Vaccination hesitancy-an analysis to address

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By: Dr. Amrit Goswamee

After the declaration of covid-19 pandemic on 11 March 2020 by the WHO the entire human race was desperately looking for a vaccine against SARS-Cov-2 coronavirus. Although vaccine development is a complex process and needs usually a couple of years and then assess the efficacy and safety, because of the pandemic and the urgency to get vaccines out quickly to save lives, the duration of follow up has been a couple of months rather than years, and emergency use authorizations have been given to the vaccines, which means that they are still under observation. Quite a few vaccines have been made available at a record pace in December 2020. itself. The developed vaccines are Covaxin, Covishield or Vaxzevria, Spikevax, Comirnaty, Janssen, Sputnik-V etc. Out of all the vaccines mentioned above Spikevax developed by Moderna labs, USA and Comirnaty developed by Pfizer are new types of vaccines called m-RNA vaccine which work by introducing a piece of m-Ribonucleic acid (m-RNA) that corresponds to viral protein usually a small piece of a protein found on the virus’s outer membrane and the rests are either viral vector vaccine that uses an adenovirus or an inactive viral strain. Even though these vaccines are made available, hesitancy factor on acceptance or refusal of jabs against any infectious disease has been an issue throughout the world since the vaccine development history. WHO in 2014 and different agencies in India also in the covid pandemic context carried out a study on the responsible factors of vaccination hesitancy covering a wide range of population from across the rich, poor, religious minority, slum dwellers to highly literate section. The survey says that vaccine hesitancy is complex and context-specific varying across time, place and vaccines.

The survey report in India shows 61% as willing and 39% shows hesitancy. The hesitancy consists of 5Cs as universal reasons viz Confidence- having suspicion on the efficacy of the vaccines, Complacency- do not need as they won’t catch corona, Constraints- it involves costs and time, Collective responsibility- if everybody else vaccinated, the other one need not and Confusion. It is also reported that among those who are extremely hesitant are the anti-vaxxers that spread infodemic for which a section of slum dwellers, religious minority and poor people are afraid of the vaccine. They think that it may cause life-threatening adverse reactions such as impotency, disrupt the menstrual cycle reducing fertility. The skepticism against vaccines amongst the 39% hesitant is varied and falls primarily under 4Cs.

However many literate persons right from the corporate sector to the university level and even persons from the medical fraternity to elderly qualified retired professionals are confused due to contradictory and conflicting reports on the efficacy of different vaccines and they fall under 5th C. The reasons behind their confusion cannot outrightly be ruled out. As stated, vide supra that vaccines developed are still in observations, very often different reports on these vaccines appear in different research journals and in different media as well. Quite naturally skepticism develops from these reports. Few examples-

i) the immunity development period between the two doses of Covishield vaccine is reported to get changed five times from 4 weeks to 45 weeks between January 2021 to May 2021.

ii) there are conflicting opinions between WHO’s expert and NITI Ayog’s expert about the efficiency of Covaxin and Covishield against delta plus variant.

iii) Covishield vaccine has the side effect of Guillain-Barre Syndrome(GBS) causing partial facial paralysis due to the attack by the immune system on the peripheral nervous system and few cases have been reported from Kerala and London (Annals of Neurology,10 June 2021).

iv) the delta variant is eight times less sensitive to the antibodies generated by vaccines (Sir Ganga Ram Hospital Group study).

v) ICMR report itself says that 86% of vaccinated persons were attacked by delta variant. Besides these, there have been several death reports of persons having administered both the jabs which develop suspicion about the extent of immunity development by the vaccines.

Recent Green Pass issue policy by the European Union(EU) against few particular vaccines also carry an inherent meaning of quality matter over other vaccines in the minds of the people. In this context, it may however be mentioned that m-RNA vaccines developed by Moderna Lab and Pfizer provide immunity for more than 2 years compared to Covaxin and Covishield as the immunity period beyond six months provided by the latter two vaccines is not known. On the other hand, only one shot is sufficient in the case of the Janssen vaccine developed by Johnson & Johnson. From these angles, these vaccines are superior in quality.

A recent speech by the Executive Director of WHO Emergencies Programme and Irish Epidemiologist Dr. Michael J Ryan to the media on July 7 last, clearly states that this virus is evolving and changing and it is also not sure to what extent vaccination protects against the ability to be infected. Under these circumstances it is quite natural to get developed swinging in the minds of this 5th C category that pushed them to a catch-22 situation as the endurance and constitution of every individual are different. Unless these real issues of vaccination hesitancy are resolved, the Government of India can never reach the herd immunity threshold of 70-85% against SARS-Cov-2. It may also be noted that the communication strategy formulated in December 2020 by the Ministry of Health and Family Welfare is not properly aware of it in the functionaries and therefore an effective communication strategy to generate sufficient scientific evidences is required so as to understand vaccine hesitancy. In rural and urban slum and tribal areas, the communication strategy should be done with the help of well-trained frontline workers, panchayat and local influences to address the 4Cs universal reasons of hesitancy. Just as a jab inoculates a harmless form of the virus in order to avoid a severe disease, in case one is exposed to it, inoculation of a clear and transparent message would prevent vaccine hesitancy in individuals if they come into contact with disinformation.

Addressing the strategies to blunt disinformation, especially on social media, Lisa Rosenblum says in an article in the ‘New England Journal of Medicine’ that quashing rumours and conspiracies with truth and reliable information alone may not suffice. Before attempting to persuade people it is required to understand the basis of fear, hesitancy, and antivax attitude. By challenging untruths it is inadvertently fed the perception that one is actively suppressing the real truth. In order to address the acute problem of confusion on vaccines amongst the literate section, the Government of India should formulate a strategy engaging experts from ICMR, vaccine manufacturers and other relevant areas and high academic institutions to conduct primary research to understand the issue so as to resolve it in a convincing way. (The author is a former Chief Scientist-CSIR-NEIST-Jorhat and he can be reached at 9435052093)

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