Scrolling through some images during a Google search, I came across this image: a collage of newspaper headlines from April 13th, 1955, about the discovery of the polio vaccine. When it was announced — or so the story goes — factories blew their whistles, church bells rang out all across America, and children were sent home from school to celebrate.
The discovery of Covid-19 vaccines hasn’t generated the same kind of public enthusiasm. Most conversations have been about side effects, questions about vaccine effectiveness against virus variants, and unequal access to them.
Public health communication around the pandemic has been described as a disaster. The outcomes of most communications — no matter who is communicating — have been confusion, distrust, fear, and despair.
How did we — citizens, public health officials, and all of us in the communications business — get it so wrong?
To begin with, communications on some aspects were far more emphatic, sustained, and persistent than others. Compare the messaging on washing hands and cleaning surfaces with the messaging on masks. We continue to use sanitizers, wash hands with soap and wear gloves, even though we now know that the virus doesn’t transmit on surfaces. But with masks and social distancing, that same emphasis and clarity seemed to be lacking.
When the ‘first wave’ appeared to have been stopped in its tracks by the national lockdown imposed in March 2020, complacency set in, and messaging on staying safe was not sustained. Remember all the funny memes and pictures on social media on how people wore masks?
In the absence of repeated messaging that Covid-19 was an airborne virus, social distancing protocols, for example, were flouted continuously: inside and outside stores, and at traffic lights on the roads.
This is a lesson not yet learned: that in a public health crisis, communication must be reiterative and sustained.
Instead, we have used a method loved in social media: scolding and shaming. WhatsApp messages with pictures of people being publicly punished like schoolchildren — having to kneel on the road with their hands on their heads, people being made to run laps around a block of streets, and then making videos of this public humiliation go viral — were legion.
In other cities, police have been handing out masks to people while also making them aware of the risks of airborne infection. But scolding seems to satisfy the many people who believe that taking personal responsibility is the solution to all our pandemic-related problems.
While it may seem necessary, it won’t get you vaccines or access to health infrastructure. Many people — like migrant workers who eventually went back to their villages — may not have had much choice or access to masks.
One of the biggest lessons learned about the HIV/AIDS epidemic was that shaming doesn’t work. Most people who may have been exposed to the risk of the AIDS infection chose to hide it, because of social stigma and fear of ostracism. That may be happening now too1.
This brings us to the second lesson not learned: communicate appropriately in a crisis. You can depend on people to do the right thing without shaming or scolding them.
Is disease transmission really so hard to explain? For more than two decades, public health experts have been aware of overdispersion: the idea that just 10–20 percent of infected people are responsible for 90 percent of transmission of the disease to other people; the rest don’t transmit it at all. Public health experts in India know this too.
Japan recognized overdispersion very early on and identified — through contact tracing and testing — the risks of the 3Cs: closed spaces, crowded places, and close-contact settings.
Perhaps, as many people believe, having to communicate to 1.4 billion people is a more daunting task, given the many languages and cultures. But it’s hard to believe that this simple message — to avoid the 3Cs — cannot be explained in easily understandable ways.
It was abundantly apparent that large public gatherings posed the biggest infection risks, which is why they are called ‘super-spreaders’. We had too many of them. The costs we avoided in the first wave were paid in the second wave, and we are still paying them.
This is the third lesson not learned: that explaining science is not so complicated that it cannot be understood by ordinary people. They will respond well to being trusted.
None of this prevented officials from issuing rules and invoking regulations on everything: the size of gatherings for marriages and funerals to working hours for essential businesses and stores and curfew times, and about testing and treatment protocols for Covid-19.
Even here, messages have been mixed.
Treatment guidelines have been issued very slowly, compared to the speed at which the pandemic situation is evolving. The health ministry did not emphasize strict adherence to them, so doctors prescribed therapies with limited, inconclusive, or even negative evidence2.
Guidelines issued by the Directorate General of Health Services on May 27 deleted therapies like hydrochloroquinine (HCQ), but the May 24 MoH and ICMR guidelines still have them3. Public trust in the health system, which has been low for a long time, has fallen even lower.
Learning these lessons quickly and applying them is what will.