The Covid-19 pandemic was the tipping point for pharmaceutical and healthcare systems as they faced an unprecedented challenge that created an opportunity for them to scale rapidly with changing technology and the innovation to get faster results. India was at the forefront to take advantage of emerging opportunities with rapid vaccine production, clinical trials and supply chain scaling up. India was also one of the fastest countries to administer vaccines to its people.

A collaborative approach from central and state government has contributed to the extraordinary journey of vaccinating more than 170 million people in India. Community-led efforts and bringing together various organizations contributed to this successful implementation. To date, approximately 55.9% of our population is fully immunized, but 44.1% are still at risk of potential infection. Despite the vigorous campaign by the Indian government, the reluctance to vaccinate has become one of the main reasons for the unvaccinated cohort due to factors such as complacency, convenience and trust.

Microscopic examination reveals immunization coverage is lagging in several predominantly tribal districts in India. Of the 48 districts where first-dose coverage is less than 50%, half have large tribal populations. Vaccine hesitancy is rampant in rural and tribal communities due to rumors and misinformation. There are countless instances of fears, myths and misconceptions regarding COVID-19 vaccination among tribal communities. There are also additional factors such as low access to health care, high reliance on daily work to achieve one’s goals, etc. Intensive engagement with communities has unearthed a myriad of fears, misconceptions and myths such as getting vaccinated could lead to COVID, people with co-morbidities will die if they get vaccinated, free vaccines mean compromised quality, etc.

A group of tribal women from East Singbhum district in Jharkhand feared that vaccination could lead to death. They also heard that many were “possessed” after vaccination. The added hurdle is that they constantly struggle with poverty and gender inequality. Women pick up various laborious jobs throughout the day for mere survival. Not only communities that are isolated but also women are falling behind even in top performing states such as Benaulim, Goa and Noida, Uttar Pradesh. In tribal populations (over 104 million people), this requires a unique and personalized approach to counter the complex challenges of difficult terrain, limited health facilities and social discrimination that create disparities in their health status. Realizing that more aggressive measures are warranted to combat this situation, we have identified the five Cs of vaccine hesitancy: trust, complacency, convenience, communication and context. If India is to move towards widespread vaccination, all of these vaccine hesitancy factors need to be addressed.

Communication remains at the heart of the fight against vaccine hesitancy. When they are thought to be less likely to contract a serious illness, this can contribute to complacency, and effective communication can avert the risk. For the various stakeholders, communication techniques need to be fine-tuned.

Transparency in communication about immunization is important to motivate communities. Few of the methods that have worked while working with communities on reducing vaccine hesitancy and raising awareness about vaccine generation have been:

• Work closely with block and district administration to identify blocks and villages with low immunization coverage and develop a micro-plan to address the challenge.
• Organize a gram panchayat workshop on the vaccination camp with panchayat chairpersons, ward members, village elders and religious leaders in blocks/areas with high vaccine resistance.

Also conduct group discussions with influencers and community leaders, answer their questions, allay their fears with scientific knowledge.

• Raise awareness of the benefits of vaccination and then get vaccinated once community influencers are assured of the safety and effectiveness of vaccines.

In areas where resistance is high, scare tactics may not work, on the contrary, may lead to increased resistance. Listening to the “why” a particular community chooses to resist is imperative to providing a convincing and scientific response through whatever mode of communication the community deems acceptable. A holier-than-thou attitude may not result in the desired behavior change within the community. Rather than instantly dismissing or condescendingly countering the religions, beliefs, or myths of a particular community, it is necessary to understand, through respectful deliberation, where their ideas and fears about vaccines are coming from.

In the past, India has combated misinformation about vaccines through communication and strong campaigning through the Pulse Polio initiative (launched in 1995). India has provided free vaccination against vaccine-preventable diseases for over 40 years, and childhood immunization rates have continued to rise. Through public-private collaborations, engaging with NGOs and with the help of dedicated medical professionals, India can also tackle the issue of COVID-19 vaccine hesitancy.

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