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 Table of Contents  
INVITED PERSPECTIVE
Year : 2020  |  Volume : 36  |  Issue : 5  |  Page : 107-111

Social vaccine for the ongoing COVID-19 pandemic!


Formerly Professor of Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India

Date of Submission21-Jul-2020
Date of Acceptance22-Jul-2020
Date of Web Publication02-Oct-2020

Correspondence Address:
Prof. R Srinivasa Murthy
553, 16th Cross, J.P.Nagar 6th Phase, Bangalore-560078, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_223_20

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  Abstract 


The COVID-19 pandemic has affected humanity across the world. Mankind and scientists are working around the clock in desperation to finding effective solutions to control and eradicate the virus and develop measures to boost the immunity of the population through an effective vaccine; all of these are likely to take time. Nevertheless, one important aspect that has come to the forefront of the pandemic is the importance of social factors at all levels, and the responses, to the pandemic; which has been referred by many professionals to as “social vaccine.” This perspective discusses its effectiveness, underlying concepts, lessons learnt, and critiques the related issue of “social distancing.” We conclude with the assertion that “the fuller use of social resources and positive outcome of the pandemic could be an important contribution from India.”

Keywords: COVID-19, pandemic, physical distancing, social distancing, social vaccine


How to cite this article:
Murthy R S, Gupta N. Social vaccine for the ongoing COVID-19 pandemic!. Indian J Soc Psychiatry 2020;36, Suppl S1:107-11

How to cite this URL:
Murthy R S, Gupta N. Social vaccine for the ongoing COVID-19 pandemic!. Indian J Soc Psychiatry [serial online] 2020 [cited 2020 Oct 31];36, Suppl S1:107-11. Available from: https://www.indjsp.org/text.asp?2020/36/5/107/297136




  Introduction Top


The year 2020 has been a challenge for the whole humanity. There has not been any event in the human history, for a century, similar to this, one that has altered the lives of the total humanity. As this writing is completed, (July 15, 2020) there are over 13 million diagnosed with COVID-19 infection with over 300,000 deaths. The impact of the economy and the lives of people have been incalculable. The changes that have occurred and the impact of this experience on the population is expected to be long lasting.

There is a scramble for finding solutions - one or more effective therapeutic agents, measures to boost the immunity of the population and an effective vaccine. All of these are likely to take time. Nevertheless, one important aspect that has come to the forefront of the pandemic is the importance of social factors at all levels, and the responses, to the pandemic. Many professionals have referred to this as “social vaccine” [Box 1].



This is the subject of this perspective.


  Importance of Social Aspects of COVID-19 the Background Top


The effort here is to understand the importance of social factors and social interventions to address the mental health effects on the population as a result of the COVID 19 pandemic.

This recognition of the importance of social aspects of the pandemic comes from a number of sources.

First of these are the past experiences of addressing major public health issues such as HIV/AIDs and control of polio and eradication of smallpox. In these past health challenges, long before the medical interventions appeared on the scene, mobilization of the individuals living with the problems (e.g., HIV/AIDS) and public education proved to be vital.[8]

Second, of these is the importance of “Community Resilience.”[11],[12],[13] There are a number of examples of the greater effectiveness of “control” in countries and communities with greater social cohesion and trust. There are variety of examples in this group. There are countries who had the experience of past epidemics such as SARS, Ebola that prepared the countries at the level of population to be ready to face the current pandemic. Examples are Taiwan, Hong Kong, and South Korea. There were other countries such as Germany, Finland, who responded at the population level to limit the spread of infection and mortality.

In the Indian context, Kerala is an example of how it mobilized resources and people to address the current pandemic based on the past experiences of NIPAH.

Heller [14] notes, “the State has managed the crisis by building on legacies of egalitarianism, social rights and public trust.” The effective measures of Kerala State are: (i) hands-on Governmental Leadership; (ii) decades of investment in healthcare; (iii) an educated and well-aware population; (iv) leveraging technology; (v) arming hospitals for the COVID war; and (vi) health promotion initiatives.[15]

Similarly, Tharayan and John [8] recognize that, “alongside infection-control,” there is the urgent need for a strategic plan of action to mitigate suffering and to stimulate economic recovery and call for a social vaccine (emphasis added) that can build societal immunity to the devastating effects of pandemics, now and later.

