Combating vaccine hesitancy among healthcare professionals
By Dr Sambit Dash
After the rollout of coronavirus vaccine in India, news about considerable number of healthcare professionals (HCPs) not turning up to receive the vaccination is worrying. As per a news report published on January 24, only 40 per cent HCPs in Tamil Nadu and 28 per cent in Punjab turned up for vaccination. Similar reports have been coming in from other parts of the country, though, along with reports of good response by HCPs in States like Odisha and Karnataka.
The uncertainty over taking a vaccine or “vaccine hesitancy” is a phenomenon that is not unique to coronavirus vaccination and applies to all vaccinations. An analysis of factors contributing and actions taken to address the reasons contributing to such hesitancy will go a long way in accomplishing coronavirus vaccination in India. Vaccine hesitancy is a complex phenomenon and as shown in a Canadian vaccine hesitancy research, it is fed by numerous factors like knowledge and information, past experience, perceived importance of vaccination, risk perception; trust, subjective norms and religious and moral convictions. In the Indian context, vaccine hesitancy has never been a major problem in universal vaccination schemes. Neither has India seen massive antivax movements like in the US. In such a milieu, one needs to analyse why the mistrust among HCPs has grown.
The major reason has to be the issue of regulatory approval to India’s indigenously developed vaccine. Despite incomplete Phase 3 trial, the emergency approval and using convoluted language have created confusion. Added to that, the report from Bhopal on unethical practice being followed during Phase 1 and 2 trials of the same vaccine has created deep mistrust among many. Thus trust, as Brownlie and Howson define, as “a complex relational practice happening within particular socio-political context”, is a crucial factor in acceptance of vaccine, and one that seems to have been hit.
That said, the high trust that Indians in general have with their Government could come handy in mitigating some of the hesitancy in the long run. While many people are surprised that healthcare professionals, who have borne the brunt of Covid-19 like no other, and who have been stressed since more than a year, are not turning up for the vaccination, vaccine hesitancy among them is a well recorded phenomenon. In a study among Swiss paediatricians, it was observed that 5 per cent of them delayed MMR and Diphtheria vaccination of their children; more than a third of 540 HCPs in Quebec, Canada, said that children were receiving too many vaccines.
Being partisan at the cost of good science by many HCPs has also contributed to the hesitancy. Keeping mum on questions about regulatory approval, deliberate misreading of study published about its Phase 1 data, are only adding to confusion of people who look up to HCPs to help them take a decision. It has been well acknowledged that recommendation from HCPs influence ccceptance of vaccines. For the general public, seeing polarisation in the HCP community, over politics and not science, is to see mixed signals. Added to these factors, the teething problems in the CoWIN app has contributed to hesitancy. The dependence on the app will only grow in coming weeks, and sorting it out is probably being done on a war footing. The Government response to factors that contribute to vaccine hesitancy has been left wanting. The recent letter shot by the Home Secretary to all States to consider taking penal action against people spreading fake news against vaccines in India is only to add to the mistrust for it is the Government’s job to allay apprehensions and engage in clear communication.
History of trouble with universal vaccinations programmes leading to reduced vaccinations or examples of scrapping of programmes are many. In France, in the 1900s, Hepatitis B vaccine was erroneously linked to multiple sclerosis and the universal vaccination programme was dropped. In the US in recent times, associating autism with MMR vaccination has done a lot of harm to the public health programme. Luckily for India, the erosion of trust is not that alarming, or so it appears, at the moment; but every controversy around vaccines, every hidden detail, every report of malpractice will be harming that trust. Collating genuine concerns over approval, availability of data, with “antivax” movement or painting people who raise query with the brush of anti-nationalism is not serving any good. It is essential to understand that good practices in this vaccination programme is essential for trust issues in other vaccination programmes in the country. Therefore to demand transparency, clarity, data, reviewed research papers, is warranted, and will result in creating more trust and reducing vaccine hesitancy.
__ The author is Assistant Professor, Department of Biochemistry, Melaka Manipal Medical College (Manipal Campus). He comments on public policy, healthcare and issues of social interest. He tweets at @sambit_dash