Do not doubt the dose: Why some people are saying no to vaccines

Vaccines have always met the wall of hesitancy although over time that hurdle has become easier to surmount. When India’s efforts to eradicate smallpox through a national programme in 1962 failed to meet its targets, people’s hesitation was countered with aggressive surveillance and coercion. The universally acclaimed polio immunisation drive, too, had to face vaccine hesitancy.

By then coercion had given way to communication. Reluctance to get the jab is also hobbling India’s ambitious target to vaccinate all adults against Covid-19 by the end of 2021. While the biggest challenge remains the supply of vaccines, there are small sections of people who remain unconvinced, for multiple reasons, about the benefits of taking them.

A new survey by community social media platform Local Circles indicates 12% of the unvaccinated do not plan to get immunised, indicating it is an issue policymakers must address. Public health experts say this has to be tackled via communication through community-level micro plans. ET looks at why some people are saying no to the jab, and how their fears can be addressed:

FEAR: IT WILL WORSEN COMORBIDITIES

FACT: Those with underlying health conditions like diabetes and high blood pressure, particularly senior citizens, are considered more at risk of severe Covid infection. They should, therefore, get vaccinated on priority. But doctors say there are people in this category who are reluctant to get a Covid jab precisely because of their condition.

“There are patients who want to take the vaccine but are not sure if they should because of medical issues or because they are taking blood thinners. This is seen among older patients in urban areas. Their children are also worried about the side-effects on them,” says Dr Tanu Singhal, consultant, paediatrics and infectious diseases, Kokilaben Dhirubhai Ambani Hospital, Mumbai. Doctors say these groups need to get vaccinated quickly. “Those with comorbidities are more anxious though we, doctors, have been saying they are the prime candidates to get the vaccine,” says Dr Suranjit Chatterjee, senior consultant, internal medicine, Indraprastha

. A revised fact sheet from ICMR says it is safe for those on blood thinners to take the vaccine. Those on anti-coagulants could stop taking it a couple of days before the jab on medical advice, ICMR DirectorGeneral Dr Balram Bhargava had said.

FEAR: IT WILL CAUSE DEATH/ILLNESS

FACT: This was a big fear in the early days of Covid vaccination. It persists among rural communities though vaccines are approved for use only after they have undergone multiple trials and have been found to be safe by regulators. In Kovalam, a fishing village near Chennai, this fear was the reason why a majority of 6,400 adults in the 18-44 years category were hesitant, says J Sundar, an entrepreneur and trustee of the local STS Foundation. “They thought, ‘If we take the vaccine, we will die,’” he says.

The foundation joined hands with Chennai’s CN Ramdas Trust and US-based CHIRAJ to offer a host of incentives to those who turned up to get vaccinated — from free biryani and mobile recharge coupons to bumper prizes of a two-wheeler and gold coins. From less than 50, Sundar says, close to 1,000 people have been vaccinated in 18 days. “We also circulated photos of us taking the vaccine to show that it was safe,” he says.

FEAR: IT’S AGAINST ONE’S RELIGION

FACT: This has hobbled immunisation efforts among diverse religious communities at various points of time, and the Covid-19 vaccination drive is no exception. Among those citing religious beliefs to avoid taking the vaccine is a 75-year-old Roman Catholic in Mumbai who runs his own chemical business; neither he nor the four other adults in his family have taken the shot. “We are creations of god and we will follow him,” says the entrepreneur, who believes, wrongly, that the vaccine contains aborted foetal cells and hence taking it would go against his faith as the Catholic church is opposed to abortion. Similarly, during Ramzan, there were reports of doubts among sections of Muslims about whether the vaccine could be taken while fasting and whether it was halal. Public health experts say it is crucial to get faith leaders involved to put such doubts to rest and reassure members of the community about the safety and acceptability of the vaccine. Pope Francis, for instance, has said that taking the vaccine was an ethical obligation and the refusal to do so, suicidal.

FEAR: “WHY SHOULD WE TAKE AN INJECTION WHEN WE ARE NOT SICK?”

FACT: It is a common question thrown at health workers and volunteers in rural and tribal areas. “Many in the Soliga community say they don’t have any illness nor are they going to cities so there’s no need to take the vaccine. This is the most common reason that comes up,” says C Made Gowda, a social scientist with Ashoka Trust for Research in Ecology and the Environment.

The Soligas are a tribal community living in and around the Biligiriranga Hills in Karnataka. Gowda, a Soliga and a community volunteer, says micro plans are being drawn up to call the leaders and three-four people from each of the 148 settlements, with a total population of 35,000, to explain what is Covid and why they need to take the vaccine. “If outsiders tell them, they won’t listen. But we are from the community and work with them.” Sachin Jain of Vikas Samvad Samiti, which works in over 100 villages in Madhya Pradesh, says his team explains to the villagers as simply as possible how vaccines are made, how they fight against the virus and why it is necessary to take the injection to prevent severe illness and death due to Covid-19.

“The biggest impact is through local leaders — if two such persons take the vaccine, others will be ready,” says Jain. Similarly, tribals in Palghar district in Maharashtra are hesitant. “They worry the vaccine may cause death,” says Vivek Patwardhan, former chief human resources officer of Asian Paints who is now working with an NGO, Aarohan. “We are trying to convince smaller batches, which we feel can lead to some getting vaccinated,” he says.

FEAR: “IT WILL CHANGE MY DNA”

FACT: Robin Abraham, a 50-year-old table tennis coach in Chandigarh, refuses to take the vaccine. Nor has he got his 85-year-old father vaccinated. He feels the vaccines were developed too fast and the effects on the body can’t be trusted. “I feel the vaccine will change my DNA. The mRNA technology is also brand-new,” says Abraham, who feels immunity-boosting food will instead help prevent Covid-19 infection though there is no evidence to support this and the only scientifically proven way to prevent severe Covid is by vaccination. While mRNA vaccines are not available in India now, both the Pfizer and Moderna mRNA vaccines reported over 90% effectiveness in preventing severe disease.

Abraham also argues that the jab may not work against new variants. This is an apprehension among a small section of the urban upper middle-class, says Dr Singhal.

“These people are very hard to tackle as they are well-educated. Some of them don’t believe Covid exists,” she says. To those who argue that people have got Covid even after vaccination, we tell them it prevents severe disease, she adds. Recent real-world data from Public Health England, published as a pre-print, shows two doses of AstraZeneca vaccine, known as Covishield in India, had 92% efficacy against hospitalisation and zero deaths in cases of the Delta variant, which was first detected in India.

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