As of March 2022, the worst of the infectious third wave of COVID-19 cases (brought on by the Omicron variant) in India is likely over. Even as a gradual relaxation in COVID-19 restrictions take force across the country, there has also been increased vaccination coverage efforts. For instance, the Government of India also began vaccinating adolescents between 15-17 years of age in January 2022. It has also introduced 'precaution' doses for senior citizens and at-risk populations who have received two doses of any vaccine. Since vaccination first became available in early 2021, more than 75 per cent of the eligible population has been fully vaccinated, and more than 1.65 billion doses of any COVID-19 vaccine have been administered.
Data, however, still indicate that only 56 per cent of the Indian population has been fully vaccinated, implying a lack of protection for nearly half the population should another COVID-19 wave arrive. Furthermore, cases in the third wave reached a peak of 350,000, similar to the deadly second wave that was dominated by the Delta variant. Epidemiologists, public health experts, and the World Health Organization (WHO) have repeatedly stressed the importance of preventive health behaviours to complement the immunity-granting effects of vaccines to control the spread of COVID-19. However, as recent research shows, there has been substantial variation across states and over time on the adherence to mask-wearing as well as vaccine hesitancy.
In our recent paper (with Varun Arora, Sujoy Chakravarty, Shagata Mukherjee, and Shubhabrata Roy), published in Health Communication, we specifically examined the interplay between preventive health behaviours, vaccine uptake, and concerns around the vaccine. This research was conducted in early 2021, prior to the rollout of the vaccine widely, where there was still uncertainty around its efficacy, price, and side effects. We conducted an online and telephonic survey on vaccine hesitancy, attitudes, and behaviors between February and March 2021 in nine Indian cities of Bangalore, Chandigarh, Chennai, Gurugram, Hyderabad, Indore, Mumbai, New Delhi, and Kolkata. We also constructed two measures of vaccine hesitancy: one was an index comprising concerns related to ingredients of the vaccine, side effects caused by the vaccine, and the cost of the vaccine. The second was simply a question that asked whether respondents believed the vaccine would be effective in preventing infection, hospitalisation, or death. Finally, we also asked whether respondents would prefer a hypothetically "free" India-made vaccine or a priced foreign vaccine (since approval for Covishield and Covaxin were still forthcoming at the time of the survey).
First, our analysis found that those individuals who believed in the effectiveness of preventive health behaviours such as hand-washing were more likely to indicate willingness to take the vaccine as well. This is potentially because prior to the introduction of vaccines, non-pharmaceutical interventions (e.g., handwashing, mask-wearing, social distancing) were the only way to fight a COVID-19 infection. Second, individuals who were concerned about the cost of the vaccine were less likely to get themselves vaccinated. Key factors that significantly influenced vaccine choice (e.g., choosing based on relative efficacy) pointed toward the role of beliefs about vaccine hesitancy (ingredients, cost, side effects), general vaccine effectiveness, as well as the source of information.
Interestingly, one of the key narratives that emerged from our study was that information sources matter a great deal for how individuals choose to get vaccinated, as well as whether or not they are willing to get jabbed. For example, respondents indicating that they would choose a vaccine based on relative efficacy were more likely to get their COVID-related information from newspapers, magazines, and the internet (as opposed to family, neighbours, or social media). There are a few important takeaways from this work. First, COVID-appropriate behaviours are strongly linked with vaccine hesitancy. There are two points to note here: (a) India is progressing steadily toward a target of fully vaccinating its adult population; and (b) the potential of newer COVID-19 mutations dodging immunity granted by vaccines. Thus, mask-wearing, frequent handwashing, and maintaining physical distance are all going to continue to be important components in the fight against COVID-19 in India. If we continue to enforce mandates around these behaviours, there is a chance that it will also contribute to higher vaccination rates. Second, the channels through which awareness is raised are critical for encouraging vaccine uptake (with an eye on 'precaution' or booster doses currently being offered). This ties in with continuing requests from researchers and public health experts to release more data on COVID-19 testing, vaccines, and various other parameters, as it will help public health communication in a major way. If India is to continue to put up a strong front in its fight against COVID-19, and prevent future infectious waves, then it is imperative for public health policy to tackle vaccine hesitancy. Given that COVID-19 restrictions have been largely withdrawn as well as large public gatherings for elections this year, achieving vaccination targets should be a priority. Our study provides a useful framework within which factors associated with vaccine uptake are highlighted. Our future work in this domain explores the psychological biases and triggers for enabling vaccine uptake, which can be used in health communication in the future. It is only with a combination of behavioural and pharmaceutical interventions that we can hope to make significant progress in the fight against COVID-19 two years on.
Hansika Kapoor and Anirudh Tagat
This article was first published on 3rd March 2022 in News9
https://www.news9live.com/health/covid-19/why-tackling-vaccine-hesitancy-is-still-important-for-indias-fight-against-covid-19-156893?infinitescroll=1
