Should vaccination be made compulsory?

What is your assessment of India’s overall vaccination performance so far? In the initial days, there was hesitation about the vaccine and there were supply issues. Do you think we could have done better in terms of creating awareness among the people?

Of. Kolandaswamy: I think the COVID-19 vaccination program is going well. These are new vaccines, and perhaps the first time that the entire population is being vaccinated in such a short period of time. Vaccine supply and logistics issues have now been resolved. Vaccination campaign was carried out in a phased manner. We started with healthcare workers, frontline workers, then persons aged 60 years and above, then persons above 45 years of age with co-morbidities and finally persons above 18 years of age. There is proper vaccination coverage throughout the country. I think over 142 crore doses have been given in India, of which 82 crore doses have been administered in Tamil Nadu. But reaching the last mile poses a challenge, especially among the population over 50 who have either received their first dose but are reluctant to take their second dose or have not yet taken their first dose. . It is important to reach people who are still reluctant to be vaccinated. I think we need to intensify efforts to educate and adopt other ways to reach out to people. We can also apply legal remedies.

GR Rabindranath: Not only awareness, but also factors like availability, accessibility and acceptability are important. In the initial phase, we were troubled by all these factors. Initially there was hesitation in the vaccine.

India’s vaccination coverage is poor compared to some developed countries. Many countries are moving towards booster doses, but we have not completed immunization of all eligible individuals until the first dose of the vaccine. About 23% of healthcare and frontline workers are yet to get their second dose in India. This is a huge public health crisis as they have to treat patients in the event of a third wave. In Tamil Nadu also, one crore eligible persons have not yet taken the first dose, while 93 lakh are due/overdue for their second dose. Governments should promote scientific awareness and ensure access. Therefore, we have much more to do. Anti-vaxxers are actively spreading a lot of rumours, pseudoscience and unscientific information. Rumors are spread through social media and WhatsApp. So, we have a big task ahead of us. The government should make vaccination a mass movement by involving people from all walks of life.

Is it possible to make vaccination mandatory? Historically, have governments made any vaccination programs mandatory? Some states are aiming for 100% coverage. Is this possible?

Of. Kolandaswamy: Yes, it is doable. I can claim that I have the right not to get vaccinated but that others are at risk of being infected by me. So my authority ends when someone else’s right begins. Rather than the rights of the individual, the rights, safety and health of the community are the top priority. In a classic example, smallpox, a dreaded disease, was eradicated by making vaccination mandatory from 1965 to 1975. Across the country, COVID-19 has been declared a notable disease under various Acts of the States or Epidemic Diseases Act. In Tamil Nadu, the state government declared it a notable disease under the Tamil Nadu Public Health Act of 1939. Therefore, the local health authorities have the power to make vaccination mandatory under section 76. If anyone wants exemption, they have to approach the judicial. Magistrate. They cannot refuse vaccination unless on acceptable medical grounds; Unless the vaccination can put their lives at risk, which is very rare. Therefore, it is highly possible to implement legal measures to get people vaccinated.

GR Rabindranath: It is possible to achieve 100% immunization by intensifying campaigns, promoting vaccination and putting indirect pressure on people. Some cities have already achieved 100% coverage (1st dose). We have to study such models. The Nilgiris district in Tamil Nadu is model one. Many countries have made vaccination mandatory. Tamil Nadu has made vaccination mandatory for entry into public places.

The rights of the individual can be curtailed for the rights of the community. During a pandemic, we have to look at the rights of the community. But we must come up with a counter campaign against anti-vaxxers who are spreading many rumors like ‘vaccines can cause infertility’ or ‘vaccines can change the DNA in the body’. We need to educate people about the importance of vaccination – we need to tell them that it is a powerful weapon against epidemics and will prevent serious illness, hospitalization and death. A vaccine not only protects the individual but also protects others. Vaccination has brought many changes in our lives. Smallpox has been destroyed by this. Polio should be eradicated soon. Millions of children have been protected by vaccination.

