Wayanad: 100 Percent COVID-19 Vaccination in an Entire District

Introduction

Wayanad is one of the smallest districts in Kerala, with an area of 2,131 square kilometers. According to the 2011 census, its total population was approximately 817,420 of whom 69 percent (approximately 566,383 people) were over 18 years of age. It is a tribal district, with scheduled tribes making up 18.5 percent (approximately 151,443) of the total population and scheduled castes making up 3.9 percent (approximately 32,578) of the total population.1,2 Almost 96 percent (approximately 785,840) of the population resides in rural areas,3 which constitute the majority of tribal areas. The challenging terrains, shortage of health facility staff and equipment, and seasonal rainfall in the district make it difficult for health workers to reach people with essential services, such as vaccinations.4 Despite these challenges, Wayanad was able to vaccinate 100 percent of eligible adults (over 18 years of age) with the first dose of the COVID-19 vaccine by adopting innovative methods, strategizing vaccination approaches, and collaborating with various departments and local self-governments.

During the first wave of the COVID-19 pandemic in 2020, Wayanad reported the lowest number of new cases on most days and accounted for only 0.36 percent of the state’s COVID-19 deaths.5 In December 2020, the peak month of the first wave, the additional caseload and death count in Wayanad stood at 5,862 and 25, respectively. However, in May 2021, the peak month of the second wave, the additional caseload grew almost threefold to 16,922 and the death count doubled to 58.6

On April 26, 2021, in the wake of an increase in COVID-19-positive cases in the area, the district administration formed a tribal COVID-19 cell (task force) to cooperate with tribal development departments to restrict the pandemic’s spread in tribal hamlets. The cell was coordinated by Dr. Nitha Sukumaran, a former health additional director at the Department of Health and Family Welfare.7 The cell was tasked with a mission to vaccinate the tribal population. The cell worked to achieve this mission with help from employees of civic bodies, tribal development departments, health and labor departments, as well as members of the Kudumbashree Mission (a women’s self-help group focused on awareness campaigns by visiting houses and public areas, designing posters, mobilizing people for vaccination, among many other initiatives8) and accredited social health activists.9

On July 29, 2021, Vythiri in Wayanad was the first tourist destination in Kerala to achieve 100 percent first-dose vaccination of its adult population. This effort was part of a state vaccination campaign to revive the tourism industry, one of the main sources of income for Wayanad.10  On August 8, 2021, Noolpuzha became the first tribal panchayat (local governing system at village level) in Kerala to fully vaccinate—with two doses—its entire adult population.11 Of the 7,602 tribal adults who mostly lived in Muthanga and neighboring forest regions, 7,352 were partially vaccinated (one dose).12 Thereafter, Edavaka, Pulpally, Thariyod, Pozhuthana, and Mullankolli also achieved 100 percent first-dose vaccination of their adult population.13 Thus, by August 16, 2021, Wayanad became the first district in the state to administer a COVID-19 vaccine to its entire adult population over 18 years of age.14 

As of December 8, 2021, a total of 668,751 first doses of vaccine (covering 101 percent of the population) and 539,693 second doses (covering 82 percent of population) have been administered in the district; Wayanad thus has the highest vaccination rates in the state and among the highest vaccination rates in the country.

How can you replicate or adapt this promising practice?

Foster collaboration

The district formed a coordination committee for the vaccination drive, comprising a medical officer, a local police inspector, Kudumbashree Mission members, and accredited social health activists. The district also created rapid response teams in each ward to facilitate inoculation by ensuring that people were mobilized and transported to immunization clinics.5 In addition, it formed an exclusive cluster in each ward to ramp up the vaccination process.13 Teams from the nongovernmental organization Doctors for You and private hospitals assisted in the distribution of vaccines. One doctor, three nurses, and one data entry operator were stationed at each immunization location.15

Empower local authorities to lead vaccination campaigns

Wayanad’s vaccination strategy was to reach out to people directly rather than wait for them to come to a COVID-19 vaccination site. In contrast, the district carried out routine vaccinations at primary health care centers. Local self-governments in Kerala were empowered significantly by a major transfer of resources and administrative authorities, which proved to be successful. The health department involved implementation agents for development programs16 at every level and activity. Wayanad also made data transparent to enable the effective dissemination of information and human resource management at every panchayat.5

What are the lessons learned from this bright spot?

