Addressing the awareness and accessibility gap during the COVID-second wave with vaccine help desks in communities
Bridging the divide with a people-sensitive approach
Months since India’s COVID–19 vaccination rollout in early 2020, the percentage of vaccinated persons to the total population remained abysmally poor. Especially for marginalised persons, the digitised rollout of the vaccination process, meant that many were immediately excluded. The lack of a smartphone and/or the literacy needed to complete the vaccine registration and scheduling on their own online made access to vaccinations challenging for many people.
In late April 2021, to help address this gap in marginalised communities where we work, we worked with youth volunteers across the Mumbai Metropolitan Region, to set up vaccine help desks. The time of setting up these vaccine help desks was critical as walk-in registrations would only commence weeks later, and that too for small stretches at a time. Work to address vaccine hesitancy also continued in Akola, Amravati and Nagpur, and as part of our work within the Maha PECONet 2.0 network. This article largely details the experiences across the Mumbai Metropolitan Region.
The decision to let community youth lead this process in different areas was intentional, given how fear and misinformation on vaccines had kept growing over the preceding weeks. By centering youth from the same/neighbouring community to help their own community members, we helped people feel more comfortable and convinced about vaccination. Many of the youth who have led the ground-up efforts outlined in this writeup are young community leaders who have worked for the betterment of their areas in different ways over the years (be it on governance related issues, social challenges and so on). While some youth faced resistance from their families to embark on this process, others faced lesser tension as they have come from supportive environments. All volunteers engaged in this process were covered by health insurance and provided basic safety equipment. Their perseverance made it possible for many of the urban poor to know more about vaccination and register for it over the next few weeks.
Setting up and early reactions
‘When we started the help desk, even though we were operating with the best knowledge we had of the ground situation and people’s needs, we knew that only once we start this work will we understand concrete challenges and ways to overcome them’, said Sachin Nachnekar, Youth Development Coordinator, YUVA.
Before the help desks were set up, youth volunteers underwent training organised by YUVA so they could facilitate interactions better once the work began. They were encouraged to clarify their own doubts, and the collective engagement helped them understand the vaccine and vaccination process well. For instance, if someone approached them with a health-related query they requested the person to check with their medical practitioner and make a decision thereafter (the youth are facilitators in the registration process, not medical professionals — the lines were clearly drawn). Or, if someone is driven by misinformation on the vaccine, how can the volunteer help them access accurate and verified information.
Despite all the preparations, however, once they started the youth faced a tall task. In most areas where the vaccine help desks were set up, people had not received reliable information about the vaccine and misconceptions were high. Moreover, people were often suspicious of the endeavour itself, asking the youth why they were doing this, whether they were government representatives, and so on. Many were scared to share any personal details, worrying that they may be vaccinated forcefully. Restrictions in many areas at this time also made it difficult to reach too many people.
‘We faced many challenges in the first week. Volunteers had to address many disagreements that kept taking place. People were bringing their biases to them; some were calling the vaccination a conspiracy; some were talking about all kinds of side effects …’ says Arajoo Shaikh, a youth volunteer, reflecting back on the initial days.
Innovating to get closer to people
Despite the negativity that many of them faced, the youth kept trying. They frequently came together to think of innovative strategies with which they could reach more people and increase the registration and scheduling count.
For instance, in certain communities the youth identified people who had already taken the vaccine. They requested if these persons could join them at the help desk occasionally, to convince others around them to opt for vaccination. This strategy was more useful if the person was a community leader or an anganwadi worker and had some influence and established networks in the community, drawing more people to the vaccine help desks. In certain cases, such as in Lallubhai Compound, Mankhurd, when the local police observed the youth at their help desk, they encouraged their efforts and tried to drive more people towards them. Seeing the youth at work, a few mahila mandals (women’s groups) in different communities also supported their efforts and tried to help the youth connect with more people. The youth kept trying to set up these local partnerships, which would help them build credibility and trust and reach a larger number of community members.
