The key to getting all eligible Indians vaccinated

A submicroscopic infectious agent — Covid-19 — has shaken our planet. The world watched in horror as the second wave wreaked havoc in India — with people gasping for oxygen, funeral pyres in makeshift lots, bodies buried on the banks of the holy Ganges. The unfolding narrative brought into sharp focus an ill-prepared nation — marked by stark disparities and inequities; a befuddled citizenry whipped by the vortex of grieving devastation, longing for coherence, and not finding it.

The past aside, India’s need of the hour is to implement a comprehensive, coordinated, and coherent strategy — anchored in the principles and practices of social and behaviour change communication (SBCC). For this, India is aatmanirbhar (self-reliant) — it has the experience, ability, and vital capacities to implement an SBCC strategy, creating an informed and engaged citizenry that seeks vaccinations, while complying with all Covid-19 appropriate behaviour (CAB) — hand hygiene, masking, distancing, and others.

However, across the country, there remains the issue of vaccine hesitancy.

A quick dipstick exercise was co-facilitated by the Advisory Group on Community Action (AGCA) members and the AGCA secretariat team housed at Population Foundation of India. Conducted in 37 districts across seven states — Bihar, Goa Jharkhand, Karnataka, Madhya Pradesh, Maharashtra and Rajasthan — it brought to light various misplaced beliefs and myths.

One, many community members believe that vaccination can lead to extreme sickness and death. Two, tribal communities believe that Covid-19 is a problem of the urban elite, and so, they will be unaffected. Three, some communities believe that vaccination is a measure to control the population, falsely believing that it leads to infertility and impotency. Four, the government is paying huge sums of money to Accredited Social Health Activists (ASHAs) to get people vaccinated.

To tackle falsehoods, bust myths and ensure that the entire eligible population of the country is vaccinated, what considerations should drive its SBCC strategy? Here are some ideas that are concrete, implementable, and have the potential for success.

First, any SBCC strategy should identify “positive deviants” — i.e; communities or individuals that have already solved a Covid-19 problem with no extra resources, and while overcoming great odds. Janefal, a village in Maharashtra’s Aurangabad district, represents a positive deviant (PD) case. “Positive” since National Geographic reported that it has vaccinated 100% of its eligible citizens with the first dose, and “deviant” because it represents a statistical exception.

How did Janefal counter rumours to vaccinate all its residents?

A task force was established of local stakeholders, including government officials, the village head, village council members, ASHA workers, and volunteers. All eligible citizens were identified and mapped, and a micro-plan was prepared to guide home visits. To counter resistance, WhatsApp videos of local officials and village leaders taking their vaccine jabs were shown. Influencers also recorded testimonials about vaccine safety — including information about the minimal and manageable side-effects.

As more adults signed on, a diffusion effect was observed — non-conforming individuals felt an increased pressure to comply with the shifting norm of vaccine acceptance. A few smartphones were used to register everyone on Co-WIN — the government’s vaccine portal — overcoming the digital divide instantly. On vaccination day, Janefal residents gathered en masse, displaying cohesion, solidarity and collective pride. According to National Geographic, the success in Janefal spurred similar vaccine drives in 16 neighbouring rural communities.

Remarkably, there are other PD villages in India. India Today identified several communities in Bihar, Uttar Pradesh, Assam and Kerala that remained 100% Covid-19-free across both waves. While awaiting vaccines, these communities went for a “social vaccine”, creating protective “social bubbles” by forgoing public celebrations — festivals, marriages, birthdays and seeking timely e-consultations with remote medical personnel. An SBCC strategy would benefit from identifying such PD practices, amplifying them, and adapting, as necessary, to the local cultural context.

Second, SBCC strategies should be turbocharged by implementing integrated 360-degree transmedia interventions on mass media, social media platforms, mobile-enabled interactive voice response (IVR) systems, and artificial intelligence (AI)-enabled chatbots. Narrative-based SBCC interventions centred around TV dramas can engage audiences and demonstrate new models of behaviours to shift social norms. Consider the dramatisation of Janefal’s vaccination story: Amid a cauldron of rumours, myths, and misconceptions, a community coming together to create a task force, mapping residents, creating micro-plans, signing up residents, and collectively celebrating its triumphs. Social media platforms, IVR, and AI can extend and deepen audiences’ narrative engagement, connecting audiences with civil society partners and service delivery. Again, capacities exist within India to carry out such integrated, long-running SBCC interventions.

Third, the pandemic offers an unprecedented opportunity for India to invest in the experimentation and implementation of a wide spectrum of SBCC programmes that hold the potential to spur transformative social changes.

Covid-19 response, recovery and rebuilding should spur a wide variety of SBCC initiatives geared to shift social norms associated with sanitation and hygiene, seeking teleconsultation for early treatment, and reducing the load on hospitals. Covid-19 has also brought sharper attention to leveraging technology-enabled platforms. The implications of such SBCC interventions can be game-changing.

The potential exists for India to shift the narrative of how it has, thus far, handled its Covid-19 response.

A decade ago, in 2011, India reported its last case of polio. India’s polio eradication programme represents a triumph of epic proportions among public health experts, SBCC scholars and practitioners. How the world will evaluate India’s Covid-19 response, only time will tell.

Ajai Chowdhry is founder, HCL. Arvind Singhal is the Samuel and Edna Marston professor of communication, University of Texas and William J Clinton distinguished fellow, Clinton School of Public Service, University of Arkansas

The views expressed are personal