The ‘Hesitance’ Virus : Combating Vaccine Hesitancy in India

This article is authored by Akarshi Narain, a 1st year law student at the NALSAR University of Law, Hyderabad.

This article examines the rise of ‘vaccine hesitancy’ during the coronavirus pandemic. Vaccine hesitancy means the refusal or delay in acceptance of vaccines despite its availability due to certain apprehensions regarding the same. The article suggests various measures to quell this fear and argues how ultimately, sociological solutions entailing a community outlook prove fruitful in bringing about such a change in mindset.

Introduction

The novel coronavirus pandemic has wrought havoc on our social lives and reshaped our views on human life and the world. It is not known to discriminate arbitrarily and has affected people across caste, class, race and cultural barriers, and has introduced new challenges. One such global challenge is vaccine hesitancy which the World Health Organisation (WHO) defines as the refusal of vaccines or delay in acceptance despite the availability of vaccination services. Vaccine hesitancy precedes the current pandemic and is most widely connected with the MMR (Measles - Mumps - Rubella) vaccine, which was incorrectly linked to developing autism in children. This current dilemma poses a greater risk since the once-in-a-century pandemic has unleashed itself in the era of globalisation and social media, which adds further complications and challenges. Moreover, it could prolong the pandemic and lengthen the path to herd immunity.

According to WHO, vaccine hesitancy was one of the top ten threats of 2019. Vaccine hesitancy is not a straightforward issue, and tackling it requires one to go into the depth of the various factors that guide the human and social perception of vaccines. Frequent reasons for vaccine hesitancy like misinformation, lack of trust in the government and health systems, doubtful efficacy, thinking Covid19 to be a common cold, lack of transparency, potential long-term effects of vaccines, and lack of outreach are being touted. Another issue is the urban-rural divide in vaccination due to greater vaccine hesitancy in rural areas. From a sociological perspective, one has to ask the question, why is this so, and do other identities like religion, colour, etc., play a role? This article aims to shed light on such difficulties alongside possible suggestions to tackling vaccine hesitancy by a historical analysis of the same in India.

Brewing Vaccine Hesitancy in 2021

The vaccination drive against the Coronavirus was initiated in January 2021, when the rollout was in its nascent state. At that time, vaccine hesitancy was seen across all groups, including doctors. In fact, doctors at Delhi’s RML Hospital rejected Covaxin due to incomplete trial results. This reflects how initially, vaccine hesitancy was a legitimate concern of the people, since this apprehension was shared not just by the layman but also by expert professionals in the field. A justified reason was that even though adverse effects had been minor, no one knew about the long-term effects of the vaccine, and a further complication with Covaxin was that it had been rolled out without completing phase 3 trials. Coupled with the fact that fewer people are required to plant doubts than to instil confidence, committed measures needed to be taken to alleviate people’s concerns.

In my opinion, at such a stage, public figures taking the vaccine could prove highly beneficial since it would quell apprehensions. When individuals, whom the society looks up to or identifies with, support a cause, people are more likely to follow that rather than hard facts because it provides some kind of reinforcement or first-hand reassurance that taking the vaccine was the right decision to make, combined with the aphorism ‘We see it with our own eyes’. Since at the time a surfeit of misinformation and fake news was doing the rounds, it became hard to trust the vaccines, and this is where actions like the Prime Minister publicly taking the Covaxin vaccine instead of Covishield (deemed safer) proved efficacious. Another crucial measure is to bring internationally acclaimed public health experts from India like Dr. Soumya Swaminathan and Dr. Gagandeep Kang on popular media channels to disseminate credible information to bust rumours. Dr. Randeep Guleria’s continued appearances on NDTV is a case in point. This would help strengthen positive perceptions about vaccines among the middle class, which have a culture of complying with credible expertise. We know how vaccines were naively attached by some political groups as propaganda by the ruling government. A civil campaign that highlights the risks and benefits of vaccination with backing from expertise would be an apt measure. This would connect civil perception with expertise tradition.

Misinformation and misplaced beliefs also contributed to the hesitancy, an example of such specious beliefs being the fears of impotency in Muslim communities in Tamil Nadu, Haryana, Karnataka, and Assam, which also goes to show that vaccine hesitancy has religious undercurrents and warns against drawing simplistic connections. This was especially the case in rural areas and requires calibrated community outreach. Community-specific ideas should be evolved to address particular fears and doubts.

