The sudden spread of the Omicron variant has disrupted Christmas and New Year celebrations and travel plans for the well-to-do. It has also brought a deep sense of foreboding for those who lost loved ones and many whose livelihoods were affected during the long-drawn and strict lockdowns. Cases continue to rise at a phenomenal rate without anyone being able to predict the end. No expert is able to assess how much this will pressurise the hospital system and health workers. The long-term impact on the human body in the years to come is still to be seen.
Countries with access to vaccines have rushed to administer booster doses and announced restrictions. The Prime Minister of India, too, has announced a phased booster vaccination plan for the elderly and children, with state governments declaring curfew zones and other restrictions. The question is whether this is enough to meet the challenge of an epidemic that emerges in new, mutated forms, defying science and medical responses.
The Horrors of the Second Wave
Public health in India – and indeed the world over – needs a much deeper calibrated response. While vaccines and pills may provide temporary relief, the focus must remain on prevention by all means that are known to us today. No public health system in the world is geared to treat and look after a significant percentage of the population that may get infected. We have seen the collapse and trauma during the second wave and there is no guarantee that it won’t happen again.
The surge of a still unknown and fully understood epidemic brings to mind a similar time over two decades ago, when HIV/AIDS raged across the world. Countries in Africa, notably Uganda, Kenya and South Africa, and Thailand and others, reported a 2% prevalence in the general population. Entire generations were wiped out. There was no preventive medicine or cure.
The World Health Organization (WHO) declared that India would be the next epicentre of the pandemic.
With its huge population, a 2% prevalence in the general population of India meant a devastating impact not only in the country but also on the world.
To add to the mystery of the disease, it was evident that the younger population was disproportionately affected. Whether it was transmission by unsafe sex, blood transfusion, or use of infected needles by drugs addicts, HIV/AIDS threatened the youth of the country, the core of the economic health of a family and society.
How India Proved WHO Wrong During HIV/AIDS
It was in 1997 that the National AIDS Control Programme was set up in India as a World Bank project. One of its first tasks was to undertake a nationwide survey and assess vulnerable populations. Without the benefit of a preventive drug or cure, the only way to mitigate the spread was through communication, ie., communication for prevention through behavioural change.
A massive public outreach and communication plan was launched to make people aware of what each one of them could do to be safe and keep their families safe. Every opportunity was harnessed to reach out to people in their language and understand the implications of unsafe behaviour. This was backed by data, partnered by social activists and supported through intensive media campaigns.
As the lead of the Information, Education and Communication section of National Aids Control Organization I (NACO I), I was deeply involved in formulating these action plans and assessing the impact of these over a period of time. Course correction and fine-tuning of messages were done wherever required.
The language was easy, the preventive action simple. An enabling environment was created where people had access to condoms, clean needles and blood banks for safe blood transfusion. The key message was “I can, I will, I must”.
History bears testimony to the fact that India was able to not just slow down but prevent an epidemic much before the anti-retroviral drugs were available. The predictions of the WHO were proved wrong.
A 'Nudge' Is All We Need
Today, we need a similar focused response to the COVID-19 pandemic. We need an effective, multi-layered communication and outreach campaign that makes safe behaviour non-negotiable.
The best prevention today for COVID-19 is adopting safe practices that keep us at a low risk of getting it – wearing masks correctly, maintaining social distance and avoiding crowded places. Vaccines have brought in a measure of protection, but their efficacy is yet to be established over a sustained period of time. Even if the best vaccines are available, ensuring that the entire population is fully vaccinated will be a huge challenge.
While governments and the medical fraternity must lead these efforts, a simple information effort will not be enough. What we need is an effective, incisive ‘nudge’ or behaviour change communication. We must stress prevention through strong behaviour change methods.
As Nobel laureate Richard Thaler says in his book Nudge,
“A nudge, as we will use the term, is any aspect of the choice architecture that alters people’s behaviour in a predictable way without forbidding any options or significantly changing their economic incentives.”
He speaks of how public policy must guide people to make the right choice.
Vaccines Weren't Meant To Be 'Cures'
Over the last few months, there has been much confusion and chaos on the communication sent out by the government on the pandemic. The emphasis on easy prevention steps was not clear enough. We were told to wear masks but it was not specified which ones and how.
The approach was casual and ad hoc. The result was that dupattas, handkerchiefs and ‘gamchhaas’ (a coarse cotton napkin) were used as masks, which proved to be ineffective. Then, there were masks on the chin, designer masks on strings of stylish beads around the neck, masks that did not do what they were supposed to do for prevention, ie., covering the nose and mouth effectively.
We were told to ‘socially distance‘ but its interpretation was left to each one of us. The results were people seen jostling in trains, public transport and aircraft. Weddings and celebrations were held with no COVID-19 protocols in place. Everyone looked the other way as we were tired and exhausted by the isolation and fear. Enforcement was arbitrary and lackadaisical. Those insisting on it were often ridiculed.
We saw public leaders disregarding these precautions in social and public gatherings. Political rallies did not heed any of these preventive measures. Weddings and parties did not adhere to any norms of safe conduct. We completely abandoned all forms of preventive behaviour.
Adding to this was the confused messaging around the vaccination programme.
One of the key messages sent out by the government and celebrities was “Jab tak dawai nahin, tab tak dhilayee nahin” (Let us not lower our guard till there is a cure). The vaccination was marketed as a cure even as scientists insisted that it was not foolproof. Those vaccinated considered themselves fully immunised against the disease, and there was no concerted effort in countering this belief.
We see the results now in the complete disregard for prevention norms. These messages create confusion, and, therefore, non-compliance with prevention measures.
India Should Reach Out to All Sections
There is a need for clarity and consistency in all communication on COVID-19 prevention. While the government and the medical fraternity must lead this communication campaign, we need to take it to the grassroots, to the young, to the rich and the poor. Safe behaviour must be the norm and not an aberration. We must wear our masks with a sense of responsibility.
India has enough talent to develop and disseminate imaginative communication strategies. Whether it’s music, drama or stories, all must come together to reach the hearts and minds of people. The phenomenal reach of social media, television and radio technology has made this easier. Messages must empower and enable, not create panic and fear.
The true test of leadership is in times of crises. Leaders are remembered for understanding what must be done and having the courage to do it despite opposition.
We need such leadership today, to communicate, to create an atmosphere where compliance with safety norms becomes voluntary and not enforced.
(Neelam Kapur is a former civil servant and former Principal Director-General, Press Information Bureau. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)