I DIDN’T KNOW IF I HAD TO FIGHT THE PANDEMIC FIRST OR THE INFODEMIC!


Two days into SMART, I was in deep waters. My very first experience in the field not only made me swim but taught me how to ride out a storm

Eliminating or reducing vaccine hesitancy was only the tip of the iceberg when I started working on the Primary Health Centre (PHC) led Vaccination Initiative in four PHCs of Nuh. The project was
launched by SMART in Nuh, a district in Haryana which ranks low on various social parameters including education, livelihood, women’s rights, and public health, among others. Its population was not just dis/misinformed, but almost felt threatened by the idea of taking the vaccine. While some people thought that it was the government’s way of controlling population growth, others strongly
believed that it would fast track their ageing. There was also a small section of people who were convinced that the vaccine would protect them from every other disease. Whereas a few were sure that
it would make them immortal! I didn’t know whether to laugh or cry! I didn’t know whether to fight the pandemic first or the infodemic.

With a lot of anxiety and nervousness, we set out to vaccinate 1.5 lac people! We put together a team of 105 people and started our fieldwork. While mobilising people for our first camp, I realised that building a rapport with the community, local administration, and influencers was key to successfully rolling out a project. While the team started mobilizing the community, I started meeting
the administration- the District Immunisation Officer, the District Collector, PHC doctors and even ANMs. We worked towards reaching out to as many people as possible and ensuring their help to
achieve our goals.

As a policy, we decided to not get into the procurement and execution of the vaccines. When we started our work, the vaccination percentage was only 27.1 for the first dose and a dismal 3.1 for
the second dose. Our idea was to create a demand for the vaccine and assist the local administration in administering the doses of the vaccine to the eligible population. To break the resistance, a well
thought out strategy was key. So we decided to bring as many voices as possible on the radio. We planned an endorsement campaign. We reached out to all those with influence to talk about the
vaccine efficacy, bust myths, become champions of the vaccine and share their experiences. We hosted live interactions with local religious leaders, doctors and the deputy commissioner on Radio
Mewat. We asked provocative questions and invited the listeners to share their fears. We took these programmes to the villages and played promos and testimonials of the local people at the vaccination camps. Our efforts started showing results. The community trusted Radio Mewat and that did wonders for us. It was just the boost we needed to kickstart our vaccine drive.

Having worked with women in 30 panchayats for an ongoing programme on Domestic Violence, women became the base of our entry into the community. The vaccination rate for women was
really low as the common refrain was – they don’t leave the house – why do they need to get vaccinated?

Even after rounds of house visits, people rejected our narratives on the efficacy of the vaccine. Others proudly carried the Supreme Court statement, which stated that nobody could be forced to get
vaccinated. But as in every community, there were some fence-sitters, people who were keen to get back to work, so we started receiving queries. Slowly and gradually we succeeded in getting some
fence-sitters to our side.

Vaccination camps in Nuh did not have a fixed location. Sometimes they were set up under a tree and sometimes in someone’s house. This should not have been a problem, but in Nuh, it was a major
hurdle. Women were extremely uncomfortable pulling down their kurta or blouse from the shoulder to get the shot in public view. We requested a panel screen or a room where women could get their jabs, but it did not seem a feasible idea to the immunization team. ASHA workers or team members would often stand holding their dupattas trying to cover the woman who was getting her shot.

We observed that some vaccinators did not have the basic material required for administering vaccines – cotton, spirit and a proper disposal box. Some ANMs did not even ask the people to lower
their shirts or kurtas and gave them their jabs through the shirts. There was no facility for drinking water or chairs to sit for the observation period post-jab. The gaps were many – but pointing out the obvious was only alienating the medical fraternity. We had no choice but to go with the flow and do what was possible for us as a non-profit.

Despite all the hiccups, our efforts began to show results. In less than two months, we facilitated the vaccination of over 50,000 people! I travelled the road from Delhi to Nuh almost every day and daily did my 10,000 steps walking from door to door in each of the 78 villages that we had adopted. Our joy knew no bounds when the Cowin app started reflecting the fast-rising numbers.

