Willing to pay the price: Second Covid-19 vaccine dose skippers

COVID authorities and medical experts are struggling to figure how a large group of Indians suddenly lost confidence in the vaccine midway between two doses

Blame it on the circumstances. Bad timing. Or, just poorly-planned policy. Delhi-based journalist-author Ziya Us Salam says these, among other factors, have led to his wife not taking the second dose of COVID-19 vaccine. “She got her first shot of Covaxin on April 13. Within a week, she contracted COVID-19. Surprisingly, all the tests that we conducted came back negative. But she was showing most of the symptoms, including high fever and loss of taste. Even her lungs were affected badly,” he remembers. By the time her condition improved, she was already eligible for the next dose. “But there was no clarity from the government about when COVID-infected patients should be taking the next dose. They were changing their stance often. Initially, it was four weeks after testing negative. A few days later, they changed it to six weeks. Scientists and researchers were also divided on this.”

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Finally, on May 19, following recommendations of the National Expert Group on Vaccine Administration for COVID-19, the Centre announced that people could take the vaccine three months after recovering from the infection. This meant that Salam’s wife was only due for her dose in August. “It’s but, obvious that a lot of people by then would have lost interest in taking the vaccine,” he says, adding, “Lack of direction [from the government] can often be misconstrued. It seemed like they were displaying a lack of integrity as well. My wife wasn’t convinced [about the whole affair]. She became dispirited, and decided against getting the vaccine,” he says. Since Salam had taken both doses, he was still insistent that she get fully vaccinated. He even booked her a slot at a private hospital in Noida. But then she got her period, and decided against going, he says. “This put an end to her pursuit.” Salam no longer wants to force her to get jabbed, “because it’s her choice to make.” “Most women who are taking the vaccine are in their reproductive age. And many are still doubtful if it’s good for them. I wish the government had spread the message [about the safety profile of vaccines] loud and clear.”

Women celebrate Diwali in Thane on Thursday. The festive season is responsible for the current lull in the vaccine drive, feel experts. “Everyone knows that after taking the vaccine, they will be down with a bit of body ache or slight fever. And, nobody wants to fall sick during the festival. Common sense dictates such a decision,” says Dr Rahul Pandit. Pic/Sameer Markande 

Salam’s wife represents the growing disenchantment as well as apathy among Indians towards taking the second dose. As of October 27, government data revealed that over 11 crore Indians who received the first shot of the COVID-19 vaccine, had not taken the second dose even after the expiry of the prescribed interval between doses. Closer home, the situation is no different. The BMC recently collected data of over three lakh people from Mumbai, who hadn’t taken their second doses despite being eligible. Of these, nearly one lakh included essential and frontline workers.

Suresh Kakani, additional municipal commissioner, BMC, says, “A lot of people also travelled to their hometowns for celebrations, and will only be back next week,” he reasons

Dr T Jacob John, leading virologist and former professor at the Christian Medical College, Vellore, is not surprised by the turn of events. “When vaccination is rolled out as a great National Ritual, what do you expect?” he asks. To put it bluntly, “If a field is left fallow, weeds grow luxuriantly. To grow paddy or wheat, a lot of work has to be done. If minds are not fed with the right information early on, mis- and dis- information will reach them fast. What is put in the minds first has greater weightage than what comes later.”

Dr T Jacob John, Dr Rahul Pandit and Giridara Gopal Parameswaran

According to Dr John, the reasons for not taking the second dose may vary from one community to another. “It could range from simple inertia, procrastination, inconvenience, or side effects that people were not briefed [about] while being given the first dose to the day’s wages lost, or no public education by trustworthy persons.” Irrespective, he says, that second dose reluctance must be investigated. “All it will take is a one day multi-site survey by social work professionals, funded by the government.”

Abhijit Raut

The Centre and state governments have already started work on a war footing to bridge this widening gap. On Tuesday, the Centre launched the nationwide mega-vaccination campaign Har Ghar Dastak against the infectious Coronavirus disease. The month-long door-to-door vaccination programme not just aims to inoculate the entire population in poor-performing districts, but also to reach out to those who have deferred taking the second dose. In a review meeting last week, PM Narendra Modi also suggested that officials form a different strategy for each town and village, and constitute a team of 20-25 people in these areas to execute the door-to-door drive.  “From a mass vaccine campaign, this is now going to become a personalised campaign,” says Dr Rahul Pandit, Director-Critical Care, Fortis Hospitals Mumbai and member of the Supreme Court-appointed National COVID-19 Task Force and Maharashtra Task Force.