Despite #vaccine hesitancy among 52% surveyed 3114 urban poor across the #Mumbai Metropolitan Region (MMR) where we work, over the past 5 weeks our vaccine help desks in 20 MMR areas have been working to dispel myths/misinformation & encourage #vaccination. A thread (1/n) pic.twitter.com/3nLeTkoftv
— YUVA (@OfficialYUVA) June 7, 2021
To help people overcome vaccine hesitancy, the youth often gave the examples of established vaccines that are taken by children, such as the vaccine to protect from polio. ‘We asked them to think back to vaccines they or their children have taken. Often they cause soreness/pain in the body and a fever persists for a day or so, but these symptoms soon disappear. The COVID–19 vaccine is no different, so there is no need to be scared’, said Vijaya Babar, a help desk volunteer.
Youth volunteers also spoke to community members about new inventions that had been made in earlier times, and how it had caused hesitancy at that time too, and hence apprehension to this vaccine was no different. ‘When the British introduced the railways, people in our country were scared to board the train. But look where we are now!’, said youth volunteer Sagar, also giving the example of hesitancy towards mobile phones in earlier decades versus the situation now. Examples really helped the youth connect with people, although not all were convinced even with these accounts.
In certain areas, the youth realised that they were not able to reach too many people from their help desk. They divided themselves into separate areas, and attended to the houses in those lanes of the community, walking door-to-door to help people understand about the vaccination process. This strategy helped them reach many more people who were hesitant to leave their homes, or were feeling unsure to approach the volunteers but had many questions on their mind regarding vaccination.
The youth in certain areas also moved the help desk location to different localities, if they faced too much resistance in certain areas. This helped them realise how, even within a small stretch of 15 minutes’ walking distance between two communities, attitudes to and acceptance of the vaccine could be vastly different.
‘A major learning for us, over the days, was how quickly we can gauge people’s sentiments about the vaccine and accordingly speak to them in a way that they feel motivated and encouraged to register’, said Rameshwari, a youth volunteer.
Overcoming resistance and registration barriers
While overcoming people’s resistance to vaccination was the first step, ensuring registration and scheduling on the government portal CoWin was another important marker to help the youth actually insure their communities from the pandemic.
However, in the first few weeks, considering the tech glitches, server downtime, unavailability of slots, location of vaccine centres far from people’s place of residence, volunteers’ patchy internet and other factors, this was often a huge challenge.
‘After spending a lot of time trying to convince someone for vaccination, if we were unable to schedule their appointment it felt very demoralising’, says Arajoo.
When the government announced the opening up of vaccinations for the 18–44 age group in May 2021, for instance, the youth volunteers were very excited that they now had a larger pool of people to reach out to. However, within hours the site crashed, and all online efforts were on hold again.
Since the youth were often not able to complete the registration and scheduling while talking to community members, they maintained a list of interested persons and followed up with them once available slots opened. This ensured that they were able to return to those they were unable to help during their first interaction, and schedule their vaccine once a slot was available. Over time, the follow-ups have taken up more time and attention (detailed later).
Building rapport with local vaccine centres
To help their community members get closer to the vaccine, many of the help desk youth in different areas also visited local vaccine centres, to better understand their daily capacity, walk-in quota and other factors. They were able to build good rapport with the centre officials, and these interactions also offered them newer strategies to help more people get vaccinated.
For instance, for some days the youth were finding it difficult to book vaccine slots in certain areas. They would only see availability in far off centres, which would be inconvenient. Local vaccine centre officials informed them of the times in the day when slots would open for that particular centre. Since then, the youth were able to optimise their time and book slots more easily.
‘We planned a team visit to the centre, so that the youth are also more acquainted with how the centre functions, and can better guide community members. The vaccine centre officials were approachable and since then began updating us regularly on how many slots are available for walk-in, so we could send people accordingly. They also shared other important information with me, such as days on which the centre is shut, so I could share this information among community members and we could minimise people’s unnecessary travel and waiting periods’, said Arajoo.
The efforts of the youth volunteers reduced the load on vaccine health centres, at a time when they were also inundated with requests.
Learning from different contexts
Training and learning remained key for the youth volunteers over the weeks, as they kept sharing challenges and successes of their work and tried to implement approaches that had shown promise in their own context-specific ways. The YUVA team also played an important role in guiding the conversations, and in mentoring the youth volunteers, and helping them keep up their mental strength.
