Achieving 95 Percent Vaccination in Two Days, the Bankatwa Way

This case study is reproduced with permission from its original authors—Sh. Shirsat Kapil Ashok, district magistrate of East Champaran district, and Dr. Shahwar Kazmi, surveillance medical officer at the World Health Organization (Motihari).

Introduction

Bihar, a state in the eastern part of India, has eight districts that have achieved 100 percent vaccination of the eligible population with the first dose of the COVID-19 vaccine (as of August 3, 2021).1 East Champaran, one of Bihar’s eight districts, is discussed in this case study to showcase the state’s vaccination approach. East Champaran has a population of 5.1 million. The district is a part of the Tirhut Division, and its headquarters is in Motihari. It has 6 subdivisions, 27 blocks, and 9 urban bodies.2,3

Bankatwa is a block in East Champaran with 10 panchayats, more than 140 villages, and a population of 116,863 (as of 2011). Bankatwa has historically low routine immunization coverage of 64.3 percent due to difficult terrain, poor health infrastructure, and vaccine hesitancy in the community, among other factors. Despite these challenges, the block has achieved 100 percent first-dose vaccine coverage of its eligible population (18 years of age and older) of approximately 62,000. The district administration was able to provide the first dose of the COVID-19 vaccine to more than 59,000 people in this population; the remaining were either pregnant women or lactating mothers. The district administration reached more than 50,000 people in the block in just two days (June 21 and 22, 2021) by properly planning the vaccination campaign, leveraging existing plans and resources, managing the supply and storage of vaccines, and addressing hesitancy among the community.4,5

Replicating the Bankatwa model, the district administration of East Champaran was able to vaccinate the more than 252,000 inhabitants residing in its nine municipal areas in the short span of 20 days (between July 1 and July 21, 2021).6

How can you replicate or adapt this promising practice?

Leveraging existing structures and resources. The East Champaran administration built the foundation of the COVID-19 vaccine rollout on previous vaccination plans, such as the Pulse Polio Immunization Program microplan and routine immunization plan, which served as guides. Using existing resources gave the district administration an advantage at the planning stage. Using the electoral roll for finalizing the number of vaccination beneficiaries and examining any gap in the vaccination rollout process was also an important step in the implementation process.

Fostering collaboration. Health officials collaborated with local people and engaged them in the vaccination drive to meet and encourage residents to get vaccinated. The health officials also collaborated with religious leaders and civil society organizations to address vaccine hesitancy and build trust among residents. Further, the health officials collaborated with staff of various national- and state-level social benefit programs to increase the outreach of the vaccination drive.

Effective communication strategy. An effective communication strategy was central to the successful implementation of the vaccination program. It helped to build vaccine confidence broadly and among critical groups, bolstered vaccination coverage, as well as dispelled vaccine misinformation. Features of this effective communication strategy included educating the public about the different types of COVID-19 vaccines available, using electric rickshaws and announcements through religious sites for COVID-19 vaccination messaging, addressing doubts and rumors proactively through media or direct communication on the ground, and ensuring active, timely, accessible, and effective public health and safety messaging about COVID-19 vaccines to the public.6

What are the lessons learned from this bright spot?

The East Champaran district took the lead in Bihar in administering the first dose of COVID-19 vaccine to the entire eligible population of approximately 62,000 adults in Bankatwa block. The district administration achieved this feat through the following strategy:

  1. Meticulous operational microplanning
  2. Consistent monitoring and evaluation
  3. Community participation to address vaccine hesitancy7

District Magistrate (DM) Sh. Shirsat Kapil Ashok directed the District Health Society to prepare a microplan for the whole campaign. The DM engaged the World Health Organization (WHO) to assist the District Health Society in planning; WHO concurrently monitored the whole process so that not a single village would be missed in the vaccination drive.5

“There are ten panchayats and more that 140 villages in the block. We started by vaccinating one panchayat first and then moving to the second. After the two panchayats were vaccinated, the DM observed that the process was too slow, and it would take us forever to vaccinate the entire block. He then advised to maximize the human and material resources for [a] few days to achieve 100 percent vaccination.” — Shahwar Kazmi, WHO surveillance medical officer (Motihari)5

