The COVID-19 vaccination campaign has been met with much enthusiasm, with some hailing it as the beginning of the end of the pandemic. But health experts fear such optimism might prompt people to pay less attention to hygienic compliance measures, such as hand washing and wearing masks in public. The emergence of new strains in the UK and elsewhere has further increased the potential risk of infection, particularly in developing countries with high population density and weaker institutions that can delay universal vaccination. In this blog, Dr Prasenjit Sarkhel and Dr Upasak Das use data from India to explore the role of the community in ensuring better individual compliance to the pandemic protocols.

• The deployment of COVID-19 vaccines in developing countries has been delayed by a number of factors, such as vaccine nationalism, high population density, and weaker health systems.
• Public health bodies should continue to reinforce good hygiene practices like face coverings, hand washing, and social distancing.
• Health messaging should take advantage of strong social networks in developing nations to emphasise the impact on the community of compliance to these practices.

Although the process of COVID-19 vaccination has gathered pace in high income countries, the situation appears bleaker for low and middle income countries. Against the backdrop of increasing human interactions, and limited evidence on vaccine effectiveness compared to efficacy, stricter adherence to social distancing and hand-washing measures continues to be a crucial pandemic management strategy. However, the cautionary notes necessitates the need of hand washing and social distancing in the post inoculation period. Premature complacency in personal hygiene measures might come at a high health cost, especially for the elderly and people with co-morbidities.

One compelling reason why social distancing must continue is that vaccine doses are unlikely to reach everybody in one go. This is especially true for low and middle income countries, largely characterized by high population density, poor health and weaker institutions. It is also feared that African countries may be left behind in the vaccination drive because of hoarding by richer nations prioritizing their own populations. As such, adherence to non-medical interventions remains a key weapon against the spread of coronavirus, especially as the virus is mutating into newer strains with higher infectivity. Using online survey data collected from India during the lockdown, we offer ways to include communities and create incentives for people to follow these protocols.

Actions like mask wearing and maintaining physical distancing cause discomfort to individuals but confer a collective benefit to society at large. It follows, then, that pro-social motives might be an important driver of behavioral change that would sustain these practices even as vaccines are deployed.  Evidence shows that fines have not been fully effective in curbing speed limit violations. Additionally, often people are found to resort to bribing the regulatory personnel and get away with norm violation. So what are the alternative options that would trigger public awareness and induce adherence to social distancing?

Public messaging regarding COVID-19 protocols relies on putting the onus of best practices on the individual themselves. While it certainly informs them about the personal health hazards of flouting social distancing norms, it also emphasizes that the effort is also borne by the individual. However, as behavioral studies have pointed out, individuals often volunteer for social causes if they believe a sizeable part of their community are also engaging in such action. Could such inducements also work in sustaining adherence to social distancing measures? Would the knowledge that others in their neighborhood are also undertaking painstaking compliance measures encourage individual preventive effort?

Our survey data, collected through online platforms between April and May 2020, provides some answers. Responses were collected from 934 individuals, mostly from cities but also suburban and rural areas. The idea was to collect information about individual responses to the pandemic and adherence to common lockdown protocol measures that include social distancing and wearing masks. We also collected their perception about the community on these protocol adherences. In particular, we gathered information on the perceived prevalence of individuals in the respondent’s community who follow these protocols. For example, we directly asked the respondents: Out of 10 people in your community, how many do you think have put on face-masks while stepping outside?

Our analysis of this data found that respondents who have higher perception of their community’s adherence to COVID-19 protocols were on average considerably more likely to better comply with the lockdown protocols and maintain social distancing. We established that individual levels of adherence to the protocols are, to some extent, driven by whether one perceives their community and neighbours are complying with COVID-19 norms. Importantly, we also find this causal relationship to hold for co-morbid respondents. One major observation is a significant decline in compliance levels with subsequent lockdowns, though we argue that if a community complies with the norms, the chance of reduction in individual adherence with time is lower.

The findings suggest immediate potential reforms in the nature and content of the public messaging campaigns for COVID-19 protection in India and other developing countries with strong social networks. To sustain compliance over a longer period of time, framing compliance tasks in terms of community impact might be more effective than financial penalties. Social distancing measures and wearing masks are positive behaviors that should be made visible to encourage them as the norm. This could be done via social media platforms to engage peers and broadcast the use of masks and safety measures. Additionally, targeted interventions in local public health centers, hospitals, or pharmacies, where the likelihood of individuals with a high-risk from COVID-19 visiting is higher, could be useful in reaching this group. Focused interventions related to community compliance, through posters or periodic announcements in these places, can be a good way to reinforce these motivations.

In short, telling people to do things because others are doing them, as opposed to penalizing them for non-compliance, might ensure better protection until the vaccine is fully rolled-out.  Even if there is resistance to compliance within the community, examples drawn from similar communities can be used as a starter. Once this resistance subsides, messages using examples from within the community can start. This can be done by utilizing local community health workers and reorienting the existing COVID-19 messaging with active participation of the stakeholders, including the national government or Civil Society Organizations among others.

This blog featured as part of a collection of health-related pieces from across the University, published for World Health Day 2021. Take a look at our other blogs exploring issues relating to the coronavirus outbreak.

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