How a Jharkhand district overcame vaccination hesitancy

In an overcast chilly evening in Mussoorie, the order of my probation district being West Singhbhum came. Despite my home state being Jharkhand, I didn’t have much idea about the district. So like anyone else, out of curiosity, I searched online for information about the district. I found that West Singhbhum or Pashchimi Singhbhum is the largest district of Jharkhand. The district is covered with hills alternating with valleys, steep mountains, and deep forests on the mountain slopes. The population density is around 210/Km2 and forest cover of more than 50%. West Singhbhum district has 67% tribal population and 85% of the population lives in the rural and hard-to-reach area. The literacy rate of the district is around 50%. The district is a hot bed of Left-Wing Extremism.
When we were in the academy in Mussoorie, we knew that our first role in the district would be Covid-19 vaccination. The central government announced that from 14 May 2021, all adults would be eligible for vaccination. Even before I landed in Chaibasa (headquarter of West Singhbhum), I knew that there had been strong hesitancy among the people in the district. Even to the extent that paramedics were not allowed to enter the village or they were threatened with bows and arrows.
The vaccination in the district was very slow and there was need for conscious effort by the District Administration as per the local need. One of the main reasons for slow vaccination was misinformation spread in the tribal and rural population. To overcome this issue, Deputy Commissioner IAS officer Ananya Mittal appealed to people through a video in Ho (tribal language spoken by a majority of the population, especially in rural and far-off areas). The same was aired on All India Radio along with some other jingles in Ho. Animated videos in Ho and Hindi were also created for vaccination awareness. These videos became viral in the district. In more interior and hard to reach areas like Goelkera block, use of loudspeakers and local music were used to attract crowds. Also, snacks and food packets were also arranged to attract people. Posters, banners and wall paintings were used as tools of IEC. A couple of mobile vaccination vehicles were inaugurated to create awareness about vaccination. This also facilitated vaccination of people in groups. There were two vehicles which covered the urban area of Chakradharpur and Chaibasa.
“Training of Trainer ‘’ initiative, which was the brainchild of Deputy Commissioner, was the most effective initiative. Under his leadership, 48 Master Trainers were trained at district level. They were educated about scientific details of vaccine and vaccination procedures by the Medical Officer-in-charge, Dr Jagannath Hembram. They were also trained on how to answer the Frequently Asked Questions (FAQs) at the ground level. These trainers were given information related to benefits of vaccination, who should and shouldn’t get vaccinated, types of vaccination available and their dosing schedule, and where vaccinations are available in the district. The most important information they were given was about some of the common side effects one experiences after getting vaccinated and what one should do in case one experiences those symptoms. These Master Trainers were divided into 18 blocks (roughly three per block). They in turn created two trainers each at the Panchayat level. These trainers carried out an awareness drive at the village level by involving teachers, youth, influential people and opinion leaders to create positivity about vaccination. The block level Master Trainers called on meetings of all Health Sahiya, Sewika, Manki, Munda, Dakuwa, PDS dealers, Mukhiya in the block and disseminated information that would help clear misconceptions in people’s mind regarding the Covid-19 vaccine.
Meetings were also held by Senior Officers of the district in various blocks, panchayat and village. There is a traditional Manki-Munda system in Kolhan-Porahat region of West Singhbhum. This is a form of governance at village and panchayat levels. Manki-Munda holds an important place in tribal society. Awareness meetings were held constantly by Member of Parliament and Members of Legislative Assembly along with Deputy Commissioner, Deputy Development Commissioner, Additional Deputy Commissioner, Sub-Divisional Officer, District Level Officers, Block Development Officers, and Circle Officers with Manki Munda and other influential persons like ANMs, Sahayika, Sewika, and PDS Dealers.