In a week, we crossed a massive number of 17,000 vaccinations! We always had faith in the vaccine but were lacking in self-belief. When we started we were not sure what we had let ourselves into. But the long queues at the camps, as well as the rising graph on the Cowin app were proof of our work.

In December, the district administration shifted focus from the first dose to the second. We followed suit, ut one problem that we were facing is the authenticity of the data. We had our figures, but the DIO and the vaccine war rooms had their own. To be doubly sure we decided on a household survey in the 78 villages. In the chilly north-Indian winter, our community volunteers started going door-to-door collecting details that people either didn’t want to give or didn’t remember. There was only a handful who remembered the date on which they got their first shot and even fewer knew which vaccine had been administered. Many did not want to share their personal details, OTPs and Aadhaar numbers, fearing digital fraud or identity theft. We were dealing with a largely uneducated population which was sceptical of the system- even though they said they trusted us. As our challenges grew, so did our strength and unity. Armed with registers, pens and a newfound energy, the team took on the task of data collection in a mission mode.

On the other hand, the vaccine camps were almost on auto mode now. We had the support of the dIO, who himself visited the camps. He made it very clear – get me 15 people – and I will organize a
camp. Despite the challenges of the community and technology, expectations from seniors Dr Basant Dubey, DIO, and his team were always there for us. I remember when one elderly person passed away within two days of getting the vaccine, the community rejected us and told us not to try and convince them. It was the CMO and DIO who came to the village spoke to the community and
convinced them that his death had nothing to do with the vaccine. For two days, we were very tensed.

We were worried that all the good work done by the
team would be wiped off in a minute. But the
programme managers along with the district
medical teams were able to surmount the fears of
the community. The camps resumed and so did the
queues.

A huge setback to the vaccination drive was the transfer of our Deputy Commissioner, Capt Shakti Singh. A strong voice and the backbone of the COVID Vaccination drive, his deep involvement in
the mobilization of all stakeholders was the key factor in Nuh moving from a 27.1 per cent to a 90% coverage for the first dose and a 75 % for the second dose. After he left, the district administration decided to shift their focus to routine immunization. COVID was no longer a risk.

The weekly meetings and posting of daily vaccine figures came to an end. The WhatsApp group set up by the DC shut down. The ANMs who were working day and night decided to take a break, and
the frequency of camps reduced. The onset of Ramazan was also one of the contributing factors. Moreover, throughout the country, the focus was shifting to RI. It was under these circumstances that
SMART also, in consultation with their donor, decided to close the project 40 days before the due date. Needless to say, the team did not take this decision well. They decided to withdraw all efforts.
They felt betrayed. They refused to complete the pending data collection and completion of entries in the tabs that had been provided. The hostility was such that they provoked the locals to not
cooperate with us. It was difficult to digest the fact that after working so well together people could be so vitriolic and vicious. But then these are the perils that we encounter as field workers.

Luckily the community has faith and confidence in Radio Mewat and SMART. Despite many provocations, they continued to cooperate with us. From a team of 105, we were now a team of 5 – who
were left to wrap up the project. Clean and verify the data and enter it in the required formats. We decided to use the ASHA workers network to verify the data. Their memory and recognition of the
community surprised us- from the names of the people to details of the family and their vaccine updates, they knew it all. With their help, we verified the data of over 30,000 households and over
150,000 people!

The project saw many lows rather than highs. But now when I look at the figures it was not a small feat that we achieved. Overall in the 78 villages covered by the four PHCs of Nuh, Ujjina, Sudaka
and Bai, SMART ensured the vaccination of 87% for the first dose, 72% for the second dose and achieved 100% vaccination of both doses in 39 villages. With the project done and dusted, I smile
to myself. I had no idea of what I was getting into in November 2021– but on April 30, 2022, as I drive back from Nuh to Delhi, with over a 100 registers in the back seat of the car, I can relate very well to the song that is playing –

Yuhin chala chal rahi yuhi chala chal rahi
Kitni haseen hai ye duniya
Phul saare jamele dekh phulon ke mele
Badi rangeen hai duniya