In conversation with Dr. Angela Chaudhuri, Partner, Swasti and Catalyst Management Services is the Health lead of the #COVIDActionCollab

● As countries prepare to initiate the implementation of COVID-19 vaccination, why should keeping the marginalized communities at the centre of the implementation strategies be important for each country?

Angela: Because it is the right thing to do! It is our moral responsibility to protect the most marginalized and partner them in our collective well-being journey. Let’s take the first roll-out priority groups- health workers, above 50 and co-morbid. Are the most vulnerable health workers who are on the front-line, who are not necessarily part of the government system (formally) or private system- will they get access? This is a voluntary choice- is the vaccination available for the health worker and the spouse- what happens when women health worker is stopped from signing up by her spouse who is not prioritised or is vaccine- hesitant (read gender equation and decision making powers), how can one prioritise over 50 poor and vulnerable ( how to reach them?) and how do the poor know of any comorbid conditions, when they already don’t have ready access to primary care.

The agency and access to health and well-being for the most marginalized needs to be intentionally explored - and the systems need to be designed to enable the same. These communities are most often left behind and are at greater risk of COVID-19 given their social, economic and health disparities. They often lack access as well as agency and it therefore becomes critical to ensure that our COVID-19 vaccine implementation efforts reach them. Protecting the marginalized communities ensures improved health quintiles for us as an entire society and helps us be collectively more productive and healthier.

● What are the implementation hurdles when it comes to reaching out to marginalized communities such as migrants, TB/HIV patients, LGBTQ communities, sex workers among others?

Angela: Honestly, Don’t know where to even begin. From stigma and discrimination, trustworthy information, valid identification document, paperwork for enrollment, agency, to systems to reach them. This is not to underplay the deep distrust and misinformation, to the perceived threat of COVID impact.

● What could be the possible challenges which can be faced by marginalized communities?

Angela: We recently concluded a 30+ countries’ roundtable on understanding community sentiments around the vaccine. Here is what the communities expressed.

1. Even within the current priority groups, there are marginalized people. There does not seem to be a solution to surface the invisible populations.

2. There is a potential that the implementation of vaccination will amplify the discrimination which already exists, with the marginalized communities being left behind due to their identity and access to systems

3. Access to vaccines is tied to citizenry documentation. For marginalized communities such as migrants, many are undocumented. Implementation policies require identity cards for vaccination and lack of such documentation and incorrect gender entries in the identity proofs may become a barrier for the LGBTQ and migrant communities.

4. The lack of choice of vaccines, and the fact that there is quite some misinformation makes communities struggle to trust the process.

5. Many marginalized communities do not have stable homes or situations- therefore 2nd doses can be missed

● What steps should be taken by policy makers and implementers while designing implementation strategies for the marginalized communities?

Angela:

- Participative planning in rolling out vaccinations will ensure marginalized communities concerns and improve vaccine acceptance.

- Community Organizations and Institutions - Health Co-operatives, Youth Associations, Self Help Groups, Micro Finance Cooperatives, Farmer Cooperatives etc need to be consulted in reaching the vaccine to the last mile

- Governments and implementers will need to design communication/ advocacy efforts in partnership with community leaders including faith leaders. Social media can play an important as well as a deterrent role in enabling successful implementation. There is a need to integrate online and offline platforms as well to address misinformation.

- Simple knowledge pertaining to the differences between vaccines and drugs; and virus and bacteria also become important while educating the public. Sources of accurate information need to be widely disseminated and simplified, easy to understand and grasp and communicate. Community champions need to be celebrated.

- As accurate information is being amplified, it is critical to continue emphasis on prevention advocacy as well, such as messages on masking, sanitizing, among others. Vaccine will not replace key infection control, but will complement these efforts. A steep learning curve with the vaccination and acceptance of the same can be expected across population types.

● Guidelines for rolling out the vaccination. Any recommendations?

Angela:

● Information (both ways), demand generation and mobilisation (Civil society) has to be led by the government in partnership with community institutions.

● Vaccine Education has to be the very basis of all conversation in THE Media. Basics of vaccines, breaking myths, large scale information dissemination using existing social capital (helplines, help desks, field people

● Active Demand generation is the need of the hour -

● Support demand creating and registrations for vulnerable populations.

● Layer on social protection helplines or other lines of outreach like family planning

● Map out quickly the social infrastructure and outreach mechanisms

● Community monitoring needs to be an essential part of the rollout. This entails providing feedback from civil society, ground-level information (listening posts pre, during and post-vaccination) and a robust feedback mechanism to feed information back from listening posts. Together this will lower the chances of people getting one dose alone and ensure that individuals complete the vaccination and are protected.