India’s need for a vaccine (over)drive

A look at the vaccination drive from a behaviour change perspective as vaccine hesitancy drops and people want to get jabbed.

With India reeling under the uncontrollable spread of Covid-19 infection, serious gaps have been exposed in the healthcare system. Even if we were to start addressing them today, it will take us a long time to build an infrastructure where 1.3 billion people of India can be looked after efficiently.

However, what we do have a lead on (or rather, had a lead on) is the vaccine. India was an early mover for vaccine production and amongst the first 5 countries to launch a vaccination program. Medical and healthcare experts say that an effective vaccination strategy is a primary way to manage the Covid-19 pandemic and keep people out of hospitals.

Soon after Covishield and Covaxin vaccines were launched in India, debates about their efficacy, side effects, etc. combined with what seemed like the waning of the pandemic towards end of 2020, and the urgency for vaccination suffered. Recent data suggests that more than 73 per cent of urban Indians are very concerned about the 2nd wave of the Covid-19 infection.

This has led to a massive increase in anxiety levels manifesting in “Doomscrolling” which is quite prevalent amongst ages 18-50. People are looking for credible news as well as social media distraction to deal with their anxiety.

A research conducted by LocalCircles across 299 districts in India, shows the vaccine hesitancy has dropped drastically from 69% in Dec 2020 to 23% in April 2021, hinting that the urban, digitally connected citizen of India is ready to get jabbed. So, once the vaccine is made easily available, we should be able to get the country vaccinated very quickly. But is it so?

A behaviour change perspective - Let us look at this vaccination program from the lens of behaviour change. I chose Fogg’s Behaviour Change model. As per the model, to effectively change the behaviour of an audience, three factors need to come together - Motivation, Ability and Prompts (MAP).

Urban focus - Fix the user experience - We have seen above that the digitally connected population feels motivated to get vaccinated due to the fear of mortality. However, the terrible experience registering on the Co-WIN platform to secure an appointment remains an obstacle.

The LocalCircles research shows that only 9 per cent of people were able to register easily and get an appointment. Most that managed to register after a few attempts, did not get an appointment. This points to the “ability” factor that is severely compromised. While it is true that as a nation this is probably the first such massive drive using a digital platform, the whole user experience requires a critical improvement.

Ironically, there are now stories of people picking up the infection at the vaccination centre itself resulting in serious doubts whether vaccination centres are safe. While some prompts have been created by way of news about registration for various age groups, and by some leaders posting their vaccination selfies, there may be more opportunities here. Perhaps, while getting vaccinated, a person could sign in from their Facebook or Google account. This could simplify posting a message on their social media handles. Tagging the location of their vaccination, could spread awareness about the nearby safe vaccination centres. We feel safe going to the place where we know our friends are shopping from, or in this case, getting vaccinated.

Rural India - Highly complex challenge - The pandemic has now reached our villages that have limited access to information or healthcare. At least two rural families that I am helping are confused whether a vaccination should be taken and are relying on “desi ilaaj”. Recently, I have read reports in media about one case of a Covid-positive migrant worker who returned to his village and was shunned by his family and kept in a hut outside the village. With no medical help or care, he succumbed.

Then there’s Ram Vilas Sain, who moved back to his village in Rajasthan this March. He says that there is no concept of masks or social distancing in his village. As is expected, there will be a lot of misconception/ fears about the vaccination. Most of them do not believe in western medicine.

The concept of vaccination is not something that comes to them naturally. We are still a highly fatalistic society. More so in rural India. In absence of a treatment or a proper infrastructure, there is a high risk that this pandemic might be seen by them as God’s way of cleansing society. I hope like hell that I am wrong about this.

Need for an integrated program - The latent motivation for some protection will increase as they start to see the rising cases and the morbid consequences. However, would it simply result in them wanting to get themselves vaccinated? Or would they flock to their known methods in traditional medicine or resort to religious rituals?

The vaccination program for infants and babies in rural India has seen growing acceptance. But it has been a long road filled with barriers. Safety concerns, doubts about the need for vaccines against uncommon diseases and suspicions towards new vaccines have been identified as the main reasons behind vaccine hesitancy. There is hence a need for a large-scale awareness building and educational campaign.

The issue of ability is not any less challenging either. The government’s healthcare infrastructure is limited in rural India. Learning from the very successful Pulse Polio program, the government will need to organize vaccination camps on specific days and invite eligible people by appointment. Easier said than done. With better reach and mobile connectivity, we could do it faster. Hell, we have no option but to do it in next 12-18 months. I would like to share a few thoughts here that can be helpful.

a. Enabling voice-based registration on Co-WIN for those with smartphones and creating IVR based registration on Co-WIN for those with feature phones.

b. Calling upon the private sector corporations such as Tata, Birla, Hindustan Unilever Limited, Reliance, Airtel, ITC, SBI and many others to use their vast distribution and sales network to help set up camps. Their entire CSR budget should be spent on doing this one activity over the next 2 years.

c. Timely prompts can be sent by the Co-WIN app by way of messages or pre-recorded outbound calls (recorded in the voice of an eminent and credible personality) directing people to proceed to the vaccination camp at the designated time and date.

d. We must target the local influencers such as the religious leaders of all sects, teachers, sarpanch etc. and recruit them as believers in the need and safety of vaccines. More than half the battle will be won if this task is done properly. They should show the way by being the first ones to register and take the vaccine. Publicise this widely. Use their reach and influence as prompts.

Collaborate to win over Covid - Finally, we must acknowledge that we are all in it together. The second wave has already shown us that we are only as protected against this virus as our weakest link that is not vaccinated, not observing social-distancing, and not wearing the mask properly.

So, organisations and professionals who have the relevant skills and resources must come together to develop a common, integrated behaviour change program that deals with vaccination, social-distancing, and mask-wearing.

This is an age of collaboration, and this is the only way we will be able to deal with this massive pandemic. I can say on behalf of many industry colleagues that contributing to the cause of protecting people, saving lives and livelihoods is on everyone’s mind. The need of the hour is a national behaviour change program and a toolkit that will help volunteer organisations as well as individuals to harmonise efforts towards a common program.

The author is Group CEO – MullenLowe Lintas Group.