One single incident is illustrative of the importance of innovation and people participation. The Thanneermukkom Gram Panchayat in Alappuzha, to enforce social distancing stands out for it is out-of-box approach. The authorities mandated the residents to carry an umbrella when they step out in the public. Two opened umbrellas, not touching each other would ensure minimum distance of 1 m from one another thereby maintaining the requisite distance to prevent the spread of infection.

Third, is the need for social action in terms of limiting the spread of the infection by actions at the level of individuals, namely, personal cleanliness such as washing hands, wearing of masks, keeping of social distance, and avoiding prolonged contact with others.


  Potential Effectiveness of the “social Vaccine” Top


In the JAMA editorial of April 2020, Hartley and Perencevich [16] observed:

Significantly, no pharmaceutical agents are known to be safe and effective at preventing or treating coronavirus disease 2019 (COVID-19), the resulting illness.[3] This leaves the medical and public health community with only nonpharmaceutical interventions (NPIs) to rely on for reducing the burden of COVID-19. These measures aim to reduce disease transmission both locally and globally and include bans on public gatherings, compulsory stay-at-home policies, mandating closures of schools and nonessential businesses, face mask ordinances, quarantine, and cordon sanitaire (i.e., a defined quarantine area from which those inside are not allowed to leave), among others. The effectiveness of NPIs has been studied theoretically,[4] especially within the context of pandemic influenza, and also through analysis of historical observational data.[5],[6],[7] A common finding of these studies is that implementing NPIs, especially when done rapidly after initial detection of a new contagious pathogen, can reduce transmission.[16]

A very interesting response of social dimension of the pandemic response is article by Abhay Bang.[17] Bang, a leader in Community Medicine and a dedicated Gandhian, envisages, the likely response of Mahatma Gandhi to the current pandemic in the country. Based on the way Mahatma Gandhi responded throughout the Independence movement, and especially the partition trauma, Bang identifies 9 actions that would have been the weapons of Gandhi, namely, freedom from fear; care of the sick; new Dandi march; inter-faith and social unity; my neighborhood is my responsibility; Himalayan blunder; Gram-Swaraj, the economy of small scale; there is enough on this earth; and prayer. It is clear all of these are components of the social vaccine.


  Concept of Social Distancing and Its Critique: New Dimension to an Old Threat Top


Loneliness has come to be an important determinant of health in general and mental health in particular.

In a recent review of the evidence on “Social Isolation and Loneliness in Older Adults” by the National Academy of Sciences, Engineering and Medicine,[18] the importance of connectedness to each other was summarized as follows:

“Human beings are social by nature, and high-quality social relationships are vital for health and well-being. Like many other social determinants of health, however, social isolation (an objective lack of social contact with others) and loneliness (the subjective feeling of being isolated) are significant yet underappreciated public health risks. Social isolation and loneliness are associated with poor physical and mental health outcomes, including higher rates of mortality, depression, and cognitive decline. Recent research documents the high prevalence of social isolation and loneliness among older adults.”

There is growing awareness of the increasing numbers of people living in isolation. A reflection of the importance of this social problem is the creation of a minister's position in the United Kingdom.

In the current situation of the COVID-19, pandemic, there is an additional dimension to social distancing. The current review focuses on the concept and implications of “social distancing” during the pandemic.

The four C's of preventing the spread of COVID-19 virus is cleanliness, avoiding contact, avoiding/minimizing continuous contact, and exposure to people in closed spaces.

Concept of “social distancing”

Using the term “social distancing” carries the implication that one is supposed to maintain a distance of at least 6 feet from each other at all times when one is interacting. Hence, the concept is “social” in nature at face value, but the actual implementation appears to be that of a “physical” one.

Nevertheless, the implementation of “social distancing” is fraught with the inherent risk of social isolation, as pointed out by the Former Director of Mental Health Division, World Health Organization, Dr. Shekhar Saxena.[19] He further mentioned that people are remaining alone and increasing their stress levels; also, international organizations and national authorities are all exercising “social distancing” when actually, what they should be saying is physical distancing but social togetherness.[19]

However, on the other hand, it may be argued that using the phrase “physical distancing” can have its own downside as it can mitigate the awareness about “social vaccine” and the risk related to COVID-19 when people mingle in familiar and/or seemingly safe environments, i.e., among colleagues, close friends, and relatives and family members where the maintenance of distance does not remain an obligatory necessity.

