Shaving off the vaccine hesitancy

The history of immunisation in India has experienced different dynamics of ‘vaccine hesitancy’ during its implementation. Vaccine hesitancy – also known as vaccine refusal, anxiety, social resistance and more – can be defined as “delay in acceptance or refusal of vaccines despite availability of vaccination services” as per World Health Organisation (WHO). Vaccine hesitancy is “influenced by factors such as complacency, convenience, and confidence” and it is “complex and context-specific varying across time, place and vaccines” (WHO). In a country like India, this complexity is more pronounced and varied across the places associated with social culture. The state of Uttar Pradesh is probably one most challenging place in this regard because of its vast population and cultural milieu. While the communal and religious background of vaccine hesitancy is the commonest discussing issue, but hesitancy due to the deep-rooted patriarchal family system is largely overlooked and least discussed. And this dominant patriarchy is evident since the age of Mahabharata, one of the greatest mythological epic of India. Now, Meerut, deeply connected with this mythological epic, is showing an amazing and innovative solution towards vaccine hesitancy by challenging this patriarchy started from the place called Bahsuma under Hastinapur block, the erstwhile capital of Kuru kingdom of Kauravas of Mahabharata.

The district Meerut is a predominantly urban establishment, where settlements are in transition from rural to urban. With a total population of 3.44 lakhs (census 2011), Meerut has many small pockets which are designated as High-Risk Areas (HRA) because of vaccine hesitancy. Also as per the census 2011, the district has a marginally higher population of males (1,825,743) than the total number of females (1,617,946) and population of children with age of 0-6 is 503,719. During the process of finding the underlying causes of the hesitancy in these HRA pockets, the district immunisation officials discovered the most usual but largely overlooked problem of hesitancy. This marginally higher population of male fraternity is the decision-maker of all (patriarchal) families in the socio-economical context of Bahsuma (as well as in the most of the parts of India). Though the average literacy rate of Meerut (72.84%) is slightly higher than the state average and male literacy is much higher (around 80.74%) compared to female literacy rate (63.98%), but lack of education & ignorance about vaccine-preventable diseases (and public health as a whole) outperforms the literal statistical data. Sometimes this ignorance is catalysed by religious or communal misbeliefs that cause major hindrance. To address this issue, the district immunisation officials along with other partners found a unique solution. It was perceived that to mobilise the male members of the family, instead of door to door awareness, it would be a better option to find a common public place where these males usually gather on a routine basis and also discuss varied topics. It would also be a unique proposition that if the place has a ‘socially acceptable’ community mobiliser who can take the responsibility to spread awareness about vaccine-preventable diseases among these males. The barbershops in these small townships are still the most common meeting points of all males of a community and the officials took this advantage. Moreover, the barber community is still holding a socially respectable position in these small peripheries of India and people are discussing varied topics with these barbers. Being directly connected with social occasions especially marriages & godhbharai (fill-the-lap), they are also well aware of families. So, barbers would be the unique propositions to address the “patriarchal” hesitance towards vaccines.

 

In August 2018, the district immunisation cell under the leadership of Dr. Vishwas Chaudhary, the District Immunisation Officer (DIO) of Meerut, started this drive from Bahsuma. Mythologically known as Bhisma Puri, that belongs to the Greatest Bhishma Pitamah of Mahabharata, Bahsuma is a Nagar Panchayet or Notified Area Council (NAC) with a population of 11,753. The place is also designated as HRA during the survey because of vaccine hesitancy. To start with, a meeting was arranged with the barbers. Though initially, about 30 barbers participated, later only about 10 remained to initiate this pilot project. Wakil Ahmed and Sonu Kumar were among those enthusiastic barbers who are still active in mobilising the community voluntarily. Being closely connected to the community, people like Wakil and Sonu know about the social occasions happening in each and every households. The aim was to target those young male population who just got married or would marry soon. With the constant support by Sadhna Pawar, the Block Community Mobiliser (BCM), people like Sonu and Wakil showed their competency in community mobilising. Seeing the efforts and working with the health department that also earned Sonu and Wakil socially respectable status, the other unwilling barbers gradually showed their interest to participate in this unique community mobilisation activity.

Beyond this unique proposition, the district immunisation cell also took another kind of innovative community mobilisation that was never taken place earlier. Along with routinely arranged mothers’ meetings, simultaneous parents’ meetings for both fathers & mothers, were also arranged at regular intervals. In these meetings, the BCM and other partners interact with the fathers directly regarding immunisation to address the patriarchal mindsets.

Both these first-ever unique, socially deep routed innovations started showing its result during the routine immunisation sessions. Seeing the success of this initiative in past few months at an HRA like Bahsuma, the district is now taking this initiative forward to a more obstinate HRA at Sardhana from 2019.

 

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Wakil(25) is interacting with his young customer who is newly married.
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Sadhna Pawar, the BMC, during her interaction with Sonu (L) & Wakil (R). Both of them were the first ever willing barbers to participate in this community mobilisation programme, voluntarily.
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The stickers are uniquely printed by District Immunisation Cell. Any barber’s shop displaying these stickers means that the barber is associated with this community mobilisation programme with health department.
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Similar to the stickers, the shops also display the rate cards that uniquely signify the association of the Barber with the programme. This engagement gives them socially respected status that encourages other unwilling barbers to participate in this programme.
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Similar to the stickers, the shops also display the rate cards that uniquely signify the association of the Barber with the programme. This engagement gives them socially respected status that encourages other unwilling barbers to participate in this programme.
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IEC materials are displayed in Wakil’s barber shop. Also the wrapper used for hair cutting carries the message to spread the awareness about vaccination.
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Parents meetings are organised on regular basis (instead of only the moth- ers’ meeting) in the community encouraging both the parents to participate and make them aware about the vaccine preventable diseases.

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