When the cleaning staff at Amsterdam's Schiphol airport decided to paint a small house fly on their urinals in the early 1990s, they made a startling discovery: While men still had the option to urinate wherever they wanted, when presented with a target, they intuitively aimed for it. 

The tiny intervention brought down unwanted spillage by 80 percent and ever since it's been the archetypal example of what has become to be known as a "nudge." 

Nudges involve a relatively small policy change that guides people to make decisions that are broadly in their own self-interest. In the case of the coronavirus, it could be as simple as using funny alternative "handshakes" or suggesting people sing Happy Birthday while washing their hands.

 

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Amid the pandemic, governments have enlisted so-called "Nudge Units" to develop these subtle tools to gently steer populations into following regulations. But despite the allure, nudging and the behavioral theories from which it stems remains controversial and many experts doubt its effectiveness in fighting the pandemic. 

"The body of evidence we have in behavioral science shows that if you're looking for silver bullets, this is not a good place to look," says Michael Sanders, a veteran nudger and the former director of research of the UK's Behavioural Insights Team (BIT), the first nudge unit in the world.

So how do nudges actually work, what policy decisions have the Nudge Units affected amid coronavirus, and can some of their methods, if any, be effective in bringing Europe out of lockdown?

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How do nudges work? 

Nudges are essentially subtle, cost-effective changes to how we are offered choices. But, crucially, they influence decision-making without changing any of our underlying incentives – it's more to do with making it easier for people to make a certain decision.

"It's not mind control," says Sanders: "It's about redesigning the environment, the way you make your choices, and the way that we present information in such a way as to allow you to make 'better decisions.'"

 

 

"Better decisions" can mean one of two things. Some nudges are designed to benefit society – like the fly in the urinal or nudging people to pay their taxes – while others are aimed at improving an individual's life in the long run, like automatically enrolling people into pension funds. 

"If you're like most people, if you have to sign up for a pension when you start your job aged 22, you don't get around to it because your retirement age is a long way away and the forms are really boring," says Sanders. "You keep on putting it off and eventually you get to a position where you've never done it and you haven't got a pension."

 

 

Here's the nudge: Instead of asking people to opt in to a pension scheme, they are instead automatically enrolled - but importantly, given the chance to opt out. "Actually most of us don't because we know we should be saving for our pension – we just don't get around to it," says Sanders. 

On applying this policy in the UK, researchers from the Institute for Fiscal Studies found that over time the number of private sector workers saving for their pension doubled from 40 to 80 percent. The choices remained the same, but the context changed everything.

 

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How do nudge units figure out which nudges work?

The key task of nudge units, explains Sanders, is essentially to fuse the human understanding of psychology with the rationalism of economics to make generalizations about social behavior that can then be acted on.

"Economics assumes that people behave as though they were rational, like very efficient robots that make the right decisions all the time," says Sanders. "Behavioral science takes people as they are – and says that sometimes we make mistakes."

One of the theories nudge units lean on most when modeling human error is "loss aversion" – the Nobel Prize-winning concept that people have a tendency to want to avoid losses much more than they would desire acquiring equivalent gains. This is the idea behind BIT proposing "opt-out" pension funds and why companies offer free trial periods. 

 

 

The theory says that if we already have a product – say a free month-long Netflix subscription – we become much less willing to give it up once we've got used to it. Essentially, if you change the framing from being one of gains to one of losses, people have become about twice as responsive. 

While there may be crossovers between market research and behavioral science, Sanders says the former is much more about "instinct and gut feeling," whereas nudge units are focused on creating "rigorous, falsifiable hypotheses and generalizable statements about human behavior."

"They won't always be true," he adds, "but very often will be, which means they can be subjected to empirical tests." That's why the majority of the work carried out by nudge units involves researching how existing theories in behavioral science literature can be applied to new policy.

 

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What have nudge units been doing during the pandemic?

Their most important role so far, aside from researching how humans are reacting to this unprecedented situation, has been in developing national messaging.

The UK's government said its nudge unit had helped it devise effective communication around hand-washing and face touching – "in particular the use of 'disgust' as an incentive to wash hands."

Sanders, the former chief scientist of the team, points to a UK coronavirus advertising campaign that shows a sick woman on a ventilator with the tagline, "Look her in the eyes and tell her you never bend the rules."

 

 

"That, to me, looks like a nudge," he says. "It's using what's called an 'identifiable victim effect.' It's much easier for you to change your behavior if you're confronted by one person who you can see rather than by a thousand."

"It's not quite the Stalin quote that one death is a tragedy and a million deaths is a statistic," he adds. "But certainly we respond more viscerally to individual cases than we do to numbers."

Some trials of nudges in the context of the pandemic have also shown promising results. Nudge Lebanon, the first nudge unit in the Middle East, employed what is known as "inoculation theory" in one of their tests in a bid to get more people to follow the rules.

