No Virus on Me: The Indian Ways of Managing the COVID-19 Pandemic: Marine to Mountain

Abstract

The case is about the coronavirus disease 2019 (COVID-19) pandemic, and India’s ‘midstream’ social marketing strategies and other strategic approaches to battle the notorious virus, the first known case of which was identified in Wuhan, China, in December 2019. The art and science of social marketing were exploited to promote a healthy lifestyle as a precautionary measure against COVID-19 infection through non-pharmaceutical interventions. Social marketing campaigns promoting healthy behaviour, improving psychological health and ensuring mass well-being were implemented to manage the huge Indian population in the metro cities as well as in the remotest communities in villages during the pandemic. The case study discusses the health intervention and promotion strategies and other preparedness adopted by various stakeholders in India. The case study also discusses the history and experience of severe past health threats in India and what those experiences contributed to India’s preparedness. The crisis worsened when the citizens could not cope with psychological and economic problems; a section of the population disobeyed the government guidelines. The government faced capacity and resource constraints. The case study ends with a dilemma on whether to continue with the lockdown efforts or ease restrictions. The government needs to decide on strategies to ensure the well-being of its citizens and ways to manage citizens and businesses of all forms. The consequence of the decision had huge economic, health as well as governance implications. The case study will provide practitioners with reference to the potential of social marketing and other crisis management strategies to address a complex problem featured with aleatory as well as epistemic uncertainty. The case study is timely and may serve as a reference to the rest of the world as an example to deal with similar problems at an industrial scale.

Keywords

Health promotion social marketing health intervention coronavirus pandemic India

Discussion Questions

What is the purpose of the case study campaign, and what implications does it have for stakeholders in terms of knowledge sharing and awareness building during a pandemic?

Who is the campaign aimed at?

Which behaviours have been targeted to be influenced in the case study?

What are the campaign’s measurable goals?

What are the barriers (e.g., physical, psychological, knowledge, and economic) that the target audience may face while engaging in the desired behaviour? Make a list of these barriers.

What are the key benefits that may persuade the target audience to change their behaviour?

What is the cost (e.g., monetary, time, psychological, or legal penalties) that the target audience associates with these desired behaviours?

Who can effectively persuade the target audience to adopt desired behaviours?

An ounce of prevention is worth a pound of cure.

—Benjamin Franklin¹ (1736)

On 30 January 2020, a headline in India Today reported India’s first confirmed coronavirus disease 2019 (COVID-19) case in the Thrissur district of Kerala. The infected citizen was a student at Wuhan University, China, who had recently returned (Unnithan, 2020).

Update on Novel #Coronavirus: one positive case reported in #Kerala.#nCoV2020. (Ministry of Health and Family Welfare [MOHFW], Government of India [GOI] at 1:42 p.m., 30 January 2020, on Twitter)

The reporting of the first case was no less a signal of war, particularly for the MOHFW and the Ministry of External Affairs (MEA). The parliament, the ministries and every government agency in the National Capital Regions was ready and started preparations to fight the virus. The state governments and union territories activated their resources.

The National Capital Region, states and union territories continued to function as usual with preventive measures, following the guidelines from the World Health Organization (WHO) and healthcare advisory bodies, and few state-level restrictions were also imposed. India appeared to be a success story in containing the spread of the COVID-19 pandemic. The situation seemed to be largely under control (Financial Express, 2020a; Livemint, 2020; The Week, 2020; World Health Organization India, 2020; Zee Business, 2020) until the first public address from the Prime Minister (PM) of India, Shri Narendra Modi.

On 19 March 2020, the Prime Minister requested the citizens to observe a ‘Self-imposed Curfew’ popularized as ‘Janata Curfew’ (people’s curfew) from 7 a.m. to 9 p.m. Indian Standard Time (IST) on Sunday, 22 March 2020, to help reduce the community spread of COVID-19 in India. The citizens largely took it as a one-day event and expected to be back to work for the week. However, just after a day’s gap, on 24 March, the Prime Minister announced that a ‘total lockdown’ was to be imposed in the country for the next 21 days.

‘I appeal to the people of India not to cross the Lakshman Rekha² of their homes in the next 21 days’, PM Narendra Modi, Government of India (The Indian Express, 2020b)

Both houses of parliament were adjourned before schedule, government activities were prioritized, private entities were asked to shut their doors, people were advised to stay home and only essential services continued due to the COVID-19 pandemic. The nation was at a standstill.

Various committees were set up at the central and state government levels to counter the pandemic. This was the mark of a once-in-a-century journey that all the stakeholders in the country supported. One of the initiatives’ objectives was a large-scale health promotion campaign to counter the COVID-19 pandemic through preventive measures. In the world’s largest democracy, this could be easily suspected to be one of the largest social marketing and preventive health promotion in recent years. It even broke its own records of smallpox and polio campaigns.

On 29 March 2020, the government constituted eleven empowered groups, set up under the Disaster Management Act, to identify problem areas, provide solutions by formulating plans and taking necessary steps to improve the healthcare system, manage the economy and reduce the misery of the citizens post the nationwide lockdown of 21 days. The groups were responsible for submitting their action plan under the guidance of P.K. Mishra, Principal Secretary to PM (Business Line, 2020).

