Why do people resist Covid-19 hygiene?

Bangladesh followed other countries in its effort to contain the Covid-19 pandemic with the initial countrywide lockdown and measures for revamping the health infrastructure. These efforts, however, proved inadequate for preventing the countrywide community-level transmission of the infection. The existing public health infrastructure proved too moribund to be repaired easily. The lockdown was marred by inadequate management, including allowing some "super-spreader" events like religious gatherings, mass movements of garment workers and Eid-related holidaying. The current strategy seems to be to continue to gear up the Covid-related health measures, including some lockdowns here and there, while letting the economy regain the normal levels of activities, albeit subject to complying with Covid hygiene. The epidemiological goals of localised lockdowns of certain hotspots remain vague, particularly when the infections seem to have spread almost all over the country, and in the absence of a surveillance system based on adequate numbers of tests to determine both the extent of current infections and the immunity acquired by past infections.

Opinion polls suggest that while the general public could accept the hardship of the initial three month lockdown, they are against a repeat lockdown, which seems to also conform to the current understanding of the authorities regarding the political sociology of such lockdowns. Compliance with Covid hygiene seems to thus remain the only fallback position, at least to let the course of the infections go through a "slow-burning" process without reaching an unmanageable peak.

Fortunately, experts believe that compliance with some simple rules like wearing masks, washing hands and keeping physical distance in public places can provide about 95 percent protection against the infection. The authorities are also now trying to convey this message to the general public in a variety of ways. But such messages seem to remain largely unheeded, as clearly evident from the visual reporting on electronic media. One reason may be that these messages do not have enough credibility with the general public, particularly because of mixed signals from time to time and in the absence of clearly defined, coherent and implementable guidelines. But there may be also other issues of individual incentives and social psychology related to the behavioural norms of Covid hygiene.

First, one of the early messages coming from the official health spokespersons was that Covid-19 is not a serious ailment for most of the infected people, which is factually correct; only about 15 percent of those who show signs of infection may develop serious symptoms, about five percent may need life-saving hospital-based interventions and less than two percent die, while many do not show any symptom at all. What was not fully comprehended was that Covid-19 may be ten times more infectious than the general cold and flu, so that while the risk for an individual to be seriously ill from this infection may be small, the total numbers of people being seriously ill and needing hospital care may prove overwhelming. Thus, the risk to society as a whole far outweighs an individual's perception of risk; it is the latter that mainly affects his or her incentives for compliance with Covid hygiene.

Second, the incompatibility between the social risk and individual incentive is heightened by the age structure of the population of Bangladesh. Compared to many other countries, the proportion of the youth population in Bangladesh is disproportionately large because of the increasing adoption of birth control measures since the late 1980s, which dramatically reduced the high birth rates of the erstwhile period. This has resulted in the so-called "demographic dividend" which is good for boosting economic growth through a youth bulge in the age composition of the population. But since younger people are less susceptible to serious or fatal Covid infections, it means that the larger proportion of the working-age population, being young, can move around with a perception that Covid-19 infection may not do much harm to them.

Third, an even more important source of incentive incompatibility arises from the fact that complying with Covid hygiene is as important for ensuring one's own safety as for protecting others. This is particularly true for the more mobile younger people whose negligence regarding Covid hygiene may prove less harmful for themselves than for the elderly who are susceptible to serious and fatal infection. As distinct from self-interested behaviour of people, complying with Covid hygiene is thus more of a social responsibility that needs far more vigorous awareness campaigns. Moreover, recent studies on experimental psychology regarding the practice of Covid hygiene also show that, as opposed to established social habit, even simple things like social distancing involve some effort and mental exercise and, therefore, more persuasion.

Since it now looks like Covid-19 is not going away soon, the policymakers have to think beyond routinely adding Covid hygiene merely as a qualifying proposition while making announcements of freeing up more and more economic activities. The foregoing analyses suggest that effective compliance will need a well-articulated strategy involving strict compulsion measures, along with more vigorous awareness campaigns. The challenges are there, not least posed by the extremely high congestion of human habitation and economic activities, especially in the urban centres. A foreign journalist once remarked on his first visit to Bangladesh: this is the only country where one cannot be in an open space without at least another person being in sight. Physical distancing in such an environment is not always easy.

The hygiene rules need to therefore be practicable while implemented strictly, albeit in a humane way. A rickshaw-puller, for example, may be excused for taking off his mask in the scorching heat of the sun while not carrying passengers; but such instances should be treated only as exceptions to the rules. Local level initiatives, involving volunteers, NGOs and other community organisations and with support from the government administration, can be a means for effective awareness campaigns as well as for identifying and supporting families in need of relief, credit or healthcare. In this respect, combatting the Covid-19 pandemic is more to do with community mobilisation than like conducting a war with a centralised command and control system, as remarked by Amartya Sen in the context of the successful campaign of containing the pandemic in the state of Kerala in India. 

The strict compliance of Covid hygiene will inevitably involve considerable economic costs, so that policies will need to be devised to share this burden of cost equitably in society. This cost will be reflected in various ways: investments needed to create more hygienic work environments in factories, fewer number of passengers carried by buses and other vehicles, suspension of services like ride-sharing by motorbikes, temporary shutting down of entertainment facilities like cinema halls and stadiums, adequate spacing of roadside vendors, queuing of buyers in kitchen markets, and so on. But it should be realised that there are not many options left. Even if we were cynical enough to accept the Covid-related loss of life for the sake of unrestricted opening up of the economy, we would be deluding ourselves in expecting that economic growth can regain its full momentum while the pandemic continues unabated.

Wahiduddin Mahmud is Chairman of Economic Research Group, Dhaka. This article was originally delivered as a speech at a webinar organised by the Cambridge and Oxford Society of Bangladesh on June 27, 2020.