Amy Lauren Fairchild from Ohio State University and Ronald Bayer from Columbia University

You probably remember public service advertisements that scared you: The cigarette smoker with throat cancer. The victims of a drunk driver. The guy who neglected his cholesterol is lying in a morgue with a toe tag.

With the proliferation of new, highly transmissible varieties of SARS-CoV-2, some health professionals are calling for the use of similar fear-based strategies to convince people to follow the rules of social distancing and get vaccinated.

There is compelling evidence that fear can change behavior, and there has been ethical arguments that the use of fear can be warranted, especially when the threats are severe. As public health professors with expertise in history and ethics, we have in some situations been open to using fear in ways that help individuals understand the severity of a crisis without causing stigma.

But while the pandemic operations could warrant the use of persistent strategies, the social and political context of the nation right now could cause it to backfire.

Fear as a strategy has increased and decreased

Fear can be a powerful motivator and create strong, lasting memories. The willingness of health authorities to use it to change behavior in public health campaigns has increased and decreased for more than a century.

From the late 19th century to the early 1920s, public health campaigns often sought to instill fear. The most common tropics included flies that threatened babies, immigrants portrayed as a microbial plague on the country’s gates, luscious female bodies with barely-hidden skeletal faces that threatened to weaken a generation of troops with syphilis. The main theme was the use of fear to control the harm of others.

Scare poster of syphilisThe Works Progress Administration created posters warning of the dangers of syphilis in the 1930s. Library of Congress

After World War II, epidemiological data formed the basis of public health and the use of fear fell out of favor. The main focus at that time was the emergence of chronic “lifestyle” diseases such as heart disease. Early behavioral research concluded that the fear backfired. For example, one early influential study suggested that people who were afraid of behavior might turn off, or even engage more in, potentially dangerous behaviors like smoking or drinking in order to deal with the fear triggered by fear-based messaging.

However, in the 1960s, health officials tried to change behavior around smoking, eating, and exercise, and they grappled with the limits of data and logic as a tool for the public. They turned again to scare tactics and try to get a bowel stroke. Knowing that some behaviors were fatal was not enough. We had to react emotionally.

Although there were concerns about using fear to manipulate people, leading ethicists began to argue that it could help people understand what was in their own best interest. A little bit of anxiety might help lessen the noise made by industries that make fat, sugar, and tobacco alluring. This could help personalize statistics at the population level.

Anti-smoking poster.New York City has run tough anti-smoking campaigns. NYC health

Anti-tobacco campaigns were the first to show the devastating numbers of smoking. They used graphic images of diseased lungs, smokers gasping through tracheotomies and eating through tubes, clogged arteries, and heart failure. These campaigns worked.

And then came AIDS. Fear of the disease has been difficult to disentangle from the fear of those who suffered the most: gay men, sex workers, drug users, and the black and brown communities. The challenge was to destigmatize and promote the human rights of those who could only be further marginalized if they were avoided and shamed. When it came to public health campaigns, human rights activists argued that fear stigmatized and undermined efforts.

A Canadian campaign against drunk driving showed the risks to others.

As obesity turned into a public health crisis, and adolescent smoking rates and experimentation with fumes sounded alarm bells, public health campaigns resumed the fear of destroying complacency. Obesity campaigns were intended to raise parents’ fear of obesity in adolescents. Evidence of the effectiveness of this fear-based approach has been provided.

Evidence, Ethics, and Politics

So why not use fear to increase vaccination rates and the use of masks, bans and distancing at this moment of national fatigue? Why not immerse yourself in the national imagination with images of makeshift morgues or people dying alone and intubated in overcrowded hospitals?

Before we can answer these questions, we must first ask two more questions: Would fear in the context of COVID-19 be ethical and would it work?

For people in high-risk groups – those who are older or have underlying medical conditions that put them at high risk of serious illness or death – the evidence for fear-based appeals suggests that powerful campaigns can work. The strongest argument for the effectiveness of fear-based appeals is smoking: Emotional pressure-sensitive adhesives issued by organizations such as the American Cancer Society from the 1960s onwards have been shown to be an effective antidote to tobacco sales advertisements. Anti-tobacco crusaders, in fear, found a way to appeal to individuals’ self-interests.

This CDC campaign used smoking stories as a warning.

At this political moment, however, there are other considerations.

Health officials confronted armed protesters outside their offices and homes. Many people seem to have lost the ability to distinguish truth from falsehood.

Some groups raised concerns that the government could go too far and undermine civil liberties, and developed a powerful policy tool to override rationality in the face of science, even the evidence-based recommendations supporting face masks as protection against the coronavirus .

Confidence in fear of public health news could further undermine confidence in public health officials and scientists at a critical point.

The nation desperately needs a strategy that can help break through pandemic denialism and the politically charged environment with its threatening and sometimes hysterical rhetoric that has created opposition to solid public health action.

Even when ethically justified, a fear-based tactic can be dismissed as another example of political manipulation, bringing both risks and benefits.

Instead, public health officials should boldly urge and, as in other times of crisis in the past, emphasize what has been sorely lacking: consistent, credible communication of science at the national level.

The conversation

Amy Lauren Fairchild, Dean and Professor of Ohio State University’s College of Public Health; and Ronald Bayer, Professor of Sociomedicine at Columbia University

This article is republished by The Conversation under a Creative Commons license. Read the original article.