Covid-19 remains an ever-present threat for the Pakistani economy and healthcare system. As Pakistan undergoes the third wave, evidence that the public may be growing impervious to health authorities’ messaging is striking. Between October and December 2020, 1,597 lockdown violations were reported on the Punjab government’s official helpline from across the province. On the other hand, demand for vaccine remains alarmingly low; only 2.2% of the 8 million senior citizens in the country have registered for inoculation while the results of a nationwide poll reveal that over 40 per cent of Pakistanis are unlikely to get themselves vaccinated. The lukewarm response from the healthcare community mirrors these attitudes. This unchecked public complacency coupled with the government’s premature decision to ease restrictions is what led the health experts to sound the alarm on a third wave.
Evidence suggests that this disregard for protective measures may be due to a lack of trust placed within those advocating them. Mounting scepticism about the vaccine, myths about the disease and the fact that the government has done little, other than mass media messaging, to pacify these fears only serve to exacerbate the situation. Recent studies conducted in Punjab have found that 54% of the respondents are concerned about the safety of the vaccine while 38% believe that they have a healthy immune system and are not worried about having Covid-19. In this environment, effective messaging is the key to tackling the situation by improving the meagre vaccine uptake while ensuring compliance with public health guidelines. Thus, how should the government go about engaging the public? Can enlisting the help of local community leaders and reminding them of their responsibility towards their community help alleviate this problem?
Our study and its setting
In order to test this, we, at the Centre for Economic Research in Pakistan, designed an experiment to measure the impact of one-on-one engagement with local religious leadership on the compliance of protocols at their mosque. Our messaging was a combination of religious appeal and public health guidelines that were interactive, involving frequent elicitation of the respondent’s reactions and agreement, as well as asking him to commit to action.
We carried out our study over a three-week period before Eidul Azha in July 2020. At that time, policy makers feared a spike in the number of infections, similar to the rise in Covid-19 cases observed post Eidul Fitr in May 2020. We reached out to 2,700 religious community leaders (imams) from 19 districts across Punjab, covering both urban and rural areas. All the respondents were randomly divided into three groups, out of which two groups received persuasion scripts. This design allowed us to compare across groups and test whether the different persuasion scripts encouraged imams to impart health advice to their congregants. The scripts contained directives issued by the government for the prevention of Covid-19 at mosques and an appeal to religious authority using a combination of ahadees, fatwas from renowned religious scholars and measures taken by other Muslim countries. The scripts then segued into an appeal to the respondent’s influential role as an imam and his responsibility to disseminate these guidelines to his colleagues and congregants.
Engagement with community leaders does work
We followed up with the imams two days before Eidul Azha to gauge compliance on Covid-19 prevention measures at their mosque by noting things such as whether or not the respondent advised wearing a mask, bringing one’s own prayer mat, performing ablution at home, or discouraged the elderly from coming. We observed that one-on-one engagement with religious leaders makes them significantly more likely to impart health guidelines. For instance, those imams who received the persuasion scripts were 25 per cent more likely to advise their congregants to wear a mask to prayers. This was despite the fact that imams who received the persuasion scripts and those that did not possessed similar levels of awareness regarding basic Covid-19 facts. Moreover, our engagement was equally effective with or without explicitly religious content in the scripts. This suggests the key mechanism that made our engagement successful was neither educating the imams on the basic facts about Covid-19 nor framing the health guidelines in secular or religious directives. Rather, it worked by connecting this knowledge with their power to persuade as community leaders and their responsibility towards their community.
One-on-one engagement, in particular, could be effective in bringing about behavioural change
Moreover, we also came across evidence that such one-on-one engagement might be effective even when mass messaging fails to induce behavioural change. Even though 70 per cent of the imams in our study had received some form of messaging regarding the spread of Covid-19 via government announcements, TV and newspapers, only 26 per cent of them had advised their congregants to wear a mask. However, with our engagement, they were 25 per cent more likely to recommend this prevention step. This suggests that public health campaigns should go beyond the use of mass messaging; the strategy should be supplemented with some form of collaboration with focal community leaders at the grassroots level.
Insights from our study reveal that there is room for policymakers to build a more collaborative relationship with such leaders through one-on-one engagement which can take the form of interactive messaging on the spread of Covid-19 along with an emphasis on the instrumental role these leaders can play in curtailing the spread of the disease in their own localities by encouraging people to change their actions.
Benefits of one-on-one engagement with community leaders
Through this messaging approach, policymakers can mobilise communal leaders (religious or non-religious) on two fronts: containment and prevention. On the containment front, authorities can seek their support to increase dissemination of health advice and, through the leaders' influence and sway over their community, also eventually help increase compliance with those measures. Similarly, these leaders can also lend a hand in the outreach of public health campaigns, such as the ongoing nationwide Covid-19 vaccination drive.
If vaccine uptake remains low, the threat of Covid-19 may linger for a while. Given the recent rise in infections, widespread misinformation and scepticism about the pandemic, mass indifference towards health guidelines, and the fact that those who have been vaccinated may still be carriers of the disease, the virus is likely to remain a threat for an even longer period than anticipated. Therefore, the Covid-19 vaccination drive needs to happen in tandem with social distancing measures. As the government rolls out its mass inoculation program, it should also consider formulating an effective communication strategy in order to impress upon the public the importance of remaining cautious. This is where partnering with communal leaders could be particularly beneficial for the dissemination of health authorities’ messaging. Communal leaders can act as intermediaries for the purpose of conveying to members of their community the importance of getting vaccinated and following Covid-19 protocols for at least as long the pandemic lasts.
The Analytical Angle is a monthly column where top researchers bring rigorous evidence to policy debates in Pakistan. The series is a collaboration between the Centre for Economic Research in Pakistan and Dawn.com. The views expressed are the authors’ alone.