Chaotic messaging from govts and politicians has harmed India's COVID-19 fight

India’s strategy has emphasised victim blaming, and criminalised and stigmatised public behaviour during the pandemic rather than communicating risks, say experts.
Narendra Modi speaks without a mask at an election rally in West Bengal
Narendra Modi speaks without a mask at an election rally in West Bengal
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In his first address to the nation after the COVID-19 second wave, Prime Minister Narendra Modi on Monday appealed to citizens to maintain discipline to safeguard everyone against the novel coronavirus. He emphasised that this was crucial to save India from another lockdown. Many of his detractors were quick to point out the hypocrisy of the Prime Minister’s message, coming just days after his election rally in Asansol in West Bengal, where Modi, who was maskless, said he was elated to see large crowds. Of course, the Prime Minister is hardly the first political leader to throw caution to the winds as far as COVID-19 protocols go.

In similar fashion, the Union government and Uttarakhand government had allowed the Kumbh mela to go ahead for over two weeks before it was made ‘symbolic’. But with India in the midst of an alarming second wave of COVID-19, what does such mixed public messaging lead to during a public health crisis? 

Speaking to TNM, Gautam Menon, Professor of Physics and Biology at Ashoka University, says,“It’s obviously not a good thing to do. One must be consistent in one’s messaging, that’s most important. For the public to see that the message is not confused. And that I would say is an error [here].”  

T Sundararaman, Global Coordinator of the People’s Health Movement and a former Director of the National Health Systems Resource Centre, however, says political leaders not adhering to COVID-19 protocols is only a small part of India’s public health communication problem. “The major part of it is that the mainstream messaging has a terrible subtext. And that subtext doesn’t help change COVID appropriate behaviours or support public health measures,” he says. 

Victim blaming, criminalising behaviour 

Sundararaman points out that India’s public health communication strategy has emphasised victim blaming, and criminalised and stigmatised behaviour, pointing to policies like collecting fines for violating COVID-19 protocols. “The overall approach to public health behaviour has been authoritarian, a law and order approach, enforcement and fines,” Sundararaman observes. “In some sense you are saying people are irresponsible so they get their disease. So when a person gets COVID-19, they may feel ashamed, they may feel guilty. All of this comes in the way of contact tracing, immediate admission.”

Sundararaman points to how messages are framed. Highlighting PM Modi’s address in March 2020 when he compared stepping out of the house to stepping out of a Lakshman Rekha, Sundararaman says, “It’s a whole complex of things that have gone wrong other than the subtext of the major messages. You have Modi’s preliminary speech also, where you have a Lakshman Rekha around the house and you step out, what happens? Evil happens. The notion of good and evil comes in. That's not appropriate to get the change that you want. So there is a much more systematic flaw in the communication.”  

Communicating risk and positive messaging

Public health communication, Sundaraman emphasises, cannot be broad based. “You must differentiate between a high risk encounter and a low risk encounter,” he explains. 

Take, for example, the case of Tamil Nadu’s latest COVID-19 restrictions. The state government has banned the public from going to the beach and to parks, while allowing restaurants, cinema theatres and malls to function at 50% capacity. The restrictions fly in the face of present scientific wisdom which is that outdoor spaces are relatively less risky than indoor spaces

“What they (TN govt) should have done is said don’t stand and talk to another person for more than 10 minutes. And if you do, you should be 10 feet apart and wearing a mask,” says Sundararaman. 

He points to countries like the UK, where citizens were allowed to go out of the house for daily outdoor exercise either alone or with a household member. “You can’t get cooped up in the house. It is bad for non-communicable diseases. In some sense you do want people to go to the beach and park, but not stand around and talk. Whereas a cinema theatre is more dangerous. Restrictions on a cinema theatre will be resisted by the entire film industry but a beach and park have nobody to fight for them,” he notes.

But could the present restrictions, which have allowed such indoor spaces to remain open albeit at limited capacity, give people a false impression that it isn’t risky to go to the movies or to dine out?  

“It certainly gives a sense of false security,” says Gautam Menon, “I don’t think we have done enough to emphasise that open ventilated areas are probably 10 times safer than any enclosed space. And perhaps this should have been done to give people an alternative earlier on.” 

