The Djinn of vaccine hesitancy: Is it still out ?
Ode Uduu, Shobha Shukla, Bobby Ramakant
Contd from previous issue
Some thought a COVID-19 vaccine had been given premature approval for public use even during clinical trials.
Confirmed Dr Raman R Gangakhedkar, who was the top scientist in the National Task Force on COVID-19, and Head of the Division of Epidemiology and Communicable Diseases at the Indian Council of Medical Research when the pandemic hit us in 2020. He said that vaccine hesitancy was stressed because in case of the indigenously produced one, its approval process hinged on immunogenicity-related data only based on phase-2 clinical trials results. Phase-3 clinical trials had not been done by that time and there was no data on its efficacy to prevent infection or preventing risk of hospitalisation and death. This created anxiety in people’s minds.
The situation is similar in Nigeria. In a study conducted across four specialised hospitals in the southern part of the country, only 55.5% of the medical personnel are willing to receive the vaccine.
Civil society at the frontline to decimate hesitancy and boost vaccine confidence
Civil society has raised awareness, dispelled myths, and mobilised communities to go for shots in India and Nigeria.
In Nigeria, Sunusi Hashim, Executive Director of the Society for Child Support, spoke of the challenges in redeeming the misinformation about COVID-19 vaccines. According to him, havoc had already been done as lack of proper sensitisation created a lot of misconceptions about the vaccine. This led to a lot of resistance across different groups.
However, with support from partners, such as Pathfinder and Vaccine Network for Disease Control, his organization has been able to break the ice through community mobilisation. “We took the advocacy campaign to the communities where we addressed misinformation as much as it sprang up. We use traditional leaders to communicate with the people and penetrate the population. Gradually, we are making progress,” he concluded.
In Uttar Pradesh, “it was only towards the end of June 2021 that village-level camps were set up with the help of NGOs. My NGO helped vaccinate around 70,000 people in the districts of Sultanpur, Ambedkar Nagar, and Chandauli with the help of mobile vans,” shared Rahul Dwivedi, a noted health activist.
In Lucknow city, the capital of Uttar Pradesh, religious institutions (like Gurudwaras, Eidgahs, or Hindu temples), sports stadiums, or historical monuments, such as Imambaras, became the venue for vaccinating a large number of people closer to their homes, and at flexible hours. Munni, who works as a domestic maid, told us that she could only get her monthly food supply from the Government-subsidised ration shops when she showed them her vaccination certificate (after getting the shots first).
Networks of people living with HIV led from the front too. “We conducted many virtual sessions at the district and state level among the community members and organised virtual capacity-building programmes for service providers with the help of doctors to bust the myths around COVID-19 vaccination and HIV. Our volunteers and staff helped make the communities aware of the importance of COVID-19 vaccination, including COVID-19 counselling. We provided counselling to 28,176 people living with HIV on COVID-19 vaccination and facilitated 7,445 of them to get vaccinated. Community members have taken booster doses as well,” confirmed Naresh Yadav, who leads Uttar Pradesh Network of People Living with HIV (UPNP Plus) and is the President of National Coalition of People Living with HIV (NCPI Plus). Daxa Patel who leads Gujarat State Network of People living with HIV coordinated with local government authorities to get her network office premises double up as a vaccination centre to encourage people to get their shots.
We should have addressed vaccine hesitancy before the rollout began
Vaccine hesitancy is not new or unique to COVID-19, rather evidence shows how it has riddled other vaccination programmes in several countries worldwide even before the COVID-19 pandemic had hit us, said Dr Heidi J Larson, noted anthropologist and the founding director of the Vaccine Confidence Project, in a session hosted by the US-based Population Reference Bureau for the Fellows of Public Health Reporting Corps.
In Kano State, Dr Shehu Abdullahi Muhammad, the State Immunisation Officer and Chairman of COVID-19 operations noted that there was no rigorous sensitisation at the initial stage. This led to a lot of resistance from the people as they were gullible to misinformation on the vaccine. According to him, this negative perception brewed strong resistance to the vaccine from the residents.
Dr Shehu, however, said that the government returned to the drawing board after the resistance was encountered. They set up a technical working group responsible for ensuring a rigorous campaign. They devised a strategy to penetrate the people through key influential stakeholders to ensure adequate response.
Dr Gangakhedkar, who was awarded the third highest civilian award Padma Shree and currently is the Dr CG Pandit National Chair of Indian Council of Medical Research, said: “In an ideal situation, one would like to have more community preparedness and mobilisation before beginning the vaccine rollout. But this was not easy initially when we were under a lockdown for almost six months, and there could not be any direct contact with the public to raise vaccine awareness. As time passed, community mobilisation improved, and newer approaches were used.”
In India, government doctors and decision makers, like Dr Surya Kant, led by example when they noticed vaccine hesitancy, even in healthcare service providers. “I was among the first doctors who took the vaccine in Uttar Pradesh. Other doctors and I showed by example that taking the vaccine was safe and essential. This was publicised by the media and instilled confidence in the public that if a doctor took the vaccine, it must be safe. This went a long way in reducing vaccine hesitancy,” said Dr Surya Kant.
Partnerships between media, government, and NGOs helped dispel myths and mobilise people to go for the shots. The government-run All India Radio’s daily broadcasts on COVID-19 helped a lot, as radio programmes have a much wider reach than TV, print, or social media, especially in remote and rural areas.
Adult vaccination was new for the public health system
In India and Nigeria, this was the first major rollout where adult vaccination was being done. “Even our healthcare systems were not used to handle adult vaccination of this scale. Despite all this, we did well in terms of providing vaccines,” said Dr Gangakhedkar, noting that India has delivered over 2.2 billion doses now.
He added: “For India, the most important step for future pandemic preparedness is to invest in developing rapid vaccine platforms of different types, such as mRNA, adenovirus, or protein subunit-based vaccines. We should adopt a transparent approach to regulatory approvals. We must reflect upon whether we should follow the US FDA approach where they have a public hearing when any drug or vaccine is being approved, and anyone can ask a question.”
He strongly called for bottom-up community engagement models and not top-down administrative ones in responding to public health emergencies in the future.
As the threat of disease outbreaks or public health emergencies will continue to loom over us, it is important that countries like Nigeria and India are solidly ready in terms of pandemic preparedness and global health security. Bottling up the djinn of vaccine hesitancy is a very doable and important step in this direction. So is regaining and strengthening the confidence of people in public services. (Ode Uduu is a Data Journalist with DataPhyte in Nigeria, and Shobha Shukla and Bobby Ramakant are part of the editorial team of Citizen News Service in India. Ode, Shobha and Bobby are among the inaugural Public Health Reporting Corps in India and Nigeria facilitated by Population Reference Bureau - PRB)