While some claim that the political leadership has not owned up to the hesitancy crisis, I believe this to be an extreme statement. One can argue that the government has not done a very successful job, however, we must keep in mind that India is a poor and populous country with limited health infrastructure. In that aspect, the government has rolled out initiatives like the Covid 19 Communication Strategy 2020, the CoWIN App, regularly published information regarding the vaccines in national newspapers, deployed local ASHA workers to engage at the ground level, etc. The latter vests public trust among ill-informed population in a personalised setting.

Sociological Solutions to Vaccine Hesitancy

I stress on solutions tailored to fit the target audience. A case in point is Tripura (also having a sizeable tribal population) which managed to battle the initial vaccine hesitancy to emerge as a vaccine trailblazer. It achieved this with the help of televised appeals by the Chief Minister, sending personalized letters and pamphlets by the Chief Medical Officers in local languages, conducting awareness campaigns, door-to-door vaccination, and thousands of vaccination camps focusing on small groups. In all of these cases, we observe that a personal element is present, and an attempt is made to reach out to the people in their own language to presumably induce familiarity. There needs to be an involvement of the civil society and community in the vaccination drive. For example, in Melghat, a remote tribal village in Maharashtra, the administration broadcast a serial on YouTube where the tribals of the same village were seen asking and answering questions about vaccine hesitancy in their local dialect. These measures become all the more crucial in the face of the digital divide and the lack of accessibility of social media platforms by the rural poor.

As authors Eve Dube and others have pointed out in their paper,‘Vaccine hesitancy: an overview’, vaccine decision-making has to be seen in a broader socio-cultural context. Vaccine hesitancy is very much a social problem rather than an individual one as it is the confluence of several social factors like shared beliefs, conversation with friends and family (a recent survey by The Quint in Indian rural areas showed that nearly 48% said that their family and friends are their sources of information and 56% believed in Whatsapp forwards), past experiences with health services, etc. that shape thoughts and thus understanding the social construct becomes imperative.. For example, a reason specific to rural villagesis thinking that the virus does not affect them as they work hard, with the disease being predominantly urban. A commonality between villagers and tribals is the lack of education and strong belief in traditional medicines, with vaccines viewed as ‘foreign’ and dangerous. At the same time, we need to be careful to avoid predetermined stereotypes about tribals like ‘tribals fail to understand because they have superstitious beliefs.’ We need to ask questions like - ‘Can I incorporate something from their culture and traditions to induce trust in vaccines?’ or ‘What kind of information or role models would have a positive influence on them?’ To devise a strategy, the government needs to have a comprehensive understanding of such reasons, for past experience has shown, as in the case of a decrease in family size, it is challenging to change the social mindset of the people and adopting coercive methods like mandatory vaccination could prove detrimental and fuel resentment. Thus instead of push strategies (no vaccine, no salary), pull strategies involving freebies should be adopted.

Is Vaccine Hesitancy Still Relevant?

Vaccine hesitancy is a complicated societal problem that needs a sensitive and pluralistic approach that should include two fronts. One should be to combat the infodemic by dispelling the myths and rumours and addressing any concerns people may have, the other being to release transparent information about the vaccines that should reach the public to instill faith and trust in them. In addition, it becomes vital to understand the regional and cultural practices of the communities for shaping an appropriate strategy. Vaccine hesitancy also seems to be declining over time, especially in countries that are further along with their vaccination programs. Now, one may ask the question that in 2022, when a large part of the population is vaccinated, why is the concept of vaccine hesitancy still relevant? The reason hides behind the emergence of novel variants like Omicron. Such mutations may emerge due to the virus flourishing in certain areas with low levels of vaccinations. Hence vaccinating one’s own community or country is not enough; the vaccine needs to be delivered to all the corners of the world, and overcoming vaccine hesitancy which still exists, is a crucial part of achieving a covid-free world. The focus needs to shift from the quantity of vaccination to the equality of vaccination, and vaccine hesitancy is one of the planks in the bridge that needs to be crossed to achieve the same.