Abstract
Although there have been studies investigating the relationship between information disclosure and voluntary compliance behaviors, the terrain of such research is largely fragmented and has been rarely tested empirically in the pandemic contexts. This article reviewed the intervention and control of the pandemic from the perspective of information disclosure with reflections on the experience in China. Furthermore, the authors propose a comprehensive framework demonstrating the overall landscape of information disclosure and voluntary compliance behaviors with highlights on (a) the tensions between privacy and information transparency; (b) the trade-offs between policy rigorousness and compliance behaviors; (c) different sources of information and how they influence public behaviors differently; and most importantly, (d) how the variegated configurations and contextualization of factors result in different influencing and moderating mechanisms between information disclosure and voluntary compliance behaviors. In the end, the authors call for future research and reforms in pandemic control practice to focus on the dynamics of information disclosure, government actions, and public compliance behaviors, which has been largely neglected so far.
Keywords
On January 8, 2020, the expert team of the Chinese National Centers for Disease Control and Prevention (CDC) officially announced that there was a pneumonia related to a novel type of coronavirus in Wuhan. However, according to a retrospective study published in the Lancet, the first case of the COVID-19 was traced back to December 1, 2019, which implied that the disease had been spreading quietly in a megacity for over a month (Huang et al., 2020). The first confirmed case in the United States was reported on January 19, 2020, in Snohomish County, Washington (Holshue et al., 2020), while it was not until March 10 that the first semi-containment zone was announced in New York (Heymann & Shindo, 2020). Similar stories were seen in many of the countries where the disease finally outbroke: that information about the disease and personal protection was little known by the public in the early stage of the pandemic.
Eliminating the infectious source, cutting off the transmission route and isolating the susceptible population has always been the golden principle for pandemic control (Maier & Brockmann, 2020). However, the very limited knowledge of the novel virus, as well as the information opacity and confusion at the beginning of the epidemic impeded the introduction of effective containment measures, escalating the transmission of the disease (Gunia, 2020). The reported R0 (reproduction rate) of the COVID-19 varies from 2 to 6, implying a greater transmission capacity than SARS in 2003 (Liu et al., 2020). What’s worse, the majority of the infected population are with mild or no symptoms (ranging from 60% to 80% in various studies), which equally contributes to the spreading of the disease (Lipsitch et al., 2020; Qiu, 2020). Since currently there is no vaccine or specific therapeutics for the virus, the control of the disease depends primarily on the isolation of the infected, quarantine of the exposed population, and social distancing of the general public. Therefore, many medical experts appealed to the public to stay at home and voluntarily comply with social distancing measures (Chen et al., 2020; Wilder-Smith & Freedman, 2020).
However, the biggest challenge for many countries is how to pragmatically implement effective social distancing and quarantine measures to contain the pandemic. Many note that information disclosure can foster greater voluntary compliance (Porumbescu et al., 2017). Another terrain of the literature gauges information disclosure and concludes that transparency does influence the way the public respond (Bae, 2014; Ruijer, 2017; West & Bowman, 2020). But they neither depict the mechanisms of how information disclosure may shape citizens’ behaviors nor explain how to translate the policies into public actions in the pandemic contexts. To supplement the theoretical framing with empirical proof, the authors conducted a survey in early February 2020 and collected 2,776 samples to investigate the possible relationships between information disclosure and compliance behaviors. With reflections on China’s containment practice, previous research findings and the results of the survey, the authors propose a theoretical framework elucidating the dynamics of information disclosure and public compliance behaviors, offering insights to inform containment research and practice in the current challenge posed by the COVID-19.