Nevertheless, this conceptual aspect of “social distancing” is still open to debate.

Implications of “social distancing”

However, “social distancing” presents challenges of a different variety in the different groups in the society. With the elderly individuals at greater risk of mortality in the event of contacting the virus infection, there is additional burden on the elderly to distance socially. The challenge for those living in urban slums, with little opportunity for social distancing is real in many of the cities in India, such as Mumbai, Delhi, Kolkata, and Chennai. It is also reported that those diagnosed to have COVID-19 infection feel guilty about spreading the infection to the families, due to limited opportunity to isolate themselves from others. Similar is the impact on the children, whose schooling has been severally disrupted due to the need for “social distancing.” One other group that is most affected are the persons with disability who experience this as very challenging. Another dimension of “social distancing” and being confined to the home is domestic violence. Another important mental health dimension is the double burden for women to care for children, maintain homes and to work, all at the same time.

In the general population, of the many behavioral measures required by the pandemic, the greatest resistance being encountered is for “social distancing.” In addition, it is the “social distancing” of either one meter or two meters that decides the reopening of the economy.

There is growing evidence of the impact of “social distancing” in terms of increased prevalence of hopelessness; in some cases, suicidal feelings.

There has been part solution through the availability of the information-communication technology. It has been possible, especially for the young people, to have the opportunity to connect through social media. However, this is often a challenge for the elders, who may find the ease of use of technology challenging. There is also the other dimension of overuse/addiction to social media, and the negative consequences of the same.

There is urgent need to address this aspect of the pandemic. However, as noted by the NASEM report, the health-care system cannot solve the problems of social isolation and loneliness alone and there is need for a larger global effort to combat the adverse health impacts of social isolation and loneliness especially among adults aged 50 and older and vulnerable groups such as children, women, and persons with disabilities and mental disorders.

There are going to be numerous “local” factors that define the impact of the “social isolation,” as well as mitigating factors that will limit the impact too.


  “Social Vaccine” Lessons Learnt! Top


Hence, the lessons learnt toward developing a “social vaccine” can be summarized as follows:

  1. The success of mastering the pandemic will depend not only on the social action but also on the public health and medical interventions as well. This would require that the politicians, planners, professionals, and people having to work together at many levels from simply understanding the pandemic to taking specific steps to mitigate the spread and effects of the pandemic [20]
  2. There is a need to build social cohesion through every means available so that the response is harmonized and maximized [11],[12],[13],[21]
  3. Professionals such as psychiatrists, clinical psychologists, psychiatric social workers, and psychiatric nurses should work together, as well as work with other disciplines (especially from the domain of public health, community medicine, and epidemiology) and with groups such as community leaders and religious leaders to maximize the interventions [20]
  4. There is need to understand the “local” strengths and needs and utilize them to maximum extent
  5. There is greater recognition and need for the professionals to continuously study the “social dimensions” of mental health and develop medical, public health and social interventions to mitigate the effects of disasters/pandemics.


Two events of the week, as this article was being finalized, illustrate the importance of the concept of “social vaccine:”

Firstly, Mr. Anthony Gutteres, Secretary General of United Nations, in his Mandela speech, referred to the social inequalities as the important challenge of the current world situation. He said: “COVID-19 has been likened to an X-ray, revealing fractures in the fragile skeleton of the societies we have built,….. “The global political and economic system is not delivering on critical global public goods- public health, climate action, sustainable development, peace.” He called for a new model of global governance with inclusive and equal participation.”[22]

Secondly, is the publication of the book, “It's okay to reach out for help” by Malavika Kapur.[23] The book is about counseling of the people, for the people and by the people. It is strongly rooted in the Indian culture and social strengths and provides illustration of utilization of the strengths of people for emotional health by using the life cycle approach. The book is based on decades of working with nonprofessionals involved in mental health, and illustrates the power of the people and the scope for innovations to address emotional health of the population.


  Conclusion Top


Bang [17] ends his article with the following sentences: “We should not be waiting for Gandhi. We should be acting on what he would have done.” In the current situation, we should not only be looking for a medical vaccine, but fully utilize the social vaccine approach.

It was over 100 years back, during the 1918 Spanish Flu epidemic, Father of the Nation, Mahatma Gandhi, as a victim of the infection, observed: “this protracted and first long illness in my life thus afforded me a unique opportunity to examine my principles and to test them.”[24] There can be positive benefits to a pandemic. The fuller use of social resources and positive outcome of the pandemic could be an important contribution from India.