Within a week during the lockdown, the nation faced an increasing crisis from breach of lockdown guidelines by a section of citizens, supply and economic concern, and a sudden rise in COVID-19 cases. What could the government have done more? What were the strategies that attributed to success stories? The roads needed to be opened, and the businesses had to go back to usual. What should be the recommendations from the empowered groups on how the nation should manage the rising crisis and crisis associated with the post containment of the virus?

The citizens needed to be under strict preventive measures for the next few months, and empowered groups felt an urge to come up with an effective social marketing plan to manage the people during the crisis and post-crisis situation (post containment of the virus). Even after the containment of the COVID-19 spread, it was evident that there would be a widespread crisis in the social, economic and psychological context. The misery of the citizens was expected to continue beyond the days of lockdown and even post containment of the virus. It was necessary to craft a social marketing strategy to guide and manage the citizens appropriately. The empowered groups began to consider how to achieve these goals in the face of so many complications.

The History of Virus in India

Those who cannot learn from history are doomed to repeat it.

—George Santayana³

India had 1.39 billion people living in varied salubrious conditions providing a perfect foreground for harbouring a horde of pathogens. It was well connected within its territory as well as with other countries by land, air and water routes, accelerating the chances of introduction and spread of the pathogen in the country. There were copious cases of viral outbreaks that had affected the Indian population for centuries, with the most recent being COVID-19.

In the past 100 years, India had successfully handled and recovered from several epidemics and pandemic viral outbreaks. The most predominant pandemic outbreaks were swine influenza (1918), Asian flu (1957), Hong Kong flu (1968), Russian flu (1977) and influenza A-H1NI (2009) caused by influenza viruses. Varicella-zoster virus (VZV) was the pathogen for chickenpox (varicella) and shingles, major diseases in India. According to the Centres for Disease Control and Prevention, VZV was an endemic in India, although it was generally non-fatal. Japanese encephalitis virus (JEV), transmitted by Culex tritaeniorhynchus Giles, 1901, and C. vishnui Theobald, 1901, was first reported from South India in 1955, which spread to Northern India by 1973. In 1978, there was a suspected outbreak in 24 states of the country and had been recurring ever since (Kumari & Joshi, 2012). Furthermore, many viruses widely found in the population with medium-to-high morbidity and mortality rates were human immunodeficiency virus (HIV)—a sexually transmitted disease, human T-cell lymphotropic virus type I (HTLV-I), measles morbillivirus (pathogen for measles), etc.

In the past 20 years, there had been acute outbreaks of a few very distressing viral diseases in India. In 2001, Nipah virus (NiV), transferred from fruit bats (Pteropus, Brisson, 1762), was first reported in 2018. It had a localized outbreak in two districts of Kerala and was accountable for 18 clinically confirmed cases and 16 deaths. In 2003, severe acute respiratory syndrome-related coronavirus (SARS-CoV) was first reported in South India (Goa), from a single clinically confirmed case, and was not as devastating as COVID-19. In the same year, 1,723 cases of dengue virus serotype (DENV)-2 and 3 were seen. In 2005, 1,145 JEV cases (including 296 deaths) were reported in Uttar Pradesh and 90 cases in Bihar. In 2006, chikungunya alone drastically affected 1.25 million people from 151 districts of 8 states. Alongside, avian influenza caused by the H5N1 virus emerged in 2006 with its recurrence in 2008. It affected the poultry birds with limited non-fatal human cases and almost collapsed the economy of the poultry industry. In 2009–2010, India faced a major pandemic outbreak due to swine flu caused by influenza type A-H1N1 virus, with 1,763 reported deaths (BBC, 2020b). In 2016–2017, India reported the first cases of Zika virus, transmitted by Aedes mosquitoes, from Gujarat that mostly affected pregnant women. It was last reported in 2018 with 157 cases from Rajasthan.

In 2020, India faced the pandemic outbreak of COVID-19, possessing a severe threat to public health. Although India recorded a small fraction of COVID-19 cases initially (as of 1 April 2020), it soon led to thousands of clinically confirmed cases and a significant number of deaths in the country (WHO Situation report, World Health Organization, 2020b) (refer to Google-monitored worldwide statistics, Google News, 2020).

Over decades, the Indian government has funded integral research on virology and drug development alongside setting up multiple research bodies and laboratories to combat the viral pathogenic crisis. As of March 2020, there were 103 Virus Research and Diagnostic Laboratory Networks (VRDLNs) spread throughout India (DHR/ICMR Virus Research and Diagnostic Laboratory Network, 2020). India was the main manufacturer for commercial vaccines of rabies, hepatitis B, rotavirus diarrhoea, H1NI influenza and poliomyelitis (Polio), although vaccines of numerous viral diseases were mostly imported (Bharati & Vrati, 2012). During the COVID-19 crisis, the Indian government was constantly upgrading medical facilities and essential equipment in the country to make them adequate for accommodating and treating COVID-19 cases efficiently. It was evident that India had the required healthcare infrastructure to manage the COVID-19 pandemic, but the resources might drain in case the virus spread exponentially.

