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India’s inoculation drive needs a new framework to address vaccine hesitancy

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The first five days' experience of the world's largest vaccination drive in India has come with a high price but is of immense value. 'Vaccine hesitancy' has emerged as the biggest roadblock while the operation as a whole presents a case of speeding up its implementation, providing training to a larger number of health workers, greater care at inoculation centres by eliminating all kinds of carelessness of all the persons involved, strengthening tracking and accountability framework, enhancing the preparedness for any future eventualities, and continuing with all the precautionary measures at least for four years to come to avoid the contagion. The situation is evolving fast, and therefore everyone needs to be alert.

The first phase of vaccination drive began on January 16 in India in which international agencies such as WHO, UNICEF, UNDP, WFP, UNFPA, etc., are also participating in various capacities. It will take at least eight months to complete. It is expected that inoculation of 300 million people in this phase could be completed only by August 2021, if we could conduct the drive as planned. The actual number of inoculations is much slower.

India could vaccinate only 6.31 lakhs health workers in the first four days across the country in 11,660 sessions. The Union Government cites 'vaccine hesitancy' as its primary reason. The Centre has urged the states to address vaccine hesitancy among some of the priority groups as if the whole problem lies with the states. The reality is that the Union Government is mainly responsible for this situation. The vaccines are given emergency use approval at the time when further trials were required. Further, the 'dos' and 'don'ts' were reportedly violated both by patients and the health professionals implementing the drive in some places, resulting in adverse effects, though infinitesimal.

Needless to say that the medical protocols and advisories framed by experts and the vaccine producers must be followed to reduce the adverse effects to a negligible level. A doctor, if he cannot improve the condition of a patient, must not deteriorate it further by his faulty decision. Any slack decision adds to vaccine hesitancy and a doctor must be more careful than the patients, most of whom are unable to accurately report their actual conditions as someone 'fit to receive the emergency vaccines'. Before the vaccination is extended to the larger population we must eliminate errors and adverse effects. "Vaccine hesitancy has to extinguish before the pandemic extinguishes," says Union Health Secretary Rajesh Bhushan. He also said that states have been directed to engage with beneficiaries. However, the Government needs to do much more.

If the Government acts properly and swiftly, the vaccine hesitancy can be removed, since adverse effects are very small in number. Only nine adverse events were reported that required hospitalisation so far. Minor adverse effects were also only 0.18 per cent across the country. The requirement of hospitalisation following immunisation was only 0.002 per cent. This is, in fact, the lowest in the world so far. In this sense, both the vaccines Covishield and indigenously made Covaxin are better than many others in the world. This is precisely the reason for which these vaccines are in demand all over the world, and India has pledged to supply the same to other countries.

"The vaccination drive will further be accelerated," says Dr VK Paul, who heads the high-level national expert group on vaccination administration. However, the speed of vaccination is very slow at present, and at this rate, India will need at least four years to vaccinate its entire population. Slow vaccination has its own problems, and therefore the whole operation needs to be accelerated to cover the entire population in the shortest possible time. It could only be done by employing greater financial and human resources in an equitable manner and garnering assistance from stakeholders to bring the most vulnerable people out from socio-economic fallout.

All this could not be done smoothly without greater support and reliable information. The manner in which rumours spread during the initial days of the drive underlines the need for proper information dissemination. Communication and advocacy efforts must, therefore, be enhanced to ensure the dissemination of factual information to stakeholders and communities. Strengthening tracking and accountability framework will help improve the situation which will not only be helpful for common people but also for the healthcare professionals and other administrative officials involved in the operation of infection control, prevention and psychological support.

Creating awareness programmes is necessary to dispel misgivings among the would-be recipients of the vaccines. The initial experience suggests that people are under the grip of safety concerns. In the first state of the first phase, only 10 million healthcare professionals are to be inoculated. When healthcare professionals and staff are found to be apprehensive about safety, one can just imagine the level of safety concerns among the people. It slows down the speed of the inoculation drive.

Though the vaccination drive is underway, the continued rise in infection and deaths, risks of new strains and other factors along with huge time to be taken in inoculation of the entire population, unrelenting vigilance against the pandemic and preventing its spread remains as important as ever. Tracking cases, cluster investigation, isolation, clinical care, and quarantining to break the chain of transmission are still required. We, as individuals, communities, and governments must keep the three 'W's' — Wear a mask; Wash hands; and Watch distance — underscored.

The critical failings in our pandemic alert and response including the early hiccups in the inoculation drive highlight India's need for a new framework. It is more so because the critical elements are found to be slow, cumbersome, and indecisive. Information, both right and wrong, is travelling faster than our system can formally report on them.

The system for alert and response should be rescued from the present trappings that are primarily analogue in a digital age. We must change it as soon as possible with proper training and a changed mindset. It also should be kept in mind that viruses travel in minutes and hours rather than days and weeks. Therefore, speed up.

Views expressed are personal

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