Long Read: The Stories Behind Covid-19 Vaccination Success In Rural Uttar Pradesh

Contrary to what many would have hoped for or wished for, India’s vaccination drive has been an unprecedented success with more than 60 crore doses administered until the second day of September.

The magnificence of the success lies in the magnitude of the scale, given the geographical challenges, the socio-economic realities on the ground, and more importantly, the unexplainable hesitancy amongst the citizens the government, both at the Centre and states, were required to address during the drive.

Uttar Pradesh, with almost one-sixth of India’s population, under the Yogi Adityanath government has attained resounding success in the ongoing vaccination programme.

By virtue of being the most populous state in the country, it has registered almost 11 per cent of the total vaccine doses administered across India, however leading Maharashtra, Madhya Pradesh, Gujarat and Rajasthan by a respectable margin.

Until this date, Uttar Pradesh has administered a total of 74,164,712 doses and counting, the highest for any state in India. Of this, 62,284,849 constitute the first dose while the remaining 11,879,863 constitute the second dose.

Maharashtra is a distant second with 60,074,215 along with further distant Madhya Pradesh and Gujarat with around 47,250,000 doses each. Interestingly, Maharashtra and Gujarat have registered more numbers for the second dose than Uttar Pradesh, indicating the slow start the Adityanath government had with the vaccination drive.

What must be factored in here is the rural population in Uttar Pradesh, the size of the state, and the illiteracy, and yet the government has ensured that none of these factors prove detrimental to the vaccine efforts of the state.

A lot of political prophecies have been decimated with Adityanath’s success. Earlier this year, in May, Samajwadi Party leader Akhilesh Yadav claimed that the government was incapable of ensuring free vaccines for the poor. Citing the reports from the disastrous second wave, many questioned whether the Chief Minister was the right man for the job.

The Uttar Pradesh government’s global tender to procure 4 crore vaccines around May was also without response, further leading many to assume that the vaccination drive was destined to fail. Reeling under a shortage then, the state government was aiming to vaccinate 1 crore people by 30 June 2021. However, by 24 June, the state had administered more than 2 crore doses.

For Uttar Pradesh, the challenge was not always the vaccines available, for with the Centre taking over the procurement in early June, the logistics was more or less dealt with. However, it was the lack of awareness amongst people about Covid even after the second wave, and the growing hesitancy, one encouraged by political opponents as well, that the state government had to strive to overcome.

Turns out, this was not the first time the Chief Minister was faced with a challenge when it came to propagating awareness against an unknown disease.

Speaking to Swarajya, Dr Sudesh Verma, state entomologist, narrated his experience of working closely with the Chief Minister from his days as the Member of Parliament for Gorakhpur and how Adityanath’s experience in dealing with the healthcare issues in his constituency, especially with respect to Japanese Encephalitis, came in handy during the vaccination drive.

During his tenure as the MP of Gorakhpur around the early 2000s, Adityanath hosted a public meeting every Saturday and Sunday to interact with the people in villages, and to understand their problems when it came to healthcare infrastructure. One of the areas that interested Adityanath back then as it does today, as told by Dr Verma, was that of child nutrition.

The early 2000s were not a great time for the backward areas of Purvanchal, given there was no proper policy on child nutrition, and for a long period of time, the region had been implementing a weak health policy, the reflection of which was evident in the repeated failed handling of Japanese Encephalitis.

For a long time, the National Institute of Virology in Pune was alone equipped to understand the causality behind the disease that consumed as many as 3,000 lives in 2004 alone. Under Yogi Adityanath, as Dr Verma stated, Gorakhpur saw the inception of a field institute of NIV-Pune in 2008. Post-2017, the institute was upgraded as a full-fledged independent regional medical research centre.

Speaking of Purvanchal, Dr Verma further added that each district had ventilators due to the problem of encephalitis, and when the Covid-19 pandemic hit the region, the upgradation of the healthcare infrastructure was relatively easy.

