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 who feel it would be better not to test as they will wind up in (voluntary) isolation.
Vaccination for COVID-19 and the annual flu jab should be the subject of a parallel campaign for introducing mask wearing (and this does seem to be happening).
More personal stories, fewer experts
Dr Tess Ryan, an Indigenous woman of Biripai country in Taree New South Wale, researcher, writer and person with lived experience of chronic illness
Q: What would an effective campaign to promote mask wearing involve?
I think the public should know they don’t need to wait to be told what to do, and wearing a mask is one of the easiest ways to protect people from the virus. A national health messaging campaign with consistent rules that encourages people rather than enforces would be a way of getting the message out there.
I also think they should subsidise masks and RATs and demonstrate that it is not health or economy; without health, there is no economy, consumer confidence is tied to health.
Indoor locations could be given ratings on how well the air circulation is. Signage could be also given for CO2 levels/circulation ratings so you know if semi-safe or unsafe to enter a premises.
And lastly, people are struggling mentally, need more support for people who are feeling isolated.
Q: What are its messages?
For some people, COVID isn’t over. We all still need to consider wearing a mask. It could prevent an infection, hospitalisation which the system is stretched right now…it could slow down the numbers of infections which means we can all get back to living ‘normally’. We don’t want to ‘go back’
The messaging needs to be positive, how to self-empower, not fear based. If you are in an accident, and there are no ambulances, no hospital beds, who is going to help you?
Every time you get COVID, not only does the risk increase of dying, it also increases the risk of long COVID and permanent disability – loss of income, loss of house, loss of everything. The more people who are infected, the more variants, the more contagious/deadly the virus is likely to become.
Wondering why there is still shortages of toilet paper? Tissues? You favourite grocery item? Lack of masks wreaking havoc on our supply chains. A society is measured by how it treats its most vulnerable, not wearing masks reflects on how we feel about our most vulnerable.
COVID is not over, and will not be over for a long time. Learning to live with COVID is not the same as pretending that it doesn’t exist. Time to step back into reality and out of the land of wishful thinking
Q: What are the values behind it?
Considering others in society (immunocompromised), civil responsibility (hospital strain) and wanting to build back up to pre-2020.
Q: What strategies would it use?
I always think using real people and their stories can help. For people within particular cultures, hearing the lived experiences of people makes a difference to their understanding of an issue. We all know masks can be annoying, but wearing a ventilator would be far more disruptive.
Q: What would NOT be helpful?
As much as I would like there to be research and experts used, I feel that some of the population just turn off now when an epidemiologist comes on the television screen. And no catchy gimmicks from the government.
Q: Any other comments or suggestions on related matters?
For some in the community, we have not drastically changed our habits since COVID began. If you have severe chronic illness, and you know what kind of damage this disease can do, you are probably limiting social outings, travel, and doing your best to stay as well as you can in order to avoid taking up room in an exhausted hospital system. Many of us may know people who have had COVID, and some of us may know people who have died from it. It can be a devastating illness, and if you survive, you may still be left with a lifetime of other related health issues. I would much rather err on the side of caution and wear a mask than take my chances.
Protection and solidarity
Professor Julie Leask, University of Sydney
I can see the discussion about mask mandates quickly becoming the debate dejour in the media over the next week or so. However, this misses the most important action: getting high 4th dose coverage in people where it is low, which happen to often be the communities bearing a disproportionate burden of disease and death from COVID. Vaccines remain our best form of protection from severe disease. Third and fourth dose coverage is still too low.
For masks, people need the factual and social awareness: the factual message looks like this: “we really need people to wear masks again ahead of this surge” and the social message looks something like: “wearing a mask is what you can do to help others stay a bit safer”. Social norms around masks help and we need carefully crafted messages that are positive.
We also need to remember that campaigns serve important functions, but alone don’t change behaviour. I find the COM-B model useful. It sees behaviour occurring when people have the capability, opportunity and motivation to perform the needed behaviours (eg, putting on a mask). Therefore, governments also need to also foster opportunity. For example, that person at the major train station handing out masks – “here is a mask – it’s yours for the train journey today”.
