Mandates bring a tonal shift in pandemic control – from solidarity to enforcement. Rules can offer support – it’s sometime easier to just be told to do something. A few people only respond to rules. But they can also undermine intrinsic motivations towards the public co-operation more generally, making behaviour more about what I can and can’t do than what I should do for others. For long-haul behaviours like pandemic control ones, intrinsic motivation is better because it carries across a number of minute and everyday behaviours impossible to police.
Mandates should bring a meaningful additional level of compliance to controlling the spread of a disease. Right now in NSW, some commentators have called for mandatory masks for all of Sydney, at a time when the state is recording reductions in locally acquired new cases, decreasing from a high of 38 on December 19 to 8 cases on December 23. The most important control measures have been rapid identification and isolation of cases and contacts, helping bring this outbreak under control, like NSW did in July after a cluster began in south western Sydney. In Victoria, mandatory masks were hoped to be enough to bring a rising outbreak under control. But within a week it was clear that a prolonged lockdown was also needed.
Mandates require significant resourcing and attention from government departments. Legislation needs to be carefully drafted to account for the range of implications they will bring. There should be a threshold for determining what is, and is not, required and means for determining compliance. This is easier for policing the wearing of masks. For vaccination, Australia uses a national register to determine compliance. But recording error or failure to enter the data means some fully compliant families have wrongly lost family assistance payments under the No Jab No Pay. Mandates need good systems in place to be fair and feasible.
Most of these issues can be justified and managed if the benefits of mandating a behaviour are deemed to outweigh the risks. Right now in Sydney, mask wearing when one cannot distance is strongly recommended. But a mandate to do so would be disproportionate when considering the downsides along with their limited role right now in controlling COVID-19. If we are unlucky enough to see established transmission across Sydney or any other region, that might change.
For now, the measures announced on Wednesday are reasonable – limited numbers inside homes with restrictions around movement of people on the northern beaches where the cluster remains focused. We must remain focused on the most effective measures – testing and isolating if symptomatic, rapid contact tracing, quarantining of contacts, and limiting large gatherings, vigilant hand and respiratory hygiene and wearing masks when social distancing is not possible. Venues need to systematically ensure all customers accurately log their details when entering.
Mandating individual actions to prevent infectious disease spread should only be in place when the shift to mandating will be effective and carries little risk, the requirement is reasonable, feasible to enforce, and well justified. Taken together, this is about weighing the benefits of an action against its risks – something Australians have become adept at doing in 2020 when it comes to infectious diseases.
Julie Leask is professor at the Susan Wakil School of Nursing and Midwifery at the University of Sydney and visiting fellow at the National Centre for Immunisation Research and Surveillance. She is an advisor to the World Health Organisation on improving vaccination uptake.
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