One Is Never Enough: How Multi- and Interdisciplinary Science is Improving COVID-19 Research

If you had to think of a scientific discipline when you hear the word, “pandemic,” what would it be?

For many, epidemiology is perhaps the first discipline that comes to mind. But the COVID-19 pandemic has made it painfully clear that successfully tackling incredibly complex challenges such as this one requires integration of knowledge from many disciplines.

Indeed, from understanding psychological and behavioral responses to the pandemic, to vaccine hesitancy,  to the effects of messaging on compliance with public health guidance, it is clear that multidisciplinary, interdisciplinary, and transdisciplinary approaches are needed to tackle grand challenges such as this pandemic (and any pandemics in the future). 

We’ve invited several experts to weigh in on how their fields are contributing to pandemic-related research, and how such research has benefited from multidisciplinary, interdisciplinary, or transdisciplinary approaches.

CHRISTOPHER MARCUM, NIAID (NIH)
Contract tracing and social network analysis

When an infectious disease emerges as a pandemic, there are two complementary responses that unfold simultaneously: the public health response and the research enterprise response.  While there are many commonalities that relate one response effort to the other, social network analysis is likely among the most frequently shared set of methods across domains.

On the public health side, for example, contact-tracing, which follows an exposure profile through a patient’s social network either prospectively (who did you infect?) or retrospectively (who likely infected you?) is a localized social network analysis.  With COVID-19, it became clear very early on that social distancing measures—which are informed by theories of social contact—would be one of the best defenses against the spread of Sars-CoV-2 infection.  As the pandemic worsened and the ability of epidemiologists and other public health responders to conduct link-tracing waned, the research enterprise stepped in with new technologies such as geolocation-aware smartphone apps that could help inform individuals of potential exposure in near real-time. This, too, was a macro form of social network analysis where data on many co-located individuals could be collected at a single place simultaneously and analyzed for exposure risk, then reported back to individuals and public health officials alike.

Because of the broad scope of social network analysis, those of us engaged in research on social networks often find ourselves involved in transdisciplinary collaborations. During COVID-19, for instance, biomedical colleagues of mine were aware of how contact-tracing, social distancing, and geolocation data were being deployed in the public health response and thought they would help researchers understand how their immunocompromised research participants were responding to the pandemic.  I developed a social network survey to collect data that could be combined with serological data from blood-draws on their patients (which can be used for pathogenic link-tracing).  Because the immunocompromised population is most at risk for serious COVID-19 complications, including death, our collaboration using social network analysis may inform whether such broad-scale mitigation strategies are effective in the most adherent and thus the “best-case” scenario. If they do not work in this population over the long-term of a global pandemic, that tells us something fundamental about the social needs and limits of social distancing in the general population.

For further reading:
Christopher Steven Marcum and Laura M. Koehly. Social networks and health: micro processes and macro structures. (2020). Journal of Social Structure, 20 (3), 1-6.

Jeffrey Rewley Laura Koehly, Christopher Steven Marcum, and Felix Reed-Tsochas. A passive monitoring tool using hospital administrative data enables earlier specific detection of healthcare-acquired infections. (2020). Journal of Hospital Infection 106 (3), 562-569.

DANA GARFIN, PSYCHOLOGY
The mental health effects of the COVID-19 pandemic

Research on the mental health effects of the COVID-19 pandemic has proliferated since March 2020, providing key insights into psychological responses to this collective trauma. Research suggests that mental health problems (e.g., traumatic stress, anxiety, depression) are elevated compared to pre-pandemic levels, although perhaps not as dramatically as many expected (Shevlin et al., 2020). Suicide rates, anticipated and rumored to be elevated, have actually remained stable and even dropped in some high-income nations (John et al., 2020). This is consistent with prior research on disasters demonstrating that resilience is normative following collective trauma (Silver & Garfin, 2016). Nevertheless, rigorous epidemiological research provides evidence on who might be at risk for mental health problems, including younger individuals, those who have experienced more pandemic-related secondary stressors, those with pre-pandemic mental health problems, and those who consume high amounts of event-related media (Holman et al., 2020). These insights allow for targeted mental health interventions to ensure that resources are effectively allocated and readily available, and so that resilience remains the dominant response. Fortunately, there has been a movement towards providing resources to address mental health problems, including telehealth options (Garfin, 2020).

Moreover, there has been a strong drive towards leveraging a multidisciplinary approach to understanding and addressing the mental health needs of the pandemic, critical given the complexity and multifaceted nature of this collective trauma (Silver et al., 2020). Interdisciplinary approaches neurobiology, social psychology, clinical psychology, and epidemiology can help provide an integrative approach to understanding distress, resilience, and recovery from COVID-19 (Holmes et al., 2020). Moreover, perspectives from decision sciences, when integrated with knowledge of psychological responses, can help inform communications regarding health protective behaviors for COVID-19 (e.g., vaccination efforts, continued facemask wearing), and help prepare the populace for future threats (e.g., infectious disease outbreaks, climate-related threats, natural disasters) (Fischhoff, 2020). 

For further reading:
Fischhoff, B. (2020). Making decisions in a COVID-19 world. JAMA, 324 (2), 2020–2021. 

Garfin, D. R. (2020). Technology as a coping tool during the coronavirus disease 2019 (COVID-19) pandemic: Implications and recommendations. Stress and Health, 36 (4), 555–559. 

