When health workers tried to convince Munir Pathan to take the COVID-19 vaccine in February, the 52-year-old farmer in rural India refused. The jab would kill him, he was certain. Pathan had read messages on WhatsApp, stating that vaccine shots are lethal and that if a doctor errs while administering the shot, it leads to an infection in the arm. The only way to save the person thereafter is by amputating the limb, the rumor went.
Pathan says, “There hasn’t been one COVID-19 case in our village since the beginning of the pandemic last year. Therefore, we did not want the risk of vaccines. It was only after our village head took the shot and survived that I started developing faith in vaccines.”
In April, Pathan took his first shot at a vaccination camp organized in his village. That day, health workers managed to inoculate 65 residents of Janefal, or 100 percent of its eligible population, setting an example for other rural residents of the country, and prompting vaccination drives in 16 nearby villages.
Credit: contributed
Credit: contributed
Janefal stands out as a role model, says Sunil Chavan, who heads the administrative affairs of the district with 4.5 million people. He lauded the initiative of local leaders and health workers for creating awareness when the vaccine rollout was only beginning in India, marred by staunch resistance in its rural pockets. “Now, every village wants to be Janefal,” says Chavan.
India has witnessed a record surge in COVID-19 infections recently, with over 26 million total infections and 291,873 deaths so far. While many believe that the fatalities in India are undercounted, the infections and deaths continue to rise. The country’s rural areas house 895 million people, or 66 percent of India’s population. However, most medical facilities and doctors are located in urban areas.
The World Health Organization, too, states that vaccines save millions of lives each year. However, vaccine penetration in rural India is hampered by many challenges, a major one being vaccine hesitancy.
Vaccine hesitancy in rural India
A nationwide survey conducted in last December discovered that only 44 percent of people surveyed in India’s rural areas were willing to pay for COVID-19 vaccines, 36 percent said they would not, while the remaining 20 percent were undecided.
Myths about COVID-19 vaccines are the biggest hurdle to vaccination coverage in India’s hinterlands, says Satish Sable, a physician at the Primary Health Centre (PHC) for Janefal.
“When the vaccination drive first started in January, people in villages were strongly opposed to it, as they were overpowered by rumors,” says Sable. “If we organized an inoculation drive for 100, only 40 would show up.”
According to Krushna Gavande, the chairperson of the village council of Janefal, the population of 525 people was “gripped” by a fear of vaccines. “They caught these rumors from WhatsApp. Many messages were doing the rounds, all blaming vaccines for untimely deaths and a host of illnesses.”
A few others, who tried to coax villagers into inoculation, faced greater resistance. Sayyed Bhudan, a police officer in Janefal, says that villagers would latch the doors of their homes, as soon as they saw him approaching. “The elderly population, especially, was petrified,” says Bhudan.
The Janefal model
In addition to vaccine hesitancy, COVID-19 inoculation in India’s countryside is hindered by many other challenges. These include online registrations for rural residents, who have limited digital literacy and smartphone accessibility, organizing villagers for vaccination at local healthcare centers, which are often located miles away, and arranging enough shots in a country, which is already reeling from an acute vaccine shortage.
It took Janefal three months of vaccine advocacy, faith building, and community mobilization before it achieved the milestone of 100 percent vaccination of its eligible population.
Sarla Zalte, who has been serving as a health worker in the village for nearly three decades, says that she has made dozens of home-to-home visits since January, trying to persuade villagers into getting inoculated. “I got my first vaccine shot on February 1, and the second one, four weeks later. I would tell villagers that despite getting both the shots, I was healthy, safe, and alive. I did not have to get my arm amputated either,” says Zalte. “But they had harbored too many misconceptions.”
Although villagers were still unconvinced, the village administration knew that it was important to vaccinate the villagers against COVID-19, especially since a neighboring village, Shelgaon, had started reporting infections.
To fast-track the process, the village administration, in early April, created a taskforce comprised of healthcare workers, the medical officer at the local PHC, police officers, the village head, and other members of the village council. The team mapped out the eligible population and started organizing door-to-door awareness campaigns, debunking myths, and listing benefits of vaccination. Every member of the taskforce got their shots, says Zalte, and showed pictures and videos of their vaccinations to villagers. They also worked longer hours to demonstrate that vaccination was safe.
During the awareness campaigns, the taskforce discovered an unprecedented fear -- villagers were afraid of hospitals. “To overcome this fear of hospitals, we decided to hold the vaccination camp in the village,” says Gavande.
The vaccination drive was preceded by a testing camp the same day, where the medical officer proposed to test the villagers for COVID-19, only to discover that the village was also plagued by a testing hesitancy. On the designated morning, eight to 10 villagers fled the village, fearing the tests.
Sable tested 101 villagers for COVID-19 that afternoon through Rapid Antigen Tests, and none of them tested positive for the disease. “Everybody was overjoyed with the negative results,” says Bhudan. “The villagers started clapping and whistling, overcome with relief. A few of them were still scared to get vaccinated, but as more and more people emerged with no immediate side effects from the jabs, the reluctance started fading away.”
To enable online registration for vaccines, the taskforce had collected ID cards of all the eligible villagers, and registered them through three mobile phones with internet connections.
The campaign’s result
Although infrastructure and the shortage of vaccines remain rife, Janefal’s model must be adapted in other villages of the country, says K. Srinath Reddy, president of the Public Health Foundation of India, a nonprofit health initiative. “[It] shows local leadership, local community spirit of support,” says Reddy. “You cannot do vaccination or any major health program with a top-down approach,” he added.
Puja Changoiwala wrote this for The National Geographic. This story is part of the Solutions Journalism Network, a nonprofit organization dedicated to rigorous reporting about responses to social problems. It originally appeared online here.
About the Author