Containment Measures in China
Lockdown and Strict Quarantine
On January 23, Wuhan was suddenly locked down and within 48 hr the other 13 cities in Hubei province were shut down as well, resulting in an unprecedented scale of quasi-quarantine of over 60 million population. The local authority took very draconian measures in the quarantine, shutting down all schools, public activities, businesses, and public and private transportation except in emergency cases (Wuhan Municipal Government, 2020a). Rigorous community management measures were implemented. All entry into and exit from the households/communities were prohibited and each family can only send one person for grocery shopping once every 2 days with a one-time travel pass issued by the local community (Hubei Provincial Government, 2020). On January 29, 6 days after the lockdown of Wuhan, the last provincial unit in China announced the first-level emergency response with quasi-quarantine measures taken nationwide. A study in Science estimated that the shutdown of Wuhan delayed the arrival of the COVID-19 in other Chinese cities for 2.91 days in average and almost entirely cut off millions of outflow from Hubei to other cities during the yearly mobility peak of the Spring Festival (Tian et al., 2020). According to the statistics of World Health Organization (WHO), the newly reported case peaked at 3,872 in China on February 5, despite the sharp peak of 15,141 confirmed cases on February 13, which was caused by the rigorous campaign to test all suspected cases by February 11 mobilized by the Wuhan Municipal government (WHO, 2020). Figure 1 demonstrates that the rigorous lockdown did not only bring forward the turning point, but also reduce the total number of infections dramatically.
Daily reported cases from December 31, 2019, to April 3, 2020.
Massive Testing and Inpatient Admission of All Infected Cases
It should be highlighted that sufficient testing is of extreme importance to the containment of the COVID-19, since the distinction of the contracted and healthy population relies solely on the testing results (Xu et al., 2020). The testing capacity was insufficient in Wuhan in the early stage, which escalated the outbreak in the city. But it soon increased as testing kits were transported into Wuhan after the lockdown. The testing capacity increased from around 200 to 20,000 per day (Wuhan Municipal Government, 2020d). The newly appointed municipal and provincial head promulgated a new policy to “test every suspected case and hospitalized all confirmed ones” (Wuhan Municipal Government, 2020b). The mild and asymptomatic patients who used to be sent home for isolation and observation were all admitted to temporary Fangcang hospitals converted from public facilities such as stadiums and civic centers. There were in total 16 Fangcang hospitals built within weeks, supplementing over 15,000 beds (Wuhan Municipal Government, 2020c). A study in the Lancet argued that the Fangcang shelter hospitals relieved the pressure on the medical system which was on the edge of collapse. And they also avoided the mixing of the susceptible population with the mild and asymptomatic cases (Xiao et al., 2020).
Classified Management With Contact Tracing and Trajectory Tracking
Successful quarantine relies on timely and complete contact tracing of confirmed cases. The Chinese government stipulates that the epidemiological investigation of a confirmed case has to be finished within 24 hr (National Health Commission of China, 2020). With the assistance of universally installed apps, such as WeChat, Alipay, and trajectory information from mobile service providers, the government could trace the trajectory of confirmed cases and find their contacts. There are QR codes pasted on public transportation for passengers to scan so that when positive cases were detected, all passengers in the same car will be contacted and traced.
To restart social and economic activities when the epidemic is under control, trajectory tracking is crucial for the identification of the healthy population. Now in most cities where economies have been reopened, entrance to public buildings requires a QR code reporting the trajectory of each individual in the past 14 days. Entrance admission is granted only when the individual did not travel to any infectious regions in the past 2 weeks after temperature testing.
Information Disclosure
The opacity and scarcity of the COVID-19 information at the early stage increased the panic in the general public and bred a lot of rumors on social media, including suspicions on unreported cases, lockdown at larger scales, and insufficient food supply. As the suspicion mounting, there were increasing uncertainties for public compliance with containment measures, particularly the mandate ones. This trend was mitigated as more information about the pandemic was revealed to the public. Many cities, for instance, Shenzhen, released anonymous case report on each single confirmed case, reporting the communities they live, their travel trajectories, and epidemiological history. It highlighted the risky spots on mobile phone apps updated on a daily basis, which substantially reduced the suspicion and rumors among the general public. Meanwhile, the municipal governments regularly released information on personal protective and community control measures of the COVID-19 on mobile apps, social media, and other platforms. Prompt information disclosure is part of the SARS legacy, whereafter the government accelerated the legislation of information disclosure in public health incidents.
How Far Does the Chinese Experience Travel?