Coronavirus Disease 2019: History

The history suggested that the virus might be natural and was traced back to an animal origin. Though by December 2019, the origin suggested was under question, the spread of infection was mainly by human-to-human transmission. The first reported COVID-19 case was unofficially reported on 17 November 2019, in Wuhan, China. However, WHO officially reported the earliest date to be 8 December 2019. On 30 January 2020, WHO announced the COVID-19 outbreak as a ‘Public Health Emergency of International Concern’ and declared the COVID‑19 outbreak as a pandemic on 11 March 2020 (World Health Organization, 2020d). Popular theories and media claimed that the Wuhan seafood market was the source of the novel virus spreading globally, but a section of the scientific community did not agree with this theory. There were attempts to trace the spread of the pandemic through the photo-sharing service on a social media platform—Instagram—by tracing users’ posts. However, theories based on such studies had some disadvantages (The Economist, 2020). In India, the first COVID-19 case was confirmed on 30 January when an infected resident of Kerala returned from Wuhan (Basu, 2020).

The media also witnessed reports claiming COVID-19 to be a bioweapon designed by the Chinese counterpart, which created a controversy, though not proved or endorsed by any court of law worldwide. The Internet, particularly social media channels, was brimming with conspiracies surrounding the COVID-19 pandemic and connected it to China.

‘The coronavirus is an offensive biological warfare weapon with DNA-genetic engineering’, Dr Francis Boyle, the creator of the Bio-Weapons Act (The Economic Times, 2020a).

All claims about COVID-19 being a biological weapon were unsubstantiated but had created rumours that convinced the citizens of various nations (Andersen et al., 2020; Berger, 2020; Cohen, 2020; Davidson, 2020; Feng et al., 2020; The Economic Times, 2020a). Though there were several theories about where COVID-19 originated, investigations about the origin of the pandemic were inconclusive.

The Indian Approach to Coronavirus Disease 2019

The Indian authorities had taken early action and focused on preventive measures as cases of COVID-19 started cropping up, mostly from individuals returning from abroad. In the initially affected states like Kerala, the government took steps to contain the spread by quarantining the individuals who showed any symptoms. The number of cases rose significantly in March 2020. The state governments started imposing curfews, and the Indian government enforced a ‘Janta Curfew’ on 22 March 2020. In response to this, the Indian Railways shut down its nationwide operations of almost 3,700 trains to contain the spread of the virus. Following the Janta Curfew, the Ministry of Civil Aviation of India ordered all commercial international air travel to be suspended from 22 March, and all domestic air travel was ceased from 24 March. A number of states also shut down all interstate borders to contain the spread by suspending public surface transportation.

All Indians who came from abroad were instructed to observe quarantine. To keep track of those instructed to be in an in-home quarantine, a stamp of indelible ink was stamped on the hands of these individuals. A number of government agencies enforced forceful arrests and quarantines in cases where the citizens were found violating their home quarantine. The Janta Curfew of 22 March effectively got the people inside their homes; the state and union governments capitalized on this and declared a nationwide lockdown on 24 March for 21 days to control the spread of the virus. Along with these measures, the government promoted ‘social distancing’ and asked the citizens to maintain a minimum distance of 6 ft among individuals. A significant impetus to this came when the Washington Post, on 14 March, published an article detailing simulations showing the effect of social distancing on the reduction of the risk of getting infected (Stevens, 2020). The state governments, in the meantime, ordered the closure of schools, colleges and universities to reduce congregations. All public gathering places were also closed. Many business organizations, too, implemented a work-from-home (WFH) policy to reduce contact among employees.

The governments also started a campaign on the efficacy of regular hand washing and the use of hand sanitizers. The Government of Kerala, for instance, released a number of short videos imploring people on the benefits of hand washing. Meanwhile, hand sanitizer sales surged, causing a shortage, with bottles often being sold five times their retail price. The authorities began a swift crackdown on such practices. With a shortage of hand sanitizers and demand for regulated prices, many educational institutions stepped up; IIT Delhi produced 50 liters of WHO-compliant hand sanitizers for distribution across the campus (India Today, 2020a).

As the number of cases rose, the medical preparedness across states became an issue; there were inadequate masks and protective equipment in various hospitals. The test used to detect COVID-19 took 24 hours to provide results. This created a bottleneck at various airports where arriving passengers needed to be examined. The Indian Council of Medical Research acted quickly to provide the necessary health advisory to the public and manage the various medical efforts across the country. Quarantine facilities were built in a number of hospitals, with agencies making arrangements for more capacity. A number of private organizations came forward at this time, like Reliance Industries Limited, which built a 100-bed-capacity hospital to deal with the pandemic (Times of India, 2020). The government planned to impose a price cap on private hospitals treating possible COVID-19 patients (The New Indian Express, 2020a). The government also roped in private testing labs to expedite the testing process (News Click, 2020). Mylab, a Pune-based start-up, also gained approval for commercial manufacture of their COVID-19 testing kits (Mathew, 2020) to increase testing numbers.

The Indian Public Health Interventions

The world appreciated India for its courageous victory over once considered deadly diseases like pulse polio and smallpox. However, the country still struggled in ensuring effective healthcare facilities for its citizens due to many social and economic reasons. The spread of COVID-19 showed an acute public healthcare facility famine in India. To counter COVID-19, the Government of India had taken a series of public health interventions. The recorded severe acute respiratory syndrome (SARS) outbreak, caused by coronaviruses in 2004, was controlled by hygiene and quarantine health interventions⁴ (Oxford et al., 2005). Similarly, to ensure the public health of citizens, the Government of India took appropriate steps, including the travel ban, closure of academic institutions, awareness campaigns, closing country borders, etc. (refer to Table A1 for details on strategies and interventions by the Government of India [Boston Consulting Group, 2020, p. 14]). The Government of India largely focused on sharing the right information and adopted preventive interventions (Smith et al., 2015) to prevent the disease from spreading and thus reduce the chances of new cases.