Abhijit Raut, collector of Jalgaon, says that since most mass vaccination camps in the district have witnessed a lukewarm response, ASHA centres are conducting localised drives

Jalgaon is one of the many districts in Maharashtra, which for the last few weeks, has been trying to tackle the problem of low double dose coverage. Speaking with mid-day, Abhijit Raut, collector of Jalgaon, says that while the first dose coverage in the region is 61 per cent, the second dose is only 20 per cent. The gap of 40 per cent is stark, he admits. “But, the major reason for this is that 98 per cent of the population here is being administered Covishield, where the gap between the two doses is 84 days.” Last week, the BMC reduced the gap between the two doses of Covishield from 84 days to 28 days for certain sections of the population in Mumbai, including people travelling abroad, government employees, as well as those working in the private sector like malls. Other districts should follow suit, say experts.

This branch of Star Imaging and Path Labs in Delhi is supposed to be the country’s first kid-friendly vaccine facility set up with an eye on COVID vaccination for Indians under 18. While reports suggest that guidelines of COVID vaccination for kids will be out soon, doctors like Dr Maya Valecha are against the move, and argue that the vaccine was never needed. Pic/Getty Images

The shortage of vaccine supply across Jalgaon through May, June and July this year also meant that the vaccination programme only picked up after August 15. “In September, we had five days, where we crossed one lakh doses daily, and one day where, we gave 1,50,000 doses. But all these people, will only be due for the second dose in the second or third week of November,” says Raut, adding that though the gap seems large, the actual number of people who haven’t taken their dose despite being eligible is only a lakh. “But, yes it’s not a small number [for the region],” he admits, saying that there’s been a general lack of interest. Of late, all the mass vaccination camps organised in Jalgaon have received a lukewarm response. The campaign is now being spearheaded by Accredited social health activist (ASHA) centres, where the efforts are more localised, says Raut.

Dr Maya Valecha; (right) Journalist-author Ziya Us Salam says his wife decided against taking the second dose, due to the initial lack of clarity by the government as to when those infected by COVID should be taking the vaccine

“At this point, we are following a three-pronged strategy. Firstly, we are trying to reach out to people personally through our health workers to remind them that they are due for the next shot. We have their phone numbers, and there’s a list that is generated daily, which shows us the details of those who are eligible. Secondly, we have also made it mandatory for all government and healthcare workers to get the shot at the earliest. If there’s any deliberate delay on their part, we are implementing tough measures, like penalties and even delaying their salaries. Lastly, we are trying to link up with establishments and people, especially those in the unorganised sector, who work in the public environment, and are encouraging them to take the vaccine as soon as possible. If people want to work in the public space, they have to follow public rules,” he says. These strategies have begun to show results. Where last Sunday, the number of people eligible for the second dose was 1,30,000, it reduced to one lakh by mid-week. “It will drop further in the coming days,” says Raut. 

Creative professional Mohit Suneja says that instead of enforcing vaccines, the government should focus on convincing people why getting jabbed will be good for them. Echoing Dr John’s concerns, he says we need a more scientific explanation as to why we should inject something foreign into our body, “but I find that conversation missing”. Suneja’s parents have taken both the doses of the vaccine, but he didn’t want to follow the crowd blindly. After much coercion from his family, he finally caved in, and took the first dose in September. “But, I won’t take the second one. At least, not until I am sure about it,” he says. He feels that right now, the vaccine campaign is more political in nature, than anything else. “We are focusing more on numbers, and how we can lead the vaccination programme in the world [India crossed the milestone of one billion COVID-19 vaccinations in October]. That’s not how it should work. The vaccine is going to affect our biology. This cannot be about winning a race.”

Suresh Kakani, additional municipal commissioner, BMC, says that the festive season is responsible for the current lull in the vaccine drive, and he is hopeful that it will pick up post the Diwali weekend. “Everyone knows that after taking the vaccine, they will be down with a bit of body ache or slight fever. And, nobody wants to fall sick during the festival. Common sense dictates such a decision,” adds Dr Pandit.

A lot of people also travelled to their hometowns for the celebrations, and will only be back next week, says Kakani. “There are even those who have taken the vaccine in another city or country, and that isn’t reflecting in our system.” The BMC has already fetched data of people who are due for the second dose of the vaccine, and has divided the task of reaching out to them, across the 24 municipal wards. “We are contacting each and every person over the phone, to find out if they have received both the doses.” If they haven’t, they are directed to the nearest vaccine centre, where they can get the shot for free. Kakani insists that nobody is being forced against their will. “We want to motivate them to take the vaccine.”

