THE COVID ANTIDOTE: A SOCIAL VACCINE
Alongside rolling out vaccines on a war footing India needs to reset social behaviour to win the battle against covid-19. EPISODE #19
Hi Everyone,
A Monday of cheer to all of you.
India is on the brink of being overwhelmed by the latest wave of covid-19 infections. Among other things it has once again bared the harsh truth of the state of India’s sell-past-the-date health infrastructure. Decades of neglect have been exposed by this once in a century pandemic. The situation has been compounded by a collective abdication of social responsibility by all stakeholders—including us citizens. The hypocrisy of allowing political congregations even while the general public is being subjected to the rigours of lockdown is no doubt galling.
In an inclement situation like this, looking outside from inside, everything seems lost. Seemingly yes. Yet there is hope. The good news is that there is a solution and to a large extent it is in our hands. The bad news is that this is not a quick-fix we so desperately seek. Instead it is something that will have to be implemented over the long term.
Accordingly this week I make the case that a social vaccine and the associated behavioural change is the best antidote for pandemics like covid-19. Changing social behaviour is more sustainable than deploying vaccines—this is not to take anything away from the scientists who have shown remarkable resilience and skills to come up with one in such a short space of time; a salute to them.
Thank you Vibha Joshi for a very apt cover photo.
And thank you readers for your support, especially in stoking a conversation, sometimes at odds with each other. Disagreements, as long as we respect each other, are welcome as they are the basis for a healthy dialogue in a democracy. Living in bubbles or echo chambers is a recipe for disaster. A big shoutout to Sonal, Vandana B, Yugainder, Kamal Monnoo, Krishnendu, Premasundaran, Balesh, Aashish, Rahul Sharma and Gautam for your informed comments and amplification. And, many thanks to readers who hit the like button 😊.
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Read on
THE COVID CONUNDRUM
Exactly a year ago, India, like the rest of the world, was bracing for the worst. The covid-19 pandemic, which originated in Wuhan, China, was threatening to overwhelm the world. Miraculously the worst case scenario did not, as forecast, pan out for India. And this despite the fact that the country still does not possess a health structure to deal with regular challenges leave alone a once in a century pandemic. It turned out to be the proverbial calm before the storm.
The spread of the virus has exploded and India is reporting over 2.6 lakh cases a day—the highest by any country and worse this is probably an undercount. Part of the problem is that an estimated 90% of the infections caused by a rapidly mutating virus are asymptomatic—hence it is strikes invisibly.
The creaking health infrastructure is on the brink of collapse and our frontline covid warriors of doctors, nurses and paramedic staff are stretched way beyond their ability and capacity. In short the situation is inclement. Social media is overflowing with heart rending stories.
How did India lose the plot so horribly?
For one, with the benefit of hindsight, all stakeholders were lulled into complacency. Second, the desperation to reclaim economic activity, with the benefit of hindsight, could have been better recalibrated. Thirdly, some state governments, after showing initial promise and investing in track-trace-treat strategy (wonder why the Arogya Setu app, which among other things help track the infected, has abruptly gone out of fashion), have all but abdicated their role even as a distracted union government struggled to stretch the limited infrastructure at its disposal.
Lastly and most importantly we may have failed to ask the right question: Instead of exploring justifications (including specious claims of how Indians have a higher resistance to the virus) we should have been asking as to why was the impact of the virus so muted? Or at least heeded the warnings of experts, some of whom are consulting the government.
And here we should have run with the epidemiologists; who could have deployed their science to breakdown the footprint of the virus, tracked its mutation and then figured a game plan to isolate the spread.
Even now there is a silver lining: the World Health Organisation is yet to classify this as community transmission; instead it is reporting the latest wave as the lesser evil, “clusters of cases”.
In other words if India plays its cards right from now on then two things are possible: One, the damage in the short run can be contained. Second, the country can be made more resilient to deal with the fresh waves that will follow over the next year and more as the virus seeks new cohorts in the population.
The Crusading Mask
Faced with the spike in infections, several state governments have opted for some version of the lockdown. Not only is this not a solution, but it will also entail attendant costs. All the more, as in the case of Delhi, if you allow cinemas to remain open and permit wedding festivities; though the attendance is capped the selective relaxation defeats the purpose of discouraging congregations in public. Similar to turning a blind eye to religious and political congregations. To state the obvious: hardly the recipe to break the infection chain.
The lockdown strategy was first tried out last year in a very different context defined by known unknowns. At that time nobody had a clue about the nature of the pandemic—in fact fear mongering experts were warning that by May-June India would be overrun. The only known fact was that India did not possess even the basic mitigation gear, like masks and protective gear for our health workers, in sufficient numbers. So it was designed to create space for building some emergency support systems.
A year later we have so much more vital information at our disposal.
For one, a lockdown comes at an enormous cost, especially to those at the bottom of the pyramid. And hence should be used only as the last option. In India bulk of the employment—some estimate it at 90%--is in the informal sector, which in turn is critically linked to economic freedom. A lockdown curtails this economic freedom and almost on cue robs people of their livelihood.
Second, we also know much more about the virus.
The latest is that the Centre for Disease Control and Prevention or CDC, the federal health watchdog in the United States and the gold standard in dealing with the SARS-Cov-2 virus which causes covid-19, has narrowed down the spread to droplet infection (caused by breathing, speaking, singing, coughing and sneezing—all of which can be curbed by using a good mask).
Further, it has all but ruled out infections due to contact with contaminated surfaces. Those interested in reading the latest CDC advisory issued on 5 April can click here.
This is both a cause for relief and worry.