The salient values with mask wearing include protection and solidarity. Right now, taking away choice and returning to heavy policing of mask wearing may not be so helpful, when people have had public health curtail so many daily activities over the last two years. We are in danger of producing reactance which could make the embedding of mask wearing harder into the future. If we were to reinstate mask mandates, there would have to be a clear rationale and a reminder of what the current evidence says. A crucial question is this: is the evidence for masks strong enough to justify policing of everyday behaviour? Does it justify the inevitable inequity in the application of punishments for non-compliance? How can those inequities be minimised in the process?
Either way, stigmatising and calling people out for not wearing masks is not helpful and in some cases may produce reactance. To sustain mask wearing into the future, we cannot always depend on public health orders and mandates. This is a long haul behaviour that may be needed for future COVID surges and flu seasons in certain settings. So motivation needs to be intrinsic, whether that be a sense of wanting to protect others, a sense that wearing a mask is something you just do in certain circumstances, or a convincing rationale that this is a highly effective method of prevention.
Multi-pronged strategies, with Mask Ambassadors
Associate Professor Lesley Russell, health policy analytst
Q: What would an effective campaign to promote mask wearing involve?
Well-recognised Australians of all ages, races, and status wearing masks – not just on posters but every day.
Also a national public campaign featuring these ambassadors + demonstrations / diagrams of how well mask wearing by everyone can stop transmission + clear national guidelines about when masks should be worn + a message about doing this for your health, the health of others.
Maybe combine with the sale of some N95 masks that through colour and design enable Australians to identify with mask ambassadors.
Certainly need to ensure the availability of top quality masks at reasonable prices.
Q: What are its messages?
If you care about your health and if you care about the health of others in your community.
This is not just about preventing COVID-19 infections but also about preventing long-COVID.
Q: What are the values behind it?
I’m doing this for you and me and my community
Q: What strategies would it use?
A widespread media campaign, across all sectors/languages/regions.
Best supported if the ambassadors are regularly seen wearing masks in all the appropriate places.
The more people wear masks, the more likely others are to follow their lead.
If masks are highly recommended/mandated, then the ability/willingness to request that people wear masks and wear them properly.
Q: What is NOT helpful?
People in high places (eg politicians, business leaders) and heroes (sporting figures, arts etc) seen not wearing masks when it would be sensible to do so.
Q: Other comments?
I do think there should be national mask mandates for certain settings – hospitals, aged care, large public events held indoors, public transport, airlines.
Rewards for mask wearing apart from being community minded – relief from other respiratory diseases (eg flu)
Innovative communications and role modelling
Professor Mike Toole, Burnet Institute
Q: What would an effective campaign to promote mask wearing involve?
The campaign should use innovative communication messages to promote the benefits of wearing high quality (N95, P2) masks. It should be accompanied by example setting so that in public indoor appearances by government ministers everyone should wear a high quality mask until they speak to the microphone.
Q: What are its messages?
In a closed setting with poor ventilation, a high quality mask will reduce the risk of an individual being infected by 70 percent. At the community level, mask wearing will reduce overall transmission by 20-30 percent, according to Burnet modelling.
But masks do not replace the value of 3rd and 4th dose vaccine boosters. They complement the benefits of vaccines.
Q: What are the values behind it?
If we can reduce transmission by around 20 percent, the effective reproductive rate will drop below 1 and the number of new cases will decline. That will lead to a reduction in hospitalisations and deaths.
Q: What strategies would it use?
Avoid more doctors in white coats and use people who may influence community attitudes, such as sporting stars, actors and comedians.
Q: What would NOT be helpful?
Avoid telling people what to do and promote the real benefits of wearing masks.
Q: Any other comments or suggestions on related matters?
Communications should also stress the importance of good indoor ventilation.
Clear messaging with localised strategies,
Localised, segmented and targeted strategies
Leanne Wells, Consumers Health Forum of Australia
We are at a stage in the pandemic where we are moving away from federally mandated mask wearing to greater emphasis being placed on personal responsibility to self-assess risk and behave accordingly. Many people in the community are still feeling vulnerable and many say this is too premature, and that moving the population to more optimal levels of mask wearing without mandates is ambitious and unlikely.
In the absence of blanket mandates, an effective, concerted campaign can play an essential role in optimising use. Such a campaign needs to be fresh, multi-pronged and motivate people to do the right thing, to recognise that they, and their family members are vulnerable, to think and act to put on a mask in settings that present greater risks.
