COVID 19 vaccination drive – information, motivation, coercion…

I am traveling now in southern Tamil Nadu for my research project field work. I have resumed travel after almost a year and half and I had mixed feelings about it. On one hand a little anxious as I was traveling after a long time and on the other hand a small excitement as it will bring back some experiences that are unique to traveling. One of the nice things about traveling, even for work, is that it gives an amazing break from routine. Mornings are usually hectic, cooking, cleaning, and getting ready for work. But travel gives me a break from this routine. As I was sitting in the hotel lobby yesterday morning, sipping a piping hot cup of coffee, I took up the local newspaper in my hand. Reading the newspaper is a long-gone habit. I just look up the news on twitter feed, online news, and YouTube channels nowadays. Holding the news in the hand in the form of a crisp new paper was an amazing experience. The headlines were about the massive success of the mammoth COVID 19 vaccination drive on Sunday the 12^th September 2021. Tamil Nadu had targeted covering 20 lakh persons with the vaccine and landed up covering 28 lakhs. The mood of the headline news piece was celebratory. As I sat reading this news, my thoughts flew to my routine Sunday clinic in rural Chengalpet district just the previous day. I had seen more than the usual number of patients and all of them were related to this mammoth vaccination drive.

 

“Sir, the sister is standing outside my house and banging my door, forcing me to come to the vaccination campaign. Is it ok for me to go?” asked a distressed Kamala (name changed) who had sneaked out the back door to run to our clinic to ask me this question. “Their badgering is relentless. They have been announcing repeatedly since past one week and even came door to door to tell us. I am not interested in the vaccine, but they are literally forcing me” said Jagannathan (name changed) who was forced to come back from his daughter’s place in Chennai which he was visiting to spend time with his two beautiful grand-daughters. These are just two instances. There were scores of others who had such experiences of being forced and coerced to get vaccinated against COVID 19. They all lined up in the clinic to check whether it is alright to get the vaccine which was suddenly being forced on them. They had heard rumors that people died after taking the vaccine. Some were worried that people with conditions like diabetes and hypertension would not do well with vaccination, as there had been news of even young people with these conditions dying after vaccination. The housekeeping staff of our clinic narrated a story while discussing the issue of vaccination during lunch break. She said, “there was a healthy robust young man in our village, father of 2 children and very active in the village. He had taken the COVID 19 vaccine the previous day. The next day was the Aadi porridge (koozh) festival in our village. He danced in the festival and played the drums for a long time. When the festivities finished and he went home that night, he kissed his children goodnight and went to bed. Suddenly within one hour he held his chest and collapsed. He died even before we could take him to the hospital.” This story sent a ripple of concerned whispers through all the staff who were sitting for lunch together. One could dismiss this as a rumor, or one could consider it as a deeply disturbing narrative associated with the COVID 19 vaccine, which is not uncommon among people. 

 

“There are vaccination camps everywhere.  Even if we go to the local primary health center to get our routine medicines, the staff there ask us to get vaccinated” said another regular patient of ours who gets monitoring visits with us and takes medications from the local PHC. There are vaccination drives in workplaces. Kanthamma (name changed) who had all along held that COVID 19 is not a real disease and the COVID 19 vaccine was unnecessary came to clinic and declared that she had been vaccinated. When I asked her what changed her mind she said, “They refused to let us go for our 100 days rural employment guarantee work scheme if we had not been vaccinated and brought the vaccines to the work place itself. How could I avoid it then? I also have to earn money to make ends meet”. Ganesh (name changed) was highly anxious when he sat down for his routine blood pressure checkup. He had always been regular on his medications and doing all the right things to keep his blood pressure under control. But his employer was now forcing him to get vaccinated, failing which he would not be allowed to come to the factory. Ganesh who is the sole breadwinner in his 5-member household, was anxious on two fronts. “I am afraid to get the vaccine because, I heard it causes fever and body pains and I cannot go to work for an entire week. If I don’t go to work, my family will not be able to eat. I am also afraid to avoid the vaccine, as I will then lose my job. I am in a fix”, as he said this, I could sense his despair.

