Universal Vaccination Key to Victory Against COVID

Sandeep Chachra *

COVID-19 Vaccination at Bashikhong in Imphal East District on 3rd May 2021 :: Pix - Shankar Khangembam

Universal vaccination, and its timely achievement in the face of a mutating virus is key to the victory against the COVID pandemic. The challenges of achieving this involve scaling up supply of vaccines, an active vaccination outreach campaign and dealing with vaccine hesistancy in our country.

People must be vaccinated with free and informed consent, and without the use of indirect force or enticements. For this to happen quickly information is the key, much needed vaccination drives must be accompanied with authentic information and awareness drives.

While timing and who it will impact the most still remain open questions, we must be ready for a third wave, which has been unfolding in other countries. Whatever doubts exist, what is quite clear is that those at risk at first will be those who have not been vaccinated fully, or at all. This includes children and young adults, as well social groups and communities and also uncovered persons with co-morobities in rural areas who do not have the information, access or harbour skepticism about vaccination.

Or simply, are on the other side of the digital divide. Our vaccination drive must be powered with the understanding that no one is safe till every one is, and universation vaccination is the best way to ensure everyone’s safety.

However, we also need to understand the challenges of achieving universal vaccination. As on 21st July 2021 about 418 million doses of the vaccine have been administered, around 80% of which were first doses. However if we want to achieve universal vaccination by the end of 2021 we would have to administer more than 10 million doses a day, a rate which keeps going up as the daily numbers hover around 20 to 30 lakhs only. The challenges we face are that of supply, ensuring vaccine outreach and tackling vaccine hesitancy urgently

The challenge of vaccine supply

To further augment vaccination supply lines, not only do the vaccines from other countries need clearance and availability, but more importantly our domestic production must scale up, to the level it has been announced in the media. For a vaccine and medicine factory of the global south, that is what India has been also known as, this is indeed a strange situation.

As we seek patent waivers internationally, we must also offer the same waivers policy and apply it strongly, internally for quick manufacture and harness our manufacture capabilities to the highest degree. Given our strong manufacturing capabilities, India should be in a position to supply countries of the Global South with the vaccines they need to make the whole world COVID free.

Need for an active vaccination outreach programme

The Union Government had made registration for the 18-to-44 group available online only via CoWIN, the Indian government portal for COVID vaccination. Keeping the reality of the digital divide in mind this policy is out of sync with ground realities. Online registration for vaccination means exclusion of crores who have no access to internet and smartphones, those who are not literate, and particularly those from rural and poor communities. Women and marginalized groups have marginal digital access.

The Supreme Court of India also flagged the nation’s digital divide by stating that even the digitally literate are finding it hard to get vaccine slots on CoWIN. The Hon’ble Court further stated that “A vaccination policy exclusively relying on a digital portal for vaccinating a significant population of this country between the ages of 18-44 would be unable to meet its target of universal immunisation owing to such a digital divide. It is the marginalised sections of the society who would bear the brunt of this accessibility barrier. This could have serious implications on the fundamental right to equality and the right to health of persons within the above age group”

The court quoted from a National Statistics Office survey of 2018 which said that around four per cent of the rural households and 23% of the urban households possessed a computer. A Telecom Regulatory Authority of India report shows the wireless teledensity in rural areas is 57.13% as compared to 155.49% in urban areas as on March 31, 2019. The report stated that: “this reflects the rural-urban divide in terms of telecom services’ penetration”.

Countering vaccine hesitancy

We need to recognize that there is significant vaccine hesitancy, and this cuts across income groups and classes, as well as geographies. In our ongoing campaign to spread awareness and updated information on #COVIDAppropriate Behaviour and Covid Vaccination in 120 districts of India, we have come across, both in town and countryside, and across social, income and age groups resistance to the idea of COVID Vaccine. This, despite the Governments efforts of using media and messaging to encourage to people to vaccinate and be safe.

The World Health Organisation(WHO) describes vaccine hesitancy as the reluctance or refusal to vaccinate despite the availability of vaccines that threatens to reverse progress made in tackling vaccine-preventable diseases. In 2019, the WHO listed “vaccine hesitancy” as among the top 10 threats to global health. From the feedback our campaigners receive, the reasons why people choose not to vaccinate range from a simple lack of information about the existence of vaccine, to difficulties in acccessing it, to more complex ones such as lack of confidence on vaccine efficacy, belief in other healing systems, to adverse impacts of vaccination including the the big fear catching COVID after vaccination, and of death.

Misinformation, lack of access to balanced and accurate information and confusing information is a major contributor. In the past months, there have been several changes in pronouncements regarding the efficacy percentage of different vaccines, vaccination intervals, on the science behind it, information on trials, and even on the speculation about the origins of the virus. Social media, and in particular the whatsapp information factory, spreads unverified information on vaccines as well are endless alternative cures to COVID.

Just over a month ago, thousands of desparate people flocked to Krishnapatnam village of Nellore district in Andhra Pradesh to get the miracle cure based on news and information making them believe that they would be treated instantly. In a civilisational country, where there are so many faith and cure systems established for ages, the ability of a government initiated campaign to convince people to vaccinate quickly is proving rather limited.

This is strange as this was not the case, with other earlier large scale vaccination campaigns such as polio. Perhaps this is explained by the counter information which is speedier, wider in coverage and comes from sources which are more trusted. Unless this is addressed, it will add a roadblock to the desire for speedy vaccination and therefore in efforts to reduce the impact of the third wave.

Here the messenger becomes as important at the message itself. When the messengers and mediums evoke trust, the campaigns of enabling more people to decide on vaccination will no doubt succeed. Local languages and dialects, and use of channels such music, folk songs, jingles and puppetry, community and local radio and news have helped us in our ongoing efforts on vaccination awareness.

In our experience from the ground, the messengers are more important. In districts where along with the district officials, where we our local volunteers have strongly tied up with communities own leaders, young volunteers, faith leaders, village school teachers, ANMs and trusted local figures and invited them to join these efforts, they have brought considerable influence on vaccination decisions.

The districts of Ramgarh in Jharkhand and Gadchiroli in Maharashtra have been successfully utilising networks of ANMs to create awareness and reduce vaccine hesitancy. There is thus need to promote. encourage and support such collective civic action supported by administration. In this regard NGOs, social organisations and community formations have a crucial role to play now and in addressing third and future waves, and will need an enabling environment and support of the state.

As in any other challenging situations, the best principle and strategy is always to embrace transparency. Inadequate investigations into deaths of people who have been vaccinated not only raise doubts about the use of vaccines but also raise questions about our commitment to transparency, which contributes to vaccine skepticism. There is strong need to investigate, monitor, and tranparently report adverse events following vaccination, including their likely causes and this has not been done, giving room to speculation and mistrust.

The fact that COVID deaths are underreported both in terms of numbers and causes of death, and its only at the instance of Courts of the land that several state govermments have begun raising death numbers, has given rise to a concern that there is something to hide, more than the inadequate management of the second wave response. Recommendations of the Lancet Task force report on India with reference to reporting adverse events following innoculation are a good beginning point.

A multi pronged approach will help India eliminate the menace of COVID in our country, but play a leadership role in the efforts of the Global South to rid the world of this menace.


* Views are personal and do not reflect those of the organisation. This article was first published in The Frontier Manipur