“We are not only fighting a pandemic, we are fighting an infodemic” — Dr. Tedros, Director-General, World Health Organization (WHO)
Since the onset of the COVID-19 pandemic, misinformation has spread at a rapid pace. This is amplified by social media and communication platforms. A lot of the misinformation specifically targets COVID-19 vaccines and remains the biggest impediment to vaccination in rural India.
In this context, the story of a small village in the hinterlands of Maharashtra stands out as an exemplar. In February 2021, when India’s vaccination drive was initiated, health care workers in Janefal, a rural hamlet in Maharashtra’s Aurangabad District with just over 500 residents, had a difficult time convincing people to get vaccinated.1 In fact, only 5 of the 75 residents aged 45 years and over (and thus eligible for vaccination) provided their Aadhaar identification cards when the local council approached them as a part of the vaccination program.
“When the vaccination drives first started in January, people in villages were strongly opposed to it, as they were overpowered by rumors.” — Satish Sable, physician, primary health center, Janefal 2
A little bit of probing revealed the misconceptions people held. Some had heard stories from neighboring villages about people dying after vaccination. Some thought that people who were vaccinated had to amputate their arms. And some had religious misgivings. In addition to these misconceptions, limited digital literacy and smartphone accessibility in Janefal made online registration for the vaccination program difficult.
It took a dedicated task force three months of vaccine advocacy, trust building, and community mobilization before Janefal became one of the few villages in India to achieve 100 percent immunization by administering at least one dose of vaccine to each eligible resident.1 Later, many residents of nearby villages came to ask the Janefal administration for guidance on setting up vaccination camps in their own villages. They believed that if a small hamlet such as Janefal could successfully vaccinate all its eligible residents, then villages with better infrastructure could also achieve this goal.
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How can you replicate or adapt this promising practice?Identify the factors driving behavior. Health care behavior is influenced by individual and environmental factors. Understanding the individual factors (such as knowledge, beliefs, and personal preferences) and the environmental factors (such as availability and accessibility of services and resources) plays a key role in developing a plan of action to counter undesirable health care behaviors. In this story, dozens of home visits conducted by health workers enabled the task force to identify unique and unprecedented fears and misconceptions. Create an enabling environment. The action plan implemented by the task force focused on removing as many barriers to vaccination as possible. For example, health workers used visual aids in door-to-door awareness advocacy to educate people and debunk myths about vaccines, and they set an example and built trust and confidence by getting vaccinated themselves first. This work created an enabling environment that was built on mutual respect and trust. Additionally, to provide ease of access and overcome any technology barriers, the task force conducted same day online registration at a vaccination camp in the village.2 |
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What are the lessons learned from this bright spot?
When the vaccination drive was initiated in February 2021, people in the village of Janefal were strongly opposed to it. According to the village chairperson, the entire village population was gripped by a fear of the vaccines.
“Upon persistent convincing, villagers would agree to take the shot, but the next morning, when it was time to go to the hospital, they would back out again. They caught these rumors from WhatsApp. Many messages were doing the rounds, all blaming vaccines for untimely deaths and a host of illnesses” — Krushna Gavande, chairperson of the village council of Janefal 2
For two months, health workers such as Sarla Zalte, who had been working in the village for nearly three decades, conducted dozens of door-to-door visits. Through these visits, Zalte was conducting an educational diagnosis to identify the predisposing factors (such as knowledge, attitude, beliefs, and personal preferences), reinforcing factors (such as social support and social norms), and enabling factors (such as availability and accessibility of services) for vaccination. Although she tried to reason with people by comparing the COVID-19 vaccine to regular newborn immunizations like the hepatitis B vaccine, she was unable to convince them.
In early April 2021, a task force was set up to address the problem. This task force was composed of health workers, a medical officer at the local primary health center, police officers, the village head, and other village council members. The team identified adults who were eligible for vaccination and implemented the following action plan:
- Conduct advocacy and awareness activities: Task force members conducted door-to-door awareness campaigns to debunk myths and explain the benefits of vaccination. They were already vaccinated themselves, so they encouraged community members by showing them their own photos and videos of receiving the vaccine.
- Build trust and confidence: Village heads and other frontline workers set an example by getting vaccinated first. They had their photos taken while getting the vaccine, and afterward, to address apprehensions, spent time painting gram panchayat buildings.2
- Take the vaccines to the people: During the awareness campaigns, task force members discovered an unprecedented fear of hospitals among village residents, who feared that the doctors would kill them and rob them of their kidneys. Additionally, the nearest vaccination center was 8 kilometers away. The task force overcame both problems by conducting a vaccination camp in the village and thus taking the vaccines to the people.
- Leverage technology appropriately: COVID-19 vaccination drives in rural India are hampered not only by vaccine hesitancy but also by issues such as mandatory online registration. Most residents of Janefal had limited digital literacy and smartphone access. The task force used three mobile phones to conduct on-site, same-day online registration for all eligible residents.
“The nearest PHC [primary health center] is 8 kilometers away, [and] with the distance and fear of hospitals, most villagers would have avoided the vaccine had the camp not been organized in the village.” — Pathan, farmer 2
How was this promising practice implemented?
The task force decided to hold the vaccination camp on April 27, Hanuman Jayanti—an auspicious day celebrating the birth of the Hindu god Lord Hanuman. The intention was to create a connection in people’s minds that the vaccine was protection from COVID-19 being provided by Lord Hanuman. On April 27, 2021, all 65 eligible and available residents from the village of Janefal received their first dose of COVID-19 vaccine (Ten Janefal residents eligible for vaccination were in medical care at the time and had their vaccination scheduled for a later date). This success was due to the continual, innovative efforts of the village administration and health workers to build awareness, trust, confidence, and physical and technological access to the vaccine.3
How a Role Model Village Increased Vaccination Rates
After witnessing the success that Janefal achieved, nearby villages started showing interest in ramping up their vaccination rates by replicating the Janefal model. Prior to Janefal’s success, the primary health center physician had succeeded in vaccinating only 400 people in the 16 villages served by the primary health center. Following the successful campaign at Janefal, the physician managed to vaccinate 3,500 people, thereby reducing the risk and consequences of becoming infected with COVID-19. In fact, the model has earned praise from the Aurangabad District Magistrate, who said, “Now every village wants to be Janefal”.
Supplementary material
0118.The Janefal Model - Addressing Vaccine Hesitancy at the Village Level.pdf
Sources
- India Covid: Vaccine hesitancy drops in rural areas; all 45-plus now vaccinated in Janefal. Khaleej Times. May 11, 2021. Accessed July 5, 2021. https://www.khaleejtimes.com/coronavirus-pandemic/india-covid-vaccine-hesitancy-drops-in-rural-areas-all-45-plus-now-vaccinated-in-janefal
- How a village in India reached 100 percent vaccination in the face of misinformation and hesitancy, National Geographic. May 22, 2021. Accessed July 5, 2021. https://www.nationalgeographic.com/science/article/how-a-village-in-india-reached-100-vaccination-in-the-face-of-misinformation-and-hesitancy
- Maharashtra village finishes 1st dose of Covid vaccination. Deccan Herald. April 30, 2021. Accessed July 05, 2021. https://www.deccanherald.com/national/maharashtra-village-finishes-1st-dose-of-covid-vaccination-980858.html