Taking vaccines and trust to tribal folk

In the core forest area of Melghat’s tiger reserve in Maharashtra, frontline workers gathered at Chopan village to encourage the tribal residents to get vaccinated at the camp they were holding there the next day.

The effort, though, did not seem to help, as none came forward to take the shot the following day. Dr Mittali Sethi, the then sub-divisional magistrate in the area, changed tack and brought the camp outdoors to inspire confidence. “People may not have been comfortable going into the anganwadi setup for their vaccine,” says Sethi, now posted to Chandrapur.

That, too, did not seem to work all that well until, all of a sudden, “kaki” stepped up and asked for the vaccine, recalls Sethi, of the moment the elderly lady helped turn the tide. About 70 people around her watched as Kaki took the vaccine and others clapped to hail her and encourage more to come forward. And they did, says Sethi, narrating an experience from a good day at getting vaccines to a hesitant tribal population.

About 70 people around her watched as Kaki took the vaccine and others clapped to hail her and encourage more to come forward. Photo: Dr Mittali Sethi, CEO, Zilla Parishad, Chandrapur (formerly posted at Melghat)

Across the country, in several remote areas, frontline staff are navigating rough terrain and patiently working through resistance to help increase the coverage of the Covid-19 vaccination drive.

“There were many bad days,” says Sethi. Fuelling the resistance were the rampant rumours such as “the body would turn magnetic after the second dose”. Sethi and local frontline workers and administrators spent long hours talking to people in an attempt to break down their hesitancy. And this threw up valuable insights, she says. These are relevant as the countrywide vaccination campaign looks to pick up pace.

The need to speak in the local language to clear misgivings and arrive at the locations in the morning, before people went to the field for work, she says, were some of the learnings. Outreach campaigns must be tailored to local needs, she says, adding that it cannot be regular office hours. Sometimes, people had not had breakfast, so biscuits and water were handed out. At other locations they improvised to include food and music, she says.

After the first dose, it was important to check on the locals to see how they were doing, she recalls, as people remember these gestures and it helps build their confidence in returning for the second dose. In fact, they were chided by locals if no one enquired after the first dose, she says.

The early months were a “struggle”, recalls Dr Rahul Ganava, district immunisation officer, Jhabua (Madhya Pradesh). Bordering Rajasthan and Gujarat, the landscape is dry and agricultural, and the residents are widely dispersed across it, he says. The general belief is that injections (vaccines) are given to children or those who are ill. So why should a healthy person take it, many asked.

Dr Ganava and other frontline workers participated in the khatla bhaitak , where they sat with the residents on khatlas or traditional cots to address their fears in the local language. The pace picked up as younger people were roped in. The challenge now, Dr Ganava says, is to get everyone to take their second dose, even if they have migrated for work to a neighbouring state.

Some of these practices that have built bridges of trust in public health interventions are being documented by the India Covid SOS platform (a non-profit, international group of volunteers, including clinicians, scientists and engineers, who aim to promote evidence-based solutions in the time of Covid) and the research group Exemplars in Global Health, says Dr Purnima Menon, a public health and nutrition researcher who volunteers with ICSOS. These successes are some of the “ïncredible bright spots” that emerged from an otherwise dark time of Covid surge and deaths. And this legacy is worth preserving for future interventions, she says.

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