Following the DM’s advice, the vaccination drive for the remaining eight Bankatwa panchayats was carried out on June 21 and 22, 2021. The District Health Society and WHO initiated the groundwork for the vaccination drive, including ensuring availability of supplies, identifying vaccination sites, and managing human resources. They formed a team of data entry operators for real-time registration on the Co-WIN app. Further, they created a control room in the block development office and established a backup team to avoid any challenges in the two-day campaign. Through all these steps, the administration was able to vaccinate more than 50,000 people in the block in just two days.5,7

Following the path of Bankatwa, Piprakothi block and Raxaul Municipal Council were able to inoculate their entire population with the first dose of COVID-19 vaccine and achieve the 100 percent vaccination target. Piprakothi block, which has a total population of 77,089 (as of the 2011 Census), administered the first dose to about 31,591 people over 18 years of age in six panchayats spread over 20 revenue villages.8

In addition, all eligible people received their first dose of vaccine in Motihari Nagar Nigam, Dhaka Nagar Parishad, Pakaridayal Nagar Panchayat, Chakia Nagar Parishad, Areraj Nagar Panchayat, and Kesariya Nagar Panchayat in East Champaran.9

“COVID-19 vaccine has been given to all people above 18 years in Raxaul Municipal Council of East Champaran (Motihari) district. Raxaul Municipal Council became the first city council in the state where everyone was vaccinated.” — Mangal Pandey, Bihar state health minister.10

How was the promising practice implemented?

Strengthening health care capacity to support immediate COVID-19 vaccination

Across Bankatwa block

The East Champaran district administration made 102 vaccine sites operational in Bankatwa block. It deployed additional health care staff, including 44 auxiliary nurse midwives and 40 data entry operators, from neighboring blocks and district headquarters. WHO supported the training of data entry operators for on-the-spot registration and community health workers, including auxiliary nurse midwives and community medical officers, for management of vaccination adverse effects. Further, the district administration moved ice-lined refrigerators from neighboring blocks to Bankatwa’s primary health center to augment vaccine storage. They were able to stock 35,000 doses of COVID-19 vaccines in these additional refrigerators.7

Across urban municipal bodies in East Champaran

To carry out vaccinations in urban municipal bodies in East Champaran, the district administration hired more than 100 auxiliary nurse midwives and trained them on immunization, COVID-19 vaccination, and adverse events following immunization. The administration maintained the group of 100 auxiliary nurse midwives at district headquarters to deploy to campaigns and increase vaccination capacity in various regional urban bodies. When necessary, the administration also deployed auxiliary nurse midwives from neighboring blocks. Further, approximately 100 data operators—who were on loan from Block Development Office (BDO), Sub-divisional Development Office (SDO), and the Collectorate Office—were trained to verify beneficiaries using smartphones and file online vaccine use reports.6

Motivating residents for vaccination

The district administration and health authorities collaborated with local influencers (such as panchayat leaders), civil society organizations, and religious institutions to get their endorsement of vaccination, which helped increase coverage. The authorities also collaborated with several national and state government programs, Panchayati Raj institutions, public distribution systems, integrated child development schemes, and the Bihar Rural Livelihoods Project (locally known as JEEViKA) to adopt an individualized grievance redressal model to win community trust. All of these resulted in a massive turnout for the vaccination drive in places that earlier had registered a high number of refusals, such as Sekhuna Panchayat.7

Some of the civil society organizations engaged in the process were:

  1. Anjuman Islamia
  2. Lions Club
  3. Indian Chamber of Commerce
  4. Madarsa Board volunteers
  5. Auto rickshaw association volunteers

“Owing to illiteracy and misconception about the vaccine, it took several meetings and awareness programs by officials and local representatives to build up a positive opinion among the Mahadalit community.” — Lalu Manjhi, a member of Musahar Vikas Manch8

WHO medical officer and district officers meet with religious leaders to address vaccine hesitancy at the Rashtriya Bal Swasthya Karyakram vaccination site in Belwatiya village in Sugauli block in East Champaran on May 10, 2021.11

“There was a distinct hesitancy owing to sheer lack of knowledge and rumors. However, the mindset changed after I took the shot in front of the public in a bid to motivate people.” — Maulana Md Noorullah, imam of Amana Masjid (religious leader), Pakaridayal Nagar Panchayat12

