* Three factors — complacency, convenience and confidence — influence the willingness of the common masses to take a vaccine

* There are more vaccine-resistant people in India than rejecters

* In 2019, the Philippines saw the devastating outcomes of vaccine hesitancy


The two old friends used to go for a brisk walk every morning. Ever since one of them died of complications arising out of Covid-19, his grieving walking partner — a retired school teacher — has been thinking about the vaccine-in-progress that he hopes will protect him from the virulent virus.

The 72-year-old resident of Baharampur town in West Bengal is waiting for the vaccine — still to be launched in India — but finds that many people around him are viewing it with suspicion.

“Many of my friends, relatives and students are reluctant to take the vaccine for various concerns. But I think their worries are irrational,” he says.

Take the case of Suren Ray (name changed). The 49-year-old farm owner from the North Dinajpur district of West Bengal says that he will not take a vaccine for Covid-19 unless vaccination becomes mandatory.

“I have no idea about the vaccine’s side effects, so why should I take a risk? I will first observe the outcomes of the vaccines and then decide accordingly,” Ray says.

A survey-based study conducted by researchers from various institutes — including the University of Calcutta, the Indian Institute of Technology Kharagpur and St Xavier’s College, Kolkata — posted on an online platform last month shows that nearly 5 out 100 people in West Bengal do not want to take a vaccine for Covid-19, and 12 out of 100 individuals are still uncertain. The study, which surveyed 1,078 people in the state in October-November 2020, pointed out that 77.27 per cent of the respondents were, however, awaiting the vaccine.

Vijay Gopichandran, a public health practitioner from Chennai, believes that a certain amount of guarded hesitancy is important when it comes to the vaccine for Covid-19. “The safety data we have for the vaccine is only about 3-6 months old. Therefore, we must be cautious,” he holds.

Not everybody who is sceptical of the vaccine is an “anti-vaxxer” — an opponent of vaccines. There is also an element of “vaccine hesitancy” among some people.

According to Sushmita Roy Chowdhury, a pulmonologist and Covid-specialist based in Kolkata, vaccine hesitancy relates to people’s concerns about the vaccine’s poor availability and side effects. “Hesitancy also relates to complacency and lack of confidence on a product even though it is available in abundance,” she notes.

An editorial published on December 1 in the journal Drug and Therapeutics Bulletin argues that three factors — complacency, convenience and confidence — influence the willingness of common masses to take a vaccine. “Issues that influence vaccine uptake include concerns over adverse effects, negative messages on social and mainstream media, access to vaccination services, and the actions of health professionals, peers and communities,” the editorial says.

Naysayers can be categorised as vaccine rejecters, vaccine-resistant and vaccine-hesitant, says Ramdas Ransing, associate professor of psychiatry, BKL Walawalkar Rural Medical College and Hospital, Ratnagiri, Maharashtra. This is known as the Hagood and Mintzer Herlihy model, he explains.

Rejecters are those who refuse to consider vaccine-related information, and are prone to conspiracy theories (some, for instance, believe that there is no pandemic). “Most likely, this group of people [a small proportion of Indian people] will choose not to have themselves or their children vaccinated,” Ransing says.

There are more vaccine-resistant people in India than rejecters, he says. The former are people who are anxious about it, but are searching for and willing to consider vaccine-related information. Vaccine-hesitants are those who would avoid Covid-19 vaccination despite its availability due to some minor beliefs or concerns (such as the fear of contracting fever after vaccination). “They will not be strongly committed to an either pro or anti-vaccine stance, so simple interventions can improve acceptance,” Ransing tells BL ink .

Vaccine hesitancy is a significant problem across the globe. In 2019, the Philippines saw the devastating outcomes of vaccine hesitancy. In November 2017, the authorities stopped the use of a vaccine against dengue owing to safety concerns. This initiative adversely affected the country’s drive against various vaccine-preventable diseases.

In September, 2019, it faced a polio outbreak, although the World Health Organization had declared the country polio-free two decades earlier. Also, in 2019, it witnessed a measles outbreak with 42,000 cases. India, too, faced substantial hindrances in the context of polio in 2018, when there were rumours that the poliovirus had been found in polio drops.

Historically, the best example of hesitancy is possibly related to the smallpox vaccine discovered by Edward Jenner, says Roy Chowdhury. “Some countries even banned the vaccine citing several concerns, but sooner rather than later evidence based medicine surfaced and good sense prevailed, leading to mass vaccination against smallpox and its subsequent eradication,” she notes.

According to Ransing, the measles-mumps-rubella (MMR) vaccine was linked to autism [in the UK] in 1998 and led to an anti-vaccine movement. “The [chances of any] resurgence of [an] ‘anti-vaccine movement’ is always there, and we must be prepared for dealing with it if the vaccines [for Covid-19] are effective and efficacious,” he holds.

Roy Chowdhury advocates mass education, stressing that it is the only way forward. “The easy accessibility of social media must be used to create awareness of the risk vs. benefit ratio of this vaccine as [its benefits appear to be] far outweighing the risk of rare side effects,” she says. When people were suspicious about polio vaccines, for instance, religious leaders in India had been drawn into Unicef-led campaigns to dispel rumours and spread awareness about the vaccine.

Awareness is essential for a country such as India where various taboos still exist around vaccination, points out Shantanu Panja, a Kolkata-based ENT and head and neck surgeon affiliated to the Apollo Gleneagles Hospital. “Safety and necessity both need to be reiterated and people should be sensitised about the vaccine,” he says. “The awareness about Covid-19 is already widespread. The same network and avenues should be used to spread awareness about the vaccine which would lead to better acceptance.”

The retired school teacher is doing his bit, too. If his friend had been administered the vaccine, he would perhaps have been alive today, he thinks, while advising people not to be wary of a jab that seeks to battle the virus.

Sanjeet Bagcchi is a physician and independent writer based in Kolkata