opinion | We’ve been working on the US pandemic response. Here are 13 takeaways for the next health emergency.

We were among a group of public health experts assigned to a task force by then-President-elect Biden to advise him on the pandemic during his post-election transition in 2020. At the time, the pandemic was about to enter its second year. We have remained engaged in the public health response. In this light, we offer 13 lessons, many of which are not yet fully appreciated or integrated into planning for the next outbreak of a dangerous infectious disease – one that many of us will likely encounter in our lifetime.

1) Human tolerance to lifestyle changes is limited.

Americans in general have endured substantial changes and restrictions in daily life and social interactions, including taking extra precautions such as wearing masks, minimizing interactions and modifying lifestyles. But patience ran out. By September 2022, 30 months after the pandemic, 46 percent of Americans had returned to their prepandemic lives, according to an Axios-Ipsos survey. This is despite the fact that on September 1 of that year, an average of 90,000 new cases and more than 500 deaths were reported per day. Patience seems to have been even shorter during the 1918 flu pandemic. If the next public health emergency happens soon, patience may run out sooner. Policymakers must recognize and prepare for the limitations of human perseverance.

2) Incentives can change behaviour. Social norms can enforce it.

Habits are hard to change. But people do change with the right incentives, such as higher taxes on cigarettes or sugar-sweetened drinks to reduce unhealthy behaviors. During Covid, workplace vaccination mandates were effective in increasing vaccination rates. More creative use of incentives and judicious mandates that do not arouse substantial resistance should be looked at.

People also tend to bow to social norms, those unwritten rules or peer practices that govern behavior in societies. Therefore, masking was easier in East Asia than in the United States. Masks were common in East Asia during the SARS epidemic of 2002 and 2003 and are often worn there to protect against transmitting or contracting infections. In the absence of such standards, it may be necessary to draw on the beliefs of government officials, celebrities, and other social influencers. Policymakers should strive to adopt public health measures that are translatable into social norms.

3) Trust is crucial.

Public trust in government and health organizations can reduce cases and deaths. The United States, already deeply divided politically, failed on this vital part of the response. By 2021, according to Gallup, only 39 percent of Americans had a lot or quite a lot of confidence in the federal government to handle domestic or international affairs. And a Pew survey in 2022 found that less than half of respondents said the country had given “the right amount of priority to K-12 student needs, public health, and quality of life.” Trust is easy to lose, but very hard to regain. It requires honesty and transparency. Future policies, especially those based on uncertain or incomplete information – such as whether a Covid vaccination mandate should remain in place – must be judged in part by their impact on societal trust.