Using a phased vaccination approach

The East Champaran district administration created a flexible and accommodative micro plan for the vaccination drive to address scenarios that might occur due to changes in the vaccine supply. As the vaccination supply would be limited at different stages of the drive, the vaccination plan focused on allocating doses to the most vulnerable points (critical populations) and COVID-19 hot spots (urban areas) in the district. The administration adjusted the urban vaccination schedule to ensure first-dose coverage of entire urban areas and second-dose coverage of those eligible—starting with high-risk priority populations. Accordingly, the urban bodies were vaccinated in the following order:

  1. Raxaul Municipal Council (pilot project for urban vaccination in the district)
  2. Motihari Municipal Corporation
  3. Dhaka Municipal Council
  4. Chakia Municipal Council
  5. Pakridayal Municipality
  6. Areraj Municipality
  7. Mehsi Municipality
  8. Kesaria Municipality
  9. Sugauli Municipality

The phased vaccination approach in East Champaran had two features.

  • Identifying and locating critical populations: The administration identified critical population groups, apart from frontline workers and health care workers, who were at higher risk of contracting COVID-19. These included those living in urban slums, in railway stations, or under bridges; minority populations with vaccine hesitancy; people living in crowded localities/shanty houses; Dalits/Scheduled Castes/Scheduled Tribes; and populations displaced due to flood. To improve vaccination coverage among these critical populations, the district team ensured equitable access of vaccination services to these groups, either through fixed vaccination sites or a mobile team. The district administration mapped and recorded all critical populations in urban areas by place of residence and work, collecting information through chambers of commerce, trade unions, and religious institutes such as Anjuman Islamia. It then established points of contact for each organization, employer, or community (as required). Additionally, the district administration arranged special vaccination drives for flood-affected populations and a mobile-team vaccination drive for critical populations at their workplace.

Special vaccination drive for flood-affected population6

  • Community mobilization for critical group: The DM coordinated with all stakeholders, including civil society members, chambers of commerce, local nongovernmental organizations, religious institutes, and trusted community organizations. This facilitated early agreement on communication channels and methods for rapidly disseminating information to dispel any doubts or concerns with regard to COVID-19 vaccines—and ultimately ensured that critical groups had access to vaccination.6

Ensuring an uninterrupted supply of services through dynamic vaccines/vaccination sites

Proactive vaccine management was a key element in achieving 100 percent vaccination coverage in the district. The district administration established coordination between vaccination centers to ensure vaccination services would be uninterrupted. When vaccines were exhausted at one center, they were supplied from neighboring centers. Similarly, when a vaccination site completed the vaccination of all eligible candidates in its catchment area, the vaccination site relocated to different communities to use the available resources to the maximum.7

“When the district received 35,000 doses of Covaxin, the DM decided to use the entire stock in one block. This was a great idea because a lot of people living in remote areas are not aware of the two vaccines.” — Shahwar Kazmi, WHO surveillance medical officer (Motihari)13

“Ice-lined refrigerators were installed at the primary health centers to store the vaccines, and proper mapping was done. Within two days, all the beneficiaries were inoculated.” — Shahwar Kazmi, WHO surveillance medical officer (Motihari)13

Monitoring vaccination coverage

Concurrent monitoring of the vaccination sites during the vaccination campaign and consequent monitoring after the vaccination campaign were conducted to assess vaccination coverage.

  • Concurrent monitoring: District administration and health officials, WHO, CARE, and the United Nations Children’s Fund (UNICEF) were involved in concurrent monitoring of vaccination sites to ensure the good quality and high coverage of vaccination. Further, the administration made midcourse, real-time changes in operations based on experts’ recommendations during concurrent monitoring.