Learning was especially focused on how the volunteers could better address people’s fears, misconceptions and doubts. For instance, in the case of people who were scared to take the vaccine, saying that someone who has taken it has died, the volunteers tried to press them to say who this has happened to, so they could check and follow-up on this case. Often, this was met with no response, and the community members would themselves backtrack a little post this.
Adapting to the external environment
In the early weeks since setup, the vaccine help desks focused all their efforts on reducing vaccine hesitancy. At this time, registrations on CoWin happened but scheduling was near impossible (due to vaccine unavailability). Once the vaccines were available, the team focused on awareness and outreach, but also conducted regular follow-ups with members they had earlier interacted with, to book them a slot. The youth also maintained a log for the second dose, so they could help the community members complete their vaccine cycle.
Once the walk-ins were allowed, the youth focused their efforts on redirecting people to the nearest vaccine centres. This involved keeping themselves updated on the vaccine centre availability for that particular day, so that there would be no unnecessary crowding or waiting.
Seeing the success of the vaccine help desk model, other partners also offered support and youth volunteers helped coordinate these drives too
While the vaccine help desks were set up daily in communities in the early days, with the youth operating in two shifts (morning and evening), later the help desk was operational only twice a week, with a better understanding of the timings when more people could be reached. Usually, three youth were assigned to each desk (two of them to register details, and one youth for crowd management), although this varied depending on area and strategies.
From April to August, the vaccine help desks assisted over 20,000 persons to get vaccinated. This included spreading awareness on vaccination, facilitating registrations and appointment scheduling. Street plays were held in different areas to spread awareness on vaccination. Some of the areas within the Mumbai Metropolitan Region where the help desk was organised includes communities located in Dahisar, Kandivali, Jogeshwari, Malad, Mankhurd, Nalasopara, Bandra, and Parel.
The help desks also spread information on COVID appropriate behaviour. Many of them also offered information on legal entitlements and how to access them. As part of the Maha PECONet 2.0 secretariat, YUVA also prepared an SOP to train partner organisations (such as Apnalaya, Alert Citizens Forum, Helping Hands and many others) on setting up and running vaccine help desks in communities where they work. For the Co-Marg project in rural Maharashtra, health entitlements were also facilitated at the desk.
The number of vaccinations facilitated are only a part of the story. The innumerable conversations, conflicts and interactions the youth experienced daily, and the repeated follow-up efforts needed to ensure that a single vaccination appointment is done, showcases the collective impact of this journey.
Continuing community efforts
Although the vaccination process is so crucial to overcoming the pandemic together, hardly any of the community members we interacted with across areas spoke about receiving any information on this from their local leaders. Some advertisements appeared on different platforms, yet no targeted efforts took place to address people’s fears and encourage them to get vaccinated. Moreover, as many of the community members constitute at-risk groups and live in remote parts of the city, it is all the more crucial to ensure that the information on vaccination reaches them all, and is made accessible for them.
While these factors made our efforts more challenging in the initial days, it also underlined why we invested in them so deeply. Over time, the youth volunteers found it a bit easier to continue the process, as more community members knew of others who had been vaccinated and were keen to take the vaccine themselves. Many young persons also approached the help desks, wanting to take the vaccine as part of their job requirement or because they want to travel.
None of this work would have been possible, if the youth in communities did not come forward and commit to this process. While they committed wholeheartedly, they were also aware that their efforts would give shape to an initiative that was forming as it went along. The youth also knew that it was difficult to estimate for how long they would need to continue. Their relentless efforts have made the collective impact possible.
Postscript: With the spread of the third wave of the pandemic in India, YUVA has kept taking ahead COVID safety and precaution oriented sessions in vulnerable communities. Small group interactions have taken place, following social distancing rules, to ensure that community members stay prepared and do not panic. Additionally health checkups and camps have also been organised at the community level across the Mumbai Metropolitan Region. Teams have also encouraged vaccination via creative mediums such as street plays. Vaccine help desks in select areas have tried to facilitate the vaccination registration process and addressed people’s queries. Our focus remains on trying to reach most vulnerable persons first.