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As governments urged to ramp up pandemic efforts, a wealth of suggestions to promote mask-wearing

The World Health Organization has urged governments to strengthen responses to the COVID-19 pandemic, warning that the number of reported cases globally has increased by 30 percent over the past two weeks.

The upsurge, which is putting health systems under extreme pressure in Australia and other countries, is driven by Omicron BA.4, BA.5 and other descendent lineages and the lifting of public health and social measures, says the WHO.

Director-General Tedros Adhanom Ghebreyesus said governments should proactively counter misinformation and disinformation, include communities in decision making, re-build trust and address pandemic fatigue and risk perceptions.

As well as boosting vaccination, governments should promote effective, individual-level protective measures to reduce transmission, such as the wearing of well-fitted masks, distancing, staying home when sick, frequent hand washing, avoiding closed spaces with poor ventilation, crowded places, and improving and investing in ventilation of indoor spaces. These would help reduce transmission and slow down viral evolution.

The WHO said governments should be prepared to scale up public health and social measures rapidly in response to changes in the virus and population immunity. The recommendations, which also encourage countries to take a risk-based approach to mass gatherings, were released on 12 July with the Report of the 12th meeting of the International Health Regulations Emergency Committee on the COVID pandemic, held on 8 July.

The advice comes as Australian health systems face escalating pressures, with Federal Health Minister Mark Butler warning yesterday that it is “likely over coming weeks that some millions of Australians will catch COVID, some of them catching it again after perhaps having caught it earlier this year”.

The Federal Government, meanwhile, is under fire for making it more difficult for people on low incomes, to access RAT tests, and to stay home from work when sick. Doctors are also protesting the end of some telehealth arrangements they say are important for pandemic control.

To help address some of the mixed and confusing messaging surrounding COVID strategies, Croakey asked a range of health leaders for their advice on best strategies and messages for promoting mask wearing as part of a vaccine-plus strategy.

The survey below of 16 health experts offers a wealth of ideas to inform efforts by governments or other groups, whether health or community organisations or philanthropic efforts.

Key messaging suggestions included: The importance of high quality masking, positive campaigns explaining airborne transmision, messages that demonstrate caring, around leave no-one behind, protection for self and community, and solidarity, that “we are all in this together” and “caring for one another, families, communities and the health system”. Prevention is for acute and long-term health issues. Mask-wearing is not the only solution but part of a suite of actions to take. Use powerful visual images and techniques to convey airborne spread.

Recommended strategies included: Provide free or subsidised high-quality masks to vulnerable, at risk, and economically disadvantaged groups. Change social norms, normalise mask wearing, education campaigns plus regulation, community engagement, enlist champions, influencers, role modelling and Mask Ambassadors, more personal stories and fewer experts, provide people with the capability, opportunity and motivation to put on a mask – for example, hand out free masks at train stations. Learn from the history of condom promotion, and partner with communities in developing customised strategies. Acknowledge that this is about long-term behaviour change, not only by individuals but also by organisations. Localised, segmented and targeted strategies, with a focus on the mask hesitant or resistant. Target messaging and strategies to those most at risk from COVID. Politicians and other high-profile leaders should follow public health advice, ie walk the talk.

What NOT to do: Make it about personal choice or freedom, heavy enforcement tone, scare or fear-based campaigns, fact overload, encourage blame, shame and stigma, provide mixed and inconsistent messages, tell people what to do, exacerbate the concerns of people who are already feeling vulnerable to COVID. Avoid politicisation of the issue and it becoming entangled with the culture wars.

The survey below includes responses from Professor Bronwyn Fredericks, Dr Eleanor Glenn, Professor Guy Marks; Dr Kalinda Griffiths, Adjunct Professor Michael Moore, Dr Tess Ryan, Professor Julie Leask, Associate Professor Lesley Russell, Professor Mike Toole, Leanne Wells, Danny Vadasz, Dr Tim Senior, Glen Ramos, Alison Verhoeven, Kristy Schirmer, and Dr Liz Moore. See also some related tweets beneath the survey.


Demonstrate caring

Professor Bronwyn Fredericks, Pro-Vice-Chancellor (Indigenous Engagement) University of Queensland, Indigenous health researcher and advocate

Q: What would an effective campaign to promote mask wearing involve?

Show people who are or would be considered role models but different groups in the population (different ages and cultural backgrounds, abilities, and genders), wearing masks doing everyday things… ie shopping, concerts, accessing public transport, working, at a boat ramp, etc.

Q: What are its messages?

Work towards prevention of spreading. ‘Stop the Spread’  Caring for self, and everyone else. Doing something for others. Caring for family, and community.

Q: What are the values behind it?

Caring for everyone! Looking out for others.

