Steven Taylor

Psychological factors have been neglected in preparation guidelines for an avian influenza (AVI) pandemic. To address this gap, a narrative literature review was conducted to (1) examine how AVI outbreaks—so far largely contained to livestock—have psychologically impacted people, and (2) consider the implications if an AVI pandemic were to emerge, in which large numbers of people would be infected. Findings indicate that AVI outbreaks have been characterized by fear, disgust, and avoidance of poultry products. Many of the other psychological phenomena observed in AVI outbreaks have been documented in past pandemics and other infectious outbreaks: Blame and anger, disease-related avoidance and stigmatization, xenophobia, conspiracy theories, panic buying, and personal stockpiling have all arisen in response to AVI outbreaks. These psychological phenomena may persist and intensify if AVI outbreaks evolve into a pandemic. The lessons learned from COVID-19 can be used to prepare for a possible AVI pandemic. However, additional measures may be needed. Fear, disgust, and avoidance of specific foods would likely distinguish an AVI pandemic from COVID-19. The threat of infected food triggers disgust, and so food-related disgust would likely be a prominent emotional reaction during an AVI pandemic. Public messaging from health authorities and others has the potential to either ease or exacerbate public concerns about food safety, depending on how the messages are crafted.

Pathogens such as viruses are too small to be seen by the naked eye, so we rely on perceptible cues such as visual or olfactory signs of disease. The behavioral immune system is a hypothetical evolved mechanism to detect disease cues. Once detected, they evoke feelings of disgust and fear, motivating escape and avoidance. People differ in their behavioral immune system sensitivity, as indicated by scores on traits such as disgust sensitivity. When threatened with infection, people scoring highly on such traits become anxious, readily disgusted, and xenophobic. Addressing disgust sensitivity and perceived vulnerability to disease through cognitive behavior therapy may help reduce xenophobia and other forms of discrimination. Further research is needed to determine how this can be translated into community programs during infectious disease outbreaks.

Pandemics end slowly and unevenly, with much uncertainty about whether an outbreak is over. Pandemic-causing pathogens may never disappear entirely, becoming endemic in human populations or animal reservoirs. Determining when a pandemic is over can be challenging for health authorities. False endings—prematurely declaring an outbreak over—can erode public trust. Complicating matters, communities also decide when an outbreak is over. The social ending of a pandemic is when people feel the risk of infection has decreased enough to resume their pre-pandemic lives. The social ending usually comes before the physical ending of a pandemic. As pandemics recede, the frequency of hygiene behaviors (e.g., handwashing) tends to decline to pre-pandemic levels. Emotionally, most people “bounce back” to previous levels of function, and some even report positive personal growth due to the ordeal. Others do not fare so well, developing persistent mental health problems. Pandemics can be catalysts for societal change.

Fleeing from urban areas during disease outbreaks is a common reaction that causes infection to spread widely and contributes to societal breakdown when departing workers abandon their jobs. Over the centuries, medical and religious writers have debated the appropriateness of fleeing. It is generally agreed that fleeing is acceptable under certain circumstances but not others. Government messaging can influence people’s decision to flee. Governments must provide financial and other assistance to vulnerable individuals during lockdowns to prevent economic-induced fleeing. If people believe the government’s mitigation measures will protect them, they are less likely to flee their communities and, therefore, less likely to spread infection to surrounding areas.

This chapter examines the relationship between personality and pandemic-related distress, resilience, and nonadherence. People most likely to become anxious and depressed during pandemics tend to have high scores on distress-vulnerability traits (e.g., negative emotionality, trait anxiety, and intolerance of uncertainty) and low scores on stress buffering traits (e.g., trait optimism, resilience, and hardiness). Although personality tends to be stable over time, cognitive behavioral interventions can modify these traits, reducing distress and improving resilience. High scores on other personality traits (e.g., psychological reactance, boredom proneness, and psychological entitlement) are associated with nonadherence to pandemic-mitigation methods. Authoritarian personality traits are associated with xenophobia and punitive attitudes toward people who deviate from society’s rules. Although authoritarians tend to see the world as dangerous, they do not necessarily adhere to pandemic-mitigation measures; they follow their leaders.

People commonly experience mild stress reactions to vaccinations. Expectations influence the odds of adverse reactions to vaccines—that is, the nocebo effect. Severe vaccination-related stress reactions such as mass psychogenic illness and functional neurological disorders are rare but receive a lot of media attention due to their dramatic nature, inciting fear and hesitancy about vaccination. When vaccination stress reactions occur, people frequently assume the vaccines are faulty or contaminated. Therefore, it is often necessary to test the integrity of the vaccine batch and communicate the results to the public. Vaccination clinics can be structured to reduce the odds of stress reactions. In most cases, vaccination stress-related reactions are short-lived and respond to reassurance. Functional neurological disorders may require more intensive interventions.

This chapter examines links between political factors and pandemic-related psychological phenomena, including factors related to distrust of government and political polarization concerning pandemic-mitigation measures. In the early stages of a disease outbreak, disease concealment and under-reporting by government officials can erode public trust, especially if the attempted cover-up becomes widely known. The role of preexisting societal tensions (“fault lines”) is examined. The chapter also reviews pandemic-related protests, including riots. On the one hand, protests are informative for pandemic management—indicating which mitigation strategies are problematic. On the other hand, protests can quickly become superspreading events. Accordingly, protests complicate the management of pandemics. Various factors increase the odds of demonstrations and riots. Understanding the reasons for opposition and protest over mitigation measures can lead to better ways of managing pandemics.

This chapter discusses the uses and effects of risk communication during pandemics. Risk communication is when health authorities and other community leaders inform the public about the degree of risk posed by an infectious outbreak and make recommendations or declare mandates about what people should do (e.g., hygiene measures, social restrictions). Good risk communication is clear, specific, and action-oriented. Psychological factors play an essential role in risk communication. Even the naming of diseases has important psychological implications for xenophobia and fear of infection. Risk communications evoking fear are commonly used to influence health behaviors. Evoking fear to induce compliance can backfire, making some people highly anxious while others dismiss the threat as exaggerated. There are also ethical concerns about frightening people excessively to compel their cooperation. Fear-evoking messages are most likely to work if tied to some protective behavior the person believes they can perform.