The law minister, District Magistrate, District Development Council, and mayor of Motihari conduct concurrent monitoring of vaccination sessions6

  • Independent consequent monitoring: The District Magistrate, Sub-divisional Magistrate (SDM), Block Development Officer (BDO), Civil Surgeon, and District Immunization Officer performed independent consequent monitoring through a rapid street survey, finding that more than 95 percent of the people were vaccinated during the campaign. WHO, CARE, and UNICEF ​​also carried out vaccination monitoring in each urban district; they reported a consistent result of a vaccination rate of more than 95 percent. WHO and UNICEF deployed 28 monitors and CARE sent 38 monitors to conduct subsequent monitoring. They found that the vaccination campaign did not miss any areas or populations.6

SDM Sikrahna and WHO surveillance medical officer conduct consequent monitoring6

  • Conducting mop-up rounds for vaccination: The district administration decided to conduct mop-up rounds to vaccinate any new entrants to these urban areas and those who had not received the vaccine earlier. The DM and partner agencies advised them to prioritize vaccination of residents previous excluded in COVID-19 containment zones.6

Supplementary material

3527.Achieving 95 Percent Vaccination in Two Days, the Bankatwa Way.pdf

1805.Brief Report on Bankatwa Special Activity.pdf

Sources

  1. Thakur RK. Eight districts of Bihar have administered first vaccine dose. The New India Express. August 6, 2021. Accessed September 24, 2021. https://www.newindianexpress.com/nation/2021/aug/06/eight-districts-of-bihar-have-administered-first-vaccine-dose-2341000.html

  2. About district. East Champaran (Motihari) website. Accessed September 20, 2021. https://eastchamparan.nic.in/about-district/
  3. National Informatics Centre, Ministry of Electronics & Information Technology, Government of India. East Champaran (Motihari) website. Accessed September 20, 2021. https://eastchamparan.nic.in/ 

  4. Health Minister said: Bankatwa first block of East Champaran where 100% of 18 plus people got corona vaccines. Dainik Bhaskar. Accessed September 23, 2021. https://www.bhaskar.com/local/bihar/patna/news/bankatwa-first-block-of-east-champaran-where-100-of-18-plus-people-got-corona-vaccines-128643314.html 

  5. Priya P. Vaccinating the most vulnerable zone of Motihari. Indian Masterminds. July 8, 2021. Accessed September 23, 2021. https://indianmasterminds.com/features/corona-warriors/vaccinating-the-most-vulnerable-zone-of-motihari/ 

  6. Ashok SK, Motihari DM. COVID-19 Vaccination of Urban Municipal Bodies, East Champaran. [Publisher city: Publisher]; 2021. Accessed October 18, 2021. https://jashneteekabihar.com/wp-content/uploads/2021/08/Covid-19_Vax-of-Urban-Municipal-Bodies_EC_State_v1.2.pdf 

  7. How to vaccinate 95% people in 2 days, the Bankatwa way. World Health Organization website. Published July 12, 2021. Accessed September 20, 2021. https://www.who.int/india/news/feature-stories/detail/how-to-vaccinate-95-people-in-2-days-the-bankatwa-way 

  8. Bhaskar S. 2 more areas in Bihar’s Champaran achieve 100% first dose vaccination. Hindustan Times. Updated July 5, 2021. Accessed September 20, 2021. https://www.hindustantimes.com/cities/patna-news/2-more-areas-in-bihar-s-champaran-achieve-100-first-dose-vaccination-101625458808289.html 

  9. Pandey CB. WHO team to visit East Champaran, study district vaccination program. The Times of India. August 4, 2021. Accessed September 21, 2021. http://timesofindia.indiatimes.com/articleshow/85015361.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst 

  10. Mangal Pandey (@Mangalpandeybjp). COVID-19 vaccine has been given to all people above 18 years in Raxaul Municipal Council of East Champaran (Motihari) district. Twitter website. Published July 06, 2021. Accessed 28 Oct, 2021.

  11. WHO Support India. World Health Organization website. Published June 23, 2021. Accessed September 20, 2021. https://www.who.int/india/who-support-in-india 

  12. Bhaskar S. Bihar: Pakaridayal first Nagar Panchayat to give first dose to all eligibles. Hindustan Times. Updated July 10, 2021. Accessed September 23, 2021. https://www.hindustantimes.com/cities/others/bihar-pakaridayal-first-nagar-panchayat-to-give-first-dose-to-all-eligibles-101625932834329.html 

  13. Nezami S. All 18+ people given first vaccine shot in Motihari town. The Times of India. Updated July 10, 2021. Accessed September 20, 2021. https://timesofindia.indiatimes.com/city/patna/all-18-people-given-first-vaccine-shot-in-motihari-town/articleshow/84275067.cms 

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