India’s first month of Covid-19 vaccination crossed 1.3 crore frontline workers. In the current phase, delivering vaccines to over 20 crore elderly and comorbid individuals is a big challenge but also an opportunity to turn the corner on this pandemic. India has never had a mass vaccination campaign for elderly adults, so we’re in uncharted waters with the Covid-19 vaccine.
There are many moving parts: moving crores of temperature-sensitive vaccine doses, matching supply with demand, leveraging new IT platforms, and mobilising communities on election-level scales. But within this chain are opportunities to use our creativity, community and convergence frameworks to add value. There are several challenges in this process, especially for rural India.
How will we pre-register the priority populations who may not necessarily be digitally-empowered? How will we mobilise the elderly to come on the vaccination day? How will we overcome public fatigue towards Covid-19 and scepticism of vaccine benefit? How will we track vaccine administration in rural areas that have poor internet connectivity?
That said, I firmly believe that there’s incredible potential for a successful Swaasthya Andolan if we lean into, spotlight, and empower local wisdom, culture and leadership. Street plays, live folk music, and jingles on loudspeakers may be organised by village leaders to turn this activity into a movement to care for our elders – a value universally recognised in our culture. Meanwhile, our youth can capture local stories to amplify the message on social media, à la “ye hum hain, ye hamaray buzurg hain, aur yahaan vaccine lag rahi hai.”
As per the guidelines, those getting vaccinated need to wait for 30 minutes in the observation room after receiving the vaccine dose. The purpose of this waiting period is to monitor for AEFI, adverse event following immunisation. In this period of captivity lies an opportunity to multiply our health impact.
Recent data from the Longitudinal Ageing Study of India (LASI) shows that three out of every four Indians above the age of 60 have a chronic comorbidity. We can use these 30 minutes to screen for diabetes and hypertension, provide counselling, and well-established treatments. For our elders, vision and mobility screenings can also be prioritised. Referrals can be made to nearby centres for corrective cataract surgeries and to NGOs for mobility assistance equipment. Oral health checkups can open the door to tooth extractions and denture fitting at nearby dental centres. Our health department has counsellors dedicated to discussing tobacco and alcohol cessation and even mental health.
These waiting rooms can provide an intimate setting to begin the conversation on critical issues for long-term health and well-being. For those who are already healthy, we can use these 30 minutes for their wellness – through introducing basic concepts from yoga, meditation and nutrition. In the background, a radio channel can have listeners call in to discuss their health conditions with a different medical specialist every hour. Counsellors can help our elderly beneficiaries instal eSanjeevani – an app connecting the users to the government’s portal for telemedicine – on their phones and walk through an online OPD visit. Local businesses can contribute to post vaccination care-packages, by providing masks, soaps, sanitary pads, condoms, paracetamol for fever reduction, and the government can also distribute user-friendly pamphlets highlighting rural health schemes.
During the peak of Covid-19, Rajasthan had extensively used the mobile app Mission Lisa (Life Saving) to screen vulnerable people for Covid and other comorbidities. 1.4 crore beneficiaries over 25 lakh geolocations were screened by 60,000 plus community health workers including 36,000 Ashas, most of whom were first-time smartphone users. As a result, we have rich spatial information available on 12 major diseases. The same workforce could be used to conduct an app-based mini digital health census of those coming for vaccination during the AEFI period. This will provide enormously useful data on rural health and can be used by public health professionals.
Convergence should not detract from the main purpose of Covid-19 vaccinations. But at the same time, I believe we must not see this vaccine campaign as a one-off activity. This is our chance to build not only a movement for health, but a movement to care for our elders. And that’s something I believe we can all get behind.
Views expressed above are the author’s own.
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