Vaccine hesitancy will prolong the return to normalcy, and abysmal figures such as a mere 10% having been fully vaccinated in India by early August of this year, are a wakeup call for policymakers and healthcare administrators. Health workers face stiff resistance from people who believe that vaccines cause impotence, lack of trust in vaccine efficacy, serious side effects and even death. Rumours about jabs disrupting the menstruation cycle and reducing fertility have also contributed to the mounting fear. A target-based approach to overcoming vaccine hesitance would entail making available credible information, promoting pro-vaccine campaigns, improving accessibility, promoting women leaders, and facilitating transformational change.
Vaccine hesitancy (VH) is becoming a global concern. Vaccine acceptance rates vary from 55% to 90% across countries as shown in a recent survey. In January 2021, the Government of India (GOI) rolled out one of the world’s largest vaccination programmes to vaccinate a population of 1.3 billion against COVID-19, in a phased manner, and has tried to ensure that all supply-side arrangements are in place. However, as of 29 August 2021, only about 10% of people had been fully vaccinated, and 24% were partly vaccinated. With a little over 336 million partly vaccinated until 28 August 2021 and at a current rate of 5.2mn doses per day, India can only cover 30% of the population by the end of 2021.
The ongoing pandemic as a health catastrophe has not only affected all ways of life but has also brought forward the challenge to fight misinformation and fake news floating on the internet and social media platforms. On 2 February, the WHO dubbed COVID-19 a massive ‘infodemic’ and has attempted to address the issue by partnering with social media platforms to clamp down on misinformation. The Ministry of Health and Family Welfare (MoHFW) stated that "rumours and fake news harming the poor most and people should be protected”. With the new June 2021 vaccination guidelines, while the GOI again tried to ensure that all the supply-side challenges were addressed, it was unable to provide sufficient attention on the demand-side hurdles such as vaccine hesitancy.
Why are people refraining from getting vaccinated?
A recent research article explored vaccine hesitancy in India and its trends across states. As part of the research, they used277,844 responses from the Facebook COVID-19 Symptom Survey (CSS). The aggregate weighted estimates at the national level suggest that a significant proportion of individuals (29%) showed hesitancy in taking up the vaccination. More than 16% showed reluctance (‘Probably Not’) and 12% were definite about not taking the vaccine. The proportion of the population hesitant to get vaccinated is highest in Tamil Nadu (40%) and lowest in Uttarakhand and Assam (15%). The CSS surveyfurther explored the reasons for not taking the COVID-19 vaccine. The top five reasons for not getting vaccinated include: “concerns for side-effects” (38%), “waiting for others to get it first” (49%), “other people need it more than me” (25%), “vaccines won’t be beneficial” (31%), and “don’t believe in vaccine” (12%). Reasons such as the “cost of vaccines” (5.4%) and “religious belief” (3.5%) as reasons for not getting the COVID-19 vaccine remain minuscule. Apart from these, research shows that in India, men (76.5%) indicated stronger willingness to accept the COVID-19 vaccine than women (73.6%). Educational differences also mattered substantially in India. Individuals with higher levels of education were more likely to say they would get vaccinated (84.9%), and individuals with low levels of education were more vaccine-hesitant (46%).
As per the LocalCircles survey, around 12% of India’s unvaccinated population do not intend to take the COVID-19 vaccine “at all” even as the country faces the prospect of a third wave. With this hesitancy, there is a vaccine wastage in India as high as 37.3% in Jharkhand, 30.2% in Chhattisgarh and 15.5% in Tamil Nadu, and this hesitancy poses a risk to ending the pandemic in India. Health workers face stiff resistance from people who believe that vaccines cause impotence, lack of trust in vaccine efficacy, serious side effects and even death. Rumours about jabs disrupting the menstruation cycle and reducing fertility have also contributed to fear and have skewed the data in favour of men. Due to these reasons, the COVID-19 outbreak has exacerbated tensions that were already prevalent amongst different religious and caste groups in India. There have been several reports of stigmatisation, discrimination, and targetted attacks in the media over the past year. Overcoming the vaccine hesitancy needs a target-based approach which will focus on the needs and concerns of individuals, groups, and communities.