Any campaign should:
- be spearheaded with a common, simple message, reinforced through localised strategies delivered in community settings where people ‘hang out’ such as shopping centres, markets, religious centres, libraries, gyms, sporting venues, gyms and markets, etc, and involving local leaders that people listen to: doctors, pharmacists, community leaders and peers. Strategies needs to be broad and innovative, using social media and new media channels as well as (and including) traditional channels.
- avoid mixed, contradictory messages and use targeted, simple language; otherwise the risk is that people will give up without clear, concise leadership.
- take a segmented, targeted approach. Research points to older people, females, suburban and urban dwellers, and those exposed to other environmental health risks such as pollutants, overcrowding and long commutes as more likely to wear masks. The goal for any campaign should be to target the mask hesitant or resistant.
- take a settings based approach. Campaigns can target individuals at a personal level but should also target business and organisations. At an organisational level, businesses can be encouraged to think about risks to them: lost productivity due to illness, financial losses, loss on trust from customers, low morale in staff.
Rules set by states and individual organisations are a different matter and vary as you move around the country. Lack of compliance with mandates on public transport, in aged care, hospital or residential facilities is worrying for vulnerable people.
Campaigns should also include ways to remind people of the ‘community obligation’ to comply when masks wearing is mandatory or required. Organisations need to be encouraged to support their staff in managing compliance.
Learn from condom promotion, and avoid politicisation
Danny Vadasz, Health Issues Centre
Q: What would an effective campaign to promote mask wearing involve?
The marked decline in community mask wearing has been characterised as symbolic of growing resistance to government coercion. In turn, it has been suggested that government reluctance to reintroduce mandates is due to its recognition that it has lost its social licence and fears a collapse in public compliance.
Me thinks we are overcomplicating the problem if we characterise it as an ideological schism over “freedom” rather than simply recognising it as an example of human contrariness. For most people, the mask-wearing equation is a matter of weighing consequence against inconvenience. The lower the perceived risk of adverse consequences (eg death) the more likely inconvenience will trump caution. After all, masks are uncomfortable, restrictive and intrusive. In addition we tend to be influenced in our choices by normative social behaviour and general non-compliance grants permission. Not to mention that no one wants to be the only person in a room wearing a mask.
An effective campaign will therefore need to elevate risk anxiety by emphasising the debilitating potential of infection even after full vaccination, and the significant prospect of long-term post-COVID impairment.
Q: What are its messages?
Masks are proven effective both for exhalation isolation and inhalation protection.
Although vaccination has reduced the likelihood of fatality, it has not eliminated the likelihood of multiple, consecutive infections and severity requiring hospitalisation.
10-30% of infections will result in Long-COVID symptoms which can be debilitating and lead to as yet unknown long-term consequences.
Why would you sacrifice your health and future rather than put up with a little inconvenience?
If that sounds too simplistic, this isn’t the first time the public has been asked to adopt inconvenient precautionary measures to avoid contagion. In fact, masks are the condoms of casual social intercourse. (Remember “If it’s not on , it’s not on”.) In health, we too often forget the successes of the past and how we achieved them. Promoting aversion to risk is a highly successful behaviour change strategy that lends itself to the COVID crisis.
Q: What are the values behind it?
It’s always useful to appeal to an individual’s sense of personal responsibility to protect their immediate social network and their altruism in demonstrating a public duty to the anonymous vulnerable, but nothing drives choice as strongly as self-interest. As Jack Lang once famously remarked “In the race of life always back self-interest – at least you know it’s trying.”
The campaign should therefore focus on self-care (extended to immediate family) by emphasising the need to dial down personal risk and dial up precaution.
Q: What strategies would it use?
One of the lessons we have learned throughout the COVID pandemic (and that we seem to need to keep relearning) is the importance of engaging with communities through their “influencers” to tailor public health messages to reflect specific circumstances. Our many community consultations have demonstrated over and over that enablers and barriers can vary greatly from one population group (or condition specific group) to another.
Q: What would NOT be helpful?
It would not be helpful to politicise the debate around face masks as a proxy for a culture war around freedom and state intervention. COVID is agnostic when it comes to political allegiance.
Q: Any other comments or suggestions on related matters?
Our successful HIV infection prevention campaigns required the normalisation of condoms as essential protection, a far more challenging and intrusive behavioural reprogramming task (requiring negotiation and consent) than simply adopting a face mask.
