Monday, Jan 30, 2023

Polio lessons for COVID vaccination

Communication drives that reach out to all sections can help ease vaccine hesitancy

India covid vaccinationAnother meta-analysis study by the British Medical Journal found that only 68.4 per cent of the population is willing to receive the COVID-19 vaccination globally. That is a low figure considering vaccines can eradicate diseases and save lives.

More than a year ago, the SARS-COV-2 virus sent the world into a bubble. We were caught by surprise and there was little or no preparation to meet this challenge. Health systems were ravaged, and countless people lost their lives. In hindsight, this could have been prevented had we been prepared.

A year later, while the virus is still circulating in our communities, we know much more about it, thanks to one of the biggest health information campaigns in human history. The world is slowly but gradually bouncing back, and science has given us another chance. Cases are on the decline. However, sporadic outbreaks have led governments around the world to continue to enforce fundamental public health measures.

At the same time, the focus has shifted to the development of vaccines. The race has fast-tracked efforts. Scientists have developed vaccines in record time and more than 250 vaccine candidates are in different stages of development globally. India, too, has already approved and rolled out Covishield and Covaxin for emergency use and many more are on the horizon. And here is where we have hit a bump, expectedly so. Vaccine hesitancy – notorious words commonly associated with inoculation drives — has been cited by WHO as one of the top 10 global health challenges.

There is no denying that immunisation is one of the most successful and cost-effective means to help children grow into healthy adults. But with any large-scale immunisation programme, hesitation and fear usually follows. A World Economic Forum survey released in November 2020 indicated a growing reluctance among people to receive a vaccine, despite progress made by numerous pharmaceutical companies and international organisations. Another meta-analysis study by the British Medical Journal found that only 68.4 per cent of the population is willing to receive the COVID-19 vaccination globally. That is a low figure considering vaccines can eradicate diseases and save lives. So, what makes it difficult and how can we tackle this lack of confidence among people?

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The answers can be found in comparing the immunisation coverage of other diseases. As per estimates released by WHO and UNICEF on immunisation — nearly one in 10 infants did not receive any vaccination in 2016. This means that infants missed the first dose of DTP/Pentavalent vaccine putting them at serious risk of these potentially fatal diseases. Another survey by WHO in 2014 revealed that among the 1 lakh parents (of children who were not vaccinated) interviewed, 33 per cent had no idea about the vaccination, and another 30 per cent only knew about the Adverse Events Following Immunisation (AEFI).

Given the severity of the pandemic, with 2.5 million deaths reported worldwide, vaccines are the only effective solution that can be deployed against COVID-19. India’s vaccine rollout has kicked off to a good start with more than 2.5 crore vaccine doses being administered as of March 15. However, the country has been witnessing hesitancy from unexpected quarters – doctors and health-workers. Such a development can have further implications on the vaccine coverage of the larger population, especially when there are less takers among the ones who save lives. The apprehension it seems has been attributed to lack of vaccine efficacy data, questions on safety, quick clinical trials, and reported deaths among the elderly and sick population.

To combat this misinformation, the Indian government has stepped up efforts to quash wrong claims and has conducted regular press conferences. The Union Minister of Health and Family Welfare, Harsh Vardhan, has led the initiative. Messages such as “Let us put a STOP to these falsehoods” and “Truth is powerful and shall prevail” have been disseminated to ensure its acceptance and uptake in a timely, accurate and transparent fashion. Eminent physicians from well-known private and public hospitals have also taken vaccine shots to boost public confidence. Pharmaceutical companies have released factsheets addressing concerns and an extensive communications campaign is being undertaken on social media platforms to ensure the right information reaches people. In addition to this, development partners have been roped in to spread awareness about the COVID-19 vaccines. All vaccines are almost 100 per cent effective in preventing COVID-related deaths, severe symptoms and complications – that’s the message the needs to go through.


Much can, in fact, be learnt from the country’s successful Polio eradication and Mission Indradhanush initiative. In 2002, when Uttar Pradesh alone harboured 65 per cent of global polio cases and vaccine hesitancy was at its peak, UNICEF’s induction of an army of social mobilisers in Uttar Pradesh and Bihar states helped mitigate fears.

Similarly, while designing Mission Indradhanush in 2014, behaviour change communications was put at the centerstage of immunisation planning. The campaign converted a routine immunisation into a Jan Andolan – a people’s movement. It mobilised communities to deal with the barriers to seeking vaccines. This was achieved through a sustained coordination effort led by the Ministry of Health with 12 different ministries.

India is on the right path with the recent decision to open the vaccination drive for the general public and to speed up private sector participation. While developed countries like United Kingdom, United States, and France are still struggling with either strict lockdowns or a health system operating under tremendous pressure, India in contrast, has done well in focusing on preventive measures such as an early lockdown, that also provided a window to establish robust health systems to contain the virus and treat those with the disease. The country has seen a drop in the number of cases – though there has been a rise in some parts of the country in the past month — and deaths considerably. Therefore, India is in a much better situation to fast track the vaccination drive to achieve herd immunity and prevent the second wave of infections.


As the third phase of vaccination closes in, it is vital that we draw inspiration from past lessons and move to inoculate our priority population. Behaviour change communications must be intensified. Mass media (radio, television, billboards, print material, and internet), interpersonal channels and community mobilisation must be optimised to advertise and achieve the desired outcomes. There is a need for active involvement of people from all strata of the society — local community leaders, associations, private sector, celebrities, religious groups, experts, and political leaders. It will not only keep misinformation at bay but find acceptance among all. Let people take the lead here. With more evidence pouring in, vaccine hesitancy among the healthcare providers is bound to evaporate soon.

The author is a former Joint Secretary at the Ministry of Health & Family Welfare

First published on: 17-03-2021 at 19:32 IST
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