Vaccinating the marginalised: Realities & insights from research
February 1st 2022
Following the months-long lockdown, and revival period from Covid-19, the most vulnerable segment of the population had gone through such an experience that could never be presented by any forum through conceptualised thoughts, theories, and documentation of experiences. But considering the need for policy responses, trying to understand the magnitude to help them overcome the adversities is necessary even if it comes short compared to the unfathomable scenario at hand. With this view, this article will try to outline a few specific salient assessments through a spatial analysis in light of recent surveys initiated by the Centre for Peace and Justice, Brac University.
The survey of 1533 households titled 'Voices from the Margins and Inclusive Policy Responses to Covid-19 Pandemic' covered 20 districts and 40 upazilas from all the administrative divisions. The aim is to observe the happenings of different aspects around the lives of the marginalised population of Bangladesh (mainly the urban slum dwellers, disadvantaged rural households, and ethnic and religious minority communities). For this purpose, a panel survey with three iterations is planned where two iterations are already completed during mid-June and early September of 2021. Considering the gravity of the issue and future policy implications, the article will present the survey findings related to both the road covered and left ahead for being a super-inclusive vaccination nation in generalised terms through qualitative lenses.
EASTERN REGION: The people in general of this region are increasingly well aware of the disease. Though the general perception surrounding the disease is always significantly influenced by religious beliefs, they are also well accustomed to the preventive measurements; but are reluctant to wear mask.
They also lack information about the vaccination system as only a handful of them know about the vaccination and its side effects, and a result more than 40 per cent people of this region are really concerned about these issues. At first, this lack of information created some misconception among the people, but eventually, the situation is expected to change over time. For instance 29.8 per cent either don't know about or don't want vaccine which was 57.9 per cent earlier in a previous survey. But, throughout all marginalised groups it is an issue of concern that after getting vaccinated people might temporarily fall ill and can not work properly for some time.
NORTHERN REGION: According to our Focus Group Discussions (FGDs) in June, the participants from the ethnic communities of this region believed that there was no cure for the illness. The lack of general information initially created some false notions about the disease such as, it does not affect those who work hard.
Overall, the participants from all spheres of the region (overall 57.7 per cent, with 72.9 per cent in Dinajpur) reported earlier that they were unaware of the vaccination procedure since there hasn't been any advocacy which is much less now (15.7 per cent), but still valid in Kurigram (30 per cent are still in dark). Initially, during the first iteration, more than a handful didn't know about where they will be able to get vaccinated (49.4 per cent), regarding cost issues (free of cost) (33.7 per cent), registration process (59.5 per cent) etc. There is a general reluctance too from most part of the population of the northern region towards vaccinations, as on average 74 per cent (87.5 per cent in Kurigram) is still not vaccinated up to September. Demotivating concerns about side effects causing loss of a day or two's work and income are causing anxiety for them. The pro-vaccine people in this region still find the present awareness methods insufficient and expect more aggressive promotion for vaccination.
SOUTHERN AND SOUTH-WESTERN REGION: Our FGDs showed that the rural population of Magura still believes that wearing masks is a hoax which is evidently because of the lack of general information regarding Covid- 19. They are not only indifferent but also the general notion about using masks was never and still not appreciated in this region. More interestingly, our qualitative exploration showed that the overall rural population of this region believes that the government is trying to harm poor people by spreading hoaxes about Covid.
While the urban households from Khulna and rural households from Magura know more or less about the vaccine, the rest (rural) of the households (94.5 per cent) from the region are little aware or unclear of the vaccination procedure. The previous two have a comparatively better idea about the registration process too. People were knowingly concerned about the Non-Communicable Diseases' patients and are confused about the protocol regarding their vaccination. They (average 32 per cent, with 65 per cent and 50 per cent in Pirojpur and Barishal respectively) demanded that the vaccination should be made available close to their home, i.e. community clinics, union health care centers, etc. as taking doses of vaccination will require sacrificing their work of at-least half-day or even full-day in cases of hard-to-reach areas. Initially, there were some rumors such as, after being vaccinated people die, people become sick, people become more vulnerable to other diseases, etc. Additionally, the understanding that there is a chance to get infected even after the vaccination and they are doing fine without it so they don't need it, is still prevalent. During the first iteration, there was very little portion of the valid population (26 per cent) vaccinated in the respective area which has not yet significantly improved (24 per cent), given that the number of valid population has increased over time.
SOUTH-EASTERN AND CENTRAL REGION: All the ethnic and rural households from Chattogram hill tract areas believed from the very beginning that Covid-19 is a serious disease. In addition, they also believed that it is a divine test for them, according to our FGDs. The ethnic minority population as communities were highly compliant to the lockdown and social distancing protocol; but the other communities of this region in general didn't wear masks, neglected any knowledge regarding the disease, and were reluctant about testing.
Only the marginalised people from urban areas showed increasing (from 36.8 per cent to 95.6 per cent) knowledge about vaccination and related procedures. Among the others from rural and ethnic communities, most believed that vaccinations were not necessary. Additionally, concerns about the side effects and probable loss of working hours before and after vaccination were also prevalent here. The registration process is also a challenge as most from hill tracts (78.9 per cent) do not own/ do not know how to use a smartphone/computer let alone the internet. So, cyber cafes/ shops incur a fee which creates a significant 'digital divide' in the case of vaccination compared to other regions.
To conclude, though there are both reported and evident successes of the administration, and the government with Covid-19 issues, it is still not the time to be content with the soft achievements. Because the absorption and adaptation of the crisis took so long that even in June 2021 during the first iteration of the survey (15 months after the first infection in Bangladesh), the scenario was still baseline even in cases like outreach and awareness. Even now of the marginalised population, advocacy activities regarding the disease, prevention, testing, vaccination etc., in any form hasn't reached 21.6 per cent; 41.24 per cent firmly believes that the information they receive about Covid-19 and vaccine are insufficient; 71.1 per cent don't have access to any smart device/ internet for vaccine registration; 16.5 per cent don't have access to any vaccination centre because of distance, and nature of inaccessibility (hilly and riverine regions mostly), and so on. So, being at this stage and considering the progress until now, evidently there is still a long way to go with our prevention, vaccination, and mitigation journey.
Hossain Mohammed Omar Khayum and Mrinmoy Samadder are working as Researchers at the Centre for Peace and Justice (CPJ), Brac University. Views expressed in this article are those of the authors and do not necessarily reflect the position of Brac University