He adds that positive messaging amid the pandemic could also help motivate people to change their behaviour. “The psychological impact of the pandemic has been such that people have been told there are many things they cannot do. But they have not been told about things that they can do. And allowing for low density public spaces, I think would have been a bit of positive messaging while preventing crowding in enclosed and badly ventilated, air-conditioned spaces,” explains Gautam.  

However, the professor emphasises that presently, in the wake of the huge rise in COVID-19 cases, it may be best to avoid going out altogether if possible. 

Sundararaman also cites the example of the night curfew, which several states have implemented to curb rising infections, as a measure of confused public health messaging. 

“Why night curfew? There is no effort to explain that. Is a night curfew going to be more effective than a day curfew? Certainly not. There is nothing that happens at night. The virus doesn’t move faster at night. You think night curfew doesn’t affect the economy,” he says, “Why would you exhaust the police force to maintain a night curfew?  It is only tokenism, what you are doing. It completely confuses people on how the virus spreads. In modern viral transmission, what meaning does it have? The subtext of the messaging is the most unscientific, non-evidence based public health communication — a throwback by a century.” 

Citizen advisories and briefings

The United States’ Centres for Disease Control and Prevention (CDC) has been at the forefront of the COVID-19 pandemic in that country, putting out regular advisories on the dos and don’ts amid the pandemic, ranging from the list of activities you can engage in if you are fully vaccinated to the risk of transmission via surfaces and more. However, in India, the Ministry of Health and Family Welfare (MoHFW) website’s guidelines are largely SOPs (standard operating procedure) — generic preventive measures — meant for establishments like restaurants or gyms, or malls rather than a layperson. These guidelines hardly underscore the risk of exposure if citizens visit such establishments. The press briefings on COVID-19 by the Union Health Secretary, Indian Council of Medical Research (ICMR) Director General and NITI Aayog have primarily focussed on the disease’s transmission, cases, fatalities and most recently on the vaccination drive across various states. 

So, should there be a separate body or department to regularly and clearly brief citizens on what’s okay and not okay during the pandemic?

“There is a division under the Ministry of Health called the National Centre for Disease Control. It is modelled on the CDC. It has a disease surveillance wing. Somehow it got marginalised, and admittedly it has poor capacity and ICMR took over. ICMR is okay for virology, [to talk about] viral mutants. But they have no real grasp of public health planning or intervention. And therefore an integrated approach has been slow in the coming. So in some sense, the capacity to understand and lead in public health communication has been surprisingly weak,” says Sundararaman. 

However, Gautam argues that it doesn’t matter who briefs citizens as long as they are credible and knowledgeable. “I would have liked to see more briefings from people in charge of epidemiology, for example the National Institute of Epidemiology, the ICMR, they are people with specific expertise in epidemiology of infectious disease. and it would have been nice. We have the National Centre for Disease Control and representatives of these organisations are deeply knowledgeable about the problems of infectious diseases and how it spreads. They would have been the right people to put in communication. But it doesn't matter to me who is communicating as long as that person is perceived to be credible and knowledgeable, and does a good job,” he explains.  

What should India be doing to improve its public health messaging? 

“Ideally, we must do studies where we look at the social determinants of behaviour in different audience segments and then design appropriate media messages and communication for that,” Sundararaman says. 

But, he believes citizens adopting COVID appropriate behaviour can come only through interpersonal communication.  “You need feet on the ground talking family to family. But to do that, you need an enabling environment. And that is what media messaging, mass media messaging does. So when the individual goes house to house, a climate has already been created. Posters, hoardings create constant reminders of the messages. Mass media creates an environment for it.  And interpersonal interaction changes behaviour. A primary network where there is trust in the community health worker and community, between the social worker and the people in the village, that is where you actually get results,” he says. 

Given that it’s been over a year into the pandemic, Gautam says people are not lacking awareness about the dos and don’ts of COVID appropriate behaviour. “There is a certain level of fatigue that has set in, and this is at a particularly bad time for the country. And it can be an effort to counter that, ask people to stick to these guidelines for longer. For as long as it takes to get over this epidemic, they must be stringent about it. It’s a question of enforcing a certain type of behaviour and to remind them that this is their duty to do so.”  

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