How India scaled up its COVID vaccination campaign

“As a doctor, I (a) understood the importance of getting the vaccine shot, but the villagers in the area showed no interest. Our Accredited Social Health Activist The (ASHA) workers were trying their best, but the villagers could not believe it,” Jain said.

“Finally, I decided to step out of the PHC and go on the ground to bring about a change in the behavior of the people,” Jain said.

This decision—inspired by a “sense of unrest within him,” says Jain—dramatically changed the nature of his workday. Had to make door-to-door house calls. Had to learn effective science communication on the go. Jain’s daily routine runs from 9 am to 4 pm, mainly inside an office, now sometimes till 8 pm. It all depends on his field visit on a particular day.

Doctors like Jain have started coming out in many parts of the country. The results of this campaign are already visible. In the past two weeks, India’s daily vaccination clip has grown exponentially. more covid-19 vaccine The dose was given in the first week of September as compared to the full month of May. Rural areas have led this mini boom. And PHC doctors are a vital force in the system that is falling into place.

Intentions vary—with the supply of vaccines improving, some states have set district-level targets that doctors have to meet; Many rural doctors also want to stop the third wave because the second wave has pushed them to the brink; Some consider it a duty to the village or city they serve.

“The average per-day dosage has increased from 2 million in May to 7.8 million in September. This number is expected to climb even higher,” said Rajesh Bhushan, Union Health Secretary.

What has helped this effort is that PHC doctors are a trusted figure in many parts of rural India. This does not mean that threats of abuse or even violence do not exist.

For example, Jain recently recalled an incident during a visit to a waterlogged area in Chhindwara district to persuade a family that had four elderly members. She said, “The eldest member of the family was angry with me because I went to (his house) for two days in a row. He threatened to attack me with a chisel if I ever went back to his house. But I persevered and kept coming back.” until I found an emotional connect with the family and told them that the risks of vaccination are much less than that of the disease. Two days later, the whole family came to the PHC and got vaccinated.”

“I wanted them to survive, so I gave them advice,” Jain said. “We are slowly gaining success. And that’s my reward.”

vaccination target

Dr Raj Kumar, District Immunization Officer (DIO) of Amroha, a district in Uttar Pradesh, is expecting to achieve 100% vaccination coverage in his district within the next 50 working days.

According to Kumar, 50% of Amroha adults have received both doses of the vaccine. He said this figure did not come easily. They had to spend several sleepless nights before the district was able to meet the daily vaccination target set by the state government.

“Uttar Pradesh is one state that had major vaccine hesitations. Our target was to deliver 14,000 vaccine doses every day,” Kumar said.

“Religious beliefs and misinformation played a major role in keeping people away from vaccines. I have to give credit to the workers of my field, but there were times when I had to intervene. I have visited temples and mosques to motivate people to get vaccinated so that we can stop the spread of the serious COVID-19 disease.”

Kumar said it is important to devise outreach strategies based on the understanding that immunization programs have never been easier. “Whether it was polio or smallpox, it took years for people to understand the importance of vaccination. And this (ongoing effort) is an adult vaccination programme. It’s all the more difficult.”

“It seems people have fears about vaccines. But, to an extent, villagers respect and listen to doctors. After teams of doctors started visiting villages, we have gained traction at vaccination centres, Kumar said.

Dr Sunil Kumar Meena also went through a similar experience in Virat Nagar, Jaipur, Rajasthan. “In my area, people refused even the Covid-19 test. Vaccination was a distant dream,” Meena said.

“Eventually, all health workers—from doctors to nursing staff—held village-level meetings, house-to-house surveys and announcements through speakers with the participation of the local ward sarpanch or teacher. Now people are coming forward.”

The average rural versus urban vaccination ratio this month has been 2.3:1. “This means that for every person vaccinated in an urban area, at least 2.3 people are being vaccinated in rural areas. If this trend continues, the rural population will get immunization in about half the time,” said Balaji S Reddy, assistant professor of operations at the Balaji Institute of Modern Management, Pune.

According to Reddy’s calculations, the rural versus urban ratio is less than 1 in only a handful of states—Delhi, Chandigarh, Mizoram, Puducherry and Telangana. The current ratio is around 1:1 in states like Arunachal Pradesh, Nagaland and Tamil Nadu. In every other state, rural areas are overtaking urban centers in terms of vaccination coverage.

