Subject: Governance

Reoriented vaccine policy

• The foremost challenge in vaccination in India has been a supply deficit.
• Announcing a reoriented vaccine policy recently, the Prime Minister announced a coherent path forward.
• Starting from June 21, the Union government will take charge of 75 per cent of the total procurement, and provide vaccines to states at no cost.
• The government has reserved 30 crore vaccines with Hyderabad-based Biological-E by facilitating an advance payment of Rs 1,500 crore.
• Fortnightly updates on the supply of vaccines to states are being taken to ensure transparency and efficiency in planning.

Dealing with two complex challenges

• Two other complex challenges that need immediate focus are vaccine hesitancy and the much-discussed digital divide in the country.

1) Challenge of vaccine hesitancy

• Contextualised and curated approaches are crucial.
• The WHO has put forth the BeSD (behavioural and social drivers) vaccination model, which emphasises “motivation” as the vanguard of human psychology during a vaccination drive.
• Vaccination coverage could be increased by incentivising and motivating citizens.
• Unfortunately, in India, misinformation, disinformation and misplaced beliefs have led to fears about the potential harmful effects of vaccines.
• The diversity of India necessitates community engagement at the local level to counter this narrative of misinformation.
• A successful information campaign requires dissemination through mediums that invoke trust.
• Local languages and dialects should be used to engage people via local radio, television channels and regional newspapers.
• Another network that can be leveraged at the district level is that of the ASHA workers and the auxiliary nurse-midwives.
• These are trusted local figures.

2) Bridging the digital divide

• It is important to introduce solutions that bridge the digital divide.
• A toll-free helpline number 1075 has been activated for those without internet.
• Similarly, districts can explore missed-call campaigns, which could ensure that minimal infrastructure is being optimised for processing high-volume user requests.
• Even though the reported adverse events following immunisation stands at only 0.012 per cent, dedicated representatives can provide vaccine-related pre- and post-counselling to individuals.

Way forward

Startups could help bridge digital divide

• The devastating effects of the second wave in rural areas have prompted fintech startups to enable vaccine registration.
• PayNearby has helped over 8 lakh citizens register through its network of agents called “digital pradhans”, who are present in kirana, ration, mobile and hardware stores, frequented regularly by rural users. 

Use points of contact for publicising benefits of vaccine and registration

• Almost 81 crore beneficiaries, 75 per cent of whom are in rural areas, procure ration from 5,46,165 fair price shops across India.
• There are over 11 lakh business correspondent outlets in India working mostly in rural areas to advance the mission of financial inclusion.
• A network of around 1,54,965 post offices (as on March 2017) exists in India of which 1,39,067 are in the rural areas.
• Such points of contact can be leveraged as dedicated units for publicising the benefits of Covid vaccines and as physical locations for vaccine registration

Direct engagement with citizens

• The Prime Minister recently described district officials as “field commanders” in our efforts against Covid.
• This ambit should move beyond just the district bureaucracy to the extensive network of public services. 
• A stellar example of direct engagement also stems from the success of the Swachh Bharat Abhiyan.
• Direct engagement with citizens contributed greatly to the operational success of previous immunisation campaigns like the pulse polio programme.

Consider the question “What are the factors responsible for vaccine hesitency? Suggest the ways to deal with it.”

Conclusion

Thinking local and utilising established networks to create culturally resonant messages is the need of the hour to reduce vaccine hesitancy, bridge the digital divide and achieve vaccine saturation.

The article contrasts the public healthcare system in South Asian countries with that of their Southeast Asian peers and highlights the shortcomings.

Subpar public healthcare system

• Super spreader events, a fragile health infrastructure neglected for decades, citizens not following health protocols, and logistical mismanagement were the factors responsible for the destruction in the second Covid-19 wave.
• What has exacerbated the situation is a subpar public healthcare system running on a meagre contribution of a little over 1% of India’s Gross Domestic Product (GDP).
• While the private medical sector is booming, the public healthcare sector has been operating at a pitiful 0.08 doctors per 1,000 people, World Health Organization’s (WHO) prescribed standard ois1:1000.
• India has only half a bed available for every 1,000 people, which is a deficient figure even for normal days.
• Bangladesh and Pakistan fare no better, with a bed to patient ratio of 0.8 and 0.6, respectively, and a doctor availability of less than one for every 1,000 people.
• While ideally, out-of-pocket expenditure should not surpass 15% to 20% of the total health expenditure, for India, Bangladesh and Pakistan, this figure stands at an appalling 62.67%, 73.87% and 56.24%, respectively.

Lack of investment in healthcare

• Major public sector investments by the ‘big three’ of South Asia, i.e., India, Pakistan, and Bangladesh, are towards infrastructure and defence, with health taking a backseat.
• While India has the world’s third-largest military expenditure, its health budget is the fourth-lowest.
• Indian government in this year’s budget highlighted an increase of 137% in health and well-being expenditure, a closer look reveals a mismatch between facts and figures.
• In Pakistan, even amidst the pandemic, the defence budget was increased while the spending on health remained around $151 million.
• Not too far behind is Bangladesh, with decades of underfunding culminating in a crumbling public healthcare system.
• Major public sector investments by the ‘big three’ of South Asia, i.e., India, Pakistan, and Bangladesh, are towards infrastructure and defence, with health taking a backseat.
• A quick look at pre-pandemic sectoral allocations explains the chronically low status of human development indicators in the three countries.

Learning from Southeast Asia

• Southeast Asia has prioritised investments in healthcare systems while broadening equitable access through universal health coverage schemes.
• Vietnam’s preventive measures focused on investments in disease surveillance and emergency response mechanisms.
• Even countries like Laos and Cambodia are making a constant effort towards improving the healthcare ecosystem.
• All have done much better than their South Asian peers.

Conclusion

Learning from the devastation unleashed by the pandemic, South Asian countries must step up investment in their public healthcare sectors to make them sustainable, up to date and pro-poor; most importantly, the system should not turn its back on citizens.