The framework proposes four new suggestions for increasing adherence, numbered as options 17 to 20 that SPI-B have not commented on before. These focus on: 17) increasing the financial penalties imposed; 18) introducing self-validation for movements; 19) reducing exercise and/or shopping; 20) reducing non-home working. We have reservations about options 17 to 19.
First, we are unclear what the evidence base is that the targeted behaviours are a substantial contribution to disease transmission, particularly given the high adherence rates currently observed in the community. Is there evidence, for example, that exercise conducted more than 1km away from the house leads to higher rates of transmission than exercise conducted within 1km of the house? Indeed, for this option, there is a risk that reducing the ability of people to apply some flexibility in choosing where to exercise will increase risk by preventing people from spreading out in nearby open space. Tightening restrictions without clear epidemiological need may lose support among people who have been attempting to adhere.
Second, the implicit assumption underlying options 17 to 19 is that people lack motivation to adhere to current guidance. This may apply to some specific subgroups (the example of young men has been given), but broadly the current levels of adherence we are witnessing suggest this is not the issue.
Third, there are equity issues within options 17 to 19. Any flat rate financial penalty will have a higher impact on poorer households, while the assumption that printing and completing paperwork is straightforward for all households can also be challenged. The assumption underlying restrictions on shopping frequency is that people can afford to buy in larger quantities. The risk of tension arising as the police are required to start penalising those who are not adhering should also be factored into considerations.