Epidemic of bad behaviour

The pandemic is now over six months old. The number of confirmed cases in India is 4.3 million and the number of active cases is close to touching a million. This places India as the second worst-hit country, after the US. The number of deaths is the third highest in the world. A lockdown was imposed to prevent the spread of the virus and prepare the health system. People were asked to follow behaviours like wearing face mask, social distancing and hand sanitisation, to break the chain of transmission. In the past few weeks, we have seen gradual unlocking of economic activity, businesses, air and rail transport and public transport like Metro.

The key to preventing infection remains protective measures like face masks and hand washing. As the economic activity resumes and lockdown restrictions are lifted, one finds people in streets, parks and other public places not wearing masks or not wearing them properly. Images of people gathering without masks in crowded markets, religious events and other such places show that norms are not being followed. In Delhi, the police have fined 2.6 lakh people for flouting norms, in three months. Of this, over 2.3 lakh were fined just for not wearing mask. Other cities have also reported a rise in the number of people without face cover in public places. People crowding in front of counters in banks, shops and roadside kiosks indicates that the norm of maintaining 6-ft distance between two individuals is also being violated. This is in contrast to the orderly queues one saw in initial weeks of the lockdown.

All these are signs of ‘behaviour change fatigue’ or compliance fatigue. Simply put, behaviour change fatigue means getting tired of a new set of rules. After remaining indoors, and in most cases without work or means of livelihood, for a long time during the lockdown, and adopting new norms like wearing masks and hand washing, people are getting tired. After all, covering one’s face while going out or not shaking hands with friends does not come naturally to us. It was a new kind of behaviour and had to be imposed through a set of regulations. Such imposed changes can’t be permanent. Hence, we see people going back to old ways. Another reason for compliance fatigue is the uncertainty surrounding the change. The uncertainty is at two levels – one is about how long this will go on, which has to do with uncertainty surrounding the pandemic itself. The other is about effectiveness of measures like face covering or hand washing, which is largely fuelled by misinformation and fake news.

Human behaviour — and change in it — is driven by perception of a particular subject, in this case the pandemic. And perceptions are shaped by information people get from various sources — government, media, peer networks and so on. If people feel that the novel coronavirus is a tolerable risk, they will go back to old behaviour. If someone is not wearing a mask in a public place, it means the person does not believe that he or she is at risk or can risk others. This perception may be based on certain information inputs — television news, WhatsApp messages, newspaper stories or YouTube videos or a combination of such sources. That’s why communication of authentic information and news related to Covid-19, precautions, treatment options, prevention, etc, is critical. Based on such information, people calculate their own risk of contracting the infection and mould their behaviour accordingly.

That’s where the problem lies. Health communication from the Ministry of Health and Family Welfare, the Indian Council of Medical Research and other official agencies is constantly playing down the real extent of the pandemic, with undue focus on certain ‘feel good’ statistics. This is happening constantly. In its press conference held this week, for example, the ministry stressed on the following: ‘more than 5 crore tests conducted so far; 33 lakh patients have recovered; case fatality rate (CFR) is continuously declining, (1.7% compared to global average of 3.28%).’ This was on a day when India became the second worst-hit country, and the number of new infections continued to rise dramatically. The ministry also highlighted that ‘the number of deaths per million population in India is only 53 as compared to the world average of 115 deaths per million,’ and that the figure of ‘3,102 cases per million population is one of the lowest in the world.’ In addition, 14 Indian states and UTs have less than 5,000 active cases.

Since the ministry’s press conferences are shown live on TV channels and social media, the message reaches the people directly. Audiences may not understand jargon like CFR or the significance of per capita comparisons. They, however get a broad message — India is doing much better than the other countries, without realising that the risk at individual level remains same or is even higher than it was at the beginning of the pandemic.

Along with transmission of ‘feel good’ data about recovery rate, the number of tests and mortality figures, is the messaging in the media around the possibility of a vaccine soon. Every little development about any of the 200-odd vaccines under development globally is projected as a ‘breakthrough’ without any discussion on issues relating to vaccine development, clinical testing, commercial manufacturing, distribution, administration and follow-up. The television narrative projects vaccine as the only panacea to the pandemic. This shapes ideas among people that a vaccine is round the corner. Such erroneous perception and ‘feel good’ health communication by government agencies will only abet a new epidemic of bad behaviour or compliance fatigue. We need to study this phenomenon and take urgent steps for mid-course correction in Covid-19 communication strategies and messaging. It can save lives.