June 3, 2021 7:30:09 pm
Written by Akshay Tarfe
In early January, the Ministry of Health and Family Welfare (MoHFW) released the ‘Covid-19 Vaccine Communication Strategy’. This comprehensive document with action points was supposed to serve as a guide for national, state and district level authorities to fight vaccine hesitancy. Five months later, the country continues to witness spike in incidents related to vaccine hesitancy. In Uttar Pradesh, villagers reportedly jumped into the river due to rumours about the vaccines causing impotency. In Kashmir, Senior Superintendent of Police (SSP) of Baramullah declared that “adding to vaccine hesitancy should be treated as abetting murder.” In Madhya Pradesh, health officials were attacked over vaccine hesitancy. This puts a big question mark over implementation of Centre’s Covid-19 vaccine communication strategy.
How big is vaccine hesitancy? Ever since India started “the world’s largest vaccination programme” on January 16, major attention has been given to shortages of vaccines, the tussle between the Centre and states over prices, the overall slow pace of the drive and patent and production barriers. Vaccine hesitancy has been ignored, with the underlying assumption that it will disappear with higher vaccine availability. But vaccine hesitancy has remained and is building up to be a problem for the future, despite India having administering 21 crores vaccine doses as of May 2021.
The macro-picture of vaccine hesitancy does not look promising either. The trends from Facebook’s Covid-19 Symptom Survey (CSS) in India show troubling numbers on vaccine hesitancy. The analysis show India’s vaccine hesitancy rate is around 28.7 per cent with variations across states and union territories (UTs). Vaccine hesitancy rates are as high as 42 per cent in Tamil Nadu and 41 per cent in Punjab as per CSS. It is important to note that the Facebook survey is more likely to have participants from urban centres, from people with internet access. The current news reports indicate vaccine hesitancy is prevalent in remote areas and geographies with limited connectivity where vaccination teams are not able to achieve 100 per cent vaccination despite multiple visits, even if doses were available. Highly-informed groups like medical students across 22 states have shown a 10.6 per cent vaccine hesitancy in a survey conducted by AIIMS Jodhpur.
What are the consequences of this? Tackling vaccine hesitancy is not only important for achieving universal vaccination but also to uphold human rights and medical ethics during the vaccination drive. Interestingly, incidents of vaccine hesitancy leading to confrontations with health authorities are not new in India. India intensified its efforts in 1973 to fight small pox through vaccination. Several drastic measures were used to contain the disease. The historian Paul R Greenough has noted records of military-style raids on the villages of north India and Bangladesh by the administration to implement vaccination using force during these times. Even back then such measures disproportionately affected marginalised groups, such as Muslims, women, tribal populations and other minority groups. While these measures might have appeared successful in the short term, they increased vaccine hesitancy for other immunisation programmes and a spike in community resentment towards health workers.
A few years later,the Government of India successfully course corrected its strategies in fighting vaccine hesitancy during the polio eradication campaign. The government collaborated with community and religious leaders to fight misinformation and fear of the polio vaccine on ground. These collaborations also provided new allies to the health department to advance nutrition, child health and maternal health.
The strategy, then, should be to tackle vaccine hesitancy with community engagement and not with force. Union Minister Prakash Javadekar announced last month that India plans to vaccinate its entire population by December 2021. As vaccines doses become gradually available and shortages are addressed, it would be vaccine hesitancy which would risk derailing India’s vaccine efforts.
During these critical times, temptations to invoke extreme measures to fight vaccine hesitancy need to be avoided by both political and administrative leaders. There have been demands to invoke the stringent Compulsory Vaccination Act of 1892 and similar legislations to make vaccination compulsory by law. This will set a dangerous precedent.
The central government should certainly focus on improving communications strategy for Covid-19 vaccination based on direct community engagement, trust building measures and compassion.
Several district officers and health workers across states are taking innovative measures to fight vaccine hesitancy with through offline means. As a first step, the government needs to create a platform which enables collaborative learning of district administration and health workers. This can include how Maharashtra’s Nandurbar district administration is using mobile teams to tackle vaccine hesitancy or how in rural Chhattisgarh folk songs are being used to spread the right information on vaccination.
Second, groups and geographies with the highest vaccine hesitancy need to be identified and targeted communication interventions need to be created to address their concerns.
Third, misinformation around vaccines even at the international level is creating havoc in rural areas as the false post attributed to a Nobel laureate showed us last week. The National Media Rapid Response Cell (NMRRC) set up under the Covid-19 vaccine communication strategy needs to alert district collectors across India about vaccine fake news in real time.
Fourth, Governments need to rope in celebrities, community leaders and mass influencers to generate credible voices for vaccination, just like
Amitabh Bachchan did for the Pulse Polio campaign. So far only the state of Punjab has appointed official ambassador Sonu Sood for vaccination.
Finally, a comprehensive review and evaluation of the Government of India’s Covid-19 vaccine communication strategy needs to be conducted considering the fast pace of infection and the ever-changing scenarios in vaccine hesitancy. Covid-19 vaccine hesitancy cannot wait to be addressed till supply chain issues are fully sorted. Delay in intensive efforts means delaying the end of the pandemic and puts us at risk of ignoring several human rights concerns in the vaccination drive.
The writer works as a media specialist at Oxfam India. Views are personal.
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