Holman, E. A., Thompson, R. R., Garfin, D. R., & Silver, R. C. (2020). The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the United States. Science Advances, 6 (42), eabd5390. 

Holmes, E. A., O’Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., Christensen, H., Cohen Silver, R., Everall, I., Ford, T., John, A., Kabir, T., King, K., Madan, I., Michie, S., Przybylski, A. K., Shafran, R., Sweeney, A., … Bullmore, E. (2020). Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry, 7 (6), 547–560. 

John, A., Pirkis, J., Gunnell, D., Appleby, L., & Morrissey, J. (2020). Trends in suicide during the covid-19 pandemic.  BMJ 371, Issue November, 1–2.

Shevlin, M., McBride, O., Murphy, J., Miller, J. G., Hartman, T. K., Levita, L., Mason, L., Martinez, A. P., McKay, R., Stocks, T. V. A., Bennett, K. M., Hyland, P., Karatzias, T., & Bentall, R. P. (2020). Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic. BJPsych Open, 6 (6), 1–9. 

Silver, R. C., & Garfin, D. R. (2016). Coping with disasters. In & D. K. F. J. C. Norcross, G. R. VandenBos (Ed.), APA handbook of clinical psychology: Vol. 4. Psychopathology and health (pp. 597–611). American Psychological Association.

Silver, R. C., Holman, E. A., & Garfin, D. R. (2020). Coping with cascading collective traumas in the United States. Nature Human Behaviour.

RICHARD CARPIANO, SOCIOLOGIST
Vaccine hesitancy

The COVID-19 pandemic has presented many quickly unfolding challenges to the broad, interdisciplinary community of clinicians, researchers, advocates, and others concerned with addressing vaccine hesitancy. While vaccine hesitancy has long been a vexing, multifaceted problem, the pandemic has introduced further complexity to it—in significant part due to the extensive misinformation and disinformation efforts that have emerged regarding COVID-19 and its vaccines. Over the past year, members of this interdisciplinary community have convened to compile their field’s evidence-based knowledge to aid decision-makers in advance of and during the COVID-19 vaccination rollout (e.g., see here, here, and here). With vaccination efforts now well underway, vaccine hesitancy will likely become more of a pressing issue in the pursuit of herd immunity.

 As such, there will be an increased need in the months (and even years) ahead for decision-makers to tap into this community’s broad interdisciplinary expertise in order to address a range of issues. Developing effective and equitable vaccination promotion and outreach campaigns is one of the most urgent issues. However, the need for an effective response will extend to other matters that the pandemic has presented as either new forms of already-existing problems or new issues entirely. These include efforts to address the growing problem of vaccine and other health misinformation circulating online; the ethical, legal, and policy dimensions regarding COVID-19 vaccination (e.g., workplace policies, vaccine passports); and the concerning evolution of anti-vaccine activism into broader, more extremist, anti-government activities.   

For further reading:
Emily K. Brunson, Monica Schoch-Spana, and on behalf of the Working Group on Readying Populations for COVID-19 Vaccine. A social and behavioral research agenda to facilitate COVID-19 vaccine uptake in the United States. (2020). Health Security, Aug 2020, 338-344. 

National Academies of Sciences, Engineering, and Medicine. (2021). Strategies for Building Confidence in the COVID-19 Vaccines. Washington, DC: The National Academies Press.

Commissioners of the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA. Announcing the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA. (2021). The Lancet Comment 379(10280), 1165-1167.

MICHELLE MILLER-DAY (HEALTH COMMUNICATIONS)
Pandemic messaging

From the perspective of health and risk communication,  messaging around COVID-19 needs to be frequent, clear, from credible sources, and with concrete information that is actionable. The recipient needs a basic understanding of their personal exposure, their susceptibility to risks, the benefits of action,  possible barriers to action, and how those barriers can be mitigated.  Remember that a recipient’s existing beliefs affect how they will interpret and use any new information.

Some key communication strategies for a general population, based on evidence from communications research:

• Make sure messaging is written at the sixth-grade reading level 
• Establish the problem 
• Use credible, evidence-based textual or visual information (e.g., facts, percentages, graphs) along with personal narratives and examples/illustrations 
• Use varied senses if possible, including visuals, audio, and text 
• Use bite-sized chunks of information and actions that are doable 
• Ensure that the information provided is from a credible expert source 
• Summarize the information before concluding 

In the end, it is important not to cast blame, but instead to nurture agency in your audience. What CAN they do now?

Health communication is a key and necessary factor in saving lives during the COVID-19 pandemic crisis. Accurate and well-developed health communication can facilitate how societies handle uncertainty and fear, promote and accomplish adherence to necessary behavior change, and meet individuals’ fear and foster hope in the face of a crisis. Due to the complexity of health behavior, a multidisciplinary approach is needed to effectively promote change. For example, health communication expertise is needed for intervention development, message design, and evaluation in collaboration with medical and public health expertise for information accuracy and addressing health concerns. Indeed, interventions including information campaigns need to incorporate expertise from a variety of professional backgrounds to spread concise and valid information using multiple channels of communication in different contexts.

For further reading:
Finset, A., Bosworth, H., Butow, P., Gulbrandsen, P., Hulsman, R. L., Pieterse, A. H., … & van Weert, J. (2020). Effective health communication–a key factor in fighting the COVID-19 pandemic. Patient Education and Counseling, 103(5), 873. 

Rimal, R. N., & Lapinski, M. K. (2009). Why health communication is important in public health. Bulletin of the World Health Organization, 87, 247-247a.