‘The objective of this plan is to stop the chain of transmission, thus reducing the morbidity and mortality due to COVID-19’, Contamination Plan Document, MOHFW, Government of India (The Economic Times, 2020b).

The government urged higher education institutions, citizens and all other stakeholders of the nation to share their thoughts, ideas and innovative solutions to strengthen the public health system (Government of India, 2020). A few innovative ideas included converting one ventilator to nine low-cost ventilators, converting a train into a mobile COVID-19 hospital (Prasad, 2020), converting stadiums into quarantine centres, etc. A number of elite Indian higher education institutes (Council of Indian Institutes of Technology, 2020; Council of National Institutes of Technology, Science Education and Research (NITSER), 2020) were researching and also facilitating other researchers/research organizations/companies/start-ups in researching COVID-19 such as IIT Delhi (IITD, 2020), IIT Hyderabad (The New Indian Express, 2020b), IISc Bangalore (The Economic Times, 2020c) and many others.

In the absence of a scientifically recommended drug or vaccine, as of 1 April 2020, non-pharmaceutical interventions became the main strategy to control COVID-19 (MOHFW, 2020a). One of the major intervention tools used by the government and other stakeholders of the nation for public awareness was social marketing. Social marketing was part of the yellow wedge of the Public Health Intervention Wheel (Minnesota Department of Health, 2020). It was used to influence the people’s knowledge, attitudes, values, beliefs, behaviours and practices to adopt preventative measures against COVID-19. The use of marketing to promote socially beneficial behavioural change had been used in public health promotion for decades (Grier & Bryant, 2005). India had experience and success in major social marketing campaigns like Swachh Bharat Abhiyan campaign.

Large-scale Social Marketing in India

The social marketing campaign success may be attributed to the efforts, active participation, selfless services and cooperation from all the stakeholders of the nation.

Product (and Services)

The core product of the social marketing campaign was the promise of safety to the citizens, ensuring better health and minimum misery and fatality. The actual product comprised a package of services that:

shared medical expertise with healthcare professionals and delivered training on preventive measures and crisis management, and skills to manage the pandemic at the ground level;

prescribed preventive measures in the form of guidelines to the citizens, self-help groups and other stakeholders of the nation to stay safe during the pandemic;

offered financial assistance for undertaking preventive measures and facilitating capacity building to fight the outbreak;

provided financial assistance, legal enforcement and encouraged responsible behaviour to offset the transition in the initial period of behavioural interventions;

facilitated interactions between government agencies and citizens, thus ensuring smooth public service delivery; and

ensured information dissemination and upheld the spirit of the nation to fight the pandemic.

Price

The Government of India invoked power under the Epidemic Disease Act, 1897, to manage the pandemic. The violators of the new government behaviour guidelines would pay a fine and maybe imprisonment according to the Act, and other laws of the country like disobedience to quarantine rule would be punishable under Section 271 of the Indian Penal Code (IPC), 1860. Failure to take requisite precautions even after the awareness of the possibility of spreading the infection or disease would be punishable under Sections 269 and 270 of the IPC. States, as required, may issue orders by invoking Section 144 of the Criminal Procedure Code (CrPC), 1973, to restrict public gatherings and Disaster Management Act, 2005. The disobedient citizens would face legal proceedings (Deswal, 2020).

The Government of India and other stakeholders of the nation made financial support arrangements for the financially weaker sections of the society and made provisions for businesses.

Place

The Government of India and other stakeholders launched social marketing initiatives covering the wide geography of the country, irrespective of the number of cases reported. India being a digitalized nation, social media and other digital platforms were among the popular channels of communication. With the help of community-level Anganwadi⁵ workers, self-help groups, healthcare professionals, police, defence personnel and other public volunteers took the message to almost every city, village and the doors of the less privileged.

Promotion

The communications were focused on benefits, highlighting the importance of preventive healthcare measures, while taking care of influencing various social, cultural, health, economic and political factors. Using a community-based approach, the communications targeted to convince all its members, particularly the women and the elderly, of their need to adopt the proposed behaviours. Awareness was generated through constant communication with the citizens through all existing communication channels. Particular communication interventions such as interpersonal interactions, group communication, microphone announcements, social media posting and live broadcast were organized across the nation. While benefit-focused messaging was appropriate in most situations, the government sometimes adopted legal means to communicate the messages. Responding to evolving programmatic needs and priorities, the most vulnerable migrant populations were especially targeted. The messages were designed to address the citizens’ hardship and motivate them for a better future. Apart from making citizens aware of the pandemic situation, the communications were also intended to uphold the spirit of the people during the time of crisis.

India had a booming mobile and information technology (IT) industry, with over 300 million users of mobile devices (Hindustan Times, 2020b). The COVID-19 pandemic proved to be a major test on these services and the various platforms like Facebook and Instagram, which were widely used by a large number and proved to be an effective ground for communicating facts and information related to COVID-19. With large Internet penetration in the country, at over 600 million users (The Economic Times, 2020d), various agencies like the government and private organizations used social media and digital platforms to sensitize the people about the COVID-19 pandemic and the preventive measures.