The decline of the second wave has also made people complacent, feels Dr Pandit. On November 2, India registered 10,423 new cases. This was the lowest in 259 days, according to government data. A large number of people also contracted the virus between the two shots, making them defer the second. “Having said that, in the last 15 days or so, we have started seeing emptier vaccination centres. It’s strange, but when vaccine supply was low, we were being flooded with queries about when we’d get supplies. When they arrived, we noticed hesitancy. When the second wave was at its peak, and vaccines were in short supply, people were queuing up, and many were also being infected at the crowded centres. And now, people are just not showing up. I don’t know what more can be done to convince people to take the vaccine,” says Dr Pandit.

For some, the side effects of the vaccine have made them averse to risking the second dose. A Mumbai-based PR professional, who wished to remain anonymous for this article, says that a colleague, who is a mother to twins, developed the Guillain-Barré syndrome (GBS), a rare neurological disorder in which the body’s immune system mistakenly attacks part of its peripheral nervous system (the network of nerves located outside of the brain and spinal cord) after taking the first dose of the vaccine. She was admitted to the hospital for three months, and is still recovering. “Though I had taken the first dose in May and didn’t have any adverse reactions, this incident made me wary. I don’t think the present lot of vaccines have been tested efficiently, and enough. Everyone seems to be responding and reacting differently to them,” she says, adding that her mother’s right hand was immobile a week after taking the vaccine. The family had to do a battery of tests. Although she recovered, her daughter argues,  “Besides, it’s not like those who are fully vaccinated aren’t contracting or spreading COVID-19. We still continue to be carriers. So, why should I put myself at risk.”   

The 43-year-old admits that not getting the second dose has restricted her access to malls, cinema halls and even offices where entry is being allowed only to those double vaccinated. But, she says that she’d rather follow COVID-appropriate behaviour—wearing a mask and sanitising her hands while maintaining safe distance—than risk taking a second dose. “Ultimately, it’s a personal choice, and I am willing to bear the consequences of my decision.” She, however, says that if a superior vaccine is approved at a later stage, which proves to be effective against the new subvariants, she will consider getting it.   

Dr Maya Valecha, a Baroda-based gynaecologist, believes that we never needed the vaccine in the first place. She along with several doctors recently wrote to PM Narendra Modi seeking an appointment to discuss the rollout of COVID-19 vaccines for children, as she feels it can have worrying effects in children. “I know a lot of people who don’t want to take the second dose, because they didn’t have a good experience after the first jab. The first dose itself wasn’t taken voluntarily by many. Even something like water should not be injected into the body without consent. If a majority of people have immunity already, why do we need it?”

Epidemiologist Giridara Gopal Parameswaran, who is also the lead at the India COVID Apex Research Team (iCART), a volunteer research and development group, says that for all double-dose vaccines, the efficacy is calculated on the basis of both doses, not one. That doesn’t mean that those who have taken just one dose are not immune to COVID-19, but it won’t guarantee long-term protection. “So, if they have taken the first dose in say, June, the immunity provided by the first dose will start to wane by November. This would make them susceptible to contracting COVID-19.” He, however, says that this again is determined by a range of factors, including whether herd immunity hasn’t been achieved. With nearly 70 per cent of the population in India vaccinated, he says we are more or less in a safe zone.

A recent report by The Exposé, revealed that COVID-19 vaccines “were increasing both infection and mortality rates”. Data analysed from the Our World in Data site of Johns Hopkins University on 247 million COVID-19 cases from the very start of the pandemic to October 31, 2021, for all 185 nations, pointed out that the highest COVID-19 death rates were in fact, in the most vaccinated countries. “Some countries have shown this aspect of increased virulence for factors that are still not fully understood,” Parameswaran told mid-day.

Dr Pandit, however, says India’s successful vaccination programme, and the present drop in infection rates, should be reason enough for people to get fully vaccinated. “If people only take one vaccine shot, it’s a wasteful exercise. It’s like leaving your medical treatment half way.” It is imperative that people understand that there isn’t a middle path here, he says. “We have to take both the doses to contain the spread.”

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Number of people yet to take second dose in Mumbai and India respectively, despite being eligible

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Percentage of people in Jalgaon who have taken the second dose compared to 61% who took the first

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