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How Rural India Bridged The Vaccination Gap With Urban Areas.

Anil Parmar, Vice President, Community Investment, United Way Mumbai

October 12, 2021 / 04:54 PM IST

Nearly 60 to 70 percent of the population lives in rural parts of India. According to the 2011 census estimates, the population share of entirely urban, mixed, and rural districts was 13.6%, 13.6%, and 72.8%, respectively. Many predicted that the vaccination coverage would be biased toward urban areas as they tend to have better public health infrastructure, and access is relatively easier than rural communities. This observation was a cause of concern when India rolled out the COVID-19 vaccine. An analysis by Hindustan Times in June 2021 showed that someone living in urban India was nearly twice as likely to get a Covid-19 vaccine shot as people living in villages and semi-urban towns.

This analysis proved true for the period between May to July 2021, wherein the vaccine coverage for rural communities was lower than that of urban counterparts. However, a refreshing trend in vaccination coverage has emerged, which enumerates higher vaccine coverage in the rural parts in the past couple of months. Of course, there are state-level variations.  Nevertheless, overall rural districts seem to be doing much better on this front. As of 1st September, rural districts received 489 doses per 1,000 population, against 451 in urban districts as per an article in Mint. However, there is no time for complacency. The government needs to improve access to vaccination for the rural population in leaps and bounds if we want to achieve 100 percent immunisation of all adult populations by the end of the year.  The hurdles are plenty when we assess the rural geographies against the prevailing conditions in urban India.

The fact that rural healthcare infrastructure is weak is well evident. While the availability of medical practitioners such as doctors, nurses, and trained ancillary staff in a government health care setup is low across India, the issue is exacerbated in rural communities. Issues of accessibility are much severe here compared to urban areas.  Hence cold chain management and taking the vaccine to the remotest part of a rural district become a significant challenge. Moreover, administering the vaccine to people with disabilities, the elderly, people with illnesses that hamper mobility needs attention.  The expected third wave is likely to be less severe in communities that have higher vaccine coverage. Health

In few districts, an encouraging step has been allowing walk-in vaccinations with on-the-spot registrations, which helps especially people with no or limited technological know-how on online registrations, booking slots on the CO-WIN dashboard.  It has undoubtedly upped the vaccine coverage.  However, this also means long queues and overcrowding at the vaccinations centers, which do not have adequate medical personnel to manage such a scenario. Many stand in the queue waiting for their turn for inoculation for hours only to come to know that there are no more vials, and now they will have to come tomorrow or some other day. In many cases, people stand waiting for their turns for a second dose only to realise that the vaccine being administered is different from what they received in the first dose.  Adhering to Covid Appropriate Behaviour (CAB) itself becomes an issue during such times, thus increasing the chances of infections at the vaccination center itself.

Regular supply and informing people about vaccine availability daily is the key to addressing these challenges. A large proportion of rural India is dependent on daily wages that it may not be easy for them to travel to primary health centers to get shots. They have to go multiple times, giving up their daily sustenance, which will dissuade them.

We are slowly and steadily moving toward the goal of immunising all eligible adults. However, a regular supply of vaccine and taking it to the hinterlands of India is a must.  Vaccines for children and booster doses for adults will need better infrastructure and delivery mechanisms on the ground.

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first published: Oct 12, 2021 04:54 pm
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