India’s 139 crore population accounts for 17.7% of world population and is also ranking second globally on COVID vaccination front with around 33 crore COVID vaccine doses been given to Indian population while as over 5.52 crore persons received both doses During this time USA has given first dose to over 32 Crore population with over vaccinated over 47% population received both doses.
Jammu & Kashmir has an estimated population of around 1.52 Crores and among them 66% are adults (18 years and above) who are eligible for COVOD vaccination which comes to around 1.00 crore population. Till date (29-06-21), over 44 lac COVID vaccine doses have been given among the eligible population from 18 years and above in Jammu & Kashmir. Among them, Over 1.65 lacs doses given to health care providers (HCW)while the front level workers received whopping over 5 lac doses.Among general population, the age group of 18-44 years (43% of total population) received over 8.26 lac doses while over 25 lac population received first dose in age group of 45 years and above which accounts for 83% of estimated 30 lac population (which is 23% of total population).
The percentage of people above 45 years who received any jab of vaccine is encouraging while it presents a dismal response from the most productive and reproductive population in age-bracket of 18-44 years, as only 13% out of estimated 61 lacs received the vaccine.
Reasons for Vaccine Hesitancy:
The reasons for vaccine hesitancy need to be worked out and addressed so as to reach a considerable immunity level which shall protect the whole community against the possible third and subsequent COVID waves.
1. Infertility concerns: Interestingly among the 44 lac doses given in Jammu & Kashmir, over 60% doses have been received by the men while females have received just around 40% of total doses while their proportion in general population to males is around 889 females to 1000 males. This seems further skewed among young women as the percentage of vaccine beneficiaries in 45 years and above would be comparable as they don’t fear from major concern of infertility as they have passed the reproductive phase.
2. Moradabad-Polio Capital of the world to Polio Chowk: Despite polio eradication initiatives started earlier, till early 1990s India was hyperendemic for polio, with an average of 500 to 1000 children getting paralysed daily. India started its mass immunisation campaign in 1995 as Pulse Polio Immunization strategy, most people stayed away. Till 2009, India recorded 741 cases, 74 in Moradabad. Most people believed the vaccine contained anti religious ingredients. The other suspicion was that the government was trying to sterilize their children. However, years later, people started talking about four basic requirements- Sadak, bijli, pani and polio. In few years due to concerted efforts by the government and various reputed organisations like WHO, UNICEF, Rotary etc, polio was eradicated from Muradabad and a road-square was named as Polio Chowk to commemorate polio eradication in Muradabad. Such myths about vaccines causing infertility has delayed polio eradication in past and is doing so nowadays during COVID-19 containment. Had myths of infertility associated with polio vaccines holding any truth, now, 25 years later after Pulse Polio Immunization, the population would have drastically reduced as no one would have allegedly begot children.
2. Adverse events following immunization (AEFI): Every vaccine has inherent property to cause some minor events. COVID vaccines have been found to cause mild fever, pain at injection site, body aches etc which may last for a day or two. As per national AEFI Committee, the overall AEFI associated with COVID vaccination has been 0.003 % which is very much negligible. However, the rumours spread by anti-vaccine lobbies and infodemics became impediments for vaccine uptake. Careless statements by a scientist that vaccine would be causing deaths within two years or causing antibody dependent enhanced (ADE) has been refuted by scientific bodies worldwide but the damage it caused to vaccination was huge.
3. Misconceptions: There are common misconceptions held by individuals and groups refusing the vaccine due to lack of information, misinformation or religious-based objections.
1. Experts sharing fact-based information: Instead of spreading deluge of messages through social media, its essential that healthcare and frontline workers who are well educated about COVID-19 vaccines, they can reach public through dissemination of required specific information to the general public on necessary aspects of immunization, including AEFI.
2. Debunking myths: The vaccine experts shall talk to public through the media of short videos circulated on electronic and social media platform which has wider dissemination
3. Engaging community leaders and influencers: Community leaders, including faith-based influencers, public health professionals and community based organisations can facilitate and conduct advocacy for vaccine acceptance and encourage COVID appropriate behaviour and SOPs.
4. Vaccines availability and accessibility: The vaccine coverage in hard-to-reach areas can be enhanced by provide adequate space, logistic support and sufficient quantity of vaccines coupled with involvement of local influencers.
5. Success stories: As most of health care workers, including female doctors received vaccines; they shall talk to the females having apprehensions about vaccination and its AEFI and debunk myths of infertility, either through face to face or short videos or radio/ TV talks or shows.
6. Special Counselling sessions/ sites to address hesitancy: The health systems shall establish special sessions to counsel such women who have apprehensions about COVID vaccination and provide them with scientific reasoning to allay fears.
7. Decision making: The women shall be empowered to take decisions about their health needs including vaccination and there shall be no force from family or spouse to stop her right to health.
The author is professor & Head, Department of Community Medicine, Government Medical College, Srinagar and can be mailed at firstname.lastname@example.org