Equitable and Innovative Vaccination Approaches in Gurugram, Haryana

In response to the pandemic, Gurugram, one of the 22 districts in the state of Haryana, took the lead in vaccinating its eligible population (18 years or older). Local health authorities adopted innovative approaches to arrange separate immunization schedules for different age groups, using social media to raise awareness, involving private hospitals, and establishing drive-through vaccine centers to expedite administration of vaccines. As a result, Gurugram emerged as the first (among 22 districts in the state) to achieve the feat of maximum vaccine coverage. It has also spearheaded equitable vaccination coverage in rural areas, which have superseded their urban counterparts.1 The aim of the district administration was to vaccinate the entire population of Gurugram (based on 2011 projected census data) with at least one dose by August 15, 2021, through collaborative and targeted efforts.2 As of July 29, 2021, 81.5 percent of people in rural areas and 73.3 percent of people in urban areas had received a first dose.3

Health authorities from Mumbai and Bengaluru have drawn inspiration from the tailored, targeted approach to vaccination in Gurugram and started implementing similar initiatives.1

How can you replicate/implement this promising practice?

Create an enabling environment – The Gurugram health department offered vaccination with no advance registration required. To overcome proximity issues, the department-initiated drive-through vaccination clinics, added multiple vaccination centers at group housing societies and industrial sites, and held special events targeting vulnerable populations, thereby increasing access, and making the process seamless.

Foster collaboration – The Gurugram health department collaborated with various organizations including resident welfare associations, private companies (such as NASSCOM, Tata, Honda), and more than 80 hospitals (public and private) to achieve maximum coverage for vaccination.

Specialized services for rural areas – The Gurugram health department established specialized facilities to increase vaccination coverage in rural areas, such as offering pickup and dropoff services, setting up vaccination events near rural populations, and using 30 health sub-centers as vaccination centers in rural areas.

What are the lessons learned from this bright spot?

The Gurugram health department launched a rapid vaccination effort beginning on March 17, 2021.6 As of August 13, 2021, approximately 2 million doses have been administered and more than 95 percent of Gurugram’s residents have received at least one dose.7 Thus, the district has accomplished the feat of having the highest number of immunization doses in the state. Gurugram achieved this feat through several innovative approaches.

Background: Gurugram is a part of the National Capital Region and is one of Delhi’s major satellite cities. It is Haryana’s second largest city and is touted as an industrial and financial center of the state. It is spread over an area of 1,253 square kilometers with a population density of 1,241 people per square kilometer.4 The city has seen considerable development and construction during the last 25 years, and as a result it has the third highest per capita income in India, after Chandigarh and Mumbai.5 The total population of Gurugram district is estimated at 1.5 million, with 80 percent living in urban areas. Gurugram boasts a high literacy rate, a wealth of private companies and numerous hospitals and medical facilities (public and private), along with high smartphone use, internet connectivity, and mobility.

Ramping Up Vaccinations Through Innovative Initiatives

“We sent our health teams to gated communities and industries for vaccination. Ambulances were stationed at these camps to shift beneficiary to a nearby hospital in case of any adverse events following immunization. It was, perhaps, the first such initiative in India. We got calls from health authorities in Mumbai and Bengaluru to enquire about these camps.”  — Martand Pratap Singh, Gurugram District Immunization Officer1

  • Building drive-through vaccination clinics in the basements of shopping malls and schools in Gurugram, enabling people to get vaccinated at their convenience within their vehicle.
  • Setting up worksite COVID-19 vaccination centers, established by health authorities, at both private and government offices.
  • Holding a COVID-19 vaccine festival and mega-vaccination drive on June 21, 2021, through Gurugram’s health department and private hospitals.8 Vaccination was conducted across 209 sites and resulted in the highest vaccination rate in a single day in the district, with more than 100,000 people receiving shots.9,10 A follow-up event called Doctor’s Day was held on July 1, 2021, during which 51,241 people were vaccinated at 220 health centers located in government and private institutions.11
  • Targeting vulnerable and professional sub-populations by conducting specific vaccination events for transgender people (approximately 200),12 widows (382 women),13 and physically disabled people to ensure equity. Events were also conducted for journalists, lawyers, bank officials, and judicial personnel, among others.
  • Launching a mobile vaccination effort on July 1, 2021, for accessing remote areas to increase vaccination uptake among those with limited access (for financial and other reasons).14 Each van includes four vaccinators, a doctor, a facility for monitoring adverse events following vaccination, and space for registration. Each van is capable of vaccinating 100 individuals per day. The health department mapped out slum areas of the district, including Bhim Colony, Nathupur, Wazirabad, Rajendra Park, Dundahera, and Sirhaul.15
  • Prioritizing vaccination in rural areas including seven villages of Gurugram—Hamirpur, Khetawas, Aklimpur, Hasanpur, Nurpur, Khuntpuri, and Meako—which attained 100 percent coverage with the first dose to eligible populations as of July 16, 2021. Health authorities set up 4,000 session sites to increase vaccination coverage. To facilitate vaccination, vaccination drives were held at primary health care centers.3

