Risk communication strategy key to fighting virus, but there’s noneAs cases continue to rise and without a strategy in place, the public is left confused and panicking, experts say. The latest example is conflict during ongoing vaccination.
Earlier this week, Chhima Sherpa, a health assistant at Bigutar Health Post of Siddhicharan Municipality, Okhaldhunga, was manhandled by a local resident because Covid-19 vaccines had not come to the municipality.
Even after the latest round of vaccination began on Tuesday, there have been reports of health workers in various districts being abused and manhandled by people for not being inoculated, according to Health Ministry officials.
“Immunisation workers have been threatened and abused in almost every district, including in Kathmandu Valley,” Dr Jhalak Gautam, chief of National Immunisation Programme, told the Post. “Health workers were even forced to shut down immunisation centres early and to flee to avoid conflicts with relatives of those from the age group who had earlier been told they would get the jabs.”
As the infection has spread throughout the country and it is said that vaccines are a reliable medium to lessen the severity and the risk of deaths due to the infection, more people are now willing to get the jabs compared to the earlier phase of vaccination when those above 65 were given their first dose, according to reports from several districts.
The official view of the Health Ministry is that such incidents of conflict are not unnatural.
“Though I am not aware of the particular incident [in Okhaldhunga], such things are not unexpected,” Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry, told the Post. “This time we changed the priority group at the last hour and that might have infuriated some people.”
Experts say a lack of risk communication strategy is to blame not only for poor communication and the subsequent manhandling of health workers but also for people not taking the risk of infection seriously.
The lack of trust in the government is responsible for people resorting to violence, according to them.
“Had the authorities made plans and conveyed the right message, people would have understood the situation,” Baburam Marasini, former director at the Epidemiology and Disease Control Division, told the Post. “Instead of doing risk communication at the time of pandemic, authorities are doing risky communication.”
The Ministry of Health and Population had announced that those aged between 60 and 64 would be immunised against Covid-19 with the 1 million doses of vaccines China donated last week. But the evening before the vaccinations were to begin it changed the eligibility criteria. While residents of Kathmandu Valley aged 60 to 64 would get the jabs, elsewhere those aged 62 to 64 would get them, the ministry announced.
“From the one million doses we got from China, we could vaccinate only around 450,000 to 500,000 people since their second doses have been secured,” said Gautam. “If we had given to all those between 60 to 64 around 50 percent of this age group would have been deprived of the vaccine.”
According to estimates, the 60 to 64 year-olds number around 850,000 in the country.
Public health experts had criticised the new announcement as discriminatory even as the number of new infections have been increasing in villages.
Meanwhile, more than 15 months since the pandemic hit the country, the Ministry of Health and Population is yet to finalise a risk communication strategy.
“We have completed the draft of the risk communication strategy and have also sent it to the provinces for suggestions,” Dr Radhika Thapaliya, director at National Health Education Information and Communication Centre, told the Post. “We will include those suggestions in the strategy and send them to the Health Ministry for endorsement.”
The lack of clear messaging and even negative messaging have led people to panic in the past. When the Health Ministry said hospitals may not be able to provide beds, as they were running at full capacity and hospitals lacked oxygen cylinders, people started to hoard oxygen cylinders.
“Hoarding of oxygen cylinders and essential drugs at home was among a few such instances that reflect the lack of public trust in the government,” said Marasini. “When the authorities lose trust, people themselves look for the alternatives.”
The objective of risk communication is making people informed about risk factors, educating them, giving assurances so that people do not panic and motivating the general public to change their behaviour.
But instead of making people informed about the risks by giving them the right information, the authorities created insecurity and anxiety in many instances, according to doctors.
Meanwhile, the government seems to have only one plan to check the spread of the virus—lockdown. By the time the prohibitory orders in Kathmandu Valley end on June 14, they will have been in place for 47 days.
The Health Ministry has been disseminating messages every day, but many of those messages are borrowed from elsewhere.
“Copying the message is not wrong but they should be contextualised,” an official at the Health Ministry said, asking not to be named. “Had we made our own risk communication strategy, our messages would have been more effective, precise and two-way.”
Every day, the Health Ministry issues some kind of message, without knowing if the message is reaching the targeted people.
Such messages in the past few days have included the danger of smoking and consuming alcohol during the coronavirus pandemic, symptoms of multisystem inflammatory syndrome among children as a complication resulting from Covid-19, notice on who will get the Chinese vaccine, and things to be aware of while taking the vaccine.
But communication is a two-way process, experts say.
According to the World Health Organisation, risk communication strategies include real-time exchange of information, advice and opinions between experts or officials and people who face the threat to their survival, health or economic and social well-being.
Through such strategies, everyone at risk is able to make informed decisions to mitigate the effects of the threat and take protective and preventive measures, says the UN health agency.
“We are still not bothered to know if the messages we are disseminating have been effective or not,” said the Health Ministry official.
Adhikari, the joint spokesperson, concedes that the ministry is copying the message from the World Health Organisation and from other sources and claims that they are aware of the need for contextualisation.
“A lot of homework has been done on the risk communication strategy and it is in the final phase,” said Adhikari.
Doctors say without effective risk communication strategy, it is not possible to contain the spread of infections in communities.
Thapaliya, director at National Health Education Information and Communication Centre who is a risk communication expert, concedes that both over-reaction and underestimation of the risk by the public result from the lack of proper risk communication.
“We are working not only to prepare the strategy but also on mechanisms to implement it,” said Thapaliya. “Several types of mechanisms at the centre, provinces, districts and the local level are needed to implement the risk communication strategy.”
But the delay in devising such a strategy has cost the country as a whole dearly. The country’s economy has suffered with Nepal registering a negative economic growth last fiscal year and the prognosis for the current one does not look good. Tens of thousands have been left jobless and with reduced incomes.
For those who have lost their loved ones and suffered from the illness brought about by the coronavirus, the price of the government’s failure to control the pandemic has been huge.
The total death toll since the pandemic began is 8,305 with the Ministry of Health and Population reporting 67 more deaths on Friday. With 2,709 new infections, the total tally of infections stands at 604,396.
“Authorities did not even do the simple things that could have been done,’’ said Marasini. “This shows that we are still not taking the risk of infection seriously. Things would have been different if experts were listened to, risks were taken seriously, and necessary measures were taken to check the spread of the virus.”