 

 

They presented subjects in Lebanon with hypothetical scenarios in which they might break public health guidelines due to holding certain misconceptions. In the same way inoculations give people a weakened version of a virus, the idea is that being exposed in advance to false information makes people better at recognizing misinformation later. 

"When it comes to the inoculation game," says Nabil Saleh, the team's vice president of strategy, "we saw that it made people 12 percent more likely than the control group to say they were now washing their hands more." 

And according to a survey on behavioral insights and coronavirus by the European Centre for Disease Prevention and Control (ECDC), some of these techniques have worked incredibly well when applied in the real world. 

 

 

A nudge in one European country "had a major impact on testing uptake," with increases of 60 percent "within a few days" of bringing in the new communications approach. 

The report also mentions how a government was alerted to people being increasingly unwilling to follow the regulations after its first lockdown – what has become known as "lockdown fatigue" – prompting a strengthening of its messaging. 

But in March 2020, more than 700 behavioral science academics signed a letter questioning the evidence of behavioral fatigue, rejecting the UK government's suggestion that coronavirus restrictions should be delayed because of it. 

"We are not convinced that enough is known about 'behavioral fatigue' or to what extent these insights apply to the current exceptional circumstances," said the document. "Such evidence is necessary if we are to base a high-risk public health strategy on it."

 

 

Officials at the UK's nudge unit were forced to deny the idea of "fatigue" had come from them, and the government made a U-turn on delaying restrictions as the death toll rose. But eight months later, the World Health Organization, along with researchers from teams such as Nudge Lebanon, in effect validated the theory in a 20-page document headlined "Pandemic fatigue."

As with any other science, the veracity of behavioral insights needed testing before it could be applied, especially in a context as unprecedented as the pandemic. And regrettably many nudges, inspired by previous behavioral science literature, have not held up in the case of the coronavirus, according to researchers.

READ MORE: From nudge to shove: How the UK's COVID-19 strategy shifted over 7 days

 

 

Have nudge units been effective amid COVID-19? 

Since the onset of COVID-19, many previously successful nudge theories have shown to have mixed or little effect during the pandemic. And, worryingly, according to research from Sanders and his colleagues at King's College London (KCL), this is true for one the field's central tenets, loss aversion.

Testing the response of 500 people to government messaging that employed the theory, they found that highlighting potential lives lost did not make people more cautious about ending lockdown measures. "Loss aversion from our research does not seem to be valid in the pandemic," says Sanders. 

 

 

"The reason we think that is, is because everybody is already in a loss frame of mind," he adds. "Thousands of people are dying every day ... To the extent that there's loss aversion to be had, it's already happening, so you can't nudge people into being more loss averse."

Nudge Lebanon's Saleh says that the theory still has an important role to play: people still tend to say they're more likely to follow policies if they invoke the idea of losing a loved one. 

 

 

But another KCL study found that while nudges increased people's intention to follow the coronavirus guidelines, they did not necessarily have the result of actually changing their behavior.

Sanders sympathizes with those looking for helpful nudges amid the pandemic. He says there was very little behavioral science literature that considered a pandemic on this scale in a developed economy prior to the coronavirus, making the task much harder. 

But even if some nudges do prove effective, he says the majority are going to have a limited impact: "It gets you an extra 5 percent of people deciding they're going to comply with the regulations ... That's the best case scenario you're looking at with behavioral science."

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So how should nudges be used during the pandemic?

Despite skepticism, the field still has an important role to play in the fight against the virus. 

"At the end of the day, a public health response is reliant on human behavior," says Linda Bauld, a specialist in the field and one of Scotland's leading health experts. "So understanding what encourages people to engage and comply, their views and beliefs about different measures like face coverings and physical distancing is important." 

 

 

The ECDC's report agrees that the potential value of behavioral insights "lies in providing a nuanced understanding" of how people behave amid a pandemic, especially in the case of informing effective communication around vaccines in hesitant population groups.

According to the WHO, one of the essential uses of nudge theory in the vaccine rollout was highlighting that trusted community members and influencers were taking the jab, a policy that's inadvertently been rolled out across much of the world. 

Inoculation theory – here, drip-feeding populations misconceptions about the vaccine to then correct them – has also shown to be effective in countering fake news around the jab, especially when the messaging has been localized.

 

 

Bauld adds that we also have to tap into solidarity in our public health communications, essentially invoking the idea of loss aversion: "We need to be sending a message to younger adults that it's not just about protecting themselves, it's about protecting others."

But Sanders continues to urge caution when it comes to relying on nudges. "If you're looking for behavioral science to give you a solution to a problem, it's not going to do that – what it's going to do is make other things work better," he says.

And despite the potential power of the field, he stresses it should never replace policy amid the coronavirus pandemic, especially when its application in a pandemic is so fresh. 

"You can't use behavioral science as an alternative to locking down," he says, "because the virus itself can't be nudged."