Our results indicate that influencing the general public attitudes and response to COVID-19 (or other pandemics) should be a public health priority. Among the most relevant covariates, accustomed freedom of assembly and association and agency were found to be associated with increased COVID-19 transmission speed (these variables were more important predictors than GDP per capita, government effectiveness, preventative interventions, or the quality of and access to health care). In Clusters 2 and 3 countries (labeled as drifting and assertive societies), freedom to act, to assemble, to move is a more commonly experienced or propagated human right than in Clusters 1 and 4 countries (labeled as reserved and compliant societies), therefore we might assume that people from these societies find it more demanding to accommodate strict governmental regulations, as well as the governments show lower stringency towards the citizens. Maintaining the need for human rights is an essential challenge during the pandemic, even if Clusters 2 and 3 societies show an elevated risk for accelerated transmission. Experiencing freedom of choice and freedom of act are basic democratic rights, yet they are as fragile as important in times of crisis, as individuals are often prone to trade freedom for security and also to modify their preferences in order to adapt to undesirable circumstances (Faden and Shebaya, 2010), especially in the context of serious public health threats. It is thus each government’s responsibility not to take advantage of the current situation or exploit the population’s fear and anxiety as a foundation of increased governmental power. The current pandemic raises several questions concerning the balance between effectively combating the spread of coronavirus and protecting fundamental human rights. Amnesty International has just recently published (2020) recommendations for European states, urging them to select responses to COVID-19 that are in line with human right obligations. These recommendations—amongst other things—include the right to privacy (i.e. increased digital surveillance is only acceptable in exceptional circumstances and in case the measures are legitimate, necessary, proportionate, and non-discriminatory); or pointing out that government responses limiting human rights (e.g. restricting freedom of movement and assembly, right to work, right to private and family life) must be led by legitimate public health goals that are based on scientific evidence.
Another important social factor is related to the public’s interpretation of the pandemic risk (e.g. “I am” at risk vs. “We are” at risk). As it was already mentioned before, individualistic values are often associated with an increase in the outbreaks of infectious diseases (Morand and Walther, 2018), assuming that individualistic cultures as opposed to collectivistic ones are more vulnerable to accelerated virus transmission, as citizens of collectivistic societies may better protect in-group members against pathogen transmission. This is in line with the pathogen prevalence theory of Fincher et al. (2008), namely that collectivistic cultures are usually situated in the hotter regions of the world, where pathogens causing more severe medical conditions are more likely to occur, therefore collectivistic attitudes serve as a means of survival (such as the protection of in-group and the exclusion of out-group members). In terms of the current research, former notions (i.e. connection between hotter climates and collectivistic cultures) can mainly be interpreted within Cluster 4 (and not Cluster 1) societies, with higher population densities. Several Cluster 4 countries (e.g. China, India, Japan, Singapore, or South Korea) are traditionally considered to be rather collectivistic than individualistic. Nonetheless, one should also keep in mind that the most cited operationalization effort regarding the valid measurement of collectivism–individualism (by Hofstede) dates back to the 1960s (Hofstede, 1980) and is based on non-probability samples. We therefore preferred to use social data derived from the Legatum Institute’s 2019 Prosperity Index or the WVS study instead of, e.g. Hofstede’s dimensions. However, since the 6th wave of WVS collected data between 2010 and 2014, it would be worth reanalyzing our data when the WVS wave 7 dataset becomes available (July 2020).
These initial findings may serve as a departing point for further research looking deeper into the social determinants of a pandemic course and severity, and applying interdisciplinary models (e.g. a joint endeavor across health sciences, public health, and social sciences) in order to better understand the social construction of increased transmission rates for highly infectious diseases. The fact that personal right to assemble or associate with others and agency were stronger predictors of reduced doubling time than HAQ index, GDP per capita, or government effectiveness once again indicates the importance of the population attitude and reaction to pandemic crisis. From a public health perspective it is of heightened relevance to explore both the ethical and psychological side of the freedom vs. security dilemma. Within the ethical framework proposed by Faden and Shebaya (2010), public health policies and regulations potentially restricting basic human rights (such as in case of severe infectious disease outbreaks) may be justified on the grounds of highlighting the overall social benefit of mitigation, promoting collective actions, ensuring fairness in the distribution of regulation burdens, or interfering with the liberty of an individual but only for the purpose of preventing harm to others (the harm principle). In times of any global crisis (such as the current COVID-19 pandemic) increased paternalism (i.e. authorities take actions to protect the health and welfare of people against their will) might also be observed. However, paternalism can be “soft” (e.g. citizens suffer from immaturity, ignorance, or the holding of false beliefs) and “libertarian” (e.g. influencing citizens’ choice through persuasion and not by using of force or compulsion) as well, and there can be considerable cross-cultural differences in the population’s tolerance for a certain level of paternalism, i.e. in countries where shared-decision making or egalitarian approaches are adopted, strict paternalism may be more easily rejected, while in other regions of the world with different cultural standards, people might be more accepting towards a more paternalistic leadership (Abedini et al., 2015).
Currently one of the most important question that still remains unanswered is whether or not libertarian paternalism (e.g. manifested in government communication and regulatory strategies) is efficient enough in terms of ensuring social distancing. In any ways, reducing negative psychological impact of quarantine might be a good public health starting point in helping the citizens to bear the frustration of limited freedom and thus keeping them motivated to maintain the expected distancing. Based on the insights of a recent rapid review (Brooks et al., 2020), main negative effects of quarantine includes post-traumatic stress symptoms, confusion and anger, depending on e.g. the duration of quarantine, infection fears, boredom, adequate or inadequate information, financial loss or stigma. Thus, some of the best practices to minimize the pathogenic outcomes of drastic regulation efforts consists of providing clear rationale for quarantine, ensuring sufficient supplies, or reminding the public about the potential social benefits of such extraordinary experiences. Keeping the public informed is particularly important as one of the most common psychological strategy to reduce anxiety is finding meaning or purpose in the pandemic. Several pandemic narratives and interpretations can be observed, many of which are rather conspiracy beliefs than evidence supported opinions, presuming covert political or economical interests behind the origin or the scale of the pandemic, and mostly supposing that SARS-CoV-2 is a purposefully manipulated laboratory construct. And even though these theories are often rebutted by scientific evidence (Andersen et al., 2020), conspiracy beliefs and misinformations are still on the rise (Mian and Khan, 2020).