Herein lies both the challenges and the opportunities to address the pandemic by social psychiatry!

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vardhan H. Physical Distancing is the Most Potent Social Vaccine; 18 May, 2020.  Back to cited text no. 1
    
2.
United Nations. Policy Brief: COVID-19 and the Need for Action on Mental Health. New York: United Nations; 13 May, 2020.  Back to cited text no. 2
    
3.
Campion J, Javed A, Sartorius N, Marmot M. Addressing the public mental health challenge of COVID-19. Lancet Psychiatry 2020;7:657-9.  Back to cited text no. 3
    
4.
Adhanom Ghebreyesus T. Addressing mental health needs: An integral part of COVID-19 response. World Psychiatry 2020;19:129-30.  Back to cited text no. 4
    
5.
Unützer J, Kimmel RJ, Snowden M. Psychiatry in the age of COVID-19. World Psychiatry 2020;19:130-1.  Back to cited text no. 5
    
6.
BBC News. 'Health Crisis has Become a Social One (crisis). BBC News; 05 May, 2020.  Back to cited text no. 6
    
7.
Reddy KS. Promote People Power Against COVID 19. The Hindu; 23 June, 2020.  Back to cited text no. 7
    
8.
Tharayan P, John JT. A Shot of Hope with a Game Changing Vaccine. The Hindu; 20 April, 2020.  Back to cited text no. 8
    
9.
Jetter J, Reicher SD, Haslam SA, CrucGys J. Together Apart: The Psychology of COVID 19. Sage Publications; 2020.  Back to cited text no. 9
    
10.
Harari YH. The Best Defence Against the Coronavirus: If we are to Defeat the Epidemic, we Need More, not Less, Trust and Cooperation, Reader's Digest; 2020. p. 18-21.  Back to cited text no. 10
    
11.
National Academy Press (NAM). Applications of Social Network Analysis for Building Community Disaster Resilience: Workshop Summary. NAM: Washington; 2009.  Back to cited text no. 11
    
12.
National Academy Press (NAM). Developing a Framework for Measuring Community Resilience: Summary of a Workshop. NAM. Washington; 2015.  Back to cited text no. 12
    
13.
National Academy of Medicine, Engineering and Medicine (NASEM). Disaster Resilience-a National Imperative. Washington, DC: National Academy Press; 2012.  Back to cited text no. 13
    
14.
Heller P. A Virus, Social Democracy and Dividends for Kerala. The Hindu; 18 April, 2020.  Back to cited text no. 14
    
15.
Ruparel L. Why Kerala's COVID Response is a Success. HealthCare Executive; 18 June, 2020.  Back to cited text no. 15
    
16.
Hartley DM, Perencevich EN. Public health interventions for COVID-19: Emerging evidence and implications for an evolving public health crisis. JAMA 2020. doi: 10.1001/jama.2020.5910. Online ahead of print.  Back to cited text no. 16
    
17.
Bang A. Faced with today's crisis, what would Gandhi do? Lancet 2020. DOI: https://doi.org/10.1016/S0140-6736(20)31413-6.  Back to cited text no. 17
    
18.
NASEM. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. National Academy of Sciences, Engineering and Medicine. Washington; 2020.  Back to cited text no. 18
    
19.
20.
National Disaster Management Authority. Guidelines on Psycho-Social Support and MentalHealth Services (PSSMHS) in Disasters. New Delhi: National Disaster Management Authority; 2009.  Back to cited text no. 20
    
21.
Srinivasamurthy R. Disaster mental health and social psychiatry: Challenges and opportunities. Indian J Soc Psychiatry 2018;34:323-7.  Back to cited text no. 21
    
22.
Gutteres A. The world is 'at breaking point' due to inequalities: UN Chief the Hindu; 19 July, 2020. [Last accessed on 2020 Jul 19].  Back to cited text no. 22
    
23.
Kapur M. It's Okay to Reach Out for Help. Bangalore: Vitastaa Publishers; 2020.  Back to cited text no. 23
    
24.
Spinney L. Pale Rider: The Spanish Flu of 1918 and How it Changed the World. Vintage, London:Vintage; 2017.  Back to cited text no. 24
    




 

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