By Dr Sandra Albert & Dr Rajiv Sarkar
The World Health Organization has declared “vaccine hesitancy as one of the 10 threats to global health in 2019. On an individual level, studies have shown the following factors are causes of vaccine hesitancy: the perception that vaccines are not effective or useful; concerns about safety and side effects; distrust of the health system; a preference for “natural health;” fear of pain and needles; lack of awareness; and prior negative experiences with vaccines. On a community level, vaccine hesitancy is seen across educational and socioeconomic backgrounds. Misinformation about vaccines spread on social media also has been a driver of vaccine hesitancy in recent years, as has negative media coverage of vaccines, including coverage of celebrities who promote vaccine refusal.” (WHO)
Vaccines are effectiveand safe
A large body of emerging data from around the world now shows the efficacy and safety of COVID-19 vaccines. These are available in reputable medical journals and international health agency websites. We present some sets of data from India which pertain to the Covaxin and Covishield vaccines. The Covishield vaccine in particular has been subjected to extensive clinical trials in several countries and a recent study from the UK shows it offers protection against the newer delta variant of the virus as well.
Study of CMC Vellore Hospital Staff*
| Group | Vaccinated | Unvaccinated | Benefit |
| Number | 7080 | 1609 | |
| Got infected | 9.6% | 27.2% | x3 |
| Hospitalized | 0.9% | 4% | x4 |
| Needed oxygen | 0.7% | 0.06% | x11 |
| Needed ICU | 0.5% | 0.03% | x17 |
| Deaths | 1 | 0 |
*Published Mayo Clinic Proceedings June 11, 2021
Ministry of Health*data on side effects Jan16-Jun 7, 2021
From total of 23.5 crore doses given
| Side Effect | Number | Percentage | Comment |
| All side effects | 26,200 | 0.01% | |
| Minor | 24,901 | 0.01% | Fever, pain and swelling at injection site, including pain and swelling, which spread beyond the nearest joint, and high-grade fever |
| Hospitalization | 2,318 | 0.001% | blood in vomit, unconsciousness, chest pain, difficulty in breathing, thrombocytopenia (low blood platelet count) |
| Deaths | 488 | 0.0002% |
*reported by CNN-News18
Human Rights
Article 25 in The Constitution of India provides for “Freedom of conscience and free profession, practice and propagation of religion (but) subject to public order, morality and health. Article 19 on the right to freedom also carries a rider, that “nothing in this article shall prevent the State from making any law in the interests of the general public”.
The Epidemic Diseases Act, 1897 empowers the government to take special measures and prescribe regulations as to dangerous epidemic disease, when the ordinary provisions of the lawbeing in force are insufficient for the purpose, so as to prevent the outbreak of such disease or the spread. Though legislated more than a hundred years ago these provisions are not outdated, since the world had experienced many pandemics over the previous centuries and while medical science has advanced, administrative measures also have an important role to play.
On June 13, 2021, a US court dismissed a lawsuit brought by 117 workers terminated by Houston Methodist Hospital because they refused to comply with a hospital order that they be vaccinated against COVID-19. The lead plaintiff, a nurse had argued that the vaccines are experimental and dangerous. The judge did not find merit in either argument. It was also noted that 24,947 other employees of the same hospital had taken the vaccine. The judgment noted that the hospital had made the correct choice to keep staff, patients and their families safer.
So far more than 400 US colleges and universities have announced mandatory vaccinations for faculty and students so as to keep campuses safe. These include Protestant, Catholic, and Jewish institutions and theological seminaries. An overwhelming majority of students of students, 96% have gotten the vaccine or have said they will get it.
Who are the vaccine refusers?
Survey data have shown that certain demographic sections of the public are more inclined to refuse the COVID-19 vaccine. An Indian study has showed that overall about 10% are vaccine hesitant. This rises to 24% in low-income groups, and 28% with low education and 24% among families who had refused other vaccines earlier. Hesitancy among scheduled caste and scheduled tribe persons were three times higher than the other sections.
In the US, refusal or hesitancy (about 25%), is higher among women, minorities, lower education groups and conservative persons. In France, vaccine refusal and hesitancy (about 30%) was associated with female gender, lower educational level, and poor compliance with recommended vaccinations in the past.
There is considerable vaccine hesitancy in Meghalaya especially in the East Khasi Hills. A survey conducted by the Indian Institute of Public Health Shillong, of Health Care Workers (HCW) not vaccinated by April 15, 2021, over half reported fear of adverse effects and a third attributed to confusing messages over Whatsapp among other reasons. Vaccine hesitancy was least among doctors (14%) while it was several times higher among nurses, allied health personnel, non-medical support staff and non-medical frontline workers (41-50%). Higher vaccine hesitancy was seen among HCW in private hospitals compared to government hospitals.
Vaccine refusal endangers the public
One pertinent example can be cited. In the last couple of decades, the increasing refusal by parents to give their children vaccination has seen a resurgence of measles in the US and UK. Measles was eliminated from the US in 2000. Now hundreds of children each year suffer from this vaccine preventable disease.
Vaccine refusal has been an ongoing problem in Meghalaya, as shown by a study conducted in 2017 by the Indian Institute of Public Health Shillong in collaboration with the Directorate of Health Services (MCH & FW), Government of Meghalaya. Vaccine refusal will delay or prevent herd immunity. Dr Srinath Reddy, President of the Public Health Foundation of India has provided some data in a recent article in the Times of India. “A recent study from Serrana (in Brazil), revealed that deaths were reduced by 95% and infections by 86%, when 60% of the population was vaccinated. On June 1, 2021, Britain reported zero COVID-19 deaths, after 59% of the British adult population were vaccinated.” Such data indicates that achieving herd immunity is possible if a large proportion of the population is vaccinated. Studies from the US indicate that herd immunity may be achieved only if 70-90% of the population is vaccinated. So not getting vaccinated puts others’ lives at risk. It may prolong the pandemic, resulting in additional hospitalizations and deaths. According to the Shillong Times of June 2, 2021, already “vaccination hesitancy among the people here is proving to be immensely costly as a staggering 91.4% of those who lost their lives owing to COVID-19 infection were not vaccinated. … Only 26 had taken the first dose while there were zero deaths among those who had both doses.”
Getting vaccinated isn’t just about you. Yes, you have the right to take risks with your own safety. One may demand individual, religious or moral rights. But when your rights endanger the well-being, safety and health of your fellow humans, especially voiceless children, it raises serious ethical issues, apart from public health considerations.
( Sandra Albert MD DrPH and Rajiv Sarkar PhD, faculty Indian Institute of Public Health Shillong)