Thousands of cattle, mainly of magnificent Kankrej and Gir breeds, in a little-known village in the Abdasa taluka of Kutch, stood in front of us as we had geared up to immunise them against Foot and Mouth Disease (FMD) in 2013. Before we could start, a young man appeared claiming to be the sarpanch of the village. He approached us and said, vaccine “nathi karau, tame loko chaliya jao” (vaccination is not needed, you all can return). No animal could be vaccinated in that village. I was about to learn that vaccine hesitancy was complex and context-specific varying across time, space and vaccines.
Five years later, 1800 km east of Kanha, a farmer in a flood-prone village at the fringe of Kaziranga National Park, politely asked me not to vaccinate his livestock and rather leave his farm saying, “aapuni forest departmentpa aahisha, muk aapunar help nalage, aapunar vaccine dator nahoi” (you have come from the forest department, I don’t need your help. Your vaccine may be outdated). Trust-deficit had blocked vaccine uptake but this was a solitary case as other accepted mass vaccinations of livestock.
The three isolated cases are from three states with distinct cultural and demographic profiles. Misinformation and trust-deficit due to inadequate communication had created the situation for vaccine hesitancy. The picture for human vaccinations is not much different either because the forces for accepting or rejecting vaccine for humans work at the same subconscious level.
On March 16, 1995, India had administered the first oral polio drops to eradicate it from India. Two decades later India was declared a poliomyelitis-free country. March 16 is a milestone for the journey that India began with its Expanded Programme of Immunization (EPI) in 1978. The EPI was renamed Universal Immunization Programme in 1985 to annually immunize 60 million women and infants. India celebrates March 16 as National Vaccination Day to raise awareness on immunization.
Long ago, the smallpox vaccine, with advantages over variolation practised in India, arrived in 1802. Yet, it took 175 long years for India to combat smallpox. The colonial powers had to frame the Compulsory Vaccination Act in 1892 to ensure high coverage of smallpox. Resistance from some sections based on the pretext of vaccine coming from cows wasn’t very helpful. Writing in the British Medical Journal (1910), Andrew Buchanan of Indian Medical Service mentions of an ‘anti-vaccination party’ and reiterates that “the greater the success of the anti-vaccination campaign, the greater will be the necessity for early vaccination of India.”
Natural calamity and disasters carry immense learning values. As Covid-19 struck India at the beginning of 2020, the first few months were lost in the confusion and rhetoric. Later it dawned on humanity that the virus was not going to vanish only by lockdowns, masks, sanitizers and distancing. Talks of vaccine soon became the fulcrum of public and political discourses. During previous pandemics, India had seen the threat of the ‘anti-vaccine party’. However, around Covid-19 pandemic, social media and popular press left little scope for the unscientific groups to spread misinformation. People – irrespective of age, sex, colour, and ethnicity – waited for vaccines to be made, tested and launched. Finally, it happened. Covid-19 seem to have united the world.
A National Statistical Organization report substantiates that only 60% of the children under five years are fully immunised across the country. This finding exposes a wide gap in the claims made by the Government of India’s Health Management Information System portal data claiming 87% coverage for children under five across the country during the same year (2017).
The issue of vaccination hesitancy needs to be acknowledged, addressed, and discussed. In the villages around Kanha Tiger Reserve, The Corbett Foundation, an agency involved in wildlife conservation, has adopted rural tools of communication, like household visits, panchayat meetings, Mohalla meetings, munadi (passing information beating drums on village streets), and wall paintings to spread information on disease symptoms and vaccine availability. These efforts have paid dividends and now villages like Bakiguda are ambassadors for vaccination uptake.
A collaborative, multisectoral and transdisciplinary approach of One Health based on the interconnectedness of people, animals, plants and their shared environment would be able to address the complexity of health.
Vaccination that works by stimulating an immune response is one of the most cost-effective ways for preventing the spread of infectious diseases. India has increased its capability to manufacture vaccines. The much-hyped vaccine diplomacy by Beijing, Moscow and New Delhi in the face of the ongoing Covid-19 pandemic is a result of many decades of complex and systematic methodological rigour. Will vaccine hesitancy overpower vaccine diplomacy in India in the context of the Covid-19 pandemic?
(The writer is a Conservation Medicine professional trained at the University of Edinburgh and serves as the Deputy Director and Veterinary Advisor to The Corbett Foundation. He can be contacted at naveen.vet@gmail.com)