Refocused Vaccination Campaigns

Context: Refocused, rejuvenated local, national, and global vaccination campaigns are possible.

Major equity and justice concern in vaccination drive

• Prioritisation not based on risk profile: Vulnerable section of the population like old age, historically marginalised communities etc., are not given priority in accordance with the risk they carry.
• Gender inequities in vaccine uptake: Driven by economic pressures to protect the (often male) breadwinner in families and historically marginalised stature of women in society.
• Poor surveillance: No COVID/vaccination data available based on gender, caste, religious, and indigenous identities.
• Digital divide: Digital apps for registration are a recipe for inequity along with age, gender, and economic dimensions.
• Global inequity: Wealthy countries secured more doses than they need, leaving poor countries to be solely dependent on supplies through COVAX.

Way forward: Local planning need to go hand-in-hand with equitable plans at national and global levels.

• Prioritise people based on the risk and need: Vaccination policy should prioritise poor, religious minorities, socially disadvantaged castes, tribals, those living in remote areas, and women.
  • E.g. Chhattisgarh’s equity-focused vaccination plan: Based on ration cardholders.
  • WHO advisory: Call for prioritising sociodemographic groups at significantly higher risk of severe disease or death (for vaccination) in the context of limited supply.
• Leverage existing capacities: Accredited Social Health Activists (ASHAs) and Auxiliary Nurse-Midwives (ANMs) have vast experience and expertise with campaign-style pulse polio vaccination and can be used for vaccine delivery.
• Re-prioritise door-to-door campaign: In urban slums and neighbourhoods, where socially disadvantaged caste and community groups and migrants from Adivasi communities often reside.
  • It can also boost the accessibility to older adults.
• Vaccination camps where people live and work: Could greatly enhance vaccine uptake among essential workers and the poor.
• Prioritise districts with larger marginalised/minority population: Adivasi districts, districts with large Muslim population etc.
• Address vaccine hesitancy districts with larger marginalised/minority population (like Muslims or tribal): Prioritise engagement of trusted spokespeople to engage in effective risk communication to build trust in the vaccine.
• Women-only vaccine days: To ensure that women know that they are being prioritised, this is because, during the 1918 Spanish flu pandemic, Indian women were more affected than men.
• Evolve data-driven interventions and prioritised resource mobilisation: Through better leadership to standardise and enforce meta-data collection and timely reporting.
• Leverage donations and other support from developed countries: Equip COVAX facility to ensure equity and justice in global vaccination drive.
• Long term vision: Set up vaccine distribution systems with equity in mind for the next pandemic.