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Thursday, June 24, 2021

Vaccine disparity: How tribal & rural districts are falling behind; Districts most vulnerable to Covid have vaccinated the least

With the virus travelling to hinterlands, lack of efforts to extend vaccination coverage and hesitancy in tribal and rural areas pose a big risk to unexposed population in future waves.

Written by Tabassum Barnagarwala | Mumbai |
Updated: May 23, 2021 1:37:02 pm
Vaccine disparity: How tribal & rural districts are falling behind; Districts most vulnerable to Covid have vaccinated the leastState public health department data, based on recorded infections and vaccinations, shows that tribal and rural districts have poor vaccination coverage and a huge population is at risk. (Express File/Representational)

Even as Maharashtra accounts for 2.06 crore immunisations – maximum across India – the state has managed to fully immunise only 3.3 per cent of its total population with both jabs.

With the virus travelling to hinterlands, lack of efforts to extend vaccination coverage and hesitancy in tribal and rural areas pose a big risk to unexposed population in future waves.

Hingoli, Palghar, Gadchiroli, Jalgaon, Solapur and Nandurbar have fully immunised less than 2.5 per cent of their total population till May 20. Except Solapur, all five districts have over 60 per cent rural or tribal population.

For those aged over 45 years, Solapur has given first shots to less than 20 per cent of its eligible population in contrast to nine districts with over 40 per cent coverage.

State public health department data, based on recorded infections and vaccinations, shows that tribal and rural districts have poor vaccination coverage and a huge population is at risk.

Of Palghar’s 35.3 lakh population, with 3 per cent having been infected with Covid-19 and at least 9.2 per cent receiving the first dose, 88 per cent of the population is still vulnerable. Similarly, 1.9 per cent of the population in Nandurbar has been infected with Covid-19 and 10.7 per cent vaccinated. This leaves 87 per cent of the people at risk.

While Gadchiroli’s 86 per cent of the population is at risk, Hingoli – with lowest vaccination coverage – has 90 per cent of its population unexposed to the virus. In contrast, 73 per cent of Mumbai’s population is vulnerable to Covid-19, 70 per cent in Pune and 68 per cent in Nagpur.

Compared to Maharashtra’s vaccination coverage of 3.3 per cent, Israel has fully immunised 59 per cent of its population, followed by Bahrain (38.6 per cent), USA (37.5 per cent), Hungary (29.14 per cent) and Mongolia (20.9 per cent).

Dr Archana Patil, Director of Directorate of Health Services said that to gauge the impact of any vaccine, at least 60 to 70 per cent of the people have to be vaccinated. “And that can take some time,” she added.

Rural areas left out of vaccine drive.

R Ramakumar, economist attached to Tata Institute of Social Sciences, said that it is not surprising that rural areas have been left out. He listed two factors for this – inability of the government to open adequate vaccine centres in rural areas and the CoWin portal heavily favouring those who have Internet connection and can operate mobile apps.

“The small section of urban educated class is techno savvy, they can manoeuvre through mobile apps. The rural population can’t,” Ramakumar said. He added that the country has perfected universal immunisation programme with door-to-door vaccination for children and the Centre should give states the freedom to operate without CoWin to improve coverage.

Tejal Kantikar, data specialist and associate professor at National Institute of Advanced Studies in Bangalore, said that regional disparity is not the only problem.

“There is disparity within urban regions. By occupation, drivers, delivery guys, vegetable vendors and hawkers are more vulnerable. But they have been largely left out. The government should reach out to associations and unions to immunise them. What we are seeing now is that people who are sitting at home and having time to keep looking for online vaccine slots getting appointments,” she added.

The Union Ministry of Health and Family Welfare data shows that Maharashtra has administered 2.06 crore jabs, followed by Rajasthan, Gujarat and Uttar Pradesh. But Kantikar pointed out that most vaccination centres in Maharashtra are in urban areas.

“Maharashtra’s vaccination numbers are so good because of few cities where the uptake is huge.”

Just five districts – Mumbai, Pune, Nagpur, Thane and Kolhapur – account for state’s 46 per cent vaccination coverage as of now.

