Covid-19 crisis: India draws lessons from Bangladesh's mask study

A study in Bangladesh's semi-rural and rural areas shows people can be convinced to keep their masks up

A recently conducted massive trial of mask usage in Bangladesh could inform public policy in India for rural areas against Covid, particularly as a temporary substitute for vaccines.
 
“Vaccinations will take a long time to arrive in South Asia to create a wall of immunity. Till then, masks are most essential,” said Mushfiq Mobarak, professor of economics at Yale university who led the study.
 
Enthused by the learnings, Self Employed Women’s Association, or Sewa, has rolled out a similar experiment for the two million women in its network in Gujarat and Rajasthan. State governments like Telangana and Bihar have also decided to adopt the lessons to make people in rural areas keep their masks up. A huge advantage with the strategy is its absurdly low cost.

 

Mobarak and his team had done a large-scale randomised controlled trial (RCT) in Bangladesh on about 350,000 people to study mask usage in semi-rural and rural areas. The encouraging news from the study is that people can be convinced to keep their masks up.
 
It is a rich study with lots of other takeaways, with huge cost savings. But abstracting from those, Mobarak’s basic conclusion is impressive. Vaccines alone cannot halt India’s current second wave. Usage of masks has to be consequently given a massive thrust in the country’s interiors. Else, as it seems already evident, even the current misery in cities could soon pale before the onslaught of the disease in the smaller towns and villages.

 
Researchers at Yale University, Stanford Medical School, along with those from Innovation for Poverty Action and local partners, found people were willing to use surgical masks if they were reminded by their peer group to do so. “People watch each other”, seems to be the refrain from the large study conducted earlier this year. Periodic in-person mask monitoring worked, said Mobarak when he discussed the report at a seminar at the National Council of Applied Economic Research (NCAER) this month.
 
To prepare the groundwork, the researchers had distributed effective but cheap surgical masks to the villages covered by the study. The people were also shown videos with popular role models like Bangladesh cricket icons to drive the message home. At mosques, imams were drafted in to reinforce the message.

 
The villages were divided into control groups where no follow-up action was taken versus treatment groups where follow-up teams landed to check what percentage of people were still using the masks after the initial burst of publicity. When people in these villages showed up without masks at the local markets, they were requested to wear one. And if they did not have a mask on their person, they were offered one on the spot. Mask wearing in these villages shot up. From an average of 13 per cent for the control group villages, the jump was nearly three times to 42 per cent. It was the highest in mosques at 49 per cent. But coercive action by the state, like penalties or other threats, did not change the behaviour of the people. When chowkidars (watchmen) accompanied the researchers, they hardly made a long-term dent.

 
The pattern persisted even 10 weeks into the trial, well after the eight-week-long mask promotion exercise had ended. Given the 12-week span of a Covid wave, this is a remarkable takeaway.
 
Echoing Mobarak, NCAER Director General Shekhar Shah said the think tank plans to extend the learnings with all the health departments of states. “The secretaries are neck-deep in handling the current crisis, yet most of them say they all wish to learn how to take this into their states,” Shah said.
 
With risk of a third wave imminent and vaccine supply not so, interest in masks as an effective short-term alternative has shot up, he said.