Reorienting vaccination drive  

Moa Jamir

Uptake of COVID-19 vaccines in the 45 years and above age group in Nagaland “remains low and stagnant” as only 1,566 doses could be administered in the past week despite the availability of vaccines, informed the COVID-19 Weekly Bulletin issued by the Integrated Disease Surveillance Programme, Department of Health and Family Welfare, Kohima on May 29.

This in essence highlights another serious challenge facing the State in tackling the COVID-19 pandemic—vaccine hesitancy. The matter has been often discussed before, but reiterated, as the severity of the second wave makes it imperative to adopt concerted policy and strategy to tackle the predicament. 

Vaccine hesitancy, according to the World Health Organization (WHO), refers to delay in acceptance or refusal of vaccines despite availability of vaccine services” and it is listed among the Top 10 threats to global health in 2019. With the advent of the COVID-19 pandemic in the recent past, one can safely assert that it is now at the top. However, it must be accepted that vaccine hesitancy is “’complex and context specific varying across time, place, and vaccines,” WHO said, and underscored the need for various strategies to tackle.

A starting point of intervention is locating the reasons behind the hesitancy—safety concerns, religious belief, conspiracy theories, local and global influences, accessibility and so on. These concerns are dynamic and evolving.

“Implementers must adequately identify the target population and understand the true nature of their particular vaccine and/or vaccination concerns; this will help ensure a well-informed intervention,” stated a WHO’s Strategic Advisory Group of Experts on Immunization (SAGE).

In Africa, WHO risk communication teams have responded to these concerns by designing and implementing orientation sessions for the target groups and contributed to increased vaccine uptake among frontline health workers, teachers, and security personnel. The intervention includes providing accurate and scientifically proven information on the vaccine and tackling rumours and misinformation.

In the case of Nagaland, the May 29 Weekly Bulletin informed that apart from a mere 27% in the 45 years and above, only 62% of the Health Care Workers (Anganwadis, ASHAs and all categories of HCW as registered on CoWIN portal) have received their first dose. The vaccination among Frontline Workers (Police, military, administration etc) was more encouraging at 80%.

The slow uptake of vaccines among the HCWs is concerning as they were the first category of populace prioritised for vaccination when the process kicked off in India on January 16 this year.    

Most importantly, HCWS are considered to be the most trusted source for vaccination and influencer of vaccination decisions among the general population. If vaccine hesitancy among the HCWs in Nagaland continues to persist, there is strong ramification for the COVID-19 vaccination campaign as well as the State’s ability to keep the pandemic at bay.

As effectiveness of the COVID-19 vaccination depends on achieving herd community implying that ‘the greater the number of people vaccinated, the less risk to the population,’ the issue should be analysed and remedied at the earliest by the concerned authority.

In addition, while accepting that there is no single strategy to address vaccine hesitancy, the WHO Advisory Group have recommended well integrated, multi-component strategies, accompanied by an appropriate evaluation process.

Chief among them is dialogue-based advocacy intervention to engender meaningful engagement. It includes the involvement of religious or traditional leaders, social mobilisation, social media, mass media, and communication or information-based tools for health care workers. The Churches and social organisations, albeit belatedly, are joining the combined effort to tackle the second wave of COVID-19. The State authority must redouble efforts to engage them in dispelling vaccine hesitancy and encouraging vaccination.

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