I have long wanted to conduct an experiment into the genetic composition of the English, based on their approach to queuing. My methodology would be to find a very long queue, one so long you cannot actually see what is at the front of it. For example, in the Arrivals Hall of an airport. Then take a random cross-section of English men and women and point them at the queue. Some will meekly join the rear of the queue and advance slowly as it does. Others will go to the front, check that it is the queue that they are supposed to be in and then return and join the back of the queue. A third, far smaller number will go to the front of the queue and upon determining that it is sadly the queue they need to be in, either sneak into the front using stealth and much looking into the middle distance or produce some self-important, compelling but fictional rationale why they should be allowed to “push-in” at the front.

In the wake of the pandemic, I think there is perhaps an alternate grouping based upon response to COVID-19 rather than waiting line etiquette. These new groups in my mind are: COVID Positives: people who while taking sensible practical precautions to avoid contracting infection, believe the end is in sight and are embracing post-lockdown life at every turn. Then there are the COVID Neutrals: sensible and careful like the first group, but wary of emerging from the protocols of Lockdown. This group are slower in returning to their old lives and continue to avoid their workplace, are careful about where they go and what they do and are waiting to see what happens next. Finally, there are the COVID Negatives: this group remain nervous about the pandemic, avoid anywhere public unless strictly necessary, worry about having to travel on crowded trains, prefer not to go back to the office, etc.

People have of course moved between these categories during the course of the pandemic. I started out as a C- but then moved into a more neutral position as time wore on and since getting both doses of the vaccine, as you may imagine, am firmly in the C+ classification. Yet this is not true for many others: the 2021 Spring Update of the Edelman Trust Barometer found that vaccination does not confer peace of mind about resuming normal activities. My own experience bears this out as I know many people who have been fully vaccinated but remain cautious, even nervous about a return to work, busy shops, crowded streets and Heaven forfend, festivals. 

So, does this suggest a fundamental personality type when it comes to global public health threats? I am inclined to think it does. Since I started my career, I’ve always been told that “fear-based messaging” is not particularly effective. Yet the last 18 months, which saw pretty much the entire population of England voluntarily put themselves under house arrest, would seem to demonstrate quite the opposite. Fear of contracting COVID-19, fear of dying, fear of overwhelming the National Health Service, fear of spreading illness to loved ones. All these combined with a deep sense of social responsibility is arguably what allowed three successful lockdowns. 

Perhaps then, it is time to re-evaluate the role that fear can play in health campaigns. Not for everyone, necessarily, but certainly for those whose response to the pandemic has been more of a C-. The addition of graphic pictorial images to cigarette packets is considered an important means of associating smoking with negative outcomes, to combat the tobacco industry’s attempts to position smoking as cool and aspirational.[i] Maybe one of the lessons of the pandemic for healthcare communicators and campaigners is not to be afraid of peddling a little bit of fear - within reason of course. There are certainly some sections of the population who respond well.

And for the avoidance of doubt, I always try and join any long queue at the front. Luckily for me, most of my fellow countrymen are too polite to do anything about it.

A version of this first appeared on PRCA.

Carolyn Paul is European Health Practice Chair.

[i] Bulletin of the World Health Organization 2009;87:640-643. doi: 10.2471/BLT.09.069575