“We are aiming at giving at least the first dose to everyone. Our medical officer created sessions for recipients without any phone number or photo ID. They were given an OPD (Outpatient Department) card with a reference number that could be used for the second dose.” — Dr. Virender Yadav, Chief Medical Officer, Gurugram9

How was this promising practice implemented?

Using innovative means for information dissemination to increase demand for vaccination. The Gurugram health department formed teams and sent them to various residential areas with banners and posters to raise awareness about COVID-19 vaccination. This door-to-door campaign strategy, combined with social media campaigns, was effective in creating high levels of awareness among the population. To meet demand, organized health teams took vaccines directly to people in gated communities and industries. People who received vaccinations were encouraged to take photos and share them via social media to reinforce the importance of the COVID-19 vaccine.16 The Deputy Commissioner of Gurugram posted various promotional materials on Twitter to increase awareness (see examples below).

Source: Twitter @DC_Gurugram

Establishing multisectoral and multi-departmental collaborations to boost immunization coverage. Nearly 37 government health centers and 52 private hospitals,6 several nongovernmental organizations (e.g., M3M Foundation), commercial enterprises (e.g., NASSCOM, Tata, Honda), and citizen welfare associations (e.g., society residents welfare associations) worked together on vaccination efforts. An app-based parking solutions provider called Park+, in collaboration with the corporate site and the Haryana health department, organized drive-through vaccination events.17

Using innovative implementation efforts in rural areas to cater to the rural population. The Gurugram health department identified 100 villages where their teams had administered first doses of vaccine to 100 percent of eligible people. These villages have higher COVID-19 caseloads and eligible population were prioritized.

“Our ASHA [accredited social health activist] workers have already visited these villages and carried out surveys. Now we will set up camps at community centers so that people can reach these sites easily to get vaccinated. As the supply of vaccines is limited, we will have to set up sites with fixed number of doses” — Dr. Virender Yadav, Chief Medical Officer, Gurugram18

The Gurugram health department also undertook various measures to increase vaccination coverage in rural areas. These efforts included mobilizing health officials, community health workers (accredited social health activists), community leaders, and panchayat members to dispel myths surrounding vaccination, instill confidence in the vaccines, and make vaccines locally available by setting up approximately 41 additional government sites at sub-centers and the panchayat office.2

“I started a campaign on social distancing and cleanliness last year when cases started to be reported in other parts of Gurugram. When we heard that a vaccine was available, we also pitched that to the people along with the health staff. We also had a lot of meetings with villagers and motivated them to get vaccinated.” — Hamirpur Sarpanch, Village Head, Sher Singh Chauhan19