In the meetings mentioned above, various stakeholders deduced that the main reason people were wary of vaccines was the side effects of vaccination. They were afraid that in case of any untoward side effects, no care would be available to them. So as a Confidence Building Measure, the district administration, with the help of NGOs like Ekjut, ICPS, C3, Dalsa, Nehru Yuva Kendra, Save the Children and Para Teachers, set up a call centre. The counsellors at the call centre were tasked to make routine calls to vaccinated people to record if they are facing any side effects. They also advised them of steps to cope up with those side effects. These calls helped develop a positive relationship between the district administration and beneficiary. The data obtained from the calls showed that about 80% of beneficiaries developed no symptoms at all. This data not only helped create a positive attitude towards vaccination, but also helped beneficiaries cope with the symptoms.
Routine health check-up camps were organized in the remote and hard-to-reach areas. During these camps, counselling was also organized and people were made aware of proper vaccination related information to overcome misconception. This also helped create confidence among people regarding vaccination.
The district administration was trying to mobilize government employees to create awareness about vaccination, but it was realized that there was hesitancy in the minds of government employees and their family members. So a drive was initiated whereby the district level officers were to collect data about the employees and beneficiaries of various schemes in their department and their family members. Then they were vaccinated in a targeted manner after overcoming their apprehension and doubts about vaccines through counselling. This was extended to beneficiary groups, SHGs, Panchayat representatives, Manki, Munda, Dakua, Teachers, PDS dealers, Krishak Mitras.
Initially, there was hesitancy for vaccination. To overcome hesitancy, to create awareness and also to protect the more vulnerable sections who were more exposed to Covid-19, a Workplace Vaccination drive was initiated under the leadership of Divisional Forest Officer, Porahat. In this drive, vaccinations were carried out in the mining area of Tata, Sail, ACC and Rungta group. Also, a vaccination drive was organised in Chakradharpur Railway Division with help from DRM Chakradharpur, Kolhan University, Chaibasa Court compound with support from Principal District Judge, and in Chaibasa Jail. A special drive was also organised in the Police Lines under the guidance of Superintendent of Police, Ajay Linda, an IPS officer. The Forest Department under leadership of Divisional Forest Officers achieved complete vaccination. Not only the employee, but also their family members were given vaccination. This not only protected the more exposed sector, but also created awareness about the benefits of vaccination.
Particularly Vulnerable Tribal Groups (PVTG) are present in several blocks of the district. Since it is a vulnerable group, a special drive was initiated in Bandhgaon, Gudri, Manoharpur, Naomundi and Goelkera to counsel them regarding the benefits of vaccination. Nukad Natak was also arranged for PVTGs for vaccine awareness. Any attitude change requires support of the people and community at large. West Singhbhum has a very vibrant civil society. Several organizations, Trusts, public enterprises, NGO groups, and clubs came forward to assist the district administration in carrying out the vaccination drive. Their assistant not only helped pull the crowd towards the vaccination camp, but also helped create awareness about the vaccination in the society. They also used the reward system. For example, camps set up by Chakradharpur unit of Marwari Yuva Manch (MYM) and Indian Oil Corporation (IOC) provided one litre of free petrol to those getting vaccinated. Similarly, the District Chamber of Commerce, Chaibasa, provided discount coupons and umbrellas to those getting vaccinated in their camp. The Chaibasa unit of Lions’ Club and Chaibasa Gurudwara jointly started a vaccination drive where lucky draw coupons were given to people getting vaccinated. Religious societies like Anjuman Islamia, Chaibasa, also organised several camps in the district which helped overcome vaccine hesitancy in the Muslim society. These initiatives also pulled a large crowd to Covid-19 vaccine centres. Several other campaigns like bike and cycle rallies were also organised in the district to create awareness.
Good performers in the vaccination drive were recognized from time to time by the district administration. The rewards would vary from cash to goodies. Even institutional funds available from the National Health Mission in forms of honorarium for vaccine mobilizer were also utilized. This helped to keep the motivation of the field level workers. This multi-pronged strategy of the district administration and cooperation from all the government officials and civil society has created a positive attitude of people towards vaccination. This has led to an increase in demand for vaccination. The district administration aims to achieve universal coverage soon.
The writer is an IAS officer, presently posted in West Singhbhum, Jharkhand.