It is clear that the abovementioned strict containment measures in China mitigated the transmission of the COVID-19 substantially. Definitely, it is doubted how far the Chinese experience can travel. The stringent containment measures in some cases can hardly be applied to other contexts. The power regime is unitary and centralized in China, which makes it possible for the central government to shut down a province at the onset and mobilize resources from all over the country to revitalize the collapsed medical systems in Wuhan. Over 40,000 medical workers were mobilized from other provincial units and military forces to support the hospitals in Hubei (“42,000 Medical Personnel Were Sent to Hubei . . .,” 2020). There would be serious legal and political barriers if similar actions were taken in many other countries. Nonetheless, there are still many lessons to be drawn with regard to information disclosure in disease control. It has been proven in practice that transparency does contribute to public compliance and ameliorated implementation of containment measures. Prompt and reliable sources of information increased the sense of security and the willingness of the public to comply with the policies. It also dispersed rumors on social media and increased confidence in the general public as indicated in our survey. Besides, the universal application of pandemic-related mobile apps speeded up the circulation of information and efficiency of the implementation of containment measures.
Seeing Disease Control Through Information Disclosure
In public health events, such as SARS, H1N1, and the COVID-19 outbreaks, public support and compliance are key to the successful intervention and containment of the pandemic (French, 2011). During the epidemic, information disclosure promotes voluntary compliance and participation in disease intervention by improving the understanding of epidemic information and containment measures (French, 2011; O’Malley et al., 2009; Schnell & Jo, 2019). In addition, some studies have highlighted the role of trust in government and policy satisfaction, arguing that public trust may also be an important channel through which information disclosure influences public compliance (Alcaide Munoz et al., 2017; Choi & Wehde, 2020; Menon & Goh, 2005). However, few existing studies have tested the influences of information disclosure on public behaviors from a systematic perspective, nor have they fully revealed the mechanisms of information disclosure, public understanding, trust in government, and public compliance behaviors. Meanwhile, existing research also lacks sufficient attention to the different types of behaviors with and without expected individual losses.
Despite the contribution of information disclosure to public compliance and disease intervention, the current research landscape on such a topic is very fragmented. How does information disclosure configurate in different contexts? What are the tensions in information transparency and privacy? How is information disclosure channeled in different mechanisms to influence public behaviors and how will different socio-cultural configurations moderate the influences? The relationship between information disclosure and public behaviors remains largely unsystematic. Therefore, the authors propose a comprehensive framework illuminating the dynamics of information disclosure and public behaviors in Figure 2.
Information disclosure and public compliance behaviors: an analytical framework.
The first question for information disclosure is what information should be released to the general public. There are generally two types of information in the intervention and control of the COVID-19. The first is the case and medical information. Some of the information is public, such as the number of confirmed cases and medical aids and resources. It also includes more private information, such as the travel history and contact history of confirmed cases. In China, the disclosure of anonymous travel and contact history of each single confirmed case in cities outside Hubei did help to disperse the rumors on social media and increase the awareness of the general public, significantly improving the level of compliance with containment measures (in our survey data). However, there is tension between privacy and information disclosure. And the degree to which information should be disclosed is subject to cultural and social disparities across different localities. On top of that, detailed information disclosure of anonymous confirmed cases seems to be more effective in the early stage of the pandemic. When the contracted population surge up, the public is unlikely to focus on each single case and it would simply be impossible for the government to report every contracted case with details.
The second type of information released is those regarding containment policies. Some of the policies, such as stringent stay home orders and (self) quarantine may harm the interests of individuals because of potential economic losses and medical costs. As a result, the public tend to be less willing to comply with these containment measures due to loss aversion and status quo bias (Kahneman et al., 1991). In contrast, those measures without particular expected individual losses, such as hands washing and voluntary social distancing, are more likely to be accepted by the public. Therefore, there is the trade-off between implementing these two types of measures. As rigorousness increases, containment policies might be more effective, but it might as well be more costly and the level of public compliance tends to decrease. Fortunately, our survey results and previous studies demonstrated that information disclosure on the policies significantly improves public compliance with containment measures, especially for those stringent ones with expected individual losses.
Another issue in the configuration of information disclosure is that information has been released from different sources. Information released from different agents might influence public behaviors in different ways. However, there has been very little empirical research on how information released from different sources affects public behaviors. In general, there are three main sources of the COVID-19 information. The first one is government entities, including the central/federal government, the local governments, and the health authorities. And more importantly, sometimes there were conflicts and confusion in the information released from different sources. For instance, the stay home orders and social distancing measures issued by different states in the United States are distinct from each other, and as well different from the guidance of the CDC and the federal administration. Besides, there is are also information from non-public sectors such as the media, researchers, NGOs, and other popular opinion leaders, which might be even more fragmented and confusing. There are also information sources from foreign countries and international organizations such as WHO. Yet unfortunately, effective cross-national coordination in information disclosure is hardly seen with the current backfire of anti-globalism.
