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‘Flawed Assumptions, Lack of Critical Detail Holding up Vaccination in Rural India’

‘Flawed Assumptions, Lack of Critical Detail Holding up Vaccination in Rural India’

At a vaccination drive at NMMC Meentai Thackeray Hospital, Navi Mumbai, August 6, 2021. Photo: PTI

  • In rural India, health workers are having trouble following up on vaccinees who received one dose, and getting them to return for the second.
  • With “patchy internet connectivity”, workers at many centres are spending more time handling data than administering vaccines, Anurag Behar said.
  • He also identified three pieces of good news; perhaps the foremost is that vaccine hesitancy in India appears to be less common than imagined.

Anurag Behar, the CEO of the Azim Premji Foundation, who is working with over 500 primary healthcare centres across 12 states in mainly rural areas and slum settlements in cities, says that vaccination is not running as smoothly as it should in rural India. As a result, the “second dose coverage is running about 25% short of what it should be,” Behar said.

In a 35-minute interview to Karan Thapar for The Wire, Behar said that the data has posed one of the more serious problems vis-à-vis the COVID-19 vaccination campaign in rural India.

First, he identified three pieces of good news.

“Vaccine hesitancy is less common and not as intransigent as often imagined,” he began. The reason why people are not coming forward is not because they have “unfounded fears and beliefs” but “good reasons” for holding back, such as loss of income because getting vaccinated can take a full day or the apprehension that vaccination can lead to fever which, in turn, could cost two-three days of work. These ‘good reasons’ are easier to handle than vaccine hesitancy.

Second, he said, is that “infrastructure to deliver vaccines is mostly adequate” – referring to the cold chain, the transportation system and the vaccine delivery centres. And third is that the supply of vaccines recently increased.

But as for the roadblocks: He said, “over 90% of places have multiple and substantial problems” – the most significant of which is that “with patchy net connectivity, entering each individual’s data for vaccination into the computer system is a herculean task”. According to him, one consequence of this is that “data handling [has become] the primary job rather than vaccination”.

A second and bigger problem is that “the data in the system does not have the addresses of individuals vaccinated”. Consequently, primary healthcare centres (PHCs) have had great difficulty contacting people who have taken the first dose but haven’t returned for the second, and have often had no way of reaching out to people who haven’t come forward at all.


He said that to overcome this problem of lack of addresses, PHC staff “often make a few hundred calls a day” to contact people. But because “phone numbers are inaccurate, people don’t respond and connections are poor,” this is often represents unfruitful and wasted efforts. And as a result, Behar said, “Second-dose coverage is running about 25% short of what it should be”. Put another way, people in rural India could be getting their second doses five weeks or longer after people in urban India have been getting their second doses.

Behar also identified an important consequence of these problems: “We may soon be awash with vaccine supplies but we will not know whom these have to be delivered to, when and where, and how to make it happen”. Another worrying consequence is that “the last 25% of the country will be the hardest (to vaccinate) and most of them will be the most vulnerable and disadvantaged”.

Also read: Vaccination in India’s Rural Districts Remains Low Amid COVID-19 Surge

A worker urges prisoners to maintain social distancing as they wait in a queue to receive the COVID-19 vaccine dose, during a special vaccination camp for prisoners, at Central Jail in Bikaner, Wednesday, June 9, 2021. Photo: PTI

Behar feared that if vaccination on the ground isn’t improved, it could be a whole year more before India is fully vaccinated. However, he made a point of stressing that several state governments have made their own efforts to overcome these problems. He was, therefore, reluctant to blame ‘the government’ because, he said, it’s unfair to lump all state governments and the Centre into one monolithic institution.

Indeed, several state governments have mobilised healthcare workers on a local level to engage people and find a way around the absence of addresses and to resolve issues arising out of assuming that people will come forward on their own to be vaccinated.

In interview, Behar also said another problem with vaccination in rural or tribal areas and slum settlements is that “the number of vaccinators is inadequate” and that “20% of places are facing shortages”. He said governments could have anticipated this problem but at the same time that it can’t be solved quickly. This is because, unlike the polio campaign, every adult (and later those younger than 18 years) has had to be vaccinated against COVID-19 and because the COVID-19 vaccines are intramuscular whereas the polio vaccine is oral – and so easier to administer.

Watch the full interview here.

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