Patralekha Chatterjee | All must get vaccine: Say no to class, digital divide

The Lal Gumbad Basti is a stone’s throw from a 14th century Sufi saint’s tomb and tree-lined Panchsheel Park, one of South Delhi’s toniest neighbourhoods. Most families who live in this slum don’t have toilets or taps at home; every morning, there are long queues outside the few community toilets that exist. Few have piped water. The 3,000-odd people who live in the basti are used to being invisible. They eke out a living as daily wagers, in odd jobs, and are part of that amorphous space called the “informal sector”.

Last December, they had their moment of fleeting visibility. Several women from the slum spoke out at the “Hunger Hearings” organised by the civil society group “Delhi Rozi Roti Adhikar Abhiyan”. I watched the live-streamed video testimonies. They brought alive the stark reality of acute hunger among many of the city’s poor who had lost their jobs and sunk into deep debt with the onset of the Covid-19 pandemic. I visited the area soon after.

Earlier this week, I called up a community worker I had met during one such visit. I wanted to check how people at Lal Gumbad Basti were reacting to the world's largest inoculation drive against the coronavirus.

Since January 16, when India launched a mass Covid-19 vaccination campaign, more than 24 million vaccine doses have been administered.
I am among those who have already got the first dose of the vaccine. The experience was relatively smooth, barring minor technical glitches like a malfunctioning server which delayed things a bit.

But recent newspaper reports are pointing out a far more disturbing trend. The euphoria about getting the jab seems to be confined so far to the better-off sections of society. But where are the poor in the vaccine queues?
Why is there such little enthusiasm about the vaccine in places like Lal Gumbad Basti?

Talking to residents, a few things became clear. The health workers and Anganwadi workers have mostly been vaccinated. Most slum dwellers, however, are still caught up with their struggle for survival; they are looking for work and/or supplementary income. Many people don’t have smartphones or computers and are not fully equipped to navigate the entire process required for the jab. Many others are ignorant or apprehensive because they have heard someone, somewhere, had faced adverse effects or died soon after taking the vaccine. Nobody has really explained all the details to them in a language they can understand and dispelled their fears about the vaccine.

“If the government can carry out mass awareness campaigns, put up posters everywhere about the need to wear masks, wash hands with soap, and maintain physical distancing, why not do the same to make people more aware about the Covid 19-vaccine, dispel all doubts and hesitancy?” asked the community worker. Why not indeed?

And this brings one to several key challenges ahead. Though many of us feel a great sense of relief that a Covid-19 vaccine is available, and we can take the jab and feel much safer, there are still many unknowns. We don’t fully know how long the immunity will last or how effective it will be against new variants of the virus. For the near future, it would be wise to continue to take all the safety precautions like wearing masks, maintaining enough physical distance, washing hands with soap frequently, and so on.

Even among the middle class, there are many who believe that once you have taken one dose of the vaccine, one is “immune” from the virus. This is not so. We need strong public health campaigns to sledgehammer these basic health facts.

Then there is the all-important equity issue. Globally, vaccine equity is seen to be the biggest moral test before the global community. It is being argued that since the coronavirus doesn’t really discriminate between the wealthy and developing nations -- access to, and distribution of vaccines, shouldn’t either. The same applies within a country. 

Global Covid-19 vaccine trackers point to India’s relatively low population-level full vaccination coverage till date. Many health experts like Rajib Dasgupta, chairperson of the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, say India was right in giving priority to vaccinating its healthcare and frontline workers and that could explain why our vaccination coverage is relatively low till now.

In a recent commentary piece in Indian Express, Mr Dasgupta noted: “The enthusiasm witnessed in the first few days since moving on to the next group of 270 million people -- those aged above 60 years as well as those between 45-59 years with co-morbidities -- was also marked by some shortcomings in the technology (booking of slots) and vaccine supply. These shall surely be fixed quickly given India’s depth of experience and capacity of the immunisation programme.”

The transient technical woes are not the only problems that need to be tackled. The greater challenge is building more public confidence in the vaccine.

India has set a target of immunising about 0.3 million healthcare workers (HCW) on the first day (January 16) across 2,934 sites; 10 million HCW should have received the first dose in about 30 days (mid-February). But as Mr Dasgupta points out: “7 million were vaccinated with the first dose till March 8, with considerable variation across states. This does point to a modicum of vaccine hesitancy in some states and/or within the states, that too among a group who actually have some of the highest risks.”

If this is the situation among healthcare workers, imagine the situation of the urban poor who live cheek by jowl and are also at great risk? In India, it is in everyone’s interest that both the well-off and the not-so-well off, the big city dweller as well as those in small towns and in the interior, take the jab if they are medically eligible.

India has many great advantages -- it has an indigenous vaccine industry and it has successfully administered vaccines to millions in the past. But if access to vaccines for all is our calling card, we must factor in the stark, ground realities -- like the class divide, the digital divide, the information divide and the gender divide in society. About 400 million Indians have no access to the Internet. Far fewer women have access to cellphones and Internet services. India’s capable frontline workers have to be mobilised to plug some of these gaps for broader vaccination coverage.