Meningitis, measles, diphtheria, rubella, mumps, rotavirus, hepatitis…these diseases place a heavy burden on India and its citizens. When a child gets admitted to a hospital, their parents feel the burden of the medical bills. For those in rural India, this burden can feel very heavy. Many of these conditions impact the child’s long-term neurological and physical development. This means they impact the child’s education and future livelihood, not to mention the impact on India’s economic growth due to this lost potential.
What makes it even more painful is that it is entirely preventable.
India has the highest number of unvaccinated and under-vaccinated children on the globe. India was one of the first countries to adopt the World Health Organization’s Expanded Programme of Immunization (EPI), and efforts from the government like Mission Indradhanush have taken a targeted approach to immunization in India. Immunization capacity has grown in leaps with these initiatives, not to mention the rapid growth we have seen since the start of the pandemic. Nevertheless, we keep falling short.
The shifting goalpost
On the one hand, there is a constantly growing disparity in vaccine coverage. Coverage numbers vary wildly by state. Rural vaccination coverage is considerably lower than urban coverage. Even in urban settings, there are significant disparities. Vaccine coverage in urban slums, for example, is deficient compared to other urban areas.
On the other hand, new variants like Omicron and Nu keep throwing challenges at us. Like a game of snakes and ladders, each new variant brings the possibility that it will side-step vaccine effectiveness and take us back to square one. Currently, just over 60% of the country’s population is vaccinated against COVID-19. Even at this rate, statisticians say we need to accelerate the vaccination drive three-fold!
However, while some of this is not happy news, are we truly surprised?
We have had an eye on the impending third wave. We have known that this is not the first and will not be the last pandemic. We had SARS before, and we will have another coronavirus in the future. This shifting goalpost validates our belief that we need to get ready to kick the ball harder and farther than ever before. Our preparedness needs to grow to meet these multiple challenges.
Sambhav’s journey to vaccinate more than 6 Lakh people proved beyond a doubt that a successful vaccination drive needs a multi-pronged strategy.
Getting to the Roots of the Issue
The first important factor to be considered is behavioral. There was a lot of uncertainty and chaos at the beginning of the COVID vaccination effort. COWIN was difficult for rural India to access due to the digital divide. Moreover, we collectively fell short when it came to arresting the spread of misinformation. Rural India believed it was a hoax or ‘divine wrath’ for the longest time. When they did start seeking vaccination, they faced even more confusion. Public Health Centres are, on average, 6 km from a rural home. While this may not feel like a lot for an urban dweller, making a 12 km round trip just to be told to come back the next day can spell untenable wage losses for a rural citizen.
The loss of faith in the health system will only be rebuilt with community interventions.
The other important factor to be considered is logistical. A vaccination camp is a logistical challenge. It needs more than just a person to administer vaccines. Ensuring efficient operations requires management and service delivery staff at all levels (state, district, sub-district) to improve their use of available information. A vaccination camp needs multiple role players to do their job well. A vaccine administrator needs to be familiar with the necessary equipment and protocol. Data entry personnel need to verify identity documents and register them into the system. Community mobilizers need to build trust, spread awareness, dispel myths, and improve attendance. Counsellors are needed to guide those vaccinated to understand the care they need to take when they need to visit next. Site managers need to manage the flow of information, materials, and people through the camp.
Building these skills at the local level so that vaccination capacity for COVID-19, any new resurgences, and other preventable communicable diseases is now mission-critical.
The Route Ahead
Each district and village needs to have the capacity to mobilize vaccination drives quickly and effectively. That means a cadre of skilled personnel needs to be trained and deployed across the country. Personnel need to be trained for the vaccination drive against COVID-19 for children with co-morbidities beginning in December. Following this, there will be a rollout for healthy children. We have eradicated polio and smallpox; if we take the proper steps now, COVID-19 should not be any different.
