A boy walks past a graffiti of healthcare workers on a street in New Delhi, March 22, 2021. Photo: Reuters/Anushree Fadnavis
India’s COVID-19 cases are hurtling with breathtaking speed towards the second peak. Unlike during the first outbreak, we have vaccines. India has approved two vaccines at the moment, the homegrown Covaxin and the Oxford-AstraZeneca vaccine known in India as Covishield. Widespread distribution of these vaccines is key to curbing the spread of the virus as well as preventing the kind of severe illness that requires hospitalisation. The longer a significant portion of our population is susceptible to COVID19, the more chance there is for the virus to mutate to a more infective or lethal form.
At times like these, people often look up to community leaders for guidance. These people could be key to galvanising public opinion about adhering to guidelines that prevent the spread of the virus. Unfortunately, both political leaders and religious leaders in India have failed to rally support for COVID-appropriate behaviour. At this juncture, healthcare workers are natural choices to fill this leadership vacuum.
Vaccine acceptance or aversion among the people has been shown to be strongly correlated to healthcare professionals’ attitude towards vaccines. It is widely established that healthcare workers averse to any vaccine can passively transmit their apprehensions to patients, setting off a domino effect of vaccine non-compliance. It is also plainly obvious that a healthcare workforce unified in its vaccine messaging can make a big difference.
But when they did become one of the first cohorts eligible to be vaccinated as part of India’s vaccination drive, which started on January 16 2021, several states in India struggled with low turnouts. The situation became alarming enough to prompt authorities to consider measures like fines or other forms of coercion against frontline workers who weren’t getting vaccinated. why did India’s healthcare workers hesitate?
Before the development of the two COVID-19 vaccines, the quickest we were able to develop a vaccine was for mumps, in four years. But pharmaceutical companies were able to produce COVID-19 vaccine candidates in a matter of months (although they drew on many years of research for their components). India’s Drug Controller General (DCGI) approved two of these vaccines, Covishield and Covaxin, for ’emergency’ use on January 3. However, the DCGI did so even as Covaxin’s phase 3 clinical trial was just getting started.
There is a pervasive belief among healthcare workers that they have been thrown off the edge of a cliff during India’s COVID-19 epidemic, into a realm of little safety. They have consistently had to work long hours in hazardous conditions, often without adequate PPE or other resources. So it wasn’t entirely unfair for some healthcare workers to think they were once again being taken advantage of. It is true that the shots’ accelerated development stood on the shoulders of previous work vis-à-vis the SARS and MERS coronaviruses – but this knowledge didn’t automatically offset healthcare workers’ worries.
It’s important to remember that working in healthcare makes nobody a specialist in vaccination or immunology. Healthcare workers aren’t immune to the ongoing misinformation infodemic about vaccines. It was a physician who floated the now widely debunked correlation between the MMR vaccine and autism, with a paper published in one of the world’s more well-regarded medical journals. Educational tools directed at healthcare workers, which treat their concerns seriously, with empathy instead of scorn, are well-indicated.
Many healthcare workers have also been infected with COVID-19, sometimes more than once, and believe this exposure to the virus sufficed to generate protective antibodies. But the WHO recommends that even those who have been infected with COVID-19 get vaccinated when they get the chance, because we don’t know for sure how durable and/or efficacious natural immunity to COVID-19 can be. And it is important that this is impressed on healthcare workers.
The Canadian psychiatrist J.T. MacCurdy grouped populations who had faced a crisis (in his case, London getting bombed in the 1940s) into three groups: ‘direct hits’, ‘near misses’ and ‘remote misses’. He described remote misses as “those who see or hear the traumatic event and witness some of the aftermath but evade physical or emotional harm”. Through a mechanism called passive adaptation to danger, people classified as ‘remote misses’ – in this case, healthcare workers who had asymptomatic or mild COVID-19 infections or had colleagues escape relatively unscathed – could develop a false sense of security. This could also explain the low vaccine uptake among healthcare workers.
There could be even other reasons for vaccine hesitancy among healthcare workers. While more and more people getting vaccinated, and without developing any debilitating side effects, will reduce hesitancy among the unvaccinated, it is imperative that we identify the true reasons for hesitancy in this key group of workers to the best of our ability.
Sumedha Sircar is an intern-doctor at KMC Manipal and consults for Suicide Prevention India Forum. She is dedicated to learning about sociodemographic determinants of health and science communication.