Covid-19 vaccination drive hit by hesitancy hurdle

In the three days since coronavirus vaccinations began in India, roughly 50 people have been given doses per session –half of the 100 on average expected by the government, data released by the Union health ministry showed on Monday, as reports poured in of people being reluctant to come forward to take the jab.

The government said that between Saturday morning and 5pm on Monday, 381,305 people were given doses in 7,704 sessions. Some health workers across the country, who are first in line to get doses, either did not turn up for their appointments, or outages in the digital platform to manage their records meant they were not informed.

The Union government has advised states to call and administer doses to 100 people on average during each session. According to figures collated by HT from across India, the total number of vaccinations by the end of Monday was 429,409.

The turnout dipped from 4,319 on Saturday to 3,593 on Monday (there were no immunisations on Sunday) in the national capital. At the All India Institute of Medical Sciences (AIIMS) in Delhi, only eight people were vaccinated on Monday, an official said, while asking not to be named.

Officials said concerns over the vaccines’ safety appear to have deterred many people.

“Initially, health care workers were very keen to get the vaccine. But then because of the infodemic, because of things doing the rounds on social media, because of side effects being highlighted more than what they were, it created a lot of anxiety not only among healthcare workers but also in public at large,” said Dr Randeep Guleria, the director of All India Institute of Medical Sciences (AIIMS), in an interview to HT on Monday.

Hesitancy was reported among some beneficiaries in the run-up to the January 16 launch of the vaccination drive. Groups of doctors said they were apprehensive or would not prefer to get doses of Covaxin, the vaccine made by Hyderabad-based Bharat Biotech.

This dose has not yet been tested entirely in Phase 3 trials, and the manufacturers don’t know how effective it is in preventing Covid-19. The other vaccine, Covishield, developed by Oxford-AstraZeneca and manufactured by Serum Institute of India, has proved its efficacy in human trials.

Two interns at Delhi’s RML Hospital, who asked not to be identified, said they were aware they could walk in and get the shots on Monday, but expressed concerns over lack of long-term data.

In UP, the state government issued a notice to a government hospital in Kanpur where only 40 people were given doses on Saturday. The state is carrying out immunisations only two days a week, Thursday and Friday from this week onwards.

The problem, as suggested by Guleria, appears to have been made worse by reports of some adverse reactions. Manohar Aghnani, additional secretary in the Union health ministry, said 580 cases of adverse effect following immunisation (AEFI) were reported in the three days.

The Union health ministry has said that most AEFIs have been mild, with symptoms such as pain at injection site, nausea and mild fever. Of the 580 – who represent just 0.15% of those vaccinated – seven required hospitalisations. For of these people were still under admission.

Experts said that these numbers were much below the thresholds for anything that should be worrying and that the risks outweigh the benefits of immunisation. “Acceptable level of AEFI would ideally be zero, but that is not the case. I think it is around 0.2% and yet we are focussing on that and not the 99.8% benefit,” said Dr Shahid Jameel, former CEO of Wellcome Trust/DBT India Alliance.

Officials also reported glitches in the Co-WIN mobile application that vaccinators use to create lists of who will be given doses during a particular session and record their status. “The portal is crashing intermittently, leading to delays. It happened on Saturday and today as well,” said Dr Vidyapati Chaudhary, principal of the Patna Medical College Hospital. “We are not getting the names of beneficiaries on time. As a result, we are unable to contact them telephonically. Some beneficiaries have complained that they did not receive any intimation about their vaccination. Sometimes, midway through the exercise, names of beneficiaries also disappear from the portal.”

Similar problems were reported in Delhi, where hospitals allowed health care workers at their facilities to walk in for doses. Their details, an official at one of these centres said while asking not to be named, will be uploaded later.

The problem was such that Maharashtra suspended the vaccination drive on Saturday after only less than 2,000 people were vaccinated across the state.

A Union health ministry official said glitches in the app were being rectified. “Almost 90% glitches have been addressed. Speed has improved. Session creation and planning has been made more flexible. A lot of the “glitches” are also because of varying degrees of IT awareness of vaccinators,” said this person, asking not to be named.

Experts believe vaccine hesitancy may be a bigger challenge in accelerating the drive. “Vaccine hesitancy had a major role to play when it came to the low vaccination rate on Saturday. Many people were comparing the two vaccines, many people wanted to wait and see what happens, and others wondered whether they needed it, having recovered from the infection recently. When people were asked to sign the consent forms, that too led to a lot of anxiety,” said Dr Suneela Garg, professor of community medicine at Maulana Azad Medical College.

Recipients who were given Covaxin were required to sign consent sheet that is typically given to people participating in clinical trials – technically, the Bharat Biotech vaccine has been approved under “the clinical trial route”, as per the regulators’ decision on January 3.