Kantikar studied data between April 23 to 29 and found that Maharashtra had only 59 vaccination sites per 10,000 eligible people. At least 14 states have more centres than Maharashtra. While Chhattisgarh has 170 centres per 10,000 eligible people, Tripura has 118, Jammu and Kashmir 165 and Punjab 150. The proportion of eligible population in these states, who have received the first dose, is higher than Maharashtra.

Weekly vaccination numbers fall

Maharashtra’s monthly vaccination coverage increased from 9.18 lakh in February to 50.17 lakh in March and 96.42 lakh in April. But a closer look at weekly data shows that from April, the state has been noting a steady decline in vaccination numbers.

From April 3-9, when state administered 22.9 lakh jabs, the figure dropped to 17.8 lakh in April 17-23, to 17.58 lakh in May 8-14 and to 7.12 lakh between May 15-21.

Health Minister Rajesh Tope said Maharashtra has the capacity to vaccinate eight lakh people daily but shortage of doses has hampered the drive.

The state has managed to touch 15-30 per cent of its weekly target, conducting 7 to 16 lakh immunisations against the targeted 56 lakh per week.

Till date, Maharashtra has received 2.11 crore doses from the Union government and immunised 2.06 crore people. At the current rate of 3 lakh vaccinations a day, Maharashtra will take six to seven months to cover the remaining beneficiaries.

As on Saturday, Maharashtra has purchased 5.21 lakh doses on its own and received 26,000 jabs from the Centre. It has around 10 lakh doses in stock. State officials expect the supply to improve by June.

Tope had said that due to vaccine shortage, they have been forced to divert stock meant for the 18-44 age group for second doses of the 45-plus group. A break-up of data shows that so far, 7.1 lakh healthcare workers, 7.4 lakh frontline workers and 29.10 lakh people aged over 45 years have received both doses. In the 18 to 44 age group, 6.8 lakh have receive their first shot.

Vaccine hesitancy

On May 18, District Health Officer Dr Shashikant Shambharkar travelled to Bhamragad taluka in the eastern tribal district of Gadchiroli. He walked 5 km to Terimilibhatthi, a remote village near the Chhattisgarh border.

“An elderly woman refused to undergo malaria test thinking that we were performing a Covid-19 test. Vaccination is a topic they do not even wish to discuss,” he said. The village has a population of 50 people and all those eligible have refused to get vaccinated.

Nearby, Mohali village’s sarpanch agreed to get a jab believing he will encourage others. “Unfortunately, five days after his shot, he contracted Covid-19 and died,” Shambharkar said.

Villagers have now refused entry to healthcare workers. “When they ask why he died, it is difficult to answer… we ourselves are learning about breakthrough infection after both doses,” Shambharkar said.

Vaccine hesitancy, lack of transportation, rumours surrounding vaccination, especially impotency, and lack of enough jabs have hit the immunisation drive in rural areas. The few slots that open up are grabbed by people from urban pockets who are willing to travel long distances to get vaccinated.

Gadchiroli, with over 70 per cent tribals among its 11.7 lakh population, has fully immunised only 28,482 people. It has not managed to breach the 3,500 mark in daily doses except once when it touched 4,500 vaccinations on May 12.

“There was some enthusiasm in urban pockets when vaccination opened for the 18 to 44 age group, but dearth of jabs has hampered the exercise,” Shambharkar said.

In Osmanabad, only three people were immunised on May20. In the western district of Palghar, 68,382 of its 35.3 lakh people are fully immunised. Over 18 per cent of those aged above 45 have got their first shot.

When vaccination began for those aged above 60 years in March, Dr Vijay Thakkar, medical officer from Malwada primary health centre (PHC) in Palghar, realised that villagers have no means to commute to the centre.

He sent an ambulance to transport eight villagers willing to get jabs at the PHC 16 km away. “But we can’t do this for all villagers,” he added.

Every week, he visits villages to raise awareness on immunisation and is gets to hear various excuses. “We need to bring vaccines to every village to ensure all get immunised,” he said.

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