Convincing the Undecideds: Overcoming Vaccine Hesitancy in Patients

Vaccination has transformed global health and is one of modern medicine’s greatest success stories. From eradicating smallpox, preventing lifelong disabilities, and slashing child mortality to now holding down COVID-19, vaccines have helped to save millions of patients over the years. Indian pharmaceutical industry has played a major role in making high-quality and affordable vaccines available for all. The country meets 60 percent of the global vaccine demand and contributes 90 percent of the World Health Organisation’s demand for the measles vaccine.

Indian companies have contributed significantly by bringing vaccines/medicines at a scale and affordable price to patients in India and across the world. For instance, licensing arrangement between Indian companies and Gilead even before the pandemic has helped the generic companies to expand access to chronic hepatitis C medicines. Voluntary licensing for COVID 19 vaccine is also working well for example Astra Zeneca with Serum Institute, J&J with Biological Evans and Sputnik with Dr Reddys and Panacea. All the companies are ramping up production facilities to meet increased requirements.

In treatment category, Gilead’s licensing agreements with generic pharmaceutical manufacturers based in India to further expand supply of remdesivir is vital. The agreement has allowed the companies – Cipla, Dr. Reddy’s Laboratories; Eva Pharma; Ferozsons Laboratories Hetero Labs, Jubilant Lifesciences, Mylan; Syngene, a Biocon company and Zydus Cadila Healthcare, to manufacture remdesivir for distribution in 127 countries.

Importantly, Cadila Healthcare and Bharat Biotech are the leading Indian companies that have indigenously produced COVID 19 vaccines.  Cadila Healthcare has produced the first DNA based vaccine ZyCov-D, which was approved for Emergency Use Authorization for adult population including the age group of 12 years and above.

Covishield produced by Serum Institute in collaboration with AstraZeneca is used widely across the country. Sputnik is also available in the market while others like Moderna Pfizer vaccine wanting to venture in India after due approvals.

India flagged off its vaccination drive in January and so far, over 15 percent Indians have been fully inoculated, and 46 percent have received at least one dose.1 However, despite a promising start, many Indians are reluctant to get inoculated, especially in rural areas where 65 percent of India’s population resides. This brings focus on ‘vaccine hesitancy’ and the need to understand what it means. The reluctance or refusal to receive a recommended and available vaccine is known as ‘vaccine hesitancy’.

The Covid Symptom Survey (CSS) conducted by Facebook in partnership with the University of Maryland, in 200 countries, revealed that a significant proportion of the Indian population is vaccine hesitant.2 As the vaccination drive continues, it is often hear individuals say that they want to ‘wait and see’ the effectiveness of the vaccine on others.

Key Factors for Vaccine Hesitancy

Multiple factors have emerged as the common reasons for the COVID-19 vaccine hesitancy in India

• Overarching concerns about potential side effects
• Ongoing narratives such as ‘Vaccines won’t work’ or ‘Don’t believe in vaccines’
• Fear that the vaccine contains virus that will cause the disease
• Doubts regarding clinical trials
• Low risk perception from COVID-19
• Fake information about infertility and death after receiving the vaccine

As per the Centre for Economic Data & Analysis at Ashoka University, only 90 women received the dose for every 100 men inoculated during this period. Half-baked information about the vaccine causing infertility is the major cause of the hesitancy in women across India.

In order to fight COVID 19 and to overcome its spread, vaccination is key. It is crucial to address vaccine hesitancy among people.

Addressing the Vaccine Hesitancy Challenge

To develop vaccine confidence among the vocal vaccine deniers, India requires

• A target-based approach that focuses on the needs of individual groups and communities
• Discussions among friends and family about their positive experiences of getting the jab
• Educating people about how the vaccine was developed and awareness generation on importance of vaccine
• Involving local influencers, NGOs, doctors, and panchayat heads may aid in vaccine uptake
• The daily wagers should be given one-day wage for taking the shot given India’s large rural population works as daily wagers who fear losing a day’s income due to vaccine
• Vaccination rate can also be boosted in rural India by announcing certain incentives such as distribution of free cooking oil or rice and lucky draws
• Amplify available content to debunk myths and misinformation about vaccination online
• Highlighting the number of vaccinated people and support research to understand the consumer perception about the vaccine
• Partner with women health providers to address misinformation about adverse impact of COVID-19 vaccines on fertility and reproductive health may help to convince women to get vaccinated

Tackling Vaccine Hesitancy: Measures Taken by Indian states

An analysis by Facebook’s Covid-19 Symptom Survey (CSS) in India shows India’s vaccine hesitancy rate at around 28.7% with variations across states and union territories (UTs).5 Some of the measures Indian states are taking include prompting people about appointments for vaccination through social chat groups, digital media and newspaper ads.

• In Rajasthan, a reminder message for vaccination date is being sent to beneficiaries on WhatsApp groups, Facebook, and Twitter by health officials
• When India began its vaccination drive, Punjab faced issues with managing anxiety among healthcare workers as there were reports of side-effects. To build confidence in people, the state strengthened its counselling mechanism, ran newspaper ads advocating that the COVID-19 vaccines are safe
• Uttarakhand shared videos of people who received the vaccine and appointed doctors from the state to promote the need of vaccines and their safety. To promote the vaccine at the grassroot level, Uttarakhand involved accredited social health activist (ASHAs) and nurses to promote the vaccine drive
• Assam addressed vaccine hesitancy by disseminating reliable information through social media, digital platforms, print and electronic channels regarding recovery details and adverse events following immunisation

Vaccine hesitancy leads to a reduction in vaccine uptake, compromises herd immunity and undermines the success of immunisation programmes. According to extant science, when herd immunity is compromised, disease outbreak becomes more likely among the unvaccinated population. For instance, when the UK was battling measles in 2017, the sub-optimal uptake of the MMR vaccine due to hesitancy led to an increase in the cases4. In France, a 2018 survey had revealed that close to one in three citizens doubt the safety of vaccines. In terms of COVID-19 vaccines, close to 50% respondents of a survey worried about factors like inadequate testing and long-term side-effects.6

The COVID-19 has highlighted the urgent need of addressing vaccine hesitancy in India, to achieve herd immunity that is one of the ways to address COVID 19 pandemic. To reinforce confidence in COVID-19 vaccine, there is a need for all stakeholders in the country to communicate transparently about the process for approving, authorizing, distributing, monitoring the safety of, and administering COVID-19 vaccine.


3 The Centre for Economic Data & Analysis at Ashoka University