In the Indian scenario, as cases burgeoned, a number of stakeholders emerged in the social marketing scene aimed at apprising the public with the latest information and advisories to tackle the threat of COVID-19. These were the (a) government agencies, (b) WHO and others, (c) celebrities and (d) private entities.

Here are a few examples of social marketing strategies used to promote preventive healthcare measures and ensure mass well-being:

Indian government (central, state, union territories) and their agencies:

The Indian government launched a campaign urging people to use the ‘Namaste’ (Pressing hands together, generally with a smile, to greet people. It was a common cultural practice in India. In Hinduism, it means ‘I bow to the divine in you’) greeting while meeting people and avoiding handshakes. This was to limit the direct contact between people and contain the spread of the virus through surface transfers. This was further endorsed as a number of world leaders and icons were seen practising it in the wake of COVID-19. This initiative promoted local as well as global well-being.

PM Modi⁶ asked the nation to follow two things: ‘Resolve and Restraint’. With this, he announced the ‘Janta Curfew’ and scheduled it for 22 March 2020. The curfew was unique as it was not a state-enforced curfew, but the citizens were expected to accept it voluntarily. It was more a litmus test for the people of India before a mass state-enforced countrywide lockdown. PM Modi asked everyone to inform at least 10 other people about the Janta Curfew and preventive measures against the deadly COVID-19. The curfew was intended to evaluate the preparedness and train the people of India for pandemic days. PM Modi emphasized unity and a unified fight against the virus. In his message, he addressed the social ostracization associated with the deadly virus. In order to foster a sense of unity among the fellow citizens, he asked the people of India to come out to the balconies and salute all those who were in essential services and risking their own lives. It was targeted towards the doctors, the nurses, the healthcare staff, delivery boys, airport officials and everyone in essential services. People were asked to express their gratitude by giving a 5-min standing ovation at 5 p.m. on Sunday by clapping hands, playing utensils or ringing bells. PM said, ‘Janta Curfew, just the beginning of a long battle against coronavirus’.

In West Bengal, the government was quick to act when the first case was reported, scaling up operations in hospitals and issuing the requisite advisories to the people. As information about COVID-19 spreading through surface contact came into light, the governments began issuing advisories regarding avoiding physical contact and keeping requisite distance between individuals. The state government popularized a ‘Circle of Safety’ concept. Chief Minister Mamata Banerjee suggested that there should be circles drawn on the floor at sufficient recommended distances where people meet for purchase and other essential interactions.

The MOHFW released a comic book for children to teach them about the COVID-19 pandemic and the measures they should undertake to stay safe (MOHFW, 2020b) In addition, advisories and graphics on the merits of hand washing and the use of hand sanitizers were also released and circulated through the media.

The Ministry of Human Resource Development made efforts to make print material and online content to appraise the public and the students. The ministry also started promoting its information and communications technology (ICT) initiatives along with the University Grants Commission in the form of digital learning platforms like SWAYAM, which provided various online courses and educational material. Other research establishments also continued their efforts in developing better and faster techniques to detect and treat the virus. These initiatives were meant to engage the student population as well as reduce academic losses incurred due to lockdown. The platforms were also used to dissipate awareness messages related to COVID-19.

The MEA started evacuating Indians from the COVID-19-affected countries such as China, Iran and Italy. In their effort, they evacuated other nationals from the Maldives and Sri Lanka. and promoted goodwill and cooperation among the South Asian nations.

Within 2 weeks from Janta Curfew, PM Modi urged the Indian citizens to switch off the lights at their residence and light up lamps, diyas, candles or mobile phone torches for nine minutes at 9 p.m. on April 5, to display the country’s ‘collective resolve’ to defeat COVID-19. As the clock struck 9 p.m. on Sunday, April 5, it was ‘Diwali⁷ in April!’.

‘#IndiaFightsCoronavirus, #9MinutesForIndia, #Diwali’, among top Twitter trends (NDTV, 2020).

Celebrities

The power of celebrities and ‘instafamous’ micro-celebrities in getting messages to their fans had been attested time and again, with celebrities often endorsing products and services over televisions and other social media platforms, which led to equity creation (Djafarova & Trofimenko, 2018; Seno & Lukas, 2007). A number of celebrity campaigns gained the attention of people and the mainstream media in India.

On TikTok, a hand-washing challenge started with celebrities uploading videos washing hands and ‘challenging’ other viewers to do the same.

Several prominent Bollywood celebrities came forward and posted on their social media accounts, urging people to stay home and take the necessary hygienic measures. Celebrities also gave funds and procured masks and other health equipment for emergency workers (Outlook, 2020). On Twitter, a new campaign #BollywoodActOnCorona trended, urging Bollywood celebrities to donate funds to tackle the COVID-19 pandemic (News18, 2020). With the large sway that the Bollywood celebrities had over the public, they were ideal candidates to disseminate information about social distancing and hand washing to the public.

Religious Organizations and Spiritual Leaders

India had, for centuries, been a spiritual and religious epicentre, with many spiritual movements and organizations such as the Rama Krishna Mission, ISCKON⁸ and others. As the spread of COVID-19 increased, a number of methods and rituals to cast off COVID-19 came into the limelight. A major practice called ‘gomutra’, or drinking cow’s urine, which some believed had healing properties, gained momentum. Vishva Hindu Parishad, a Hindu group, organized a ‘gomutra party’ for its members and followers (Pandey, 2020). Many such gatherings were also organized in other parts of India like Delhi and Kolkata.

