Policy research. Wanted: A targeted Covid-19 vaccination drive for low-literacy areas

A sizeable 2,600 kilometres from each other, the literacy rates of Shrawasti in Uttar Pradesh and Pathanamthitta in Kerala are also far apart at 47 per cent and 97 per cent respectively. And now, a substantial gap between the Covid vaccination coverage in the two districts seems to be adding to these distances.

Even more disturbingly, the gap is widening over time. Three-and-a-half months since the launch of India’s vaccination drive this year, on April 30, while 28 per cent of Pathanamthitta was administered the first-dose, just 4 per cent of Shraswati was vaccinated. By end of August, though vaccination at Pathanamthitta had risen to 78 per cent, it slouched at 29 per cent in Shrawasti.

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Like in Shrawasti and Pathanamthitta, the gulf in the Covid vaccination coverage between districts with high and low literacy is on a perturbing increase across India. This implies that districts with larger share of illiterates are likely to be flare zones in the forecasted third Covid-wave.

But, on the positive side, it also means that urgent pre-emptive vaccination strategies targeted at high illiteracy districts could go far in containing such Covid surges.

The evidence for this progressively broadening vaccination-coverage gap emerges from our study of data for 740 districts on the government’s vaccination portal CoWIN against their respective literacy rates as per the census.

Analysis

Our cross-analysis finds recorded vaccination coverage on the last dates of April, June and August of 2021 showing the gap widening steadily from 6 to 15 to 20 per percentage points respectively between districts with literacy rates trending around 60 per cent at the lower end and 95 per cent at the upper end. (See graph below.)

To arrive at this robust and positive correlation between literacy and vaccination over time, our study begins with scraping the CoWIN website for data from when India’s vaccination drive began in January 16, up until August 31, 2021. The district-level information on vaccination so derived from CoWIN is then merged with district-wise demographic details available in the census.

The resultant combined dataset provides us with information for 740 districts out of the current-total 741 districts in India. An analysis of this dataset shows a progressively increasing gap in the vaccination coverage between districts trending at around the same 60 per cent and 95 per cent literacy rates.

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On April 30, the vaccination coverage was at 8 per cent and 14 per cent in the low literacy and high literacy districts respectively. But by August 31, the cleft had broadened, with low literacy districts still at only 31 per cent vaccination coverage against 51 per cent in the high literacy districts.

An even more explicit depiction of the starkness of this gap, perhaps, is that four crore more people would have been vaccinated had the vaccination coverage rate in the low literacy districts kept pace with that in the high literacy districts. This estimation is based on the fact that the average vaccination coverage in districts with less than 60 per cent literacy rate is at 28 per cent, and their combined population is 17 crore.

FILE PHOTO: People wait to receive a dose of COVISHIELD, a vaccine against coronavirus disease manufactured by Serum Institute of India, at a hospital in Noida on the outskirts of New Delhi, India

Moreover, the findings of our study gain a pressing pertinence given that a Covid third wave is predicted between September and October in an August 2021 report by the National Institute of Disaster Management (NIDM) under the Ministry of Home Affairs (MHA). The report warns that the imminent next wave could see up to five lakh Covid cases per day.

‘Smart vaccination approaches’

An immediate and focussed effort at increasing vaccinated populations seems to be our best bet at being able to restrict the forewarned unleashing of such an overwhelming burden of disease. But that would require adoption of ‘smart vaccination approaches’ that target vulnerable and priority groups over mass vaccination, as recommended by an Indian Council of Medical Research (ICMR) study.

And it is critical that areas with large shares of illiterate populations are identified and listed among these vulnerable and priority groups. The sooner we start the more effective we are likely to be in combatting a problem that is evidently snowballing.

Also read: Four factors that increase the risk of vaccinated people getting Covid

As our study finds, vaccinating illiterate populations has been a challenge since the drive began; and one that is on a perilous growth as manifest by the widening coverage gap between low and high literacy districts. Given that we tallied 250 million illiterates in the last count, and just about 12 per cent of our population is fully vaccinated yet, a targeted vaccination strategy is imperative to making a prudent public health choice.

(Soma Wadhwa and Arijit Das are Research Fellows at the India Development Foundation.)

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