Q: What strategies would it use?

Show people who are or would be considered role models but different groups in the population (different ages and cultural backgrounds, abilities, and genders), wearing masks doing everyday things… ie shopping, concerts, accessing public transport, working, going to a boat ramp,  etc.

Q: What would NOT be helpful?

Using people are role models who aren’t doing everyday things, or who are unlikely to model good practice in the every day ie who only do it for the photo op or sponsorship.

I don’t like the over use of footballers, and I know it doesn’t work with some of my family members who speak of footballers ‘doing things’ for the sponsorships or money.

Q: Any other comments or suggestions on related matters?

Right now most of the ambulance services and large urban hospitals are struggling to manage, as are workplaces with people off sick. Slowing down the spread would give people on the frontline a chance to regroup, and catch their breath. Right now we are risk of burning out the very people who can assist those in need of care. Governments and politicians need to take an upper hand here and do what is right for everyone, and act to ensure as many as possible are going to get through this safe, and well. They as we will be judged on how we manage this in the years to come by those who study this pandemic, and the generations that follow.


Target social norms, enlist champions

Dr Eleanor Glenn, Co-Director, Common Cause Australia, an organisation that helps environmental and social justice advocates to put values at the heart of their work. Eleanor is a qualitative researcher and communications expert, with a PhD in climate change communications and engagement. In 2021, she led research and provided advice to several local and State governments on COVID vaccination messaging.

Q: What would an effective campaign to promote mask wearing involve?

Social norming. We are social creatures who take our cues from others. In the end, actions speak louder than words. We need to see all sorts of people everywhere – GPs, politicians, teachers, sports people (off the field), shopkeepers, hairdressers – wearing masks. My GP is no longer wearing a mask, and his patients will be taking health cues from him. The NSW rugby team, who must be very interested in staying well, walked past our local cafe yesterday, and not one of them was wearing a mask.

We can help get this happening by engaging networks of mask-wearers, the ‘champion’ approach. They’re people who wear their masks proudly and encourage others in their circles to do the same. Journalists have a big role to play in the images and footage they choose for stories!

Then it can snowball from there.

Q: What are its messages?

Firstly, a wake-up call: we’re still in the middle of the pandemic, with infections and deaths increasing again. It’s winter! peak time for COVID.

Then encourage people to wear masks as one of the most effective ways of protecting ourselves and importantly, protecting others. Masks work no matter the variant, no matter your vaccination status. Masks are also protective against colds and flu, which as always can be nasty in winter.

In our research (on vax), people understood that there is no silver bullet against COVID. There are a handful of highly effective things we can do to protect ourselves and everyone else, and mask wearing is one of these alongside hand-washing, physical distancing and vaccination.

Q: What are the values behind it?

As for vaccination, love and care values. We wear masks both to take care of ourselves but to look after others who are counting on us to help keep them well. So it’s about responsibility.

Q: What would NOT be helpful?

“Choice” framing, ie “it’s your choice to get vaccinated / wear masks” promotes individualistic thinking (‘what’s in it for me?’) which is not useful for the overall COVID effort, a collective endeavour.

“Freedom” framing, ie we’ll soon be free to do what we want, if we wear masks. Amping up ‘freedom’ reminds us that our ‘freedoms’ are being taken away (a core message of anti- COVID vaccination/anti-lockdown activists).

Heavy enforcement tone.

Scare campaign, fear-based.

Fact overload. People make decisions primarily on the basis of values, emotions and identity, not facts – which is why engaging love and care values and social norming are so important.


Positive campaigns explaining airborne transmission

Professor Guy Marks, respiratory physician UNSW

Q: What are the campaign’s messages?

Masks are important for stopping the spread of COVID-19 because they stop both emissions of virus-containing aerosols into the air and stop people at risk (everyone) from inhaling aerosols containing the virus

Any mask is better than no mask. N95 masks are better than surgical or cloth masks

Masks need to be well-fitted and worn appropriately.

Masks should be worn in indoor spaces (particularly, poorly ventilated and heavily populated indoor spaces) and in other circumstances where people are closely packed together.

Q: What are the values behind it?

At present, vaccination has very little impact in reducing the risk of transmitting or receiving COVID-19 virus infection. Hence, the only way to prevent COVID-19 is to avoid exposure to the virus.

Exposure to the virus occurs mainly by the airborne route.

Virus enters the air by being exhaled into the air by someone with COVID-19. The source case may not have symptoms and may not know they have COVID.

It follows that the only method for preventing infection is to interrupt airborne transmission. This can be done by using masks (as described above), avoiding crowded indoor spaces and other congregate settings, and ensuring that indoor spaces are well ventilated and (if possible) use other methods to remove the virus (eg filtration).

Q: What would NOT be helpful?

