BIDS Critical Conversations 2021 "Normalizing Masks: Health And Economic Implications"

Bangladesh Institute of Development Studies (BIDS) organized a webinar as part of the organization’s series of Critical Conversations on June 9, 2021, focusing on the effectiveness of mask-wearing to combat the spread of COVID-19 and its wider implications. Dr. Binayak Sen, the Director General of BIDS, set the premise of the webinar by pointing out that the spread of COVID-19 is now higher in border districts compared to Dhaka, which is a newly developing pattern in the second wave of the pandemic. He suggested that movements of people from the border districts towards Dhaka should be restricted to curb the spread. Despite growing scientific evidence advocating for face masks as an effective tool to curb the spread of COVID-19 and save lives, mask usage remains low across many parts of the world, and strategies to increase mask usage remain untested and unclear. In this context, Ahmed Mushfiq Mobarak, Professor of Economics at Yale University, USA, delivered the keynote presentation on the theme “NORMalizing Mask-Wearing in South Asia: Scaling Up an Effective Approach." The presentation focused on the findings of a study based on a cluster-randomized trial of community-level mask promotion in rural Bangladesh involving 341,830 adults in 600 villages. The study employed a series of strategies to promote mask usage, including free household distribution of surgical or cloth masks, distribution, and promotion in markets and mosques, mask advocacy by Imams during Friday prayers, role modeling by local leaders, village police accompanying those mask promoters, providing monetary rewards or certificates to villages if mask-wearing rate improves, etc. The findings suggest that free distribution of masks along with role modeling by community leaders produced only small increases in mask usage. However, adding periodic monitoring by mask promoters to remind people to put on the masks increased proper mask-wearing by 29.0 percentage points. This tripling of mask usage was sustained overall 10 weeks of surveillance, which includes a period after intervention activities ended. Physical distancing also increased by 5.2 percentage points. These results point to changes in social norms as a key driver of behavior change. Village police accompanying the mask promoters had no additional effect on mask-wearing, suggesting that the operative mechanism is not any threat of formal legal sanctions, but shame and people’s aversion to a light informal social sanction. The upshot is that improved mask-wearing norms can be achieved without incentives that require costly monitoring, aesthetic design choices and colors influencing mask-wearing, and that surgical masks with a substantially higher filtration efficiency can be a cost-effective alternative to cloth masks (1/3 the cost) and are equally or more likely to be worn. Furthermore, the study suggests that the use of masks results in one-quarter of the benefit of a country-wide lockdown but with one-tenth of its cost. Thus, given the rate of vaccine roll-out, vaccine hesitancy, and spread of new variant of coronavirus, mask-wearing might be the most cost-efficient way to control the spread of the pandemic. Professor Mobarak also pointed out the need for resources to provide free masks to people and to monitor and reinforce the mechanism. 

After the keynote presentation, the first panelist of the discussion, Dr. Firdausi Qadri, Emeritus Scientist, Infectious Diseases Division, icddr,b, emphasized on the necessity of convincing people for effective large-scale implementation of mask usage. She also asserted the importance of using clean masks, as unclean masks can do more harm than good. The second panelist, Mr. Asif Saleh, Executive Director, BRAC, Bangladesh, made a short presentation on the current involvement of BRAC to reduce transmission, promote positive behavioral changes and community involvement, and urged the policymakers to focus on increasing community participation. He informed that some 42 non-governmental organizations will distribute 1.30 crore reusable surgical and cloth masks among ultra-poor families of 34 districts to reduce the transmission rate and increase mask-wearing behavioral change.

Special Guest, Mr. Abdur Rouf Talukder, Senior Secretary of the Finance Division, Ministry of Finance, discussed the initiatives taken by the Government to implement mask use in Government Offices. He acknowledged that positive behavioral changes among people to increase mask-wearing are challenging. He drew attention to the problem of environmental pollution due to mask disposal and also cautioned that the cost of distributing masks to the general public may exceed the cost of producing masks which can be a limitation to the suggested initiatives.

Mr. Mohammad Jainul Bari, Secretary of the Planning Division, Ministry of Planning, also a Special Guest, shared his experience in implementing the behavioral practices to reduce the spread of COVID-19. He mentioned the difficulties faced of promoting social distancing and mask usage. 

The distinguished guests appreciated the initiatives taken by Professor Mushfiq Mobarak and his team. Dr. Atiur Rahman, former Governor of the Bangladesh Bank, suggested that encouraging children to promote mask-wearing among parents could be an effective strategy. Dr. Mohiuddin Alamgir emphasized that COVID-19 has to be tackled from a human development perspective focusing on mask usage, social distancing, and vaccination and utilizing the grassroots-level connection of the CSOs of Bangladesh. Eminent economist Professor Rehman Sobhan suggested that the government should create collective machinery where the health ministry, local government institutions, and civil society should work together to implement widespread mask use. He called for using appropriate diplomatic strategy to ensure that we get sufficient vaccines to vaccinate the whole population.  

In his concluding remarks, Dr. Mashiur Rahman, Economic Affairs Advisor to the Prime Minister, Government of the People's Republic of Bangladesh, acting as the Chief Guest of the webinar, discussed the challenges and successes of the government to fight COVID-19 and pointed out that the novelty of this pandemic has constrained the health ministry in achieving more successful results. He also mentioned the challenges of identifying the ‘new poor’ during the pandemic as reported figures of income, land ownership, and other assets suffer from definitional challenges and multiple interpretations. He appreciated the research and initiatives taken and concluded the webinar with the hope that such community-level support will reach the most vulnerable people affected by the pandemic.