Supplementary material

8547.Equitable and Innovative Vaccination Approaches in Gurugram, Haryana.pdf

Sources

  1. Kumar A. Gurugram shows the way in jab drive. The Hindu. Published on June 23, 2021. Accessed on July 13, 2021. https://www.thehindu.com/news/national/other-states/gurugram-shows-the-way-in-jab-drive/article34939627.ece
  2. Pati I. Urban-rural vax gap in Gurugram too but an unusual one. The Times of India. Published July 29, 2021. Accessed on August 5, 2021. https://timesofindia.indiatimes.com/city/gurgaon/urban-rural-vax-gap-in-gurgaon-too-but-an-unusual-one/articleshow/84842880.cms.  
  3. Pati I. Urban-rural vax gap in Gurugram too but an unusual one. The Times of India. Published July 29, 2021. Accessed on August 5, 2021. https://timesofindia.indiatimes.com/city/gurgaon/urban-rural-vax-gap-in-gurgaon-too-but-an-unusual-one/articleshow/84842880.cms
  4. District Gurugram. Demography. https://gurugram.gov.in/about-district/demography/.  Accessed on July 26, 2021
  5. District Gurugram. About District. https://gurugram.gov.in/about-district/. Accessed on July 26, 2021
  6. News. Coronavirus vaccines administered at 89 hospitals in Gurugram rapid phase. Business Standard. Published on March 17, 2021. Accessed on July 13, 2021. https://www.business-standard.com/article/current-affairs/coronavirus-vaccines-administered-at-89-hospitals-in-gurugram-rapid-phase-121031700029_1.html
  7. COWIN. https://dashboard.cowin.gov.in/. Accessed on August 13, 2021
  8. News. Mega vaccination drive: Gurugram to give 30,000 shots at 209 session sites. The Times of India. Published on June 21, 2021. Accessed on July 13, 2021. http://timesofindia.indiatimes.com/articleshow/83700713.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst
  9. Pati I. Big vax day: More than 1 lakh take shots at 209 sites in Gurugram. The Times of India. Published June 22, 2021. Accessed on July 13, 2021. https://timesofindia.indiatimes.com/city/gurgaon/big-vax-day-more-than-1-lakh-take-shots-at-209-sites-in-gurgaon/articleshow/83732099.cms
  10. News. Mega vaccination drive: Gurugram to give 30,000 shots at 209 session sites. The Times of India. Published on June 21, 2021. Accessed on July 13, 2021. http://timesofindia.indiatimes.com/articleshow/83700713.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst
  11. News. Doctors' Day: Gurugram sets record with over 51,000 COVID vaccinations. India TV. Published on July 2, 2021. Accessed on July 20, 2021. https://www.indiatvnews.com/news/india/doctors-day-gurugram-sets-record-with-over-51000-covid-vaccinations-coronavirus-pandemic-covid-strain-corona-second-wave-716233.  
  12. Behl A. 200 transgenders, sex workers vaccinated at special camp in Gurugram. Hindustan Times. Published May 31, 2021. Accessed July 21, 2021. https://www.hindustantimes.com/cities/gurugram-news/200-transgenders-sex-workers-vaccinated-at-special-camp-in-ggm-101622395242435.html
  13. News. Gurugram: Four vaccination sites for widows in 18-44 age group today. The Times of India. Published on June 2, 2021. Accessed on July 27, 2021. https://timesofindia.indiatimes.com/city/gurgaon/four-vax-sites-for-widows-in-18-44-age-group-today/articleshow/83157892.cms
  14. Pati I. Gurugram: Now, two vaccine vans to give jabs in slum areas. The Times of India. Published April 13, 2021. Accessed July 21, 2021. https://timesofindia.indiatimes.com/city/gurgaon/now-two-vaccine-vans-to-give-jabs-in-slum-areas/articleshow/82039501.cms
  15. Pai I. Gurugram: Now, two vaccine vans to give jabs in slum areas. The Times of India. Published on April 13, 2021. Accessed on July 27, 2021. https://timesofindia.indiatimes.com/city/gurgaon/now-two-vaccine-vans-to-give-jabs-in-slum-areas/articleshow/82039501.cms
  16. Pati I. First day, heartening show in Gurugram: Over 11,000 in 45+ group get vaccinated. The Times of India. Published April 2, 2021. Accessed on July 21, 2021. https://timesofindia.indiatimes.com/city/gurgaon/first-day-heartening-show-in-gurgaon-over-11k-in-45-group-get-vaccinated/articleshow/81863944.cms
  17. News. Drive-through Covid-19 Vaccination Available This Weekend In Gurugram. CarDekho. Published on May 29, 2021. Accessed on July 27, 2021. https://www.cardekho.com/india-car-news/drivethrough-covid19-vaccination-available-this-weekend-in-gurugram-27216.htm
  18. Pati I. Gurugram: Health department eyes 100% first dose target in 100 villages. The Times of India. Published on July 17, 2021. Accessed on July 27, 2021. https://timesofindia.indiatimes.com/city/gurgaon/health-department-eyes-100-first-dose-target-in-100-villages/articleshow/84487701.cms
  19. Pati I. Gurugram: 2 villages have given first shots to all, 5 others set to follow. The Times of India. Published on July 16, 2021. Accessed on July 27, 2021. https://timesofindia.indiatimes.com/city/gurgaon/2-villages-have-given-first-shots-to-all-5-others-set-to-follow/articleshow/84458357.cms
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