Stigma and victim blaming is never helpful. Need positive campaigns.


Leave no one behind

Dr Kalinda Griffiths, UNSW, OzSAGE, a Yawuru woman.

Q: What would an effective campaign to promote mask wearing involve?

An effective campaign to promote mask wearing would be based off accurate, scientifically proven information. In order for it to be effective, it would be developed to reach all people in the nation, being developed in multiple, required, languages. It would also target those populations who are greater risk of severe disease and death if they contract COVID. This will include the elderly, the immunocompromised and Aboriginal and Torres Strait Islander people.

Q: What are its messages?

Masks will save lives. The better the mask, the more lives that are saved.

Masks protect yourself, and they protect others.

There are a range of masks to choose from, and the choice of mask will impact the level of protection you get. Community masks include cloth and surgical masks, as well as respirators such as P2, N95 or KF94.

Well fitted masks work best. For those people wearing a cloth or surgical mask, ‘double masking’ can improve both filtration and the fit of the mask. ‘Knot and tuck’, where a knot is made on both sides as close as possible to the mask can also improve the fit and filtration.

Masks can be worn by anyone 5 years and older, along with 2-5 year old children where developmentally appropriate.

Asymptomatic transmission is common. So even if you don’t feel sick or have any symptoms, you may still have COVID, and may be transmitting it to people you come into contact with. Universal mask wearing is important because it reduces the rate of transmission in our community.

Q: What are the values behind it?

Leave no one behind.

Vaccine-plus. In order to be successful in the prevention of COVID-19 and the protection of the population, a Vaccine-plus approach should be taken. This includes, vaccines, mask, testing, tracing and other non-pharmaceutical interventions (including crowd control, movement restrictions, blended learning and working, curfews, lockdowns and measures that reduce contact between people).

Q: What strategies would it use?

It would involve the input and oversight by expert members across the range of relevant disciplines. This would include but is not limited to people working in public health, health promotion, epidemiology, clinical disciplines, occupational hygiene, Aboriginal health, multicultural engagement, and communications.

To ensure consistent messaging nationally and across all state and territory jurisdictions, all governments, along with appropriate experts will need to be involved.

Q: What would NOT be helpful?

Mixed and inconsistent messages.

All information provided has been adapted from the OzSAGE.org website and available media releases.

More information specific to masks can be found here: https://ozsage.org/media_releases/community-mask-use/

Education about transmission and masks can be found here: https://youtu.be/kX9t8jQ9-fM


Strong, well-funded campaigns, plus regulation

Adjunct Professor Michael Moore, Past President World Federation of Public Health Associations, Distinguished Fellow, The George Institute, University of Canberra

Q: What would an effective campaign to promote mask wearing involve?

The most effective public health campaigns combine media, advertising and reaching out to the community combined with regulation. Huge reductions in motor vehicle related trauma and death were achieved in this manner – constant media messages combined with seat belt, drink driving, limits on speeding and requirements for safer vehicles. Adopting similar principles to prevent such rapid spread of COVID is important. The regulations were not all introduced at once.

Beyond vaccination, mask wearing is an important key to reduction in the number of cases of COVID, along with better ventilation, hand washing and social distancing. Mask wearing regulations, like those reducing motor vehicle trauma, can be introduced step by step. Crowded indoor spaces such as nightclubs, pubs and supermarkets could be a first step. Sporting facilities and spectators at big sporting games could be a second step. The advantage of the latter is that it also sends a very public message as audiences at games such as State of Origin often appear on our television screens.

Q: What are its messages?

The key question for Australians is how many more Australians have to die because you prefer not to wear a mask? How many Australians will need to live with long COVID? How many people will be denied elective surgery? How long will our hospitals need to be overcrowded? How many people will need to miss out on work? How much loss of productivity? How much do we expect to see empty supermarket shelves or limited products on offer?

Q: What are the values behind it?

The value of human life and a healthy community is behind the importance of governments to take some appropriate action. Freedom from over enthusiastic government regulation is an important value in democracies. Fully fledged lockdowns are now unacceptable and high levels of vaccination should support this. However, there are other less invasive measures that will make a significant difference.

Q: What strategies would it use?

Strong, well-funded campaigns combined with appropriate level regulation.

Q: What would NOT be helpful?

It would not be helpful to take actions appropriate for a pandemic without access to vaccines, such as lockdowns and broad mask mandates, introduced with little notice. We have all seen those who wear masks under their chin or with their nose hanging out.

Q: Any other comments or suggestions on related matters?

Contact tracing seems to have gone out of the windows. There can be little doubt that the case numbers being presented in the media are not the full picture as we rely on people doing their own Rapid Antigen Testing and then reporting to the government. And there are plenty