The U.S. has once again found itself in the thick of another public health crisis with the Biden administration officially declaring the monkeypox epidemic as a public health emergency. Still reeling from the Covid-19 pandemic, the monkeypox outbreak could virtually not have come at a worse possible time for Public Health agencies and healthcare organizations which are just now regaining their footing following a hugely trying couple of years. And while there is hope that a swift response to the monkeypox vaccine could save the public health establishment and healthcare industry from becoming over stretched once again, there are still very real concerns swirling both inside and outside of the healthcare space about whether the Biden administration will be able to drive the response that is needed.
As the Covid-19 pandemic shows, just having the vaccine available does not mean that everyone at risk will immediately go out and get the shot. This is because healthcare decisions are very nuanced and driven by unique patterns in decision-making. So, while a flashy advertising campaign to drive awareness may work for some, for those that are more reticent it likely calls for a deeper more personalized approach. This is where applied behavioral science comes into the equation.
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Applied behavioral science driven healthcare initiatives are proven to help at-risk communities overcome some of their most pressing challenges – from HIV/AIDS prevention to improving neonatal care, which is why it is once again being viewed as a prime mover in addressing the monkeypox outbreak. The problem is that America’s history with behavioral science and healthcare hasn’t been a tremendous success. Since the Obama administration’s debut of a behavioral science task force in 2015, behavioral science as a priority languished under the Trump administration, and while the Biden administration did resurrect it to a degree, efforts that were rolled out throughout the country during the Covid-19 pandemic – like paying people to get vaccinated – were largely panned and ineffective.
So how can the government get it right this time? Here are a few key aspects that are needed to find greater behavioral science driven success this time around.
Leverage “wisdom of tribe” to address misinformation
Covid-19 response has been plagued with a vast amount of misinformation ranging from diagnostics, treatment, and vaccination. The same is already happening with Monkeypox, with centralized health authorities trying to win over the masses despite the Covid-19 pandemic showing that a sizable portion of the public does not trust them. Therefore, we are already on a path towards a repeat of the Covid-19 pandemic response. However, it doesn’t have to be this way. For example, based on recent learnings around identifying mechanisms to counter misinformation, instead of leaning on centralized authorities, the U.S. government should be considering mechanisms to share information that can spread through like-minded social networks and clusters. People are shown to trust information that comes from within their own tribe more than just random celebrity endorsements or through broad-based sponsored campaigns. This means partnering with local organizations and trusted local influencers to build confidence in vaccination and prevention methods from the grassroots on up, as opposed to trying to fight misinformation flames with a top-down approach that can ultimately make matters worse.
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Do not see parallels between monkeypox and HIV/AIDS
Just like when the Covid-19 outbreak began and was being comparatively reduced to the flu, we are seeing a narrative in monkeypox being comparatively enhanced in relation to HIV. Monkeypox is not the same as HIV. Unlike the initial days of HIV, the communities that are being impacted by monkeypox are a lot more resilient and have the ability to adapt to risks. Therefore, comparing monkeypox with HIV can lead to a feeling of helplessness or resignation instead of action. Public health officials also need to be very clear in illustrating the risk distribution between HIV and monkeypox to ensure that the public understand the distinct risk factors that are at play. For example, although it is in short supply, there is also a vaccine for monkeypox available where there is still no vaccine for HIV. Monkeypox is also “usually a self-limited disease” with symptoms that last from 2-4 weeks. Drawing these distinctions is imperative to building trust by helping individuals better understand their risks and avoid drawing harmful and incorrect false equivalence between HIV and monkeypox.
Be aware of the stigmas
Any disease that is linked with sexual networks is at a much higher risk of facing stigmas. And with the preponderance of early monkeypox patients being men that have sex with men, stigmas are certainly something that are going to need to be carefully studied and addressed – particularly as the health industry draws a line between HIV and monkeypox. This is again where targeted communication and sympathetic grassroots efforts will have a huge impact in getting high-risk individuals to take proactive steps. Furthermore, because these actions need to be paired with broader community efforts, decision-makers also need to find a way to overcome stigmas as well in order to drive a well-resourced and collective push. Stigmas can prevent people from less at-risk populations from engaging with a collective effort regardless of what it pertains to. Therefore, decision-makers need to get out ahead of potential stigmas by clearly providing context and laying out risks, such as highlighting skin-to-skin contact or mother-to-child transmission, to showcase that anyone can contract monkeypox, and thus, a communal effort is needed to prevent the spread.
There is no cheat code or one-size-fits-all approach to public health success. It takes a carefully crafted approach that hits on as many established behavioral cues as possible to drive action. This of course is not easy, but by keeping these few areas in mind, and learning from the mistakes of the past, the U.S. government and its international partners can create a more effective response to the monkeypox outbreak than they have for previous health emergencies.
Photo: BeritK, Getty Images
Ram Prasad co-founded Final Mile, a pioneer in applied behavioral sciences, in 2007 and is currently the CEO. Final Mile integrates behavioral sciences and human centered design to tackle complex behavioral challenges in global health, financial empowerment, transportation safety and other issues involving human decisions. Final Mile is leading several behavioral insights and design efforts across Africa, Asia, and North America in collaboration with implementers, governments, health systems, international NGOs and other key stakeholders.
Alok Gangaramany is a Behavioral Science and design practitioner with over 15 years of experience in addressing complex social and business problems by leveraging tools from diverse disciplines including behavioral science, design, organization change management, data science, and complex systems science. He leads Final Mile’s efforts in addressing complex behavioral challenges in global health & development sector. He has worked extensively on projects focused on improving outcomes of infectious diseases such as HIV & TB, reducing road safety accidents and improving sanitation & hygiene behaviors.
