Communication around mask usage has been confusing, with some countries and authorities recommending it while others advising against it for reasons of ineffectiveness, shortage of supply or for potentially leading to risk compensation based behaviours. In countries where mask usage was made mandatory, there has been evidence of dramatically reduced transmission rates compared with countries not using masks widely.
What will work:
Enforcing mandatory mask usage right from the get-go of any pandemic will be effective in helping reduce transmission rates. This should be echoed by all authorities consistently at the international, national and local levels, and avoid enforcing it only with specific groups of people. There is evidence that enforced mask usage has helped overcome barriers to consistent mask usage such as social stigma, low risk perception and anxiety around defying social norms. Here are some of benefits of universal/near universal mask usage:
Helps avoid stigma of the illness: Many health authorities have recommended wearing masks for COVID-19 only if people are sick; however, reports of people wearing masks being attacked, shunned and stigmatised have already been observed. Having masks worn only by the suspected/confirmed infected has also led to employers in high-risk environments banning usage. In many countries, minorities suffer additional stigma and assumptions of criminality – for instance, black people in the US have reported reluctance to wear masks in public during this pandemic for fear of being mistaken as criminals. Stigma can be a strong force in human societies that cause delay in testing and treatment. A uniform enforcement of mask usage across all populations can help tackle this barrier.
Increases risk perception by serving as a visible signal and reminder: As such, signalling participation in health behaviours by wearing a mask as well as visible enforcement (for example, shops asking customers to wear masks) can increase compliance. Masks are an important signal that it’s not business as usual, thus increasing risk perception amongst people who haven’t yet grasped the seriousness of the situation. Pandemics require us to change our behaviour — our socialisation, hygiene, work and more — collectively, and knowing our fellow citizens are on board is important for all efforts.
Establishes social proof which drives compliance with health behaviours: Seeing everyone around using masks regularly makes it more socially acceptable. This is a key driver of stigma reduction (by not differentiating between sick and healthy people), as well as a reminder to people that they should start taking the situation seriously – because everyone is doing so. In some Asian countries like Hong Kong and Taiwan, government leaders and their staff set a good example by wearing masks when making public appearances. Instances like these urge an individual to conform to preventive health behaviours that the majority of people are following.
What needs to be improved:
Messaging around mask usage has to be promoted along with other health behaviours such as social-distancing and hand hygiene. It is ineffective by itself.
Implementers need to take into account the supply chain management of masks / capacity to manufacture when there is demand surge. Promote the message that medical masks such as N95 respirators have to be prioritised for health workers, and provide channels for the general population to access non-medical masks through community drives and citizen advocacy.
Who would this be most useful to:
Government & Policy Makers
Public Health Experts
Here are a few examples where citizen advocacy played a critical role in promoting universal/near-universal mask usage:
To curb Coronavirus, Hong Kong tells the world that masks work
Czech Republic’s #MasksForAll Campaign