Its success was underwritten by a commitment from the get-go to not only engage with affected communities but to partner them in developing customised strategies through an empowering process we would today describe as co-design. We can do it again.
Community-led messaging; we are all in this together
Dr Tim Senior, GP
Q: What would an effective campaign to promote mask wearing involve?
It would be based on the evidence of how effective public health campaigns work! It should be developed with the communities who would be most affected by COVID, and messaging would be targeted for specific groups, rather than one monolithic campaign. There would be messages in different languages, and messages aimed at different age groups. Some of it could be site-specific – so mask wearing for public transport, health services, aeroplanes, cafes/restaurants, retail etc – messaging might be different for each.
It would be backed up by community leaders wearing masks when they are in public – politicians, local counsellors, local business leaders, health professionals.
This would be backed up by easy availability of masks – so instead of policing a mandate, police are giving out masks to wear. They could be available on entering venues etc.
A simple message is better, but the mask availability of N95s should be as high as possible.
Q: What are its messages?
Wear a mask whenever you are indoors.
Q: What are the values behind it?
“We are all in this together!” (Remember that!). Mask wearing is about protecting those around us and protecting our loved ones who may be vulnerable.
Mask wearing is about preserving the capacity of the health system so it can care for me and the people I love (and everyone else) at the time they need it.
Q: What strategies would it use?
Develop it with the communities (plural!) most likely to be affected (like we didn’t at the start of the pandemic! https://www.theguardian.com/australia-news/2021/aug/13/fear-and-loathing-in-western-sydney-how-nsws-covid-response-failed-migrant-communities)
Q: What would NOT be helpful?
We are in a pandemic against a highly infectious virus. It doesn’t help to be judgemental about people who catch COVID, or to apportion individual blame for decisions to wear masks or not.
Also, we saw during the 2021 COVID outbreaks that fines for COVID breaches fell on the most disadvantaged, even though they were the most compliant (eg see https://www.theguardian.com/australia-news/2021/oct/27/western-sydney-disproportionately-fined-for-covid-lockdown-breachesand https://www.theguardian.com/australia-news/datablog/2022/feb/10/incredible-imbalance-nsw-covid-fines-during-delta-higher-in-disadvantaged-suburbs) and it’s highly likely that mask mandates would be similarly policed. For this reason I have mixed feelings about mask mandates. I think they can send a powerful message that goes beyond personal responsibility, but also reaching for a policing solution to a public health problem does have its risks.
Q: Any other comments or suggestions on related matters?
I think this shouldn’t just be a question about mask wearing, but about a set of public health control measures, one of which, and possibly the simplest, would be mask wearing.
I think we need to be clear about the aims of the measures, and for me that would be twofold – protecting those most vulnerable from COVID, and preventing the health system from being completely overrun. (Actually, there’s probably a third aim, too, and that is avoiding as much long COVID as possible – we don’t know the consequences of this yet, but I think it is likely to be medium term inability to work across multiple sectors of society – and don’t forget those initial COVID waves hit essential workers, and long COVID in essential workers could have a massive impact.)
I don’t expect we’ll go back to lockdowns (at one point I did expect multiple local lockdowns based on restricting transmission, but I don’t think there’s any appetite for that currently). We could think about social distancing measures and ventilation, specific industry measures such as on aeroplanes, public transport, restaurants/cafes, retail, and of course health services, as there are specific considerations in each of these about transmission.
We need to have another push on vaccination – COVID and influenza.
These measures don’t just impact COVID either; they impact all the respiratory viruses that have had massive increases in circulation this winter – COVID, influenza, RSV.
We need good data on disease surveillance. It seems crazy that RATs won’t be free for those on pensions/health care cards at the start of August, though I am sure the current system under-reports COVID case numbers. We always had a good handle on influenza numbers through the surveillance measures before COVID, so it is possible to do (though influenza-like illness reporting is harder to interpret in the COVID pandemic).
I think we need to consider health system capacity too, in the context of COVID, influenza and RSV. There are consequences of delayed elective surgery, of multiple rolling staff shortages. GPs are managing the increased rates of viral illness symptoms, including the quite complex assessments around eligibility and safety of antivirals, vaccinating against COVID and flu (as well as pneumococcus, shingles and all the routine childhood vaccinations), managing the high mental health impacts, managing people’s regular chronic diseases, managing other chronic diseases, and all at a time where longer telehealth consultations aren’t funded by Medicare, Medicare rebates are way too low to fund services properly, so GPs are dropping bulk billing to be able to pay staff and keep the lights on. Waits in Emergency Departments are really long (which keeps people away who do need to be there, waits for ambulances are really long. This is a perfect storm, and of course those worst affected will be those who can’t pay to bypass the public system. We will see a worsening of health inequalities unless we pay specific attention to health inequalities.
