Leaving no one behind

On 24 June 2022, the International Organization for Migration (IOM) India and the NITI Aayog jointly hosted an event – the National Engagement on COVID-19 Vaccination & Migrants: Leaving No One Behind. IOM also launched its study by the same name. This study captures the attitudes, knowledge and perceptions that influence migrant workers (internal as well as returnees from overseas) either towards hesitancy or acceptance of the COVID-19 immunization mandate of the Government of India.

Since the onset of the pandemic, cumulative efforts of the government (centre and state) have created an impressive repertoire of measures to mitigate and contain the impact of the contagion. The latest data from the government’s CoWIN platform shows more than 196 crore (1.96 billion) vaccine administrations, of which more than 91 crores (910 million) are complete vaccinations.

In response to the urgency to vaccinate India’s massive population, the National Expert Group on Vaccine Administration for COVID-19 (NEGVAC) was set up in 2021 for comprehensive guidance on vaccine administration.

The result has been multi-sectoral and stakeholder approaches, public-private partnerships, use of technology and robust monitoring systems that brought the most-hard-to-reach within the fold of the vaccination campaign.

In his opening remarks, Sanjay Awasthi, Head of Office, IOM India, stated that “during the pandemic we have discovered the value of migrants in society and the national economy, thus making their health and well-being a priority for all of us”.

During the launch of the Report, he emphasized that “migration is a social determinant of health that can impact the overall health and well-being of individuals and communuities”.

There is historical evidence that, various individual and systemic barriers prevent the ready adoption of healthcare measures. The sudden halt in human mobility significantly impacted the entire population of migrant workers - internal and overseas returned.

With the deprivation resulting from the sudden loss of jobs and heightened uncertainty combined with suboptimal health-seeking behaviours, it is presumed that migrant workers were more likely to experience a higher burden of COVID-19 infection.

On the achievements of the Government of India, Shombi Sharp, Resident Coordinator for the UN, India, reflected on efforts which surpassed national bounadries.” The Government not only came to the aid of her own citizens “but also provided aid in the form of vaccines to other nations, including in UN Peacekeeping Missions, truly epitomizing the slogan of leaving no one behind”.

Representatives from the health and labour departments of 14 states deliberated upon strategies for ensuring equitable delivery, access, and utilization of the COVID-19 vaccine services. The discussion during the session focused on the experience of the Health and Labour Departments of various States in ensuring the vaccine coverage efforts for migrant workers.

In case of Delhi, Dr. Puneet Jaitley, the state immunization officer, shared that “to properly reach all cohorts, dynamic activities were undertaken like vaccination under bridges for homeless persons, dedicated centers were set up for women, delivery agents, housemaids and those which are in left-out areas. To market the drive and motivate people, influencers like religious leaders and government representatives were roped in”.

Commissioned by IOM in partnership with UNFPA, the study was conducted in 10 cities with million-plus populations, with 78.1% men and 21.8% women participants. During the pandemic, a mixture of old and new challenges like socio-cultural perceptions towards vaccines in general, conflicting information from myriad sources (infodemic), and the rise of social media and online channels in influencing people’s decisions collided to create a complex set of challenges that became the basis of the study.

Identifying ‘accessibility’ as a crucial determinant for vaccine uptake, the study also provides a closer look at gender gaps which perpetuate barriers to immunization. While presenting the findings from the Report, Dr. Sanjay Kumar, Population Dynamics & Research Specialist, UNFPA, talked about absence/exclusion of women from digital platforms which emerged as an important reason for their dependence on others to access information and get motivation for getting vaccinated.

Migration experts and grassroots-level practitioners provided recommendations to improve COVID-19 vaccine confidence  improving demand among migrant workers. The discussion also referred to the study, which found evidence that financial concerns, questions regarding vaccine efficacy, post-vaccine adverse reactions and vaccine accessibility protocols (registration, documentation, etc.) also contributed to vaccine hesitancy.

Dr. Aparna Joshi, TISS, talked about the need to move away from the conventional ways of thinking about psychosocial and mental well being. “The journey of migration is full of stressors, so we should think of making mental health a vital part of all migration-related work”.

The study also found that employers played a significant role, in about 8% of the cases, in motivating migrant workers to avail themselves of the vaccines. At the height of the pandemic, many large-scale corporates had absorbed the vaccine costs for their employees. Industry stakeholders represented by Confederation of Indian Industries, ASSOCHAM and Maruti Suzuki, shared their valuable experiences in ensuring vaccination amongst migrant workers.

Dr. Shubnum Singh, Principal Advisor, Health, CII shared that “CII created a Taskforce, co-chaired by Dr. Naresh Trehan and Dr. Naresh Forbes that convenes regularly to analyse the status of COVID incidence and strategize the next points of action, which include demand aggregation of vaccination and healthcare services. ”

In closing, IOM and UNFPA shared some of the highlights from the study. Of the 91.3% of surveyed respondents, who were aware of the vaccine programme, 48.6% got their information from TV; 20.7% relied on informal channels, such as social media and online sources.

Language emerged as a barrier to accessing information since many surveyed respondents belonged to the states of Uttar Pradesh, Bihar, West Bengal and Odisha, employed in southern (38%) and western (19%) states. Amongst returnee migrants from overseas, not only the hospitals and health care centres but also the internet and circle of family and friends were major sources of information about prevention, preparation and the vaccine programme.

Dr. Muniraju S B, Deputy Advisor, NITI Aayog, expressed hope that the study “will help in identifying gaps in vaccine delivery, and ensuring that migrant workers’ issues are highlighted so that there is better preparedness for the future”.

Based on learnings from the study, IOM in collaboration with Purpose has launched a campaign to drive vaccination intent; sensitize community healthcare workers and other stakeholders; and strengthen the ecosystem around migrant-inclusive vaccination. This campaign dovetails with the Verified Initiative, a global communications infrastructure to address the most pressing impact of mis- and disinformation on COVID-19 and promote accurate, science-backed information.