Vaccine hesitancy amidst the Omicron storm
Vaccine hesitancy is predicated by many myths. These stories range from sublime to the ridiculous. One such myth is Covid-19 vaccine, particularly based on mRNA technology, can alter the DNA or our genetic material. The other one reads: the Covid-19 vaccine is microchipped into the body, so that the vaccine-receivers can be tracked through 5G technology. A vociferous anti-vaccine movement asserts that the so-called randomised clinical trials of vaccines are aimed at people with lower IQ, minorities and the impoverished, while the control group is unvaccinated. They propagate that it is a form of eugenics, the principles of selective breeding to humans, where the ‘control group’ will succeed to govern the world affairs.
Vaccination hesitancy too has created some legendary stories. Our future generation will reminisce about these tales with some anecdotal and folkloric approach. Many eligible adults refused vaccines believing it would either turn them impotent or their offspring will be born with congenital anomalies or autism. The vaccine hesitancy, or the so-called refusal of vaccines or delay in acceptance, can manifest in many forms, as this is a complex and context-specific phenomenon, varying across time, geographies and the public discourse surrounding certain vaccines. Many people colour their stories of how vaccines are made or these chemicals work in the body, which shape their psychological disposition, including fear of needles, side effects, line of defence or distrust of public authorities.
In the thick of Omicron wave in India, the tribal people of remote villages in Nabarangpur district of Odisha were convinced the pandemic was caused by evil spirits. They propitiated their tutelary deities with libations and many fled into the forest when the anganwadi workers arrived to vaccinate them.
In Malgaon, Dandamunda, Khoparadihi, Sandhimunda and Fatki villages in Chandahandi block, the village guardian deities were carried in palanquin in a carnival-like gathering. A team of health officials, who indefatigably promoted Covid vaccination awareness campaign ahead of elections in India's most populous state, when arrived in Uttar Pradesh's Ballia, a secluded village, were wrestled to ground, while some villagers even climbed trees to stay away from vaccination.
Primary healthcare workers in Pondicherry, who were labouring on a door-to-door campaign to vaccinate everyone, met with a similar incident when 39-year-old Muthuvel from Konnerikuppam village deterred the health workers sitting on a tree, citing the ridiculous reason that he would not be able to consume alcohol following the jab. An elderly woman at Mettupalayam violently chased away a healthcare worker, who went to vaccinate her, by appearing to be possessed by Mariamman, the iconic goddess putatively known for bringing fertility and healthy progeny and curing her devotees from anything ranging from cholera to chicken pox. This highlights the role played by superstition and lack of education in rural areas in vaccine hesitancy.
Vaccine hesitancy has been cited as one of the top 10 global health challenges by the World Health Organisation (WHO). LocalCircles' survey conducted in October last year in India indicated that 70.4 million citizens were reluctant to take the jab. This number spiked to 115.9 million in the similar survey in early November, and follow-up survey in December revealed that only 69.6 million citizens were dithering to take the Covid-19 vaccine.
These results indicate that vaccine hesitancy grows when the Covid-19 curve flattens, but the vaccine secures greater acceptance as and when the curve goes north as was seen by the shortage of vaccines when the second wave was at its peak. Evidently, the vaccine hesitancy rate in India saw a descent after the second wave of the pandemic ravaged the country in April-May in 2021.
The vaccine is winning over a larger share of its eligible recipients, with teens aged between 15 and 18 years added to the eligibility group. In fact the youth and teens are majorly pro-vaccination. Buoyed by the enthusiastic response to the teen vaccination the government is likely to expand the ambit of children’s vaccination drive to the 12 to 14-year-olds from March.
According to the World Economic Forum’s survey conducted between 22 October and 5 November 2021, some 90 per cent in India insist they and their colleagues at workplaces must be fully vaccinated against Covid-19, while 93 per cent concur to wearing masks when in public places or in proximity with others.
To better comprehend trends in vaccine hesitancy in India, Facebook’s Data for Good team analysed tens of thousands of public posts about the topic on Facebook. The research included insights on hesitancy from Facebook’s Covid-19 Trends and Impact Survey (CTIS), which tracks information on vaccine acceptance at a local level in over 200 countries and territories worldwide.
According to CTIS, India had one of the highest rates of vaccine acceptance in the world, with almost 77 per cent of respondents affirmed that they would like to receive the vaccine. However, the remaining 23 per cent still can sabotage the nation’s ambitious vaccination campaign.
The high proportion of hesitancy is being driven by those choosing to ‘wait and see’ if the vaccine was safe. Hence, the Indian government now needs to build its vaccine campaign around the information deficit and answer people’s questions about vaccine safety and efficacy. Leveraging these revealing insights gained by CTIS, India's vaccination campaign must focus on personal stories of successful vaccination through trusted peers, family members and healthcare workers.
Apart from the operational challenges in delivering vaccines to India’s teeming 1.38 billion people, vaccine hesitancy remains a barrier, with health workers facing resistance from people, who believe that vaccines aren’t effective and cause serious side-effects. Vaccine decision-making is complex and influenced by individual observations, experiences, knowledge and even values and beliefs. Changing vaccine attitudes and behaviours often calls upon multiple interventions at various levels to be effective, including programmes that target individuals, social influencers, the health workers and communities at large.
In recent years, multiple research has found promising leads on how to influence people’s health behaviour and these insights provide the opportunity to evaluate at scale. For example, personal stories about why people chose to vaccinate may be compelling and this can be aligned with broader research and consensus within the field of vaccine acceptance and behaviour change.
The comparative lower rate of hospitalisation and severe disease and deaths seen with Omicron is in large part thanks to the vaccination which prompts the body’s immune response to the virus. Moreover, the majority of patients with Omicron, who required hospitalisation or developed severe symptoms were unvaccinated. As we are currently in the eye of a blustery Omicron storm, the vaccine hesitancy must be fought at all levels.
Ending the pandemic requires us to get to much higher levels of vaccination, especially targeting the unvaccinated population, which has not taken even one dose of the vaccine. In fact, the unvaccinated population serves as an easy host and can help the virus replicate quicker, thus increasing the chances of mutations and can result in more infectious and virulent variants with increased chances of immune escape.
In conclusion, if vaccine hesitation must be won over on a war footing, it is essential to educate the anti-vaxxers and dispel their myths to ensure their vaccination to prevent more contagious and virulent variants in the near future.