Covid Vaccine: Reaching last 20% would require as much investment as Reaching the first 80%!

A 3 hr discussion with Gaurav Gramin Mahila Vikas Manch in Rural Patna, Bihar, provided a rough glimpse of what is happening in #covid19pandemic #vaccination programme in the country. Using participatory tools and approaches, one could garner that despite efforts from the Governments, there is still a long way to go.

Excerpts from An interaction with Programme Team of Gaurav Gramin Mahila Vikas Manch led by Ms. Prathimakumari Paswan on Covid Vaccine Initiative of Community Collect initiative (Dashboard | Communitycollect ) on December 15, 2021 at Parsa Bazar, Patna Rural, Bihar, as reported in discussions with Deepti, Dheeraj and Pradeep, COLLECT team.

Time Transect Walk: The supply of vaccine was very limited, there was scarcity until mid September, when the supply started increasing. By mid November, home visits started happening to vaccinate the unvaccinated. The demand for vaccination was high between April to August, as an aftermath of second wave. At that time, only those with good links and networks and been able to pay got their vaccine. A number of people at margins tried but did not get access to vaccine. However, by mid November, the demand slowed down.

1st layer of Discussions: Card Sorting, to identify the narratives from communities who are still not even taken first dose: The category largely consist of elderly, those with illness, those who are pregnant; those with disability. From gender lens, there is a number issues that are not publically spoken on relationship of vaccination with pregnancy, those with infants, those who are menstruating. From caste lens, the community that are being discussed have little of assets; some do not have even identification certificate, even aadhar; and lot among those not vaccinated are those who are in streets like Nomadic and those who are homeless.

2nd Layer: How many are yet to be vaccinated? With respect to persons vaccinated, by now (mid December), the vaccinated are almost 70-80% in eight hamlets they are currently working on this programme. What worked is the Government's Home Visits which ensured that a number of them got vaccinated, primarily when they saw that nothing is happening to their neighbours and relatives, those hesitating also vaccinated.

3rd Layer: How to reach out to 20-25%? One member said, Government has ensured supply, now individuals have the onus to get vaccinated. To this, another person retorted that it is not so simple. Then they did card sorting to list the problems why they are not vaccinating themselves. Reasons: 1.Many are not able to take second dose because they do not have certificate for first dose, which was in someone else's phone number, who has migrated. 2. These members are being asked to visit the centre to get vaccination, which is many KMs away. Being unemployed, many are trying to save on expenses. 3. In centres, often they are returned if they are not enough to open one vaccine box. 4. Some are not ready to disclose their illness fearing stigma. 5. Some found that their certificate already issued, so are not vaccinating.

4th Layer: Why these reasons are occurring? 1. With Covid, other development issues for unemployed have been sidelined. 2. Covid numbers have come down, so there is no fear. Health is not emergency issue. 3. Those who cant access their first dose certificate and those who have got false certificate of having vaccinated- require only software solution. They are not in small numbers.

5th Layer: What solution government has offered? 1.There is apparently a lottery programme, where everyone gets a token on vaccination, and one in thousands will get a prize. 2.The Jivika members apparently threatened that they would not receive benefits if they do not vaccinate. 3.Some are threatened they won't get ration. A team member said, this threat or carrot policies are not right. They could be counterproductive. People have to be dialogued with and convinced.

Solutions: Post that, we discussed the plan. They said while many have vaccinated, unvaccinated are still in good number. They discussed a plan. (1) The home visit team has marked cross in front of houses who are refusing to vaccinate. We can identify ten such houses and identify reasons why they are not vaccinating. If this has health related then we will ask some doctor to speak to them. We will analyse reasons and submit to Block medical officer to suggest a plan to convince them. (2).While there were honorarium for doctors (one month extra salary), there is none for ASHA or ANC or Sanitation workers. They should get some incentives. (3).This absence of first dose certificates or those who get info that they have already been issued certificate without vaccine, government should introduce some Help column in Cowin website to address such issues or even acknowledge. (4). No carrot and stick policy be done with citizens. Carrot and stick policy needed for Government teams. The Government needs to understand that one needs to invest on community-level workers to reach from 80% vaccination to 100%. Last 20% requires as much effort as the first 80%, because those 20% are not invisible, but visible as others!.

Chaaya, Vinay, Pinki Kumari, Rekha, Rita, Ajay, Kallu Kumar and Kavita, GGMVM team led by Ms Prathimakumari Paswan)