With the supply situation gradually easing and the state taking control of the procurement, states can focus on the distribution and work towards the mammoth task of vaccinating the country by 2021 end. The target till the end of the year is to administer 90 lakh doses on a daily basis to complete 133.6 crores by the end of the year.
While all the attention had been focused on fixing supply constraints, the data on vaccination from across states points towards a larger problem which will manifest soon. Till date, even after nearly 3 months of the vaccination program being open for senior citizens, a little over 45 per cent of the above 60 population have been vaccinated with at least one dose. Supply constraints were largely seen for the 18-44 population but half the senior citizens in the state still not having a single shot of the vaccine points towards a demand problem.
Odisha has till date vaccinated just about 52 per cent of the above 60 population. While Odisha is one of the few states which has been registering a higher vaccination rate compared to the national average, it is still far behind states like Rajasthan which have been able to vaccinate nearly 85 per cent of their citizens above 60 years of age, with at least one shot. There are other states like Tamil Nadu which have only covered 21 per cent of the senior citizen population in the state despite having a relatively better health infrastructure and a higher literacy level than other states.
The motivation level of the citizenry towards getting the vaccine can be mapped on a scale from reluctant to confident with the hesitant population lying somewhere in the center. In the coming months, the state will have covered the people in the ‘confident’ end of the scale and would have significantly covered a lot of people with minor levels of hesitancy. The peak of voluntary vaccinations will be met very soon once the supply situation eases out. After that, the state will have to devise new strategies to draw the more hesitant and reluctant populations to get the vaccines. Going by the turnout for the senior citizens, this is not going to be an easy job.
It is unfortunate that even with the signs of vaccine hesitancy becoming glaringly obvious as the coverage increases, we can also see active and purposive political campaigns to disrupt vaccine uptake. Fueling hesitancy though well thought out and well-crafted outrage campaigns questioning the efficacy of Covaxin to associating vaccines with the BJP and openly denouncing it to a new low of insinuating that the vaccines are made with bovine blood, the politics around vaccines has been abysmal and sinister. Trust on vaccines is a difficult issue by itself and adding more barriers to uptake by playing on political divisiveness and religious beliefs is the biggest disservice that can be done to the country at this point. Political parties and social leaders with their irresponsible and malicious comments have done irreparable damage to the issue.
Even With These Concerns, What Should Be The Way Ahead?
The first and most obvious step that the centralized procurement policy would allow the government in the near future, would be to do away with all artificial barriers which are impeding vaccinations. That would include walk-in vaccinations for all age groups and taking vaccinations closer to the communities in the form of health camps and drives. Government's immediate priority should be to remove effort barriers both in the form of distance, technology and convenience which contribute to the tendency to delay vaccinations. This can be done by moving the services closer to the communities and allowing people to walk into any government facility and get a vaccine without prior registration. The registration needs to happen at a decentralized village/ward level with the help of PRI members and volunteers.
This needs to be followed by a demand generation campaign with a dedicated focus on addressing vaccine hesitancy. This campaign, while being absolutely essential for the country as a whole, would have to be made absolutely decentralized with a strong focus on individual outreach and inter-personal communication. While structural issues could be leading to hesitancy at this point, in a few months we will largely be left with motivational barriers which cannot be addressed through only mass communication. Trust building, addressing misinformation, using champions from within the community and targeted nudges aimed to address specific behavioural barriers observed in different groups would have to be deployed for a long term to ensure that demand is sustained.
Serum Institute, Bharat Biotech and Sputnik have all ramped up production. Three new vaccines including the nasal vaccine by Bharat Biotech are in advanced stages of trial. Another of those vaccines, Corbevax made by Hyderabad based organization Biological E has already been pre-ordered by the central government. There is talk of both Pfizer and Moderna also making their way into the Indian market. Therefore, it is safe to assume that we will soon be in a situation where the supply concerns regarding the vaccines will have been adequately addressed. The course correction in the procurement policy has come through, though late and the policymakers should ensure that they take the right lessons from our chronic public health issues. With an ambitious target at hand for the end of the year and the sheer scale of the exercise of vaccinating a country like ours, we need to be ready to shift our lens from ‘we need more vaccines’ to ‘we need to get more people to take these vaccines’.
(DISCLAIMER: This is an opinion piece. The views expressed are the author’s own and have nothing to do with OTV’s charter or views. OTV does not assume any responsibility or liability for the same.)
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