Vaccination: The State must lead the charge of the enlightened brigade
On April 26, when the murderous second wave was at its peak, my colleagues and I zoom-huddled over an excel sheet. We were trying to understand how informal workers could be readily vaccinated. At the time, we assumed vaccine equity was the single biggest challenge. Our data was counter-intuitive.
A fortnight earlier, we had surveyed 4,774 adults from 2,097 families to glean their perceptions about vaccination access. Our respondents were from 14 slums across Delhi and Ghaziabad. Much to our surprise, only 7% of the respondents were willing to be vaccinated.
Some of the stated reasons were no surprise. About 20% said since they were well, an “injection” was unnecessary. Some believed they would pull through, since they had survived this long. But 31% described themselves as “afraid” of the vaccine’s aftermath. “Please,” wailed a young man tearfully into his cellphone, “don’t ask me to take the teeka. What will happen to my children?” Evidently, one of the overwhelming fears was of death by vaccination. Vaccine-caused impotency was an additional concern. Most unexpected was a throwback to 1857; Hindus and Muslims believed the shot contained extracts of sacred or banned animals.
The role of fake news, rumours and poorlyinformed local influencers is palpable. Those who expressed (misplaced) fears claimed they received this information from WhatsApp and general chatter, and claimed that “everyone knew this”. They had not received any other kind of scientific information to encourage them to vaccinate. Such damaging misinformation seems to be filling in an information vacuum.
In May, as the second wave persisted, we called 1,200 people to be vaccinated. Of these, only three per cent agreed. Then we enrolled a charismatic leader from a Delhi slum, who convinced 12 people to get the first shot. In the videos she made, they were pleasantly surprised to be unharmed. Yet, women said it was impossible for them to leave their children, figure out centres and reach there. Not only is the digital divide a barrier, but the multiple roles women have had foisted on them, is an additional challenge.
Erasing vaccine hesitancy in every pocket is pivotal to closing the chapter on this endless pandemic. What approach might work?
The State must lead the charge of the enlightening brigade. Fighting false information is daunting, but possible. Campaigns with influencers such as the local councillor and legislators to celebrities can build confidence. Doctors must weigh in as well. The media and social media should amplify this.
Vaccines must be made easily available, especially when we have enough of them. Instead of hoping that the poor will overcome multiple roadblocks and register or forego a day’s earnings in these hard times, mobile units should roll out, on priority, in all slums. Why not use our under-used public transportation buses for walk-in vaxxing?
Local leaders have a special role in ensuring this becomes a gamechanger, as Mumbai showed us. Currently, camps are held in the clubs and localities of the better-off, mostly organised by themselves. Even when domestic staff is encouraged to attend, it doesn’t touch most of the urban poor. And, remember, much as 40% of the urban population lives in slums. We must reach them more effectively.
Some of India’s influential upper-middleclass citizens proclaim that the poor don’t seem to have been hit as intensely by even the second wave, far less the first. In reality, we don’t know. We don’t have credible data. Anecdotal interactions are too local, hiding as much as they reveal. And irrespective of which class got affected to what degree, the simple fact is that each of us has to take the jab for all of us to be safe.
With the second wave ebbing, a new vaccine policy framework in place, and a renewed push by governments to encourage vaccination, there is hope. But to see light at the end of this tunnel, India must ferociously identify where vaccine hesitancy still exists and battle this.