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Gravity of the situation

  • Over the initial phase of the national lockdown (March 24 to April 14), India reported a 20-fold increase in confirmed SARS-CoV-2/COVID-19 cases (468 to >10,000), and a 36-fold increase in deaths (9 to 330).
  • Increased testing may partly account for this; but testing is still inadequate and this data represent underestimates.
  • The case-fatality of 2% to 3% is indicative of the large number of deaths India can expect.
  • The failures in widespread testing for infection or for immunity imply that transmission-chains via asymptomatic, mildly-symptomatic and pre-symptomatic people remain undetected.
  • The lockdown (an extreme example of mitigation) has been extended to May 3.
  • The dire socio-economic consequences and the scale of human tragedy that play out daily make a prolonged total lockdown undesirable.
  • Alongside infection-control, a strategic plan of action to mitigate suffering and to stimulate economic recovery is urgently needed.

What is a social vaccine?

  • A social vaccine is a metaphor for a series of social and behavioural measures that governments can use to raise public consciousness about unhealthy situations through social mobilisation.
  • Social mobilisation can empower populations to resist unhealthy practices, increase resilience, and foster advocacy for change.
  • When applied to pandemics, the effectiveness of a social vaccine is determined by the extent of dissemination and uptake of accurate information about personal infection risk and methods to reduce the risk through consistent core messages disseminated through a variety of means.

Lesson from HIV pandemic’s Serious Issues

  • The human immunodeficiency virus (HIV) that causes the acquired immune deficiency syndrome (AIDS) is believed to have made the zoonotic jump from monkeys through chimpanzees to humans in Africa as early as the 1920s, but the HIV/AIDS epidemic was detected in 1981 and was a pandemic by 1985.
  • The early years of the HIV/AIDS pandemic were also a time of global panic. The cause was unknown (till 1984) and diagnostic tests were unavailable (till 1985). Since there was no treatment, a diagnosis of HIV infection was a death sentence.
  • Widespread fears of contagion rendered many infected people homeless and unemployed. Many were denied access to care.
  • Stigma, discrimination and violence towards infected individuals, their families, social groups (sex-workers, gay men, drug users, truck drivers, migrants), and even health workers, were common.
  • Criminalising sex-work and injecting drug use followed
  • Conspiracy theories, misinformation and unproven remedies were widely propagated.
  • The blame game targeted world leaders and international agencies.
  • The preparedness of health systems, societal prejudices and socio-economic inequities were starkly exposed.

How was the HIV pandemic handled?

  • Reducing HIV transmission centred on acknowledging that everybody was potentially infected — even those apparently healthy — and that infection occurred predominantly through sexual transmission and intravenous drug use.
  • The core preventive messages involved being faithful to one sexual partner or 100% condom use during sexual intercourse outside stable relationships; resisting peer-pressure for risky behaviours, and harm reduction for intravenous drug use.
  • These measures conflicted with prevailing cultural, social, religious, behavioural and legal norms.
  • These strategies and advocacy against stigma and discrimination were successfully adapted in India.
  • These skills and experiences can be innovatively adapted for the current pandemic.

How it can work?

  • The core infection-control messages are available from official sources. Maintaining physical distancing in social situations (unless impossible) and wearing cloth masks or facial coverings in public (especially where distancing is impossible) by 100% of people (and 100% of the time) is key to preventing infection along with regular disinfection of oneself and one’s surroundings.
  • Effective and innovative IEC and SBCC strategies should address the barriers and facilitators to implementation.
  • People are more likely to practise these behaviours if all leaders (without exception) promote them publicly and consistently, the whole community believes in their importance, and if proper information, support, and materials are available and accessible.
  • Coercive or punitive methods are invariably counter-productive, as was seen with HIV/AIDS.
December 2023