In addition, Indian astrologers capitalized on the phenomenon and released several videos and online content with their predictions on the crisis (Deccan Herald, 2020). Pujas⁹ were also organized to pray for the quick and timely eradication of the disease and speedy recovery of the victims (Bomnalli, 2020).

Spiritual leaders asked their followers to stay calm and take the necessary measures to avoid the infection. Sadhguru, a prominent spiritual leader in India and with considerable sway over the youth of India, took to YouTube to address his followers on the crisis, advising them to avoid travel and take necessary health precautions. ‘We cannot decide what life throws at us, but what we make out of it is hundred percent ours’.

To spread the message of social distancing and avoid congregating in large numbers, many prominent places of worship like the Jagannath Temple in Puri and the Sai Temple in Maharashtra closed entry for the public. Eventually, following the order of a complete lockdown from the government, the congregation was banned at all places of worship. In addition, religious foundations, opened their doors to the homeless and needy to shelter them in these trying times (Carvalho, 2020). They served as an important agent to motivate and pass the message from the government to its devotees and society at large.

Ayurveda, India’s traditional medicine, had a significant following in India, with major brands like Himalaya and Patanjali recording billions of rupees in revenue. Ayurveda products were touted to have special abilities in warding off COVID-19, and sales spiked across India (Venugopalan, 2020). However, the Ministry of AYUSH released a statement saying that such treatments did not have any proven results against COVID-19 and asked people to turn to conventional medical science for help. ‘Havan’, a fire ceremony of Vedic culture, was practised to fight COVID-19 to create awareness to prevent the spread of COVID-19 and give people ‘Hope’.

With an essentially religiously inclined population, such methods grounded in Vedic literature and Ayurvedic methods were expected to influence people during such times of crisis. Religious foundations in India greatly influenced the people and had major resources at their disposal to reach out to people, advise them on the best course of action and reiterate the preventive practices.

Corporate and Private Entities

India had a large private sector, with a number of companies with market capitalizations in billions of dollars. As the COVID-19 pandemic spread through the country, many of these companies enacted WFH policies. Private organizations were actively involved in social marketing concerning health interventions to deliver public well-being.

Organizations such as Wipro, Infosys and Amazon implemented a WFH policy to ensure the safety of their employees. The companies emphasized the ‘joy of being at home and family time’. In some cases, the organizations also extended other health benefits to their employees, with the Cricket Association of Bengal announcing that its employees’ health insurance would cover COVID-19 (The Sentinel, 2020). The organization promoted that work was important, but the safety of their employees was as important, ‘Organizations that care for employees’.

International organizations like Google, which had a track record in releasing doodles to commemorate various international and local events, themed Ignaz Semmelweis (who pioneered the art of washing hands) to urge people to make an effort to wash hands.

Indian milk giant Amul had a long history of using cartoons to commemorate national and international events, from sports achievements to tragic world events, with a play of words surrounding its portfolio of milk-based products. With the vast network of AMUL and its positive image in the Indian public, it released a number of cartoons with messages to protect the people. From commemorating the heroic efforts to evacuate Indian students from Wuhan to hand washing regularly, Amul’s team made some noteworthy cartoons to garner the attention of the Indian public (refer to Figures B1–15).

Few of the Asian Paints advertisements, conceptualized by Ogilvy, touched upon different facets of life inside a typical Indian home to encourage people to stay home. The advertisements showed various activities families could do together at home and emphasized the opportunity to spend quality time with their families.

Media Houses and Platforms

In the social marketing efforts of various stakeholders, it is imperative to note the contribution of the large media houses and platforms. In India, there were over 892 television channels with over 430 news channels. Major media houses like India Today, Time Group and ABP Group started 24 × 7 coverage of the pandemic, giving timely information to the public. Other media platforms like InShorts and LiveMint provided information and advisory on their mobile apps to the public. InShorts, an aggregated news provider, gave regular updates on its app on the latest developments in addition to advisory to its users. Through social messages, all these platforms ensured that people were not afraid and guided them to join a unified fight against the virus and obey government guidelines.

The Ministry of Telecommunications, Government of India, asked various telecom providers to replace the caller tunes of mobile users with a caller tune, which apprised users about the COVID-19 pandemic and advised them to keep safe and look out for any symptoms associated with the virus (Chakravarti, 2020).

WhatsApp was one of India’s most popular messaging apps (Financial Express, 2020b) and had a massive reach across the Indian populace. Stakeholders like the government were injecting their content on a timely basis, which spread exponentially via WhatsApp forwards. In addition, the government agencies activated WhatsApp chat numbers and circulated them to aid better communication with the public, which was a WhatsApp Chabot to deal with the people’s queries and spread awareness.

Role of Social Media in Beating the Lockdown Blues

With the government advising on staying indoors and eventually calling for a lockdown, social media became a major means of socializing while maintaining the distance.

Various memes on the requisite measures started making rounds on Facebook and other platforms. Games like riddles and others started appearing, which engaged the members. Facebook also became a virtual gathering place for many. The moment was big for social media platforms to actively engage users and manage extra traffic (Majumdar, 2020).