Then in what possible mechanisms does information disclosure impact public voluntary compliance? We propose three possible mechanisms through which public compliance might be improved from the perspective of information disclosure. The first is that information disclosure facilitates the understanding of containment measures. The issue definition of the COVID-19 varied considerably in different countries at the early stage. Some countries perceived it as a serious emergency with draconian countermeasures taken while some others reacted less aggressively. However, the issue definition of the government and the public might shift as there was more information disclosed. And therefore, sociologists and policy analysts argued from the utilitarian perspective that the public are more willing to comply with containment measures when they have a better understanding of the issue. They tended to comply with the policies if the benefits and consequences of the measures are well understood (Murphy, 2016). The second potential mechanism is mediated by awareness and acceptance of the policies. There is empirical evidence in China and other countries that information disclosure in e-government, fiscal policies, and other public policies enhances the trust and policy satisfaction of the government (Kim & Lee, 2012; Park & Blenkinsopp, 2011). It has been argued that psychological conditions, such as trust, satisfaction and the sense of security, may improve compliance with public policies. The third potential mechanism is through changes in the perception and values of the public. Information disclosure may reshape people’s perceptions of the pandemic as well as the containment measures, thus enabling the public to overcome difficulties and act in accordance with the requirements of the policies.
However, the influencing mechanisms are moderated by various configurations of contextual factors such as religions, beliefs, social capital, cultural differences as well as other personal factors. It is unsurprising that the contents and sources of information disclosure vary dramatically across different countries and places. In parallel, information disclosure also works in different mechanisms under specific political, social, economic, and cultural configurations. The proposed framework helps to draw an overview of the landscape of the relationship between information disclosure and public compliance behaviors, which might enlighten future research and practice on improved and coordinated global pandemic control.
Prepare for the Next Pandemic to Come
Our knowledge of the novel virus so far, is still largely limited to the observations of scientists, especially virologists and epidemiologists. In fact, the spread of the COVID-19 is a social phenomenon and public administration issue as well, which has been insufficiently investigated. As an emerging and on-going public health crisis, there have been very few voices from the fields of public administration, sociology, and psychology, which are all important to improving the efficiency and effectiveness of containment measures. Therefore, we call for more research and insights into containment practice to develop the knowledge of information disclosure, government actions and public behaviors in pandemic situations.
Specifically, we would like to call for future research into the following topics: (a) how is information disclosure practiced at different stages of the epidemic and how does it influence the behaviors of the public and the government?; (b) How to mitigate the tensions and conflicts between transparency and privacy? And similarly, how to balance the trade-offs between policy rigorousness and public compliance?; (c) What are the possible approaches to cross-national information disclosure and action coordination in preparation for the future pandemic to come?; and (d) We would also like to call for experimental studies to investigate the mechanisms of information dissemination, public trust, and compliance with different sorts of containment measures.
In parallel, we would like call for attention in current disease control practice to the following aspects. (a) The prompt and timely disclosure of pandemic information, particularly at the early stage, is of crucial importance to reduce the transmission and spreading of the disease. (b) Information disclosure of the COVID-19 can be improved in terms of the information accessibility of the general public. Information disclosed to the public is more easily understood in simple and succinct forms. (c) Before the promulgation of certain containment measures, their possible policy costs, for both the individuals and the society, should be properly evaluated. The measures need to be properly disclosed so as to reduce the tensions between policy rigorousness and public compliance. (d) Attempts to coordinate information from different sources, including the government, public health experts, and other agents need to be encouraged. (e) As a global crisis, the containment of the COVID-19 is subject to more coordinated international actions across the borders of different countries.
Footnotes
Authors’ Note
Weihong Ma is also affiliated with Shanghai Jiaotong University, P.R. China.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the National Social Science Foundation of China (Grant No. 18ZDA108), the 13th five-year plan of philosophy and social sciences project of Guangdong (Grant No. GD19YGL19), the fundamental research foundation of Guangdong (Grant No. 2019A1515110197), and the National Natural Science Foundation of China (Grant No. 71904130).