 

Some women who demand ‘an injection to help with the back pain’ every visit to the clinic, were now scared of injections. They were requesting me not to give any injection. When I tried referring a patient to Chengalpet GH for cardiology consultation, her husband said it is risky to take her there and his exact words were “COVID oosi pottu saava adichuduvaanga” (they will give her injection and kill her). The injection, which used to mean ‘pain relief’, ‘cure’ to many, had now started meaning ‘death’, ‘pain’ and ‘fear’. 

 

Recently a group of students at our college conducted a community-based survey of vaccine hesitancy in urban and rural areas. The rural component of the sample was from the same area from which we get our clinic patients. One of the important findings of this survey was that the prevalence of vaccine hesitancy was close to 45%. The most common factor leading to hesitation to get vaccines was fear of side effects of the vaccine ranging from fever to fear of death due to the vaccine. Another set of students conducted a similar study in the Heavy Vehicle Factory in Avadi, Chennai. There a large proportion of the population had been already vaccinated (70%) as part of their work. Among the remaining 30% who had not been vaccinated, there was a significant 40% prevalence of vaccine hesitancy. This makes one wonder whether acceptance of the COVID 19 vaccine in the working population is truly voluntary or whether it is influenced by the ubiquitous vaccine mandate. 

 

The news headline article concluded its piece by noting “it seems vaccine hesitancy that was present in early phases of the COVID 19 vaccination campaign has reduced in Tamil Nadu and people have thronged Sunday’s campaign sites for their vaccine”. I am wondering if this is true. Is this ‘success’ of the massive vaccination campaign because of a truly perceived benefit of the COVID 19 vaccine, or is it a coerced participation? There were some reports in which public health officials had given small incentives like snacks, eggs, some money to vaccine acceptors. I doubt if these minor carrots were the reason for the massive vaccine acceptance. It was probably the stick in the form of threat of job loss, livelihood loss, inability to travel, inability to resume college/school and all these important threats which pushed them to these campaign sites. 

 

At the end of the clinic, after seeing and counseling and allaying anxieties of so many patients about the vaccine, I am wondering about the ethics of these types of massive vaccination campaigns. I am sure the patients who walked into my clinic to discuss the vaccine was only the tip of the iceberg. There are probably thousands of others with so many doubts and questions about the vaccine which are troubling them, and they have no place to go and no one to ask. The only source of information for many of them is social media, which often gives very mixed and confusing messages. The coercive actions by the state public health system literally pushing people to get vaccinated makes the information provided by them questionable in the minds of the people. One of my patients said, “they are constantly badgering us to go to get vaccinated. They have an agenda in mind. So it is difficult to believe what they are saying about the vaccine” This is so true. What is required right now is a respectful, honest, and transparent community engagement. Gram Panchayat (village administrative meetings) meetings including all members of the village, the village leaders and public health officials must be held at the village level and open communication encouraged. Question and answer sessions which must address the anxieties of the people about the vaccine side effects, vaccine complications, vaccine related deaths and other questions must be conducted in each village. People must see that the intention of the public health system is welfare of the people. They must be convinced of this. 

 

I conducted an open house question and answer session among people who attended our clinic one day. It was not an easy 1 hour. The same questions came round and round about the adverse effects of the vaccine and vaccine related deaths. I tried addressing the issue in different ways. I am not sure if I had successfully communicated the message that the COVID 19 vaccine is effective and safe. But I am sure the hesitation in the minds of a few people was removed. Such small group meetings and discussions are essential. They not only clarify people’s doubts but spending that kind of time with people automatically builds trust. This is a time for building trust in the public health system and trust in the vaccines. 

 

The COVID 19 vaccination saga will be one more chapter in the COVID 19 story book, full of twists and turns in the narrative. As my short reverie over the cup of coffee faded away and it was time for us to leave for the field, I thought aloud with my colleagues, “maybe there will be a day in our future when all we have to do is provide information to people and wait for them to understand it and come forward to participate in a public health intervention”. The car that was to drive us to the field had arrived, we opened the doors of the hotel lobby and walked out to the car.