Science Must Prevail

Today, hesitation regarding COVID-19vaccination is a significant barrier to achieving rapid vaccine coverage in many parts of India. Massive shortage in availability of vaccines and issues regarding its distribution are, of course, major factors holding us back in many states, but reluctance towards the vaccine also makes the task of ensuring immunity among the majority of our population difficult. But moving beyond ‘victim blaming’, we need to dig deeper and understand the underlying reasons for vaccine hesitancy so that it can be minimized. Addressing this issue is as much an essential step as is stepping up steady vaccine supply and delivery.

We regularly read stories about people, particularly in rural areas, who are reluctant to approach vaccination centres, even actively avoiding vaccination staff visiting their homes. Before rushing to dismiss them as being ‘unscientific, we need to understand that scientific attitudes among the public are shaped in a social context. We need to reflect on how rational thinking in India has been undermined in various forms, especially in recent years.

One does not have to look too far to understand the roots of growing irrational beliefs. Take the example of a chief minister who persists in hosting the massive Kumbh mela in his state during the second COVID wave, encouraging lakhs of people to bathe together without any precautions and declaring that “Maa Ganga’s blessings are there in the flow … So, there should be no Corona”; a vocal MP claims that drinking cow urine can ‘cure Corona’; a minister advises people to burn cow dung to ‘sanitize’ the environment. And when a prominent ‘godman’-turned-businessman publicly dismisses modern medicine as being ‘stupid science’, yet no action is taken against him, we begin to understand just how deeply entrenched the systematic undermining of scientific ethos in India is. When irrational messages by such ‘opinionmakers’ are showcased as ‘solutions’ on social media, the stage is naturally set for popular opinion to become less receptive to scientific measures.

The spread of irrational beliefs alone does not explain people’s hesitation about COVID-19 vaccines. A WHO document analyzing vaccine hesitancy has identified lack of trust as being a crucial factor in shaping this phenomenon. Inadequate trust in healthcare systems can lead people to become reluctant, even suspicious when they are offered services in certain situations. Such weakening of trust, especially in north India, can be traced back to the family planning programme of the 1960s and70s, which included coercive measures and even forced sterilizations. Public-health staff, themselves under pressure to achieve targets, began to be shunned as agents of a hostile scheme. Subsequent poor functioning of public health systems due to underfunding, understaffing and political neglect have also contributed to breaking public confidence in these services.

Often there is also concern about the motivations of private healthcare providers, due to large-scale commercialization and frequent patient experiences involving overcharging and irrational care. Supporting this explanation is a national study on COVID vaccine hesitancy among Indian states, in which Kerala was found to have the least vaccine reluctance. This reflects higher public trust and a more positive perception of the state’s primary healthcare system, allowing it to effectively reach a population already motivated and willing to use various public-health services. A third important factor here is social grounding of mass communication. While routine messages promoting CO-VID vaccination have been broadcast across India, field-level observations tell us that, until now, such official communications have not been sufficiently impactful. In contrast, consider the story of a cluster of tribal villages in Maharashtra's Amaravati district, where local staff developed and displayed a series of videos in Korku, the indigenous language of the area’s residents, to convince them to take the COVID vaccine. Combined with organizing gram sabha meetings, and actively involving local people in culturally relatable messaging, this has led to four tribal villages achieving100 per cent COVID vaccination. There are similar experiences of locally rooted communication strategies leading to markedly improved vaccination cover-age from other states too.

Given this complex interplay of factors, an integrated approach is required to minimize vaccine hesitancy in India. Firstly, governments across India need to partner with diverse civil society groups and community leaders, to reshape and refine communication strategies. Vaccination messages must be locally contextualized and shared in language and idioms ordinary people can relate to. Secondly, trust in public-health services must be greatly strengthened, so that people regain confidence in these systems. As part of the long overdue agenda of upgrading public-health infrastructure, a number of steps could be taken immediately to rejuvenate people’s trust. This may include setting up help desks in all medical facilities to assist and guide patients, improving the honorarium and morale of frontline health staff such as Accredited Social Health Activists (ASHA) workers as well as rapidly orienting them to better communicate with communities and form coordination committees along with civil society initiatives and bodies at various levels, to enable positive feedback and social mobilization.

Finally, we need to remember that it was Jawaharlal Nehru who coined the term ‘scientific temper’—defined as an internalized attitude of logical and rational thinking; not merely parroting science lessons for examinations, but applying scientific thinking in our daily lives. Today, as citizens, we should demand that political leaders at all levels set the right example by standing up for socially relevant science, which is the foundation of public health. This must be done not just in words, but through concrete decisions and actions to curb all kinds of obscurantism, even if it emanates from the powerful.

Overcoming vaccine hesitancy is not just an issue of broad-casting routine information, it involves rallying people to join the movement towards collective health and welfare; it requires better trust and communication between public agencies and citizens; it is about strengthening scientific attitudes and deepening public dialogues, which lie at the heart of a functioning democracy

Dr Abhay Shukla is a public health professional and health activist. He is the National Co-convenor of Jan Swasthya Abhiyan.