“Most urban residents seem to be suffering from vaccination hesitation. This can be attributed to over-thinking by the educated and informed class. The hesitation seems to be waning, but it is still there. On the contrary, the rural population has undeniable faith in the doctors of their area,” Reddy said.

challenges remain

On 1 September, India administered more than 10 million vaccines in a single day for the first time. Thereafter, the country broke that mark in two more days. Both walk-in (at the vaccination centre) and assisted registration through 1075 helpline are on the rise. But challenges remain.

Dr Mehul Mehta, Anchor of Maternal and Child Health and Nutrition at Tata Trusts said that many villagers are technically challenged and do not want to go through the hassle of registration.

“Also, on MGNREGA sites, people will disappear once they hear that a frontline worker has come to promote vaccination. In the evening, he used to go to the house of the frontline worker and tell him not to go to his house for the vaccination campaign. Hence, many frontline workers will avoid home visits,” Mehta said.

“There are many myths about vaccination in tribal areas in southern Rajasthan – people will die after being vaccinated; that they will have a fever; If they get vaccinated their population will drop; Or the vaccine is not good,” Mehta said, adding that earlier in some villages no one was getting the vaccine, but now the pace is picking up.

A study published in the latest issue of the Indian Journal of Public Health says that the vaccination program in India has matured over the past few decades and has shown great resilience. Program strategies to combat vaccine hesitancy and social resistance based on the experience of pulse polio and measles-rubella campaigns may not prove sufficient for the COVID-19 vaccination campaign, which includes both vaccine optimism and vaccine skepticism, study titled Covid – Said 19 Vaccinations and the power of rumours.

The researchers involved in the study further added, “Risk communication and community engagement strategies must account for both the psychological responses and the social contexts under which misinformation spreads.”

“Responsibility at the systems level is able to modify the information ecosystem to reduce selective risk and opinion polarization. (On the one hand), this calls for an interdisciplinary team of social scientists, psychologists, computer scientists and public health professionals , and on the other hand, an ‘IT war room’ in industries and continued engagement with the Internet (that is) during and after the consumer-drive,” the researchers said.

drone delivery

In addition to hesitation, as India’s vaccination campaign picks up pace, reliable supplies will also be an important factor—especially in inaccessible rural areas. In an effort to address the latter concern, the Indian government now plans to leverage the use of drones to provide stable access to COVID-19 vaccines, even in remote rural areas. The pilot drone delivery program began last week.

The ‘Medicine from the Sky’ project will be trialled in the southern state of Telangana. This will include beyond line of sight (BVLOS) drone flights for the delivery of vaccines. And the tests will take place over a period of 28 days.

HealthNet Global of Apollo Hospitals is a founding partner in these trials, as well as World Economic Forum, Telangana government and NITI Aayog. With the country focusing on achieving 100% adult immunization, reliable vaccine supply will be a major hurdle that needs to be overcome.

Telangana Minister for Information Technology, Industries, Municipal Administration and Urban KT Rama Rao said, “The pandemic has highlighted that the health supply chain needs to be further strengthened and drones present a strong value proposition, especially when it comes to When it comes to remote areas and emergencies.” development. “Drug from Sky is a first of its kind initiative in the country which generates insights that will benefit the entire ecosystem,” he said.

If the drone delivery trial is successful, the model could also be used for the commercial delivery of emergency medicines and vaccines. After initial trials, there are plans to expand the network within the state before partnering with other states.

The initiative will also outline a number of challenges that the drone delivery service can potentially solve – how to monitor operations and implement such a program. “The use of drones could make the delivery of critical drugs, vaccines and other essential medical supplies more widespread and faster. The technology will strengthen India’s (existing) universal immunization programme, said Vikram Thapalu, chief executive officer, Healthnet Global and Apollo Telehealth.

“Drones would be best suited for hilly and tribal areas where stock-outs are experienced frequently. It could also aid India’s ongoing efforts to control mortality and morbidity as the country grapples with the pandemic. The ‘Medicine from the Sky’ initiative will generate important insights that can drive future adoption strategies as well as policy interventions to incorporate drones into the health supply chain.”