Worth reiterating that no-one wants a neoliberal solution to a pandemic – low tax, small government does not make for a good pandemic response! And health and the economy are not mutually exclusive, but are completely dependent on each other.
I should add, I’m not an epidemiologist or a vaccinologist or a public health specialist or an immunologist, or a communicable diseases expert, so there are undoubtedly nuances I’ve missed here. However, as a GP – a specialist in primary care and generalism working in an Aboriginal community- I’m confident that the policy decisions made will worsen the health of my patients if specific attention is not paid to the effect in communities like mine. Certainly, I know that people who feel vulnerable to the worst effects of COVID are still wearing masks, are using hand sanitiser all the time and are still staying home as much as possible.
Change social norms, based on values of equity, solidarity, and economic security
Glen Ramos, Public Health Policy Executive and Patient Advocate
Q: What would an effective campaign to promote mask wearing involve?
It would involve all levels of government and public health organisations ensuring that the key messages – SARS-Cov-2 virus is airborne, wearing a mask reduces your risk, and everyone masking together works better – are communicated across all levels of society.
In particular, campaigns would need reach out to those communities that have been disproportionately impacted by COVID. Campaigns would need to not only be education based but directed at changing the social norms around mask wearing behaviour in public spaces, especially indoors.
Q: What are its messages?
There are three key interrelated themes pertaining to mask wearing that should be communicated.
Firstly, the SARS-Cov-2 virus is in the air. The risks relating to airborne transmission pathway have not been conveyed accurately or sufficiently. These include that aerosol transmission is by far the highest risk pathway, poor ventilation and shared indoor air spaces pose high risk settings, and people can spread the virus before they develop symptoms. Additionally, even with all vaccinations and boosters up to date a significant risk of developing Long-COVID remains if you are infected.
Secondly, wearing a well fitted high quality mask reduces your risk of developing COVID. Masks rated N95, P2, KN95 (equivalent or higher) provide the wearer with excellent protection from breathing in SARS-Cov-2 virus laden aerosol particles. Better yet, these masks are source control – they stop or reduce the load of SARS-Cov-2 virus laden aerosol particles exhaled into the air. Less virus in the air simply means less risk for those people exposed to those spaces.
Thirdly, masks work better together. Whilst it’s great that people choose to wear masks to protect themselves, better protection is provided by when more people wear masks. It’s a collective effort that rewards everyone.
Q: What are the values behind it?
Equity, solidarity, and economic security.
COVID has created an underclass of people that are excluded from participating in society As they need to sequester themselves to protect their health and that of their families. The use of masks in public indoor spaces allows these people to be able to equally participate in more aspects of communal life without the high risk to their health. It is about equity for all people, not just some people. This collective action is a type of solidarity which has benefits for the community as a whole. Keeping people safer and healthier is not only a great result for each person individually but collectively enables our society to function without the disruptions that COVID can bring. This enables people to keep working and provide for their families ensuring not only their economic security but also that of our communities.
Q: What strategies would it use?
Primarily health promotion-based strategies centred around education, behavioural changes, and social practices. This would be inclusive of national advertising campaigns and localised tailored community-based approaches, with additional focus reaching ethnic and minority communities.
Free high-quality masks should also be made available to vulnerable, at risk, and economically disadvantaged groups.
Q: What would NOT be helpful?
Imposing mask mandates without education and social change campaigns would be very unhelpful and likely to increase resistance against mask usage.
Q: Any other comments or suggestions on related matters?
Whilst masks can be very effective, they don’t solve all COVID related transmission. Many people will continue to undertake activities which expose them to high-risk situations where masks are not suitable or appropriate. This does not mean we shouldn’t seek to increase mask use, but simply realise that they form part of a range of protective measures, and one which increases participation and inclusivity of people that are currently on the sidelines of our society.
Stay positive, and avoid judgemental, punitive messaging
Alison Verhoeven, Adjunct Professor, Institute for Health Transformation, Deakin University
Q: What would an effective campaign to promote mask wearing involve?