Adopt a tailored vaccination approach to ensure maximum outreach

To achieve 100 percent vaccination, Wayanad adopted a hybrid, tailored approach to ensure maximum outreach to people. It organized massive immunization campaigns, where it vaccinated approximately 100,000 people each day. At the same time, it set up special mobile vaccination units to cover 49 villages17; an additional 28 mobile units covered the tribal hamlets.14 Health officials adopted various unique approaches like the election model (when political leaders conduct door-to-door canvassing), and awareness raising through local languages. Health officials kept the whole process transparent for better understanding and visibility of campaigns.

"The government had formed 28 mobile teams to visit the remote tribal hamlets. The teams also visited the houses of 636 bedridden patients and administered vaccines." Veena George, Kerala State Health Minister9

From January 15, 2021, the district shifted its approach to focus on vaccinating people who were unable to attend vaccination camps or were bedridden at home. Thus, between January 15 and August 15, 2021, the health department was able to vaccinate 636 bedridden people at home. The district also allowed special arrangements for those who lived in hamlets without identity cards. Officials registered these people for vaccination through the CoWIN app using the identity cards of other residents (such as neighbors and family members) as a reference.11 During the same period, vaccines were administered to 96 percent of the population through government facilities.4

“The vaccination process started in the district on January 16, and the district administration set the target and began preparations in February to achieve the first district in the country to have fully vaccinated the population. From there, we saw a massive participation by eight departments in the district such as local self-government, revenue, health, disaster management, transport, police, Kudumbashree, and Scheduled Tribe development. Apart from this, we have received immense support from MLAs [Members of Legislative Assemblies], MPs [Members of Parliament], and tourism minister PA Mohamed Riyas.” Dr. Adeela Abdulla, District Collector4

“Tourism has been one of the main sources of income for Wayanad. Through this mega vaccination drive, the district administration also targeted to keep the tourism sector in the district open and active as soon as possible.” Dr. Adeela Abdulla, District Collector4

How was this promising practice implemented?

Organize special vaccination camps

Wayanad organized hundreds of special vaccination camps for all wards within the district. To avoid overcrowding, the local self-governments decided which wards to prioritize and capped the number of people who could receive vaccination in a ward to a maximum of 200 per day.5 

Conduct mega vaccination drive

From August 14 to August 15, 2021, Wayanad conducted a mega vaccination drive to vaccinate 100,000 people a day.18 Wayanad residents who had not been vaccinated in previous inoculation drives were vaccinated in this two-day mega vaccination drive, which was held in various parts of Wayanad.19

Hold special vaccination drives for tribal people

In association with the Scheduled Tribes Development Department and nongovernmental organizations, Wayanad held special drives for tribal people, such as March Mission, Mop-up April, and Gothra Raksha May.4 In March 2021, the district administration organized the March Mission campaign, which was sponsored by the tribal department. The campaign aimed to complete vaccinations for tribal people 60 years of age and older. In April 2021, the district administration held another special campaign, Mop-up April, to cater to tribal people in the 45-year and older age group. The Evangelical Social Action Forum bank donated its corporate social responsibility funds for the Mop-up April campaign. Vehicles were dispatched to tribal hamlets to transport people to immunization sites. The organizers mobilized people and gave them drinks and refreshments. In May 2021, the district organized Gothra Raksha May to carry forward the vaccination drive.4

Use analog tools to complement digital platforms

The health department followed the process used during elections in wards. For example, villagers received slips with a token number that stated the place and time of their vaccination. In the 413 wards of Wayanad, people were given at least two options to choose their vaccination slots.5 To avoid long queues at tribal camps, a special squad visited families the night before their vaccination slots and completed their registration process.13,20 Such a strategy was adopted because the majority of the tribal population did not have access to the CoWIN registration app or did not possess identification cards. Furthermore, the literacy rate was low among the tribal population, which introduced challenges to accessing and understanding the CoWIN user interface. This manual approach helped people access vaccination with ease and saved them the trouble of navigating a digital registration process.

Build trust and raise awareness through local languages

According to the district collector, teams boosted the confidence of tribal groups by bringing them together at meetings and inoculation camps. Community members felt encouraged when they saw their neighbors attending panchayat meetings or getting vaccinated. This facilitated them coming forward on their own the next time for a meeting or for the second dose.

Officials also employed community radio, local television, promoters, and booklets—using tribal languages like Paniya and Chettri—to inform people about the pandemic and explain why immunization was vital to tribal people. District collector Dr. Adeela Abdulla broadcast daily Facebook livestreams with COVID-19 data (e.g., number of cases, deaths, and people recovered; vaccination sites; and vaccination slots available) to ensure optimal awareness.5 Dr. Abdulla also posted various posters and videos on social media channels to motivate people to get vaccinated.

Supplementary material

Wayanad - 100 Percent COVID-19 Vaccination in an Entire District.pdf

Sources

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