To further aid the citizens in the region, Adityanath encouraged people to operate community kitchens to offer free food to the ones with relatives or family members in hospitals, along with making other resources available for the economically weaker sections.

One of the prophecies predicting doom for India’s vaccination drive was linked with the inequality of accessibility for the economically weaker sections. Recognising the problem, the UP government ensured that teams travelled to every village from district hospitals to make people aware about the disease and the imminent threat from it.

Dr Verma emphasised the success of Mission Indradhanush, launched in December 2014, that further aided the success of the Covid-19 vaccination drive in the villages of Uttar Pradesh. Thanks to the logistics already in place for Mission Indradhanush, the state government was not only able to access the remote villages for vaccination, but also managed to use the existing manpower to encompass a greater share of the population, Dr Verma concluded.

It was not until late June that the vaccination drive in Uttar Pradesh picked up momentum, which also explains the catching up the state has to do when it comes to the number of second doses administered, given the mandatory 84-day gap. The delay in momentum had more to do with the hesitancy than the availability of vaccines in rural areas.

Speaking to Swarajya, Ankit Gupta, a teacher with one of the rural colleges in Uttar Pradesh, said that had the anganwadi workers not been engaged, the lack of awareness would have continued to be a challenge.

In the initial days, teams could not even get more than three to five people to take the dose, and the teams in villages were forced to idle away their time in villages, as people refused the vaccine. Rumours of forced sterilisation, vaccine-induced impotence, and even death were being circulated, further adding to the hesitancy against the vaccine, Gupta added.

Shivesh Pandey, another resident of Uttar Pradesh, elaborated on the rampant vaccine fear in his conversation with Swarajya. In some places, people were refusing to come out of their homes, and there were also rumours of people running from the villages to escape the vaccine in the earlier weeks. However, all that changed as primary teachers and anganwadi workers were engaged to spread awareness across the villages, more than 90,000 of them.

Narrating his experience from the ground, Pandey elaborated on the importance of the Prime Minister and Chief Minister leading from the front. "When people, who do not understand the disease, its origins or consequences, witness the PM or the CM taking the jab, it instills some confidence in them."

Heeding to the call of the CM, the village heads took the vaccine, and as more and more family heads, all above 60 and vaccinated in the first drive before the second wave, took the jab, the hesitancy against the vaccine decreased and people started coming out in large numbers, especially after June.

Within Uttar Pradesh, around 5,000 sites for vaccination catering to more than 90,000 villages also disabled the problem of accessibility.

For long, the people in villages were accustomed to making a trip to the government hospitals in districts, with limited resources, for all their needs. However, had the vaccine administration been left to the district hospitals, the people would have found it inaccessible by virtue of distance, lack of manpower in these hospitals, and for the hospitals themselves becoming potential hotspots for the spread of the virus.

Thus, setting up a vaccination site, one for every 20 villages, on an average, the state government overcame a number of challenges in one go. Further, the Aadhaar-based documentation process carried out by the primary teachers and other anganwadi workers aided the follow-up process for registration, and will also be helpful in the future for the administration of the second dose, and if needed, a booster dose.

The success of the Yogi Adityanath government can be imagined as an equivalent to vaccinating the entire country of Thailand or the United Kingdom or Italy or Spain 1.5 times or Canada twice or Australia thrice. Thus, it turns out, the monk in the saffron suit has attained success many in the Western world can only dream of replicating.

Seeking a re-election, Adityanath has ticked all the boxes for a successful vaccination drive, and from here, the momentum must be sustained to ensure a similar scale of success for the remaining population and the approaching mandatory second doses and plausible booster shots. With his success, Adityanath must also mainstream discussions around healthcare infrastructure, an issue he resonates with, in the upcoming elections.

The state government also deserves credit for being able to curb the number of cases in the state, a feat Maharashtra and Kerala, states with far more literacy and resources cannot claim, and once the dust settles on the pandemic, a deeper study of what Yogi Adityanath did right is warranted, especially in the rural regions, for that can serve as a lesson for the future generations and foreign nations.