With the efficacy of mass messaging systems, there was also the concern of misinformation being spread on these platforms. As the pandemic grew in the initial days, a number of fake news started cropping up. Press Information Bureau (PIB) of India launched a fact-check campaign to dismiss various fake information and news coming forward. With a national body like the PIB, the public could be assured of the credibility of information from various sources (Hindustan Times, 2020c). The various media houses and platforms, including the mass messaging platforms, had the responsibility of getting the right facts and information out to the public in a timely fashion.

Political Bodies

When the pandemic hit, the political climate in India was tense due to some controversial measures by the government. With the advent of COVID-19, a number of political parties responded by suspending any political gatherings and ongoing demonstrations—the crisis brought about a uniting front for the various political bodies of India. A unified political force with vast political networks could ensure sound delivery of necessary services and aid to the public.

The PM called off ‘Holi Milan’,¹⁰ organized by the ruling party, to send a message of social distancing to the nation (The Economic Times, 2020e). Various political stakeholders also took to social media to urge people to stay indoors and take the requisite measures to protect themselves and others.

Family, Friends and Neighbours

With the government taking various measures to spread awareness on the crisis and the requisite measures the public should take, the nation, in solidarity with the government, also made efforts to create awareness. Many posted special ‘stay-at-home’ frames on their Facebook profile photos. Along with that, a number of people posted similar content on their WhatsApp, Instagram and Snapchat, urging people to adhere to the directives. The responsible citizens took the responsibility to make their neighbours, friends and family aware of the preventive measures and ensure they adhered to them.

International Agencies and the United Nations

International agencies like the United Nations and its health arm, the WHO, had been proactive in handling many global epidemics and coordinating humanitarian efforts worldwide. WHO released a number of advisories and pamphlets to aid the public and held regular press briefings to disseminate information (World Health Organization, 2020c). WHO released a daily situation report with the latest statistics on the pandemic. They also announced developing an app to educate users about COVID-19. As a general outreach to the public and to contain the outbreak of misinformation and various ‘myths’ surrounding COVID-19, the WHO added a section on the COVID-19 pandemic to keep the people up to date (World Health Organization, 2020a).

The United Nations issued necessary advisories on the COVID-19 pandemic releasing a frequently asked questions (FAQ) section to apprise the public with correct information on various issues concerning the virus (United Nations, 2020). Meanwhile, the United Nations sought a ceasefire across all conflicts to contain the spread of the virus (Brzozowski, 2020), and the UN Secretary-General said, ‘The fury of the virus illustrates the folly of war’.

The International Monetary Fund (IMF) began early stock of the economic fallout of the COVID-19 pandemic as stock markets worldwide started to fall, and the governments began scrambling to revive the markets. The IMF advised the governments and their central banks to take specific measures to contain the economic fallout. The IMF Managing Director, in a meeting with finance ministers and central bank chiefs of the G20,¹¹ said ‘The human costs of the Coronavirus pandemic are already immeasurable, and all countries need to work together to protect people and limit the economic damage. This is a moment for solidarity’ (International Monetary Fund, 2020).

The Indian Challenges: Marine to Mountain

‘Coronavirus crisis has engulfed the entire human race… For a developing country like ours with a large population, the growing challenge of coronavirus is not a normal situation….’

PM of India, Narendra Modi (Hindustan Times, 2020a)

India had a vast land with the world’s second largest population. Due to such a huge population spread across a vast geography, the country was highly diverse in culture, ethnicity, economy, linguistics, etc. Managing the COVID-19 pandemic in such diversity was a challenge in itself. The cultural aspects influenced the process of symptom recognition, labelling, help-seeking and the structure of health systems. Various aspects like humiliation and unnecessary isolation could bring down the efficiency of the healthcare systems (Angel & Thoits, 1987). When Ebola broke out, the cultural hurdles were similar to the earlier endemic, acquired immunodeficiency syndrome (AIDS), even though Ebola was different in various aspects (Chan, 2015). Similarly, there were various challenges for India as a nation, which perhaps were the outcomes of the meritorious characteristics of the nation such as having wide and diverse geography, cultural richness, and diverse and huge population.

Cultural differences were one of the major challenges that India needed to overcome to fight the pandemic. In the case of human immunodeficiency viruses (HIV)/AIDS disease, culture played a vital role in the contamination of the disease as well as the spread of it. The social stigma attached to sexually transmitted diseases was the major reason (MacPhail & Campbell, 2001; Airhihenbuwa & Webster, 2004). The cultural aspects like the societal agreement and assumptions were considered while implementing public health measures (Napier et al., 2014). The vast cultural differences in India posed a challenge that negatively influenced the public health sector to deal with the COVID-19 pandemic efficiently. It was observed that in different parts of India, the citizens in some cases ignored or revolted against the government-proposed measures like self-isolation or quarantine practices due to the cultural (and religious) influences.

In India, a certain community became a matter of national-level discussion after a series of messages on social media that preached, ‘This coronavirus is nothing. It’s God’s National Register of Citizens (NRC). It’s God’s wish who stays and who is summoned up’. Further, similar messages on the digital media encouraged people to throw away the masks, with a song, ‘God Se Dar (Fear God)’. Similar claims, like ‘COVID-19 Doesn’t Affect us’, ‘invoke the religious book … hand-shaking and hugging can cure disease’. These messages were quickly perceived as misleading and were not attached to any religion by the educated and responsible citizens. Nevertheless, a section of society fell prey to such messages. In national and international health emergencies, these messages demonstrated the potential unrest on the communal and domestic level and encouraged a section of society to disobey the government’s guidelines. These types of events were attributed to the cultural, religious and political history of India.