An effective campaign is one which would focus on the positive reasons for wearing a mask, would be targeted at different population segments, and would use appropriate media channels to reach those population segments.
Q: What are its messages?
Staying COVID-safe is the only way we can protect ourselves and the people around us from becoming very ill.
COVID-safe means (inter alia) being vaccinated, wearing masks, respecting social distance, staying home when unwell.
Q: What are the values behind it?
Respect for the diverse needs and values of different population groups, and a non-judgemental approach to understanding why people may be resistant to wearing masks.
Q: What strategies would it use?
Multiple communication channels and messaging appropriate to different population groups.
Q: What would NOT be helpful?
Judgemental, punitive messaging.
Visual imagery matters
Kristy Schirmer, Zockmelon
Q: What would an effective campaign to promote mask wearing involve?
The key messages are that masks are effective in reducing the spread of airborne viruses. The best examples of this include this clip, and the famous ‘Sneeze’ campaign from South Australia.
Using the visual component of particles should be front and centre of any campaign.
Secondary to this are that masks are here to stay and are now a part of our everyday lives. From there, a campaign can be pragmatic and focus not just on the ‘why’ but also the ‘how’.
Q: What are its messages?
Why: Masks are effective at reducing transmission of air borne viruses
How: The best masks are N95 rated
It’s important to learn how to use your mask effectively
Q: What are the values?
I think it’s important to normalise mask wearing by showing how it look in society. For example, footage of people communicating effectively with a mask through other verbals like thumbs up and eye-smiling, people still engaged and positive in everyday situations (e.g. sharing a seat on a bus or ordering a coffee). Emphasising how easy and effective it is as a virus prevention strategy.
Q: What strategies would it use?
Perhaps not primary strategies, but additional collateral to be successful could include simple instructional videos on using a mask (how to put on and take off effective and safely) including for children, and safe storage/carriage of masks. Australian children today should and could be the experts on mask wearing for generations to come, so inclusion in kids shows, working with influencers in the 4-17 year old demographic could be invaluable in educating a new generation – everyone from Big Ted through to musicians, sportspersons and YouTubers.
Q: What would not be helpful?
It’s important to work with media so they don’t celebrate and glorify non-mask wearing as a positive. At the time mask rules were relaxed in across various jurisdictions, endless media stories started with “Smiles are Back”, and “early Easter present” which further normalised non-mask wearing.
Premiers and other health leaders have a role to play, in particular a popular slow-mo mask removal video was popular on Mark McGowan’s socials (see https://www.facebook.com/watch/?v=326544525629158) and later replicated by Annastasia Palaszczuk normalised and celebrated not wearing masks. This was damaging to a very effective public health tool.
I believe other strategies including effective handwashing, air flow and symptom checking/testing should also be included in a wider campaign for managing COVID and seasonal flu.
Caring for one another, families, communities and the health system
Dr Liz Moore, Public health manager, Aboriginal Medical Services Alliance Northern Territory (AMSANT)
Q: What would an effective campaign to promote mask wearing involve?
Messages in language, explaining why it is important and also why it is important you wear a high quality mask
Subsidised or free masks for vulnerable people
Visual images
Q: What are its messages?
Wear masks to protect yourself but also vulnerable people in your community – masks work best when most are wearing them.
Wear high quality masks in high risk situations (P94 preferably )given the high infectivity of Omicron.
Wear them properly – covering mouth and nose
If you find it difficult to wear them, prioritise wearing them indoors.
Omicron is not a mild disease for people at higher risk.
Q: What are the values behind it?
Caring for one another and family.
Protecting our communities and our health system.
Q: What strategies would it use?
Role modelling
Visual images
Some honest data about the number of Aboriginal people who have died or become seriously ill. This is not generally known (at least 30 deaths in the NT and 140 nationally). Most of these have occurted in the Omicron period.
Q: What would NOT be helpful?
Blame and shame.
From Twitter
Watch the interview with Professor Michael Baker
Watch the video.
Messages to the Federal Government
Regarding the Victorian Health Minister not taking health advice to implement mask mandates in some settings
Mask-promotions from AMSANT, courtesy of Chips Mackinolty.
• This article was updated on 14 July with additional comment
Previously at Croakey: If real heroes wear masks, what are we waiting for?
