Beyond COVID 19 Vaccination Rates: It’s Time to Address Vaccine Hesitancy in India

Globally, including India is continuously striving towards improving Covid 19 vaccination rate. In India, about 15.55 %  of the population has been inoculated with at least one vaccine dose as of 17^th June 2021. Low uptake of vaccines has the power to reduce the Vaccination impact. The World Health Organization defines vaccine hesitancy as “to delay in acceptance or refusal of vaccination despite the availability of vaccination services.” The determinants of Vaccines could be understood through the WHO-led 3Cs model. In this model, 3Cs represents Complacency, Convenience, and Confidence as three categories. Complacencyrefers to the factors which represent the perceived risks of vaccine-preventable diseases. Indeed, where it is low, the population will not feel the vaccination need. Convenience is another factor that refers to the physical availability, affordability, and willingness-to-pay, geographical accessibility, ability to understand (language and health literacy). The last, Confidence, that refers to the trust in terms of the effectiveness and safety of vaccines, and  the delivery system that delivers them.

Vaccine hesitancy exists in different degrees globally.  Align with that, Sallam ‘s Concise Systematic review study reports that how COVID 19 Vaccine acceptance rate varies from country to country (Ecuador-97%, France-58.9 % , Malaysia-94.3%, Indonesia -93.3%, and China-91.3%,  Kuwait-23.6%, Jordan-28.4%, Italy-53.7, Russia 54.9%, Poland-56.3%, US-56.9%, and France-58.9%). Coming to India, Choudhary’s Study (COVID19 Symptom  Survey, based on Facebook data) reports that the Vaccine hesitancy exists in different degrees in different states ranging lowest to Kerala with 20 % while the most in Tamil Nadu with 42 %).

The GoI and state government have implemented a package of interventions to deal with all three determinants of hesitancy. Despite these, the Choudhary study reports that the vaccine hesitancy for Covid 19 is 28.7% at the national level. Media reports entail that hesitancy still exists in all three determinants. These are; Complacency ( Rural Population think that the coronavirus spreads only in cities), Convenience (Hesitation about travel among the elderly population), Confidence(Religious Sentiment regarding use of Calf Serum in Covaxin Vaccine;  Fertility potency Concerns; Vaccine Efficacy Concerns; Covishield Vaccine Safety Concern link with blood Clotting ).

Communication plays the most significant role in hesitancy reduction. Hesitancy is one of the critical elements in India’s Communication Strategies for Covid 19 Vaccination. On 24th February 2021, the GoI has developed and rolled out the strategies across India during the initial Vaccination drive. Communication strategies include a framework from the National level to the village level with specific activities. The strategies also include training of the entire communication frameworks from the national level to the frontline.

Covid 19 Virus variants are continuously changing. On these variants, Vaccine efficacies vary significantly. Apart from that, the rolling vaccines have limited efficacy evidence from field studies. On safety, different safety concerns arise for different vaccines like; thrombosis with thrombocytopenia syndrome (TTS) due to Covishield and Johnson and Johnson; Rare heart inflammation due to Pfizer and Moderna led Vaccines. These efficacy and safety concerns aggravate the vaccine hesitancies further.

Conclusion: Considering the vaccine as one of the most effective tools to fight the Covid19 pandemic, India has adopted an emergency approval route to allow effective and safe vaccines for mass vaccination. On 16^th January 2021, India launched the mass vaccination program to fight against COVID 19. It gets an initial jolt due to the limited vaccine supplies, which is improving now. Historically, vaccine hesitancy has always been in society. The Indian Government has implemented strategies to counter hesitancies, though still it has been reported in significant Indian population. The use of aggressive culturally sensitive  Information Education and Communications(IECs), Behavior Change Communications(BCCs), Interpersonal Communications (IPCs) tools with gender, religion,  age group optics could be instrumental in reducing vaccine hesitancy. However, these tools’ implementation needs to be target-based with solid monitoring and evaluation approach.

Authors :

Sanjeev Kumar works with the Health Systems Transformation Platform (HSTP) in Research Specialist Capacity. He has worked with multiple State Health Systems in India. (Twitter: @snjvkumar386)

Anand Kumar, Public Health Professional, India. He has extensively worked in strengthening Urban Health & MCH Services in Bihar, India. ( twitter:@optmanand)