A few months ago, as the country reeled under the impact of the second wave of COVID-19 , officials deep inside Madhya Pradesh’s tribal districts had to contend with an additional crisis: vaccinating a people firmly resistant to any coronavirus vaccines.
It was April 15, 2021, and less than 10% of the eligible population had been vaccinated in Jhabua, the district in Madhya Pradesh, per government figures, with one of the highest percentages of Scheduled Tribes population in India. It was then that district officials decided to leverage tradition in their efforts to convey the message of timely vaccination . They started by organising khatla baithaks ( khat means “woven bed,” and baithak means “meeting”), or community meetings, to dispel vaccine myths.
By July, Jhabua saw a five-fold increase in vaccination uptake, with approximately 40% of eligible people in the district having received at least one dose. In fact, as members from the department of Women and Child Development handed out turmeric-smeared rice to rural houses as a traditional means of welcoming people to vaccination programmes across the district, vaccination drives across the district saw a discernible uptick.
An easy interpretation of this intervention might make it seem that Jhabua district is an outlier in the larger narrative of COVID-19 containment strategies. However, the data has made us see that, quite simply, it is not. Like Jhabua, there are multiple districts and regions where individuals and groups, from both government and civil society, have stepped in to ensure that impact of COVID-19 was mitigated in any and every way possible — even if that meant the use of rice or khatla baithaks . But just as it is easy for such stories to dissolve in the predominant din of the news cycle, it is also easy to see why our journey over the last several months began.
Space for initiatives
In April and May 2021, when the nation was going through the peak of a crippling second wave, a small group of us — that soon grew to over 500 people — came together to form India COVID SOS. We realised that there existed a wide spectrum of people who had made it their mission to help society steer to safer shores in this pandemic: medical professionals who, despite the volume of patients, were managing COVID-19 in an evidence-informed, pragmatic way; teams vaccinating entire villages once overwhelmed by hesitancy; workers ensuring even the remotest areas had adequate oxygen supply, etc. These efforts needed to be foregrounded, and a space was essential to document learnings from such successful initiatives.
Subsequently, together with Exemplars in Global Health, our research led to the development of case studies from India; now publicly available, these case studies highlight interventions and innovations that drove meaningful outcomes in the pandemic response across India.
We confirmed that the story of Jhabua was not one of exception. As our case studies show, there are other commendable endeavours as well. For instance, in February 2021, when India’s vaccination drive was initiated, health-care workers in Janefal, a rural hamlet with just over 500 residents in Maharashtra’s Aurangabad district had a difficult time convincing people to get vaccinated. Some had heard stories from neighbouring villages about people dying after vaccination. Others believed that people who were vaccinated had to amputate their arms.
To build trust and confidence, village heads and other front line workers set an example by getting vaccinated first. They had their photos taken while getting the vaccine, and later, to address apprehensions, spent time painting gram panchayat buildings. A task force was also set up. It comprised health workers, police officers and village council leaders who discovered villagers had an unprecedented fear of hospitals and were terrified doctors would kill them and rob them of their kidneys if they went in for treatment. With the nearest vaccination centre being eight kilometres away, the task force overcame both challenges by conducting a vaccination camp in the village, taking the vaccines to the people. They also did this on April 27, Hanuman Jayanti — an auspicious day for the locals. It was an insightful and clever way to leverage the occasion for the right cause.
In Tamil Nadu and Bihar
In Nilgiris, Tamil Nadu, the district administration in collaboration with local non-governmental organisations (NGOs) addressed vaccine hesitancy effectively, too. The NGOs enlisted the help of community members to write songs in tribal languages to share the benefits of getting vaccinated. The district administration also recorded statements from village leaders in their own languages, regarding the vaccine’s effectiveness, and broadcast those messages throughout the district’s different villages. This helped villagers engender trust, and soon, vaccination rates there went up, too.
In East Champaran, Bihar, district officials remarkably achieved 95% COVID-19 vaccination of adults in the Bankatwa block in just two days using what has been dubbed the “Bankatwa Way”. Bankatwa block historically had low routine immunisation coverage of just 64.3% due to challenges of difficult terrain, poor health infrastructure and vaccine hesitancy in the community, among others. To tackle this, the district adopted a mission mode approach. This was a concentrated effort of all government departments in collaboration with World Health Organization, civil society organisations, local elected leaders, and religious leaders to mobilise all eligible people in the district for COVID-19 vaccination. In just 48 hours, over 55,000 of the block’s 62,000 registered inhabitants were vaccinated by setting up vaccination sites in each of the area’s 102 villages and hamlets. The effort had a knock-on effect across the district with similar intensive effort campaigns, delivering 100% first dose coverage by early October.
Work in progress
Like these stories, there are many such novel, inspirational efforts that can be found in the case studies we have helped to collate. Our idea has always been to capture a broad canvas of learnings that could inform policy at the highest level, through critical vignettes showing what is working best (or not). But we are just getting started. It is essential that we keep working toward expanding the scope of our case studies, making them a reservoir of accurate information and inspiration. If we can effectively share and disseminate learnings and highlight the best interventions from across different domestic geographies, we can take a step towards being better equipped to tackle health crises in the future.
(India COVID SOS is an international non-profit volunteer group of scientists, clinicians, engineers, policy-makers, community organisers, and industrial partners. Exemplars in Global Health brings together researchers, funders, and collaborators around the globe with the mission of identifying countries that are positive outliers in global health. Their analyses of best practices strive to be a template that can be potentially replicated by others at a country/regional-level.)
Purnima Menon is a senior research fellow at the International Food Policy Research Institute, New Delhi. Madhukar Pai is a professor of epidemiology and global health at McGill University, Canada. They are volunteers with India COVID SOS