We know now, with the benefit of hindsight and research, that the mask is clearly the most important line of defence against the spread of the virus. But we also know that this simple task eludes most: either we refuse to wear a mask or if we do then it is worn exposing the nose. Check out the video below:
At the same time by identifying the mask as the durable solution, epidemiologists have provided a tangible public face to the covid-19 pandemic.
This has been brilliantly articulated by Biju Dominic, a behavioural scientist, in a piece published in Mint. (Those interested in reading the full column please click here.)
“Many problems are invisible to human eyes, with the result that they are often not taken seriously. The invisibility of a problem could be on account of the microscopic nature of its cause, as with a pathogen, or the fact that it occurs in closed spaces, as in the case of domestic violence. What this pandemic has taught us is that if an unseen problem like covid is addressed by visible interventions like mask-wearing, it is easier to establish its existence in popular perception. When such overt measures are adopted widely enough to become social norms, the larger society starts playing a larger role in solving the problem.”
A Social Vaccine
The mask then can become the rallying call for the government, activists and general public to mobilise public consciousness to adopt appropriate behaviour to contain the covid-19 pandemic.
This is what is described as a social vaccine wherein mobilisation underwrites interventions—like wearing masks—with political commitment. As a result of the campaign more people should be willing to sport the mask in the appropriate way. What this does is to alter the circumstances of public behaviour and thereby force favourable health outcomes.
You may recall that there was considerable political mobilisation last year when covid-19 struck and people did actually buy-in. At that time however the focus was on getting people to follow the rules of a lockdown.
A year later the priorities have changed to protect both lives and livelihood—in other words we have to learn to live safely with the virus. So wearing a mask should be the primary buy-in for the people. And for politicians this should be a walk in the park; surely if you can organise regime change by convincing people to vote for you then mobilising people for a public good can’t be so difficult.
If matters are not fixed, then it is only a matter of time before public anger begins to get monetised electorally. Goes without saying that in such circumstances it is always the incumbent who will be held accountable.
Moreover, this is not unfamiliar territory for public policy in India.
A social vaccine was the strategy which enabled India overcome the challenge of HIV infection. Not only was there a national campaign backed by the government and several non-profits, including the Gates Foundation, to educate people about the importance of safe sex (particularly in the use of condoms); in addition there was special outreach to high risk groups like truck drivers and prostitutes, identified as force multipliers of the epidemic. And eventually the spread of HIV was contained.
In the final analysis it is clear that the present wave is serving as more than a wake-up call. It is calling for extraordinary steps. And in this a social vaccine forcing a behavioural reset is the most sustainable and cost-effective antidote for the long run. As they say prevention is better than cure.
Recommended Reading
This week also marked the end of an era.
Jeff Bezos stepped down as the big boss of Amazon. Reminded me of Sunil Gavaskar when he chose to retire while he was still at the top of his career. A remarkable quality to know when to call it a day.
And typically Bezos marked his exit with what his trademark letter to the shareholders of Amazon; a practice he started in 1997! It makes for compelling reading, especially this passage he quotes from the book by Richard Dawkins.
“Staving off death is a thing that you have to work at. Left to itself – and that is what it is when it dies – the body tends to revert to a state of equilibrium with its environment. If you measure some quantity such as the temperature, the acidity, the water content or the electrical potential in a living body, you will typically find that it is markedly different from the corresponding measure in the surroundings. Our bodies, for instance, are usually hotter than our surroundings, and in cold climates they have to work hard to maintain the differential. When we die the work stops, the temperature differential starts to disappear, and we end up the same temperature as our surroundings. Not all animals work so hard to avoid coming into equilibrium with their surrounding temperature, but all animals do some comparable work. For instance, in a dry country, animals and plants work to maintain the fluid content of their cells, work against a natural tendency for water to flow from them into the dry outside world. If they fail they die. More generally, if living things didn’t work actively to prevent it, they would eventually merge into their surroundings, and cease to exist as autonomous beings. That is what happens when they die.”
Those interested in reading the full text of the letter please click here.
Till we meet again next week. Stay safe.
A very timely article on our dismal health sector !! India is the second largest populated country in the word after China , but health infrastructure is far from satisfactory for majority of its population. Expenditure on health sector is just around 5% of the GDP.India has around 17% of the world's population but it bears a frightening 20% of the Global Burden of Disease (GBD).
70 % of our population lives in rural areas but only 20% of hospitals and 50% of total dispensaries are located in rural areas.It shows the Rural urban Divide.
The role of private sector in providing health services has grown consistently. More than 70 % of hospitals in india are run by the private sector. It provides healthcare to 80 % of outpatients and nearly 50 % of in patient's. It also plays a dominant role in medical education , training, diagnostics, manufacture and sale of pharmaceuticals etc.The private hospitals are expensive and beyond the reach of the poor.The govt has to take urgent steps to improve public health services.
The photo by Vibha Joshi is very apt in the present scenario!! I fully agree with you lockdown is not the solution to this problem. The mass migration of workers clearly shows the futility of this action.Social vaccine is rightly the way forward.
The quote by Jeff Bezos, the king of cyber commerce and the founder of the world's most customer centric company is very profound!!
The three main events of public gathering that I can think of are - Farmers protest, Election rallies and Kumbh mela. These events must have been a catalyst for the spread of the pandemic. Maharashtra however, till about a month ago, had about 60% of the cases, although it was not part of the three events. The reason that comes to mind is social behaviour, as pointed out very rightly, in your write up Anil. Whereas European countries changed their behaviour and were able to control and reduce the outbreak of the pandemic; conservative Americans, Brazilians and now Indians have failed to make the required adjustments. China through the state machinery and countries like New Zealand, Australia, Japan and South Korea have kept their casualties to a minimum through discipline, as a way of life.