India’s vaccine program, one of the largest in the world, was just taking off when the second wave of COVID-19 turned into a tsunami and hospitals and crematoriums were inundated. With such a large population, the fight against an unfamiliar enemy could only be won through mass vaccinations, a fact corroborated by top virologists. As the noise regarding the lack of vaccine availability reached a crescendo, another pressing issue started to unfold, that of vaccine hesitancy in rural India.
With the government aiming to vaccinate the entire eligible population by December 2021, vaccine supply is only half the dilemma. With almost 60% of the Indian population in rural areas, issues of accessibility and lack of manpower and infrastructure arose. The wall of suspicion, fake news, and rumors are still having an impact on vaccination rates in these areas.
Some of the Issues
Public Health Facilities: Although public health facilities have come a long way and played a primary role in managing the Covid-19 pandemic in rural India, there still are fewer takers than expected. Primary Health Centers in some areas are inadequately staffed with substandard infrastructure and facilities.
General Mistrust: People of rural India fear going to the vaccination center as they fear they will be subjected to testing and, if found positive, be incarcerated, never to return home.
Cultural and Religious Perspectives: People form opinions based on their deep-rooted beliefs that appear to clash with their cultural systems and values. Vaccine hesitancy in this context is often the result of inherited religious views that are seldom questioned.
Misinformation on Social Media: Dissemination of information through social media, especially fake news or fake information, is shared with vested interests or by miscreants. With the social media revolution using smartphones, it becomes a challenge to curb fake shares that further ignite vaccine hesitancy in rural India.
Side-effects and Questions on Efficacy: The media has played a stellar role in reporting issues faced in rural areas during the pandemic. However some reporting on side effects caused by the vaccines (i.e., clotting) led to a scare among those in rural areas. Reporting on the process of clinical trials and questions of efficacy has only added to the issue.
Curbing Vaccine Hesitancy in Rural India
The first and second waves of the pandemic led to an enormous loss of life and livelihood. Unemployment and economic growth has been stalled in its tracks. With the impending third and subsequent waves, the only safeguard is vaccination. While the nationwide rollout saw urban India accept immunization with open arms, rural India has lagged far behind due to hesitancy and availability.
With the government promising to vaccinate the entire adult population by December 2021, tackling the hesitancy is urgent. As history tells us, immunization programs like “Mission Indradhanush” have yielded encouraging results in tackling hesitancy and increasing acceptance. The way forward is through massive outreach programs through a PPNP (public-private, not-for-profit partnerships) framework to derive maximum value in the shortest-possible time. A multipronged strategy should look to –
- directly target under-vaccinated populations/ communities
- disseminate awareness and knowledge of the benefits of vaccination
- make vaccines easily available
To improve vaccination uptake and coverage, health education approaches and initiatives will be the most effective in changing attitudes. Some outreach programs that were used earlier and some new strategies that can be used are:
1) Use of influencers through electronic and social media: film and sports personalities.
2) Local influencers: Village elders, panchayat heads.
3) Performing troupes (Nukkad Natak)
4) Personal contact through accredited social health activist (ASHA) and anganwadi workers.
5) Spread awareness through FCRS-approved community radio stations.
6) Point of presence (PoP) collateral and communication through mobile vans
7) Countering and fact checking of fake news about vaccines on social media
Stories on the Ground: The New Age CORONA WARRIORS
Community radio stations across India have braved lockdowns and played an important role in ensuring awareness about COVID-19 in rural communities. The mainstream media has poor reach in rural India, and rural community radios help to bridge the last-mile gap. To identify concerns of the public and provide authentic and genuine information, these stations have played an instrumental role as community media in India during the pandemic. The local flavor of these stations ensures that this mass media service has a unique position in rural hinterlands.
Alfaz-e-Mewat community radio station, an initiative of SM Sehgal Foundation, has been doing stellar work during this pandemic to spread awareness on public health. As per government officials, only 75,225 people of the 14-lakh population of Nuh were vaccinated before May 31, 2021, and there is concern among many to ramp up the drive. Nuh, one of the most “backward” areas in the country, has always looked at immunization programs with suspicion, driven primarily by lack of awareness among the people. Recently, the district administration of Nuh partnered with Alfaz-e-Mewat community radio to fight myths and disseminate information, using positive messaging to assuage the fears of communities.
Senior health officials on condition of anonymity told the Hindustan Times that villagers were reluctant to take the vaccine due to several rumors that it is poisonous and may lead to impotency. “When health workers visited some villages to appeal to the locals to take the vaccine, the villagers emerged with sticks, threatening to attack them. Some even assaulted them and pushed them out of the village, alleging that the vaccine is poisonous.”
Nuh deputy commissioner, Captain Shakti Singh, spoke highly of the efforts of the community radios work in collaborating in this endeavor. He shared that officials and volunteers have been on the ground, motivating people; and to widen our outreach, rural community radio is the best way to do it. “We want to use their audience base to communicate with the people and disseminate information around COVID and the vaccine.”
Alfaz-e-Mewat radio has a reach of 225 villages and is being used to reach locals to transmit information about vaccination from the district administration, chief medical officer and other influencers. Six to seven programs are dedicated to COVID-19. The station also broadcasts messages from the senior officials, including the deputy commissioner, easing fear around the vaccines.
Officials claim the initiative has helped increase the number of villagers reaching the vaccination centers in the district. Organizations such as UNICEF and Community Radio Association are also supporting projects on COVID-19 prevention, vaccination, and COVID-appropriate behavior.
The idea has been to reach out to maximum villagers and bust the myths, so that more and more people get vaccinated. Community media in India and the rural community radio broadcasting has helped in a big way, and the numbers are increasing. The coming together of district administration and radio stations has played a proactive role in creating awareness about the COVID-19 pandemic and the significance of vaccination, leading to an increased turnout.
The mainline print media covered the work being done by Alfaz-e-Mewat, S M Sehgal Foundation’s brainchild in this regard.
The local administration asked the rural community radio stations to reach out to the inhabitants who are resisting the vaccine due to various myths. Vaccine hesitancy due to illiteracy, misinformation, and rumors have been quite a challenge.
The efforts of the two radio stations in the district having dedicated programs on COVID-19 are gradually helping people to ease fear around vaccination and follow COVID-19 appropriate behavior.
The war against COVID-19 will be won and lost with all of us following COVID-appropriate behavior, as the pandemic plays out in the coming times. With public health systems gearing up in the urban areas, vaccination drives have to now pick up the pace in rural India. We cannot afford to be lax in this regard; and how we deal with rural India will have major implications in the future direction of India and its economic growth.
After all, we do not want this pandemic to end like the 14th century “Black Death,” when millions met their end, especially when we have the tools (the vaccine) to fight it. Now the time has come to use innovative strategies and partnerships to ensure that hesitancy issues are put to rest.