Vaccination Has Slowed Down: Mobilise Communities

By Glenn C. Kharkongor

What should have been a vaccination overdrive has shown a dismal downturn. The numbers tell the story. The state’s efforts, sincere and well-meaning though they may be, shows apparent dis-coordination between the political leadership, health directorate, and the bureaucratic administrative machinery.

 Political leaders look for political points, whether in the treasury or in the opposition. The health directorate, run by doctors, tend to be focused on medical issues such as preparedness of hospitals. The bureaucracy, which is the arm of the government that must run operations finds itself sandwiched between the politicians and the doctors.

 It seems to me that decisions made by the political leadership are largely influenced by the doctors who often carry the day with their degrees and medical jargon. This sometimes intimidates, rather than merely influences. Having been in the fraternity for fifty years in mission hospitals, medical colleges and government committees, I have often seen the sometimes undue influence that doctors exert on decision-making processes.

 An example of this was the recent decision for lockdown. It was the right decision, but among the major reasons cited was the fact that hospital capacity would soon be under strain. This was a correct conclusion, but dictated by medical concerns. The decision to make two pre-fab hospitals is also correct, but it again shows a curative mindset, which has taken precedence over a preventive attitude.  Such is the average doctor’s outlook, conditioned by his/her training.

 This brings in a subtle skewness in the decision-making strategy, in which strong influencers elevate medical priorities and thus relegate prevention to secondary importance. Decisions such as the recent lockdown was not accompanied by a clear preventive strategy, which is why public health specialists and epidemiologists must be in the forefront.

 Vaccination slowdown

An example of this skewness is shown the vaccination data, obtained from the cowin.gov.in dashboard for Meghalaya state and the Johns Hopkins University world Covid date centre.

As on May 8, 2021, only 2,75,458 (42%) of the eligible population of 6.5 lakhs have been vaccinated. In the past 2-3 weeks, the vaccination numbers have slowed from about 15 thousand a day in the week of Apr 26 – May 1 to the numbers shown below:

The vaccination slowdown is perhaps caused by several factors, one of which is vaccine refusal. The efforts by government and community leaders to increase the vaccine rate has had limited success. It may be that the state does not have sufficient vaccine stocks. At a vaccination centre set up last Thursday near my house, only a few persons were vaccinated. The staff said that forms had run out so left to get some more, returning two hours later with only a few forms, and closed shop soon thereafter. Many who stood in line could not get vaccinated.

 Vaccine shortage

The central government is tight-lipped on vaccine supplies, with no certain timetable for vaccination while the pandemic rages on. The Financial Express of May 8, asked the question, “If the Indian government has paid the two vaccine companies (Serum Institute and Bharat Biotech) for additional vaccine doses, then why is the overall stock of vaccines reduced and also the rate of vaccinations declining? The ambitious vaccination drive that India embarked… gathered steam in April touching around 4 million vaccinations a day. But…the rate of vaccination has slipped to 2.3 million doses a day.”

On May 6, the central government announced that it had provided over 171 million doses to all the states free of cost till date, and that 8.9 million doses are still available with the states. In addition, 2.8 million vaccine doses would be made available in addition to the states within the next three days. That is 11.7 million doses for the states. This, going at the current rate of vaccination, will get consumed in a matter of days. To vaccinate all adults with two doses the country will need an additional 1.2 billion doses. Who knows how long it will take for his astronomical figure to be reached?

Bhutan showed the strategy that poor countries should adopt. It has vaccinated 93% of its adult population. A study by the Harvard University School of Public Health has noted “that while the U.S. has the world’s best medical system, the nation has neglected a public-health focus on prevention—which Bhutan and some other socially cohesive low- and middle-income countries have adopted to avoid being overwhelmed by epidemics.” Bhutan cannot afford expensive high-tech curative medicine and neither can Meghalaya, nor run many hospitals when health manpower is in short supply.

In the approach to Covid, Meghalaya needs to adopt a small, poor country approach. We should not have missed the bus on preventive measures like vaccination. Now vaccine supplies have rapidly dwindled and the situation for the next few months looks grim.

Community Mobilisation

Community mobilization has also failed. The reluctance of the dorbars to collaborate with the government shows neglect of this important asset. The dorbars appear to have genuine reasons for their hesitancy: lack of resources, manpower, and increased community exposure and risk. However, one enlightened and resourceful dorbar has shown community concern and responsibility. This shnong has had a recent rise in positive cases, mainly from returnees coming through Umling. 

Located within the Shillong Agglomeration, this dorbar has set up a unique self-help model by setting up its own Covid quarantine centre. It has obtained 20 beds, mattresses, pillows and linen from a sponsor. The dorbar is providing other amenities from the small surplus gained from the household fee for garbage collection. A small daily charge will be levied from the quarantined persons. The estimated a monthly deficit of Rs 1.2 lakhs will be borne by the dorbar. They can financially mange for 3-6 months, by which time it is hoped that the pandemic will be brought under control.

Suggestions

Daily briefing of administrative updates by operational heads such as the chief secretary, health secretary and DC rather than politicians or doctors. There should be public health updates and advisories by public health experts. DIPR and the Shillong Times should publish daily data on vaccinations and vaccine doses in stock.

 As the >45 year age group have had their chance, provide vaccinations to anyone who walks into a vaccination centre. Exhaust the vaccine doses available. When more are vaccinated, the safer the state will be. When vaccine supplies are exhausted, appeal to the central government, high court, or international foundations for help. If a state says it has no more vaccine and pleads its case, it will strike a chord somewhere.

 Mobilise the dorbars by addressing their concerns and needs. Some of the poorer shnongs will need financial help, for which a monthly scheme can be worked out. Volunteers in the Covid community quarantine and care centres should get priority vaccination. Provide crash course healthcare training for community volunteers. Financial incentives can be given to shnongs based on vaccination acceptance. 

A poor state must vaccinate.