Target-based approach to overcoming hesitancy
As a way forward, we propose:
- Creating more awareness by making available credible data and information: Lack of credible data around COVID-19 has been a challenge that the country has been facing since the pandemic started; India’s research community have raised their concerns in the past in accessing data on the patterns and severity of the COVID-19 infection. Availability of transparent data systems and real-time monitoring will help in fighting against misinformation, building trust, and in efficient decision-making. Many state governments have set-up COVID-19 war rooms that aim to ensure real-time monitoring, but it is equally important that quality of data is emphasised to preempt and assess the situation for better service delivery and outreach to citizens. The accuracy and quality of data and information would help in creating more targeted awareness campaigns.
- Promoting social media for pro-vaccine campaigns: The Indian government should harness the power of social media platforms to wage a pro-vaccine campaign. Research shows that there is a “need for cognitive inoculation against misinformation”. It recommends tracking “COVID-19 vaccine misinformation in real-time and engaging with social media to disseminate correct information [to] help safeguard the public against misinformation.” Apart from that, the government should undertake more ‘conventional’ campaigns through TV and newspaper advertisements in adequate measure to curb misinformation.
- Improving accessibility: Technology is considered to be a part of the socioeconomic space – from ensuring technological viability to sustainability, it also requires addressing accessibility concerns. Govt of Odisha’s Department of Social Security & Empowerment of Persons with Disabilities Department (SSEPD) and UNDP have conduct awareness programmes around digital training and financial literacy for the elderly and people living with disabilities in India, which helps to facilitate access to various government services which are available on digital platforms. The Government of India should leverage this portal to promote pro-vaccine behaviours and facilitate the process to register online. Furthermore, the Bombay High Court has advocated for the door-to-door vaccination drive which is the need of the hour for senior citizens and disabled members of society from various walks of life. The Maharashtra government is set to launch a door-to-door vaccination trial drive starting August 2021.
- Promoting frontline workers to reduce gender gaps: Evidence has shown that exposure to female leaders in government helps to bridge the gap in biases in perceptions. Additionally, it is equally important to pay attention to supporting and promoting frontline workers such as Accredited Social Health Activists (ASHAs), who play a critical role in creating awareness and providing last-mile delivery in their communities. After continued strike by 70,000 ASHA workers earlier this year, the state government of Maharashtra has acknowledged their efforts and are going to increase the salary for ASHAs. It is critical to ensure that a support system is created for frontline workers to meet their needs by providing for their safety, insurance, and risk allowance for their service during the pandemic. Further, promoting targeted outreach programmes by involving community platforms like SHGs to mobilise and create awareness amongst households is needed to ensure women and marginalised members of the society are not left behind.
- Facilitating transformational change: Transformational change will be required by the government to address the systemic barriers, and to promote sustainability and in building a resilient system. With internet penetration in India standing at below 50% in 2021, India has miles to go in setting up basic infrastructure for connectivity and addressing structural barriers for effective implementation of IT-enabled systems. While achieving transformational changes might be a long-run outcome for the government to achieve, in the short to medium term, it would be worthwhile to leverage mobile connectivity (which currently stands with more than 85% of the population having a phone connection) and would be advantageous in adapting service delivery through other technology such as Unstructured Supplementary Service Data (USSD) and Interactive Voice Response (IVR) technology for immediate and urgent needs that have to be met where physical mobility is restricted due to the pandemic or lockdown circumstances.
Conclusion: In light of these, the GOI should promote pro-vaccine campaigns and provide necessary services in high illiteracy and poverty prone areas to increase the vaccine uptake. At the same time, misinformation should be curbed and condemned. Spreading accurate and sufficient information on COVID19 vaccines should be encouraged and can improve vaccine uptake. Therefore, the GOI needs to be more upfront in providing the latest information about COVID-19 vaccines. Achieving the ambitious target to vaccinate 300 million individuals by September 2021, requires a collaborative effort from relevant stakeholders to prevent the potential third wave. Going forward, India’s ability to achieve its objectives of vaccination campaigns will depend on health care capacity, overcoming vaccine hesitancy and misinformation, and ensuring an equitable distribution of vaccines.