(Focus - India)
The major significance of vaccination is keeping us safe and secure from infectious diseases before we come in contact with them. Our discussion with Dr. Raghunandan, a respected general practitioner from India, will throw more light on the other facets of the vaccination.
Dr. Raghunandan is a General Practitioner who currently runs Sharada Clinic, Bengaluru.
The National Immunization program is going on. The government distributes vaccines free of cost in all the government setups across the nation. As far as awareness, few people like the Anganwadi workers, have the onus to spread the message, to go home to home in a village, and talk about vaccine programs, their importance, their usefulness, etc.
The existing vaccine paradigm assumes that vaccines only protect against the target infection [1]. However, some research contradicting this says that vaccines improve the overall health of a patient as well. What are your thoughts on the effects of vaccines in improving the overall health of patients?
Dr. Raghunandan: There can be some contribution of the vaccine in improving the overall health of a patient. Basically, vaccines are nothing but an antigen; it is an artificial antigen. When a natural virus or bacteria attacks us, you have created a bacteria or virus or a part of the virus or a part of bacteria in the laboratory, which is much weaker and cannot produce a natural infection, but it will produce a reaction to a small extent. So, there will be a lot of antibodies that are produced in the body, and this works like a memory for the body. When there is a natural exposure to the virus or the bacteria, there will be a sufficient amount of memory cells, or antibodies, which are capable of producing a lot of antibodies and protecting against the natural infection. This is the basic mechanism of how the vaccine works.
Suppose if you get the vaccine against a particular disease, in the future, that infection will be prevented in specific, but generally, when the infection is prevented, there will be an improvement in the general health. In that sense, you can consider that the overall health is improved.
Vaccine hesitancy impacted vaccination rates, which in turn increased emergency department use, morbidity, and mortality [2]. We understand that there are still a group of people who make the decision not to vaccinate their children. What approaches can be taken to ensure vaccination in children?
Dr. Raghunandan: Education and awareness programs. We need to talk to them and explain what exactly a vaccine is and how it works. So, if we do this education program for awareness, I think some change in attitude and some changes in practice might come. That is how we can make them accept that this is not harmful or this is not dangerous to them.
The number of people who have heard about vaccines was surely less before the pandemic. Now, even the villagers, and an illiterate person, knows what vaccine is. People now know there is something called as vaccine that must be taken, vaccine protects us against some kind of infection; and that vaccine is useful. In this sense, I think COVID has helped to increase the awareness levels of vaccines among the public.
What about education and awareness programs being done in India doctor?
Dr. Raghunandan: There are some NGOs- non-governmental organizations but scale-wise, it is not very big, it's not big enough to cover the huge population.
Do you see any role of the national immunization program in addressing vaccine hesitancy?
Dr. Raghunandan: The National Immunization program is going on. The government distributes vaccines free of cost in all the government setups across the nation. As far as awareness, few people have the onus on them to spread this, like Anganwadi workers are supposed to go home to home in a village, and they will talk about vaccine programs, their importance, their usefulness, etc. But at the ground level, I'm not sure how it is being done. Programs are in place, but I am not sure about their execution.
What impact does COVID 19 pandemic have on the national immunization program?
Dr. Raghunandan: The number of people who have heard about vaccines was surely less before the pandemic. Now, even the villagers, and an illiterate person, knows what vaccine is. People now know there is something called a vaccine that must be taken, the vaccine protects us against some kind of infection; the vaccine is useful. In this sense, I think COVID has helped to increase the awareness levels of vaccines among the public.
There were misconceptions about COVID 19 vaccines initially. In this context, what factors influenced the refusal of COVID vaccination in India?
Dr. Raghunandan: I think there are a couple of factors there. There's a subgroup of people, a small minority of the population, which thinks that the vaccine can cause death or vaccine will cause infertility. This does not have any scientific basis, and we are not sure about how this got generated and how it has come across people's minds. But a minority of the population always thinks vaccine is bad. What I observed in my experience is that the government started giving COVID vaccine when the wave was at its peak, at the beginning of the second wave, when they had already got a natural COVID infection, and despite having a cough, cold, running nose or throat irritation, or fever, people did not know that whenever there is an active infection, you should not take vaccines.
They already had a natural infection that overlapped with the vaccine. So, a lot of people thought that the vaccine itself caused the fever. So, I think there was a problem with the timing of the vaccination. Maybe the government could have waited for the cases to come down. They could have taken initiation of increasing the vaccine program when the cases were fewer. So, this is one thing that people got a bad impression about the COVID vaccine; they thought that if you take the vaccine, you will get infected with Coronavirus. But the fact is that not only the COVID vaccine, all vaccines for that matter, whether you take typhoid or chickenpox vaccine, every single vaccine has got a very minimal amount of side effects, like allergy, etc. People would have taken this minimal reaction in a negative way, and they would have spread out among their friends, neighbors, etc., which influenced others in their hesitation to take vaccines.
What approaches did you or your institution take to create awareness among the public?
Dr. Raghunandan: I work in an individual clinic, it's my own clinic. So, whichever patient comes into the clinic, I have always been educating them to take a vaccine that is protective; even if it doesn't avoid the infection or the exposure, at least it will reduce the severity. This is what I have done on a face-to-face, person-to-person basis in a clinic.
But at a large scale, I have not been able to take any initiative because I did not get any opportunity like in newspapers, radio, television etc. Those patients whom I educated to take the vaccine will go and tell their friends, relatives, and neighbors that this is what my family doctor said. So, they might motivate some other people as well.
As a concluding note, what do you suggest to ensure the continued success of immunization programs in countries like India?
Dr. Raghunandan: I think the media plays an important role. If I'm not wrong, I saw that many people watch private channels on television. If we talk about a remote village or tribal area, there will be at least a television with satellite connection channels. Not only Government channels, but I'm also talking about entertainment channels as they have a very big role to play. They can keep producing promotional videos with brand ambassadors who have a lot of influence on the public regarding vaccine importance. I think that will play a major role. We call them key opinion leaders whose message influence on the majority of the population. Me or you talking about vaccines might not make much difference. Apart from that, newspapers or social media can also have an impact. Also, as everybody goes to school and finishes their primary education at least, if you bring a chapter on vaccination in the school curriculum, children will get awareness, and they might carry this forward to the next generation.
Thank You.
Reference:
https://pubmed.ncbi.nlm.nih.gov/32645296/
https://pubmed.ncbi.nlm.nih.gov/28774498/