In November last year the Indian government launched its ‘Har Ghar Dastak’ Covid-19 inoculation campaign to increase vaccination coverage nationwide. Under the campaign health workers would go door-to-door to vaccinate people eligible for the second dose and also those who have not taken the first dose.
The idea was to cover all those Indians who had been left behind in earlier vaccination rounds, which had already reached an impressive 100 administered doses.
A few months later though, while there is a short spurt in coverage, there are still vast numbers who have been unable to get vaccinated, especially in remote parts of the country. The campaign is also facing hurdles especially due to vaccine hesitancy among common people, who are victims of a variety of wrong information and fake news being spread about vaccines through social media.
Pilkhana is a remote tribal village in Kalamb Tehsil of Yavatmal district of Maharashtra with a population of 25-30 families. In the village, 7-8 people have died between two waves of Covid. What was the cause of death, it is not clear. But, it is believed that they died due to Covid as they could not be treated on time. Many of them were not ready to go to the hospital as they felt if they went they would die there, even their dead body would be disposed of without their families getting to see them.
Even though the village was in the grip of Covid yet in the same village, people refused to get vaccinated when the state health system came to provide COVID vaccination. Further, after the third wave, by February 2022, while the fear of Covid itself had reduced to negligible levels most of the fears were due to the misconceptions spread about vaccines. Pilkhana is just one example of many tribal-dominated villages or other areas in the state, where a similar situation remains in many even today.
Lack of clarity, accountability and education
In Pilkhana, only a few people could be vaccinated under the ‘Har-Ghar Dastak’ campaign. When some villagers were asked why they chose to get vaccinated, the reasons had nothing to do with fear of Covid. Instead, they replied that they got vaccinated to avoid problems accessing state supplied rations or to be able to travel and work.
In more normal times, in villages like Pilkhana, people have to walk for miles to obtain treatment for various ailments. When they saw the vaccination campaign reach their doorsteps there was suspicion in the minds of villagers as to the very purpose of the entire exercise.
The vaccination drive and the urgency associated with it created fear in the minds of villagers about possible adverse effects and the subsequent difficulties involved in obtaining treatment as there are no hospitals for miles around.
When the villagers of Pilkhana were asked about vaccine hesitancy they explained it by saying ‘We don’t have to go somewhere on an airplane so why get vaccinated?’ or ‘There is no Covid in our village’. There are still many such misconceptions like this, which remain an obstacle to increasing vaccination coverage.
Although it was the administration’s responsibility to clear these doubts from the minds of people, there was no outreach to them to help them overcome their misunderstandings. Except for the employees of the state health department no other government agency or institution was involved in the vaccination drive at all. Therefore, there was a lack of clarity, accountability and public education in this campaign.
In contrast, at Dhamangaon Garhi village, which is at a distance of 60 kms from Amravati, the outpatient department of the hospital here receives 170-200 people every day who want to get vaccinated. There is much greater enthusiasm among locals for getting vaccinated because of the targeted campaign done by the administration to educate them. Despite the fact that the health workers here were grappling with the stress of staff shortage and extra work they worked with doctors in the vaccination campaign to achieve the goal of administering the Covid vaccine to most village residents.
Inadequate means and resources
The state health system has neither the time, nor the resources to launch a separate campaign to convince the villagers on this issue, as it will require door-to-door persuasion, in other words it would require an army of health workers. There should be a large number of human resources involved, but they are not.
ASHA workers could have been among the most important health professionals to carry out this work. But, in Maharashtra they have been on strike for a long time. At the same time, the rest of the medical staff cannot walk from village to village throughout the day. As a result only 20 percent of the population in a remote area gets vaccinated, in the same time it takes to vaccinate 80 percent of an urban population.
According to state health authorities it is the responsibility of the people to take care of themselves, remember their dosage and date and take care of their health. This has been the main message of the government’s ‘My Family, My Responsibility’ campaign. However, not everyone has access to smartphones or online platforms to follow health advisories about vaccination doses and dates.
The bitter experience of the people in past years regarding the poor quality of government health services together with rumours spread through social media platforms about Covid 19 has made them sceptical about getting the vaccine. This has made it difficult for the health department to achieve full vaccine coverage in many areas.
The first thing that needs to be addressed to overcome this problem is to allocate more resources to health infrastructure and to ensure availability of health personnel on a long term basis. The second step needed is to strengthen the health facilities from the village to the tehsil level to its full potential. The third is to involve everyone in policy change, from NGOs working in the village, to policy makers at the national level. This is because, often the issues of tribal and rural health development are related to larger issues of concentration of power and lack of decentralization.
Fourthly, local committees or public representatives should be involved in the anti-Covid vaccination campaign as they have been in the fight against Covid itself. So, all such committees should first be reconstituted and strengthened. The fifth step required is to provide the villages with adequate funds and resources to take care of public health at the local level itself.
Shirish Khare has been associated with rural journalism for a long time and has been continuously reporting on the economic, social and health impacts of rural life during the Corona pandemic.