of the coronavirus. The most wide-spread of these a hospital system) is not in itself enough for the genera- *To whom correspondence should be addressed. E-mail: tion of protective motivations [2]. Also, during the pan- [email protected]. demic, evidence has emerged that positive feelings such Author contributions: MBP, LEC, RAN, AR & SL conceptualized as empathy [5] and optimism [6] play a significant role, the study. LEC conducted epidemiological modelling. MBP, perhaps especially in the face of increasing fatigue. AB, MFL & FJ collected survey and experimental data. MBP, The challenges posed by more infectious variants call AB & MFL analyzed survey and experimental data. MBP, LEC, RAN, AR & SL wrote the paper. for intensified communication with the public, utilizing 1 Figure 1: The effectiveness of public health communication with (Panel A) and without (Panel B) the hope asso- ciated with vaccines. Panels C-D report unstandardized coefficients of marginal effects from OLS regressions that compare responses in the Hope Condition (Panel A) and Threat Condition (Panel B) to a control condition, respec- tively. Hinges denote 95% confidence intervals and whiskers denote 99% confidence intervals. a visual communications aid that clearly expresses the tions about infection and vaccination rates and hospital present rationale for engaging in protective behavior. To capacity (see discussion below). sustain both public trust and public motivation, this vi- To assess the communicative efficacy of this visual aid sual communication aid should be anchored in available and associated text, we conducted an online population- epidemiological knowledge and sensitive to the full spec- based experiment with a sample reflective of the US pop- trum of psychological motivations, including the human ulation in the beginning of February 2021 (N = 3022) capacity for hope. (for details on all data and models, see code repository1). Testing the Effects of Hope and ‘Buying Time’ Participants were randomly assigned to one of three con- ditions: (1) A control condition, which simply informed To create a visual aid for a hope-oriented communication the participants that more infectious variants of the coro- strategy, we built realistic epidemiological models reflect- navirus were spreading in the US and that authorities ing possible trajectories of the epidemic in one of the first may urge citizens to more strongly adhere to the health countries where B.1.1.7. was identified (Denmark). We guidelines. (2) A hope condition that displayed the graph modelled three scenarios (Fig 1A): (1) A scenario without from Fig 1A to the participants and described the dis- B.1.1.7. and without the implementation of stronger epi- played epidemic scenarios, emphasizing how the ‘goal is demic control measures. In this scenario the epidemic is to buy time until vaccines against COVID-19 take effect’. effectively controlled until vaccines take full effect (blue (3) A threat condition that displayed and described only dashed curve). (2) A scenario with B.1.1.7. but without the initial half of the graph, focusing exclusively on the the implementation of stronger epidemic control mea- threat from the infectious variants without mentioning sures (the red curve). Here hospitalizations exceed capac- vaccines and associated hopes (see Fig 1B). After expo- ity as B.1.1.7. becomes dominant until the vaccines take sure, respondents were asked to rate whether they found full effect. (3) A scenario with B.1.1.7. but where stronger that the information conveyed ‘a fearful message’ and ‘a epidemic measures are implemented (the green curve). hopeful message’. Subsequently, respondents completed This reduces the infection rate and manages to keep hos- four 3-item batteries that measured whether the informa- pitalizations below capacity until the vaccines take full effect. The models were generated from realistic assump- 1https://github.com/SocialComplexityLab/pandemic\_hope 2 sion the other outcome measures on observed feelings of hope and fear (controlling for the experimental treat- ments), demonstrate that feelings of hope (bs = [.49; .58]) predict these outcome measures substantatively and sig- nificantly stronger than feelings of fear (bs = [.13; .20]). These findings demonstrate that in the current phase of the pandemic, including the hope promised by the ad- vent of vaccines into the communication of future scenar- ios is effective in motivating stronger adherence to health guidelines and may facilitate a better public understand- ing of the pandemic situation that an exclusive focus on the threat from new, more infectious variants. Assessing the Need for Public Communication To assess the need for intensified health communica- tion about the new variants, we ran online surveys in eight Western democracies that have already identified Figure 2: Knowledge, fear and behavior change be- these variants within their borders: The US, UK, Sweden, cause of new, more infectious variants. Proportions with France, Italy, Hungary, Germany, France and Denmark. associated 95% confidence intervals within each coun- In each country, we surveyed about 500 respondents dur- try (Denmark, Sweden, United Kingdom, United States, ing January 2021. Respondents were sampled to match Italy, France, Germany & Hungary), that agree ‘com- the population