As the Covid-19 and pandemic related household food insecurity news keeps on trickling in, it is obvious that the fight against the coronavirus is far from over. So does its impact on health and nutrition. With the sheer absence of therapeutics and relevant vaccines to contain the new virus until early 2021, a number of prevention behavioural practices were largely propagated by the scientific community. These included maintaining physical distance, frequently washing hands and wearing a face mask.
Covid-19 vaccinations still throw a challenge of low uptake in many regions across the world, though many pockets in India have done fairly well with the jabs to the entitled recipients. Lack of access to vaccines, poor access to health facilities for vaccination, insufficient and inappropriate use of available resources, poor technical capacity and least empowered decision-making bodies, lack of political will, civil conflict and war, and natural disasters – all of these contribute to under-immunization in many countries. Therefore, there are two dimensions to the vaccination programme. These include ensuring equitable supply/access and logistics, and the demand-generation/positive behaviour change marketing strategies.
While supply and logistics throw challenges in ensuring equitable access to all, a significant emphasis on the health seeking behaviour aspects in communities also plays a significant role in achieving immunization targets. Covid-19 vaccination is no exception as it is already posing a mammoth logistic challenge for the health systems in most countries. Yet, in some select communities the demand-generation aspects like making communities accept the vaccination remains a major bottleneck for the political leadership and health communication experts.
Clinicians, scientists and communication experts are emphasizing on how people need to strictly adhere to pandemic appropriate behaviours, such as hand-washing, face masking and physical distancing, including ensuring getting a jab in the arms – whenever it’s accessible. Preventive behaviour is the key to emerging out of the pandemic as recommended by health experts.
Most people have reckoned that this pandemic is primarily a ‘behavioural practices’ issue, both at individual and at community levels. As a result, such people will adopt practices as are being disseminated by the credible and trusted sources. Yet, there will always be a few hard-core laggards who defy acceptance of any positive change. Such segment of population, of course, have their own reasons based on myths, rumours or incorrect beliefs. Conspiracy theories and a vast sea of misinformation is playing abound, though it was at-work even before the launch of the Covid-19 vaccination drives. The outrage of the infodemic gained momentum especially through the social media and digital space. People ought to understand that this virus is an absolute new pathogen which, even after over two years, is still being researched and studied, including its fast emerging mutants. Therefore, in the initial months of the pandemic, the leading health agencies, respective national health departments, scientific community, clinicians and epidemiologists struggled to find out the more realistic mode of transmission, correct therapeutic/clinical treatment protocols and the research on vaccination. The initial bottlenecks included delay in declaring the pandemic and the immediate next was discouraging use of face-masks with a barring exception of health providers! Promoting ‘avoidance of face-masks’, nevertheless did a huge damage, during the pandemic’s evolutionary months, leading to unchecked spread of the virus.
With the onset of the ongoing pandemic, people have become familiar with the concept of “risk compensation”. In other words, in most situations which are perceived as risky, individuals tend to adjust their respective behaviours, thus compensating to minimize that specific risk. Therefore, people who perceived the SARS-CoV-2 as a major threat to health, in most cases, would wear appropriate masks, wash their hands regularly, and maintain physical distancing by avoiding large crowds, especially when cases began to surge. However, the effects of risk compensation tend to dilute away over time as the ‘fear and risk’ threat start wearing off, as is being observed post Omicron wave in India in early 2022.
With the setting-in of a possible pandemic fatigue, the current rise in Covid-19 cases across the continents is observed. Alongside is the decreasing adherence to the risk reduction strategies in many population clusters in the first quarter of 2022. It is bound to further add to complications in the public health efforts and whatever little gains were made earlier.
Covid-19 vaccines were rolled out across the world with the start of 2021 and it created much needed optimism and euphoria. However, public health experts and risk-communication professionals will have to be appraised of another vital feature of risk compensation. It is noteworthy that the vaccine nearly served as the panacea to the pandemic risks; therefore, further weakening the critical adherence to other pandemic appropriate behaviours like regular hand washing/sanitizing, physical distancing and face-masking. This phenomenon, in which individuals respond to safety measures with a compensatory increase in risky behaviour, is named the Peltzman Effect.