Various religious organizations supported the government, helped counter various cultural issues and motivated the followers to obey government guidelines. The offenders and disobedient citizens were charged under the Epidemic Disease Act.

The population density, climate conditions and medical care qualities could affect the transmission of the virus (Dalziel et al., 2018; Hemmes et al., 1960). A huge population of more than 1.3 billion people enriched with diversity challenged the system in a unified fight against the disease.

The Indian government was appreciated worldwide for its measures to prevent the virus from spreading, but the other side of the story was worrisome. With the growing number of COVID-19 cases, the burden on the public healthcare sector across the country was multiplying. The required resources to fight the pandemic were becoming increasingly inadequate. The country was not equipped with enough resources to handle the outbreak if it flared up viciously. There were 713,986 government hospital beds in India (Singh et al., 2020b). The ratio was as low as 0.55 beds for 1,000 people in India. The Government of India was not adequately prepared to handle outbreaks like COVID-19. There were more private hospitals across the country than government-owned hospitals. However, the outbreak was primarily managed by the government hospitals in India. According to a report, 5–10% of the COVID-19-infected patients needed critical care, which required ventilator usage, and it was reported that not more than 26,000 ventilators were available in the countries’ government hospitals. It should again be noted that the private hospitals and their capabilities were not being taken into consideration, and if taken into considerations, the number of beds, intensive care units (ICUs), ventilators, etc., would go exceptionally high. But in a developing country like India with social as well as economic problems, the inclusion of private hospitals, in general, would bring with it an additional set of problems for the government.

Various other problems such as the vast geography, concentrations of medical facilities in selected cities, weak political control in remote geographies, underdeveloped communication facilities to remote geographies, conflicts among political parties, declining economy, economic uncertainty of daily wage labour, corruptions in the system, artificial increase in prices of essential commodities, procurement and import difficulties amidst international travel ban and lockdown in various countries, lack of education and awareness among a section of society, citizens flooded with misinformation through various channels and gaining support from public servants in essential services made it very difficult for the government to fight the pandemic.

The Rise of Crisis

With the imposition of the lockdown, the country witnessed a strict adherence to government guidelines in the initial days. As time passed and the number of cases grew exponentially compared to other countries, people began to take the guidelines lightly. The government and other stakeholders warned the citizens that the situation was not as good as perceived and might even worsen in the coming days.

Today, I am speaking to you not as an India player but as a citizen of the country. What I have seen in the last few days is people moving in groups, not abiding by curfew rules, not following lockdown guidelines. It shows that we are taking the fight very lightly. But this fight is not as easy as it looks or feels.

—Virat Kohli, the Indian Cricketer, said in a video (India Today, 2020b)

Even after such appeals from the Indian celebrities, a section of the society was still not behaving responsibly. The situation accelerated with time; it was becoming psychologically difficult for people to stay at home and maintain social distancing. At large, people were miserable due to supply-side disturbances and difficulties in procuring essential commodities. Further, low-income workers, like daily wage workers and a large section of Indian society living below the poverty line, were under serious financial stress. Even citizens who belonged to the middle class were facing financial issues due to loss of jobs and artificial price hikes of essential commodities. Unable to cope with psychological and economic problems, a section of the population began to disobey the government guidelines.

The kind of devastation that is going to be faced by the bottom 50 percent of the workers in the informal sector is unimaginable.

—Dr Jayati Ghosh, Professor at the JNU New Delhi (Singh et al., 2020a)

Financial hurdles and healthcare capacity issues constrained the Government of India. As the weeks passed, just before the ending week of the 21-day lockdown, India witnessed a surge in COVID-19 cases, leaving thousands infected and hundreds dead. A team of researchers from Indian Institute of Management (IIM) Rohtak predicted that the number of COVID-19 cases would increase exponentially in India and amount to more than 150,000 cases by the first week of May 2020 (Anand, 2020). It was during this time that the government needed to decide on its lockdown extension strategy. International advisories suggested extending the country’s lockdown (Boston Consulting Group, 2020, p. 6), but then how will the nation manage? Continuing with the lockdown could push the country into further psychosocial and economic stress.

Managing the citizens in a lockdown was getting increasingly difficult, and the economy was under stress. On the other side, withdrawing or easing the lockdown could increase community transmission and casualties. If the lockdown was withdrawn, managing citizens and encouraging them to take precautions would become even more difficult.

The Government of India and its machinery were on their toes. It was time to make some bold decisions. ‘We are determined not to accept the defeat… We will craft a sustainable solution and must make it happen … but how?’ A government official¹² wondered to himself.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Disclaimer

The origin of the coronavirus disease 2019 (COVID-19) pandemic has yet to be ascertained, and investigations into the origin are ongoing. There was no funding received for this article. The authors declare that they have no known competing financial or political interests that could appear to have influenced the work described in this article. Opinions expressed here, if any, are personal and do not represent the positions of the authorship team’s respective universities. The case is created solely to serve as a springboard for classroom discussion. The case is not meant to be an endorsement, a source of primary data, or an example of effective or ineffective management.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

Appendix A

Appendix B

Notes

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