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Our capacity to vaccinate will soon hobble our campaign to tackle the pandemic. The disadvantaged and vulnerable will be hit the hardest. India’s shortage of vaccines has till now obscured the question of our vaccine delivery system’s capacity, as also the matter of public demand for vaccination. As the supply of doses improves, these gaps will get clearer.

Getting everyone in India to take covid vaccines requires much more than addressing ‘vaccine hesitancy’. People need to be mobilized to get vaccinated—enabled by convenient access and accurate information—matched by delivery. In a few places, these matters are being dealt with effectively. The rest of the country can learn from them.

Before anything else, let’s banish a dysfunctional notion from our midst. The phrase ‘vaccine hesitancy’ is imputed with value judgements. Of irrational behaviour—often leading to dismissal and disdain. But if we truly listen to people, we realize that most people have good reason for their behaviour. Their concerns must be addressed. An empathetic approach is essential to deal with this phenomenon effectively.

Taking a vaccine shot is a difficult exercise for the majority today, and nightmarish for many. The closest vaccination centre is often a few kilometres away. For most people, this is a day’s investment—whether they walk or use public transport—which means a day’s wage lost. At the centre, experiences vary from long queues to the schedule being cancelled because of vaccines not reaching—given the unpredictability- ridden supply of doses. Waiting for 8-10 people to gather for a vaccine vial to be opened—since each has 10 doses—is also common. Often, the required numbers don’t show up for hours, and then people return home exasperated, asked to come another day.

Many of the vaccination centres offer uncomfortable experiences, bordering on the unpleasant. Few have decent waiting places or toilets, with people having to brave the heat, rain and other elements. The struggle to upload the identification details in the central app is a common stress-point for everyone. Not everywhere, but in too many places, vaccination teams treat those who have come to get vaccinated without adequate dignity or with bureaucratic nonchalance, instead of care and sensitivity.

Loss of wages—not only on the day of vaccination, but also as a result of even a mild reaction to the injection with 2-3 days or more of fever—is a possibility now widely recognized. For most, there is no (or inadequate) medical support available in the event of any reaction to the vaccine—understandably evoking deep apprehension.

Though it’s not as widespread as often presumed, misinformation also feeds existing fears. Vaccines cause infertility, alcohol after a shot can maim you, those who do hard physical work don’t need vaccines, someone in the next village died after taking the vaccine... these are the sort of things one hears most often. But such misinformation is rarely the determining factor of behaviour; these only add to a complex mix of reasons. Misinformation has merely filled a vacuum of good information; we have done a shoddy job of public communication so far. Fostering a patient, personalized dialogue with individuals who have taken the vaccine and have high local-area credibility, along with sustained community education, would be key.

The very rational bases for many people’s unwillingness to take a covid shot is visible in depressed demand for the required second dose. In essence, those who have faced problems with the first dose don’t want to face these another time. Noticeable on the ground almost everywhere, it is also observable in our aggregate country-level data: The country-wide second dose count today is estimated at around 20% less than what it should have been, if one looks at time gaps from the first dose.

An all-India ‘vaccine-to-people’ approach instead of our ‘people-to-vaccine’ model, along with adequate post-vaccination medical support, would be essential to improve delivery and address the issues curtailing demand. We need rigorous planning and flexible scheduling of camps and door-to-door delivery, with the detailing done on the basis of relevant data at the level of each village and mohalla. Many other pieces need to be orchestrated in tandem: Systematic and sustained community education and mobilization efforts, the sensitization and proper training of vaccination teams, thoughtful selection and management of camp sites, and efficient programme management at the level of primary health centres to match popular mobilization with delivery.

Current poor delivery practices, ineffective communication, inadequate post-vaccination support and all-too-real economic losses, all combine to dissuade people from taking vaccines. This imagery of the vaccination drive seems etched in public consciousness. Making vaccination predictable, convenient and dignified is necessary to offer a better experience and alter these perceptions. Not just in large urban centres, but in the remotest corners of our country.

After 12 weeks on the road across the country, all I can say is that we need a total revolution in our approach if we have to vaccinate our population fast. Else, third and fourth waves would be inevitable.

Anurag Behar is CEO of Azim Premji Foundation

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