How India can combat vaccine hesitancy

The diversity of India necessitates community engagement at the local level, through mediums that invoke trust, to counter misinformation about Covid

Biladi, a remote village in the district of Nandurbar in Maharashtra, recently found itself in national news. In this small village, with a population of a thousand, Sachin Patki, the principal of the zilla parishad primary school, has begun a crusade against the misinformation around vaccines. Every morning, he dons a different costume — as a policeman, a doctor or even a religious deity — to educate village residents about Covid-appropriate behaviour and the importance of inoculation. Not too far from Biladi is Bhagdari village, where the district administration of Nandurbar organised one-day vaccination camps for villagers.

The vaccination drive in India began on January 16. As of June 7, 232 million people have been vaccinated. We must recognise the major challenges in vaccinating the entire population. The foremost challenge has been a supply deficit. Announcing a reoriented vaccine policy on June 7, the Prime Minister announced a coherent path forward. Starting from June 21, the Union government will take charge of 75 per cent of the total procurement, and provide vaccines to states at no cost. The government has reserved 30 crore vaccines with Hyderabad-based Biological-E by facilitating an advance payment of Rs 1,500 crore. Fortnightly updates on the supply of vaccines to states are being taken to ensure transparency and efficiency in planning.

Two other complex challenges that need immediate focus are vaccine hesitancy and the much-discussed digital divide in the country.

With no “one-size-fits-all” solution to vaccine hesitancy, contextualised and curated approaches are crucial. The WHO has put forth the BeSD (behavioural and social drivers) vaccination model, which emphasises “motivation” as the vanguard of human psychology during a vaccination drive. Countries like the US and Israel have successfully driven up their Covid vaccination coverage by incentivising and motivating citizens. Unfortunately, in India, misinformation, disinformation and misplaced beliefs have led to fears about potential harmful effects of vaccines.

The diversity of India necessitates community engagement at the local level to counter this narrative of misinformation. Following the example of Biladi and Nandurbar, local authorities, cultural leaders and influencers must be empowered to spread the right information on vaccines. Indore, for instance, has set up crisis management committees at the district, block, panchayat and ward levels with public representatives to engage with people.

A successful information campaign requires dissemination through mediums that invoke trust. Local languages and dialects should be used to engage people via local radio, television channels and regional newspapers. Local artists can be encouraged to ideate and innovate through music, murals, graffiti, dance and drama. In the tribal districts of Chhattisgarh, for example, popular folk songs are being used to highlight the benefits of vaccination.

Another network that can be leveraged at the district level is that of the ASHA workers and the auxiliary nurse midwives. These are trusted local figures, who have considerable influence over the healthcare decisions of the community. The districts of Ramgarh in Jharkhand and Gadchiroli in Maharashtra have been successfully utilising such networks to create awareness and reduce vaccine hesitancy.

It is important to introduce solutions which bridge the digital divide. However, it is imprudent to suggest that only those with smartphones are getting vaccinated. Besides self-registration, the CoWin platform facilitates on-camp vaccine registration, which accounts for 55 per cent of the total doses administered. Over 2.7 lakh common service centres for vaccine registration will now benefit the unconnected. The Unique Disability Identification Card covering 32.38 lakh divyang beneficiaries has been added to the existing seven identification sources on CoWin.

A toll-free helpline number 1075 has been activated for those without internet. Similarly, districts can explore missed-call campaigns, asking citizens to give a missed call on local helplines, which could ensure that minimal infrastructure is being optimised for processing high-volume user requests. Even though the reported adverse events following immunisation stands at only 0.012 per cent, dedicated representatives can provide vaccine-related pre- and post-counselling to individuals and address queries around registrations, follow-ups and more.

The devastating effects of the second wave in rural areas have prompted fintech startups to enable vaccine registration. PayNearby is a startup operating across 17,622 pin codes and has helped over 8 lakh citizens register through its network of agents called “digital pradhans”, who are present in kirana, ration, mobile and hardware stores, frequented regularly by rural users. Adopting such unique models at local levels and integrating them with the established government and civil society networks across India can increase vaccine coverage.

Almost 81 crore beneficiaries, 75 per cent of whom are in rural areas, procure ration from 5,46,165 fair price shops across India. There are over 11 lakh business correspondent outlets in India working mostly in rural areas to advance the mission of financial inclusion. A network of around 1,54,965 post offices (as on March 2017) exists in India of which 1,39,067 are in the rural areas. Such points of contact can be leveraged as dedicated units for publicising the benefits of Covid vaccines and as physical locations for vaccine registration.

The Prime Minister recently described district officials as “field commanders” in our efforts against Covid. This ambit should move beyond just the district bureaucracy to the extensive network of public services. A stellar example of direct engagement also stems from the success of the Swachh Bharat Abhiyan. A volunteer network of 120 million school students, one million masons, 6,50,000 swachhagrahis, 2,50,000 sarpanches, 700 district collectors, 500 zila preraks, 20 brand ambassadors and the Prime Minister steered the outreach. This level of direct engagement with citizens contributed greatly to the operational success of previous immunisation campaigns like the pulse polio programme.

Vaccines mitigate the chances of contracting Covid-19. There is no caveat to this singular truth. There is much to draw from the robust diversity and vibrance of India to create an effective combination of insightful messaging, impactful mediums and digital interventions. Thinking local and utilising established networks to create culturally resonant messages is the need of the hour to reduce vaccine hesitancy, bridge the digital divide and achieve vaccine saturation.

This article first appeared in the print edition on June 12, 2021 under the title ‘A creative and local vaccine push’. Sahay is Young Professional (communication) and Mishra is monitoring & evaluation lead at NITI Aayog. Views are personal.

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