The central government has stated that vaccination is voluntary, while noting that any false suspicion may result in vaccine hesitation. Do you think governments have created enough awareness about vaccines and their potential adverse effects? There are still some who are afraid of vaccines. Have people built up enough confidence?

Of. Kolandaswamy: The vaccination coverage achieved so far would not have been possible, but would have been due to education, awareness and trust built among people. Also we should educate people more in a very focused way. Governments and health departments are taking adequate measures but we can still enlist these population sub-groups and make targeted efforts to create awareness. We need to focus on educating people and ensuring that 100% vaccination is achieved. It may take a little more time. At Public Health, we believe in an education and service approach far more than a legal standpoint. Also, legal remedies can be used appropriately – by restricting entry, encouraging or discouraging – to persuade people to get vaccinated. Rumor groups and anti-vaccine lobbies should be dealt with seriously and legal action should be taken against them.

GR Rabindranath: Steps have been taken by the governments to create awareness but they are insufficient. There should be innovative and creative advertisements in the media to attract people towards vaccination. We can do door-to-door campaigns with local groups. In some districts, they have achieved full immunization by involving local people in campaigns. Panchayat leaders, ward members and women of self-help groups should be made aware first and then the public should be educated. We have to put in a lot of effort to promote vaccines. There are aggressive campaigns against vaccines. We have to rely on science.

Let’s look at vaccine equity and access. Has vaccination reached even the remotest villages of the country?

Of. Kolandaswamy: Yes. We have come across many video clippings of health workers traveling to inaccessible and remote places like hills and forest areas. Initially, we had issues with the availability of vaccines and logistics. These issues have been gradually resolved. Accessibility and availability have been fully addressed. Now the real challenge is to reach out to the reluctant population.

GR Rabindranath: Eligible individuals should be vaccinated by the middle of the following year. For this, vaccine equity is essential. Many western and developed countries have more vaccines than they need and are wasting/stocking vaccines, while less economic countries do not have enough vaccines. In fact, only less than 20% have been vaccinated in low-economic countries. This is a huge problem and will create many new strains or forms in the future. This is why the World Health Organization has said that instead of giving everyone a booster shot, we should provide two doses of the vaccine to all eligible people around the world. Developed countries have a major role to play. They should understand their responsibilities and the problems faced by developing and low-economic countries. The COVAX program must be respected. All countries that make adequate vaccines must supply them to the WHO’s COVAX programme. India has huge manufacturing capacity. Therefore, the government should take measures, and the public sector companies should also be involved in vaccine production.

Do you think there is transparency in reporting post-vaccination adverse events in the country?

Of. Kolandaswamy: Adverse events are reported systematically at primary, sub-centre, block and district levels. There are various committees consisting of experts who go through the reports. I firmly believe that post-vaccination adverse events are reported in a transparent manner. There is no need for any doubt over the reporting of adverse events following vaccination and the safety of vaccines. People who have a fear can get vaccinated in a large facility that has many doctors and emergency services.

What should be the way forward to promote vaccination among people?

GR Rabindranath, Governments should advertise on television or newspapers. There should be an adequate stock of vaccines while new vaccines should be introduced. We should vaccinate children, while the eligible population should be given a booster dose. We must increase the production and supply of vaccines for poor countries to end the pandemic. The government should encourage people to get vaccinated. It is very important to inculcate the confidence of the people.

Of. Kolandaswamy: The focus should be on educating the people by involving doctors, influential people of the community like religious leaders, political leaders, panchayat leaders and other influential groups, frontline and health workers. I think we can promote vaccines by putting social and legal pressure on the unwilling population and taking strong action against anti-vaxxers. If full immunization is achieved in the next few months, and we consider vaccinating children, the overall incidence of COVID-19 will decrease.

GR Rabindranath is the general secretary of the Doctors Association for Social Equality; Of. Kolandaswamy is a public health expert and formerly the Director of Public Health and Preventive Medicine, Government of Tamil Nadu.