Even at a subconscious level, those who have not received a vaccine may slack in wearing face-masks and in maintaining physical distancing in crowded places, when these people know that others are receiving the vaccine for the last many months. Therefore, as the number of people who are vaccinated increases, the Peltzman effect may also evolve due to a higher misplaced sense of security in an assumed herd immunity much prior to the expected widespread immunity is truly present in the communities. Hence, it throws a challenge to the communication experts and public health teams because, unfortunate that it is, the very optimism that is essential to encourage widespread acceptance of the vaccine shall undoubtedly end-up contributing to the overconfidence among people, which can ultimately worsen this effect.
It is critical to understand that for the current pandemic, a Peltzman Effect may manifest in varied ways for different groups of populations, including patients. Widespread misinformation and a highly politicized public health landscape have resulted in a wide spectrum of behaviours in response to Covid-19. Among those who refuse to practice pandemic appropriate behaviours - the anti-maskers or those who reject social-distancing guidelines - the Peltzman Effect will be nil.
Social and behavioural scientists have been contemplating whether or not the Covid-19 vaccinations would result in an increase in risk-taking behaviour? Undeniably to present an increase in a risky behaviour, a measure must first be visible, this is the criterion well met with the Covid-19vaccination due to discussions and publicity it has generated world over. Every individual who receives the vaccine will be very well aware that they have done so. Risk compensation is more likely to occur if people are highly motivated to take on the risky behaviour and if it is within their control to do so. Naturally, both of these -- motivation and control -- well apply to the current pandemic because it is both personally desirable and relatively easy to return to a pre-pandemic lifestyle free of face-masks and physical distancing. And the final factor, which is the overall effectiveness of the intervention, entirely depends on the vaccine that shall be understood in the long term.
At different stages of pandemic or an outbreak, some core health communication frameworks serve as a common denominator in planning and designing targeted activities. Unfortunately, most agencies are either withholding or rolling-out bulk of information without paying apt attention to its purpose, without clearly understanding the risk-factor’s profile of its focused target audiences and missing out in addressing the critical gaps in tailoring of messages. There is a need for local leaders, trusted and credible celebrities to reach out to masses with customized do’s and don’ts. It can be easily construed that the success of communication campaign on the pandemic is dependent on: (1) Timeliness of communication, (2) Simplicity, directness and consistency of the message, (3) Appropriateness of the selection of channels/tools, (4) Transparency in information sharing, and (5) Public faith and trust in the communicator.
It is widely evidenced by the fact that Covid-19 has already resulted in hundreds of thousands of human mortalities worldwide, needless to mention a much greater number of serious and long haul morbidities. While vaccinations offer a partial respite to the humanity from serious morbidities and infection causing death, the most effective weapon against the virus remains prevention, which is continued adherence to key pandemic appropriate behaviours, though making a choice between livelihoods and life is a serious question that still looms large.
Covid-19 risk for household food security
As is widely reported and documented through multiple studies, the Covid-19 pandemic continues to have profound negative impacts on people’s lives, especially the vulnerable, socially-excluded and hard-to-reach populace. However, little is known on its effect on household food insecurity (HFI) in poor setting resources.
A longitudinal field-based study, held in Uttar Pradesh between 2019 and 2020, concluded that the HFI increased sharply from 21% in December 2019 to 80% in August 2020, with 62% households changing the status from food secure to food insecure over this period. More specific to children, newly or consistently food-insecure households were less likely to consume a diverse diet as compared with those in the food-secure households. Households with consistent food insecurity were more likely to engage in varied mitigating strategies such as reducing other essential non-food expenditures, borrowing money to buy food or even selling jewellery and other valuables to procure essential foods.
The ongoing pandemic and earlier lockdowns posed a significant risk to HFI that in turn had critical implications for child feeding practices and coping strategies. Although the free-ration distribution strategy of the government provided some respite to the vulnerable groups, the current analysis emphasizes the need for further considered investments in the targeted social protection strategies and safety nets as an integral part of multisectoral and innovative remedies in improving HFI during and post-COVID-19.
(The author is a senior Consulting Adviser, Strategic Communication & Programmes, with the UN system in Asia and the Pacific.)