Between hesitancy & monsoon: How Manipur health workers are managing COVID vaccination
Vaccination drive

How has Manipur handled the global pandemic? The answer to this question depends on how you see the numbers. For a state with just over 3 million people, a death toll of 1,628 (as of August 7) may not seem very high; until you compare these numbers with neighbouring states of Nagaland and Mizoram. Both the states have a lower population than Manipur (Nagaland has 2 million people, Mizoram has just over 1 million people) but their combined death toll (582 for Nagaland, 161 for Mizoram) is less than half of Manipur. So where is Manipur lacking? Or is this simply a case of bad results despite best efforts?

This question cannot be answered without a detailed analysis and understanding of the state’s vaccination efforts and successes. 

Recently, two ASHA workers and the people of Azuram village in Tamenglong, north-west Manipur were awarded for managing to get the maximum number of people to take the COVID-vaccination jab. The two ASHA workers: Nambuanliu and Diana each won a cash prize of Rs 10,000 for bringing 300 persons each, while Azuran village was awarded Rs 50,000 for vaccinating 149 eligible persons out of 153, scoring a success rate of over 97%. As of August 5, 20,827 persons had been vaccinated in Tamenglong, with only 4,315 receiving the second dose. 

The rewards and acknowledgements are part of the vaccination process that started in the state earlier this year. As per the vaccination report of the National Health Mission, Manipur, from January 16, when vaccination commenced in the state, till August 5, the total vaccination in the state comes to 11,34,815 ( 1st dose) and 2,33,708 ( 2nd dose)3. As per media reports, there are about 2 million eligible people for vaccination. 

How have the tribal districts fared?

Interior tribal-hill districts like Kamjong, Pherzawl have comparatively low vaccination records. Kamjong recorded 9,278 vaccinated persons ( 7684 with the first dose and 1594 with the second dose), while Pherzawl recorded 11,284 ( 8,857 for the first dose and 2,427 for the second dose). Kamjong and Pherzawl have a population of roughly 50,000. As expected, Imphal West district has the highest vaccination rate, with 2,85,026 people. Of this 25,0755 have received their first and 34,271 have received their second dose. 

Meanwhile, the new daily positive cases continue to be above the 700 mark, with daily double-digit fatalities since the second wave hit the state. 

Misinformation, sickness: Why people remain in fear of vaccines 

Ever since vaccination began, there have been many who suggested that the low vaccination, especially in the hills, is due to the hesitancy of the villagers to avail the vaccine. The hesitancy or fear of the vaccine was attributed to the religious or cultural beliefs of the rural tribal populations. 

Besides this, numerous pieces of information regarding the COVID-preventive vaccination were circulated on social media leading to fear among the villagers.

Tamenglong’s Chief Medical Officer, Dr Gracy Majachunglu believes such misinformation has hugely hampered the progress leading to the reluctance of villagers to come forward. Furthermore, reports of Covid-related death even after taking the dose-either in the state and elsewhere-also added to the doubts and hesitancy. According to Dr Majachunglu, the District Administration’s announcement for rewards came as a huge boost. “Now, even the village headman/ chairman has contacted us for vaccination,” the CMO says, adding, “people are responding”.  

Deputy Commissioner of Pherzawl, Mannuamching, says, “besides the misinformation on social media, reports of death – such as the 48-year-old Anganwadi worker who died a week after taking the vaccine has added to the fear”. 

Speaking from his current location in Phungyar in the Kamjong District, Dr Prakash Chandra, the District Immunization Officer said that one of the difficulties he and his team face is convincing the villagers to come forward. Villager’s reluctance, the DIO said, arises from several mischievous misinformation: contents and videos – circulated on social media platforms, mainly WhatsApp – which most people use. This includes content like “a vaccinated person will have a life span of 2 years” or ” when there is no cure for cancer how soon can a vaccine be developed. there is no need for a vaccine”. This has caused tremendous fear and reluctance. 

COVID-19 vaccination drive

“That is the main reason why people are reluctant,” said Dr. Chandra. “I also received the video on WhatsApp, it is in Meiteilon,” he added.  

It is not just apocalyptic messages, but also reports of people suffering from a sickness that has added fuel to the fire. For instance, Vungdeih, a resident of Muallum village in Churachandpur, said, “Two of my family members, my husband and my son, were down with high fever for over 3 days after taking the vaccine, I was really scared”. Consequently, the 45-year-old has since been avoiding the jab. Another resident from Muallum said, “People are hesitant mainly when they see those vaccinated people getting sick with fever.” 

Lal, the youth organisation secretary of Muallum village, “messages circulated on WhatsApp are mostly for fun and not taken seriously but one thing is sure. We need to convince the villagers and we are doing that.”

The medical team had come to Muallum village for the second time. Until June 30, about 140 persons have taken their first dose. Muallum village has about 150 households. 

Lulun from Thanlon village says that his wife is hesitant, but added that “if someone, say a medical team, comes to the village, everyone will be willing to take the vaccine.”

The monsoon factor

And it is not just hesitancy among locals. Given that the northeast is witnessing monsoons, even reaching villages can be a herculean task. Dr Chandra explains: “The roads are very bad. To travel in the interior, a 4×4 is a must. We travel in an ambulance. We used to get stuck on the road and recently our vehicle suffered a leakage too. But we are making good progress.”

Dr. Machunglu concurred with Dr Chandra and added that in districts like Tamenglong, road transport is a huge challenge that becomes worse during the monsoons. In many cases even the medical team would get sick, or some of them tested positive, so there are occasions when they had to cancel their trips due to heavy rain, she added. 

Then, there are the logistical issues. Take the example of Churachandpur, where medical staff were given emergency training to enter data on their mobile phones earlier this year. Every individual was asked to produce their Aadhar card or ID proof with a telephone number. No vaccination was administered before registering their name and identity online. However, in a region where the internet can be erratic, registrations would often fail. Churachandpur-based journalist and YouTuber Lian Langel said since registration requires identity proof and telephone numbers, many of the older people would come with phone numbers of their children written on paper. “In Churachandpur district, most people possess an ID but not necessarily a mobile,” said Langel. In some cases, the data entry process would also encounter false registrations such as making an online registration in the name of “frontline worker”. 

‘Religion not a factor behind hesitancy’

In many parts of the country, religion has been cited as a favour. However, in Manipur, this does not appear to be a factor, according to immunisation officer Dr Chandra. “There is no interference or opposition from the Church. I have witnessed two pastors from two villages coming for vaccination in Phungyar itself,” he asserted. 

Journalist and Co-founder of the online news portal “Hill Digest” Joshua Amo also dismissed the religious factor as unfounded. He said, “If there is the availability of and access to vaccines, there will be no talk of religion.” Regarding remote villages, the journalist said, “For example, there are no PHCs in most villages in Pherzawl district so the medical staff has to go and vaccinate people.” 

According to the journalist, the slow vaccination progress has a lot to do with the availability of the medicine as well, besides the absence of healthcare centres. 

Rev. Prim Vaiphei, President of All Manipur Churches Organization, also clarified that the low vaccination had nothing to do with the church. He asserted that no mainstream Churches in Manipur had issued any diktat nor preached opposition to vaccination.  

Rev Vaiphei recalls that in 2010 when the Aadhar card – which was an identity number- was initiated, some independent church and preachers linked it to the biblical number of the beast, popularly called ‘666’ or antichrist.  

“They preached to stop people from getting the Aadhar card issued. This current Covid vaccination is also a sequence of that. These people are aggressive and adventurous. They are fundamentalists and easily convince people not only in Manipur or the NE but across the world.”

The author is a freelance journalist based in Imphal. 

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