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Syllabus- General Studies 2(Governance)
Issues relating to quality of life: livelihood, poverty, hunger, disease and social inclusiveness.
Context
As we look ahead to what is promised to be a transition from a lack of vaccine supply to one of greater availability, the plan must be to prioritise people based on the risk of severe disease, and need — essential principles if we plan with justice in mind.
Issues/ target group
| Issue/Target Group | Solutions
|
| Urban slums and neighbourhoods– where socially disadvantaged caste and community groups, and migrants from Adivasi communities often reside, have poor access to and low levels of trust in the health-care system.
| · Vaccines should be provided in camps or door-to-door in slums and other such areas. Appropriately, local governments are considering providing vaccines to older adults in door-to-door campaigns. · A similar approach — vaccination camps where people live and work — could also greatly enhance vaccine uptake among essential workers and the poor. · We need to ensure that those who work for daily wages are able to get the vaccine without having to forego work or pay.
|
| Adivasi communities also reside in remote and forested areas that are also being ravaged by waves of death, presumably due to COVID-19
| Vaccine distribution should be prioritised to districts where they live.
|
| Religious Minorities– In India today, perhaps the most marginalised are religious minorities, and, specifically, poor Muslim communities.
| Vaccine distribution should also be prioritised to Muslim-dominated tier-3 towns across the country.
|
| Women
| · We need women-only vaccine days to ensure that women know that they are being prioritised. · In the current pandemic, it is very possible that if women are not explicitly prioritised, economic pressures to protect the (often male) breadwinner in families, and the historically marginalised stature of women in society, will end up resulting in gender inequities in vaccine uptake — early signs of exactly this have been recently reported.
|
Chhattisgarh Model
Equity-Focused Vaccination Plan-
- The plan prioritised ration card holders, specifically because they are poor, and often live in multi-generation, larger households, putting them at higher risk of infection.
- They also often lack access to mobile phones and the Internet, which are necessary to register for vaccination.
- Though the High Court asked that the plan be modified to provide vaccines to the general public alongside ration card holders, efforts should be made to cater to the marganialised when there is limited supply of vaccines
- WHO’s strategic advisory group of experts on immunisation recommend prioritising sociodemographic groups at significantly higher risk of severe disease or death (for vaccination) in the context of limited supply.
Other Issues
- Data insufficiency– Unfortunately, our data during the pandemic do not allow us to examine whether gender, caste, religious, and indigenous identities have impacted the risk of SARS-CoV-2 infection or death. Despite global calls for better surveillance, including among vulnerable groups, India does not regularly report even gender-disaggregated data. Despite crowd-sourced efforts to collect and make data available, reporting of geographic and other meta-data for tests conducted and sequenced samples is variable across laboratories and States.
Better leadership to standardize and enforce meta-data collection and timely reporting is essential to inform data-driven interventions and prioritised resource mobilization.
- There is a need to refocus on equity and justice at the national and global levels as well.
- Nationally, people have recognised that digital apps for registration are a recipe for inequity along age, gender, and economic dimensions, and reports have highlighted the plight of those on the wrong side of the digital divide.
- CoWIN datathat are available to date show that vaccination rates have been inequitable between tribal and non-tribal areas, for example. Going forward, let us focus on first doing no harm — get people vaccinated to save the lives most at risk.
- Globally- wealthy countries have once again, as during the 2009 H1N1 flu pandemic, secured more doses than they needto vaccinate every member of their population, and even pre-ordered booster doses.
This leaves only poor countries to be dependent on supplies through COVAX, and they find themselves at the end of the line. This is a wake-up call for setting up vaccine distribution systems with equity in mind for the next pandemic.
Way forward/solutions
- Local governments and municipalities should prioritise vaccines for the historically marginalised by focusing through the lens of equity and justice.
- It would require prioritising the poor, religious minorities, socially disadvantaged castes, Adivasi communities, those living in remote areas, and women.
- In Indian villages, Accredited Social Health Activists (ASHAs) and Auxiliary Nurse-Midwives (ANMs) have vast experience and expertise with campaign-style pulse polio vaccination and newborn vaccination; their expertise should be harnessed to take vaccines to villagers.
Conclusion
An explicit focus on justice would prioritise the engagement of trusted spokespeople to engage in effective risk communication with vulnerable and marginalised communities, and to build trust in the vaccine.
We should ensure that we remove barriers to vaccination for the most vulnerable in India to minimise preventable disease and deaths.
At the national level, the recent decision to procure vaccines centrally and make COVID-19 vaccines available free of cost through the public system goes a long way towards ensuring equity and justice.
Question- The vaccine distribution policy should be based on the principle of equity and justice targeting the most vulnerable on priority basis. Elucidate.
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