The administration of the COVID vaccine has been patchy throughout the world. While many in the global north are considering their second booster shots, several people in the global south remain unvaccinated (even with a single dose) of COVID vaccine. Even within countries, such as India for example, there are large disparities in vaccination across regions and in between urban and rural areas.

However, this disparity is not the subject of this blog. Is there a possibility that state run vaccination drives are plenty, yet many in a city remain unvaccinated? It may seem that the only case when this is possible is when there is vaccine hesitancy. But that is not the case. SPARC’s experience says there is more to it.

SPARC’s vaccination drive

With generous donations of vaccines from philanthropists, SPARC and its network of slum federations (largely the women from Mahila Milan, which is the federated women’s collective) conducted vaccination camps at various locations in Mumbai, in slums and slum relocation colonies. In the aftermath of the devastating second wave of surging COVID pandemic, there was an upward tick in the number of vaccination seekers resulting in a huge rush, and therefore unexpected shortage of available doses. Some of it was related to the global shortage of raw materials and many other political challenges domestically. Post second wave, things appeared to be returning to normal, and eventually the rush dwindled.

But then the Government of Maharashtra suddenly announced that in order to travel in the Mumbai suburban railway system, one needed to be fully vaccinated. The suburban railway system – known as the lifeline of Mumbai – is the very heart of Mumbai’s public transport system, being the cheapest and fastest mode of transport for people to travel for work. The working class in Mumbai live in the suburbs, whereas work locations, and therefore economic activities, are concentrated in the southern part of the city, requiring people to travel between 40 to 100 kilometers every day. Naturally, the sudden announcement resulted in a mad rush of people wanting to get vaccinated to be able to travel using the trains.

One would think that strong public systems that penalize non-vaccinated citizens would also have a strong and well spread-out vaccination drive. And this is true for Mumbai. However it still could not solve the small but important issues that required what we call the ‘last mile connectivity’!

Understanding vaccine uptake

Let us look at some statistics around how the response to SPARC’s vaccination drive was:

At first, it was felt that there are more women than men. When asked, a woman said, it was convenient as it is closer home and they can manage filling water, washing clothes, cooking, sending children to school and other care work in between and can come for vaccination. Standing for several hours at the public vaccination centre, which is some distance away, was not convenient. One woman stated that she “doesn’t need to travel in the suburban trains for work”.

But at the end of administering about 10,000 doses, there were an equal number of men and women who sought vaccination, and an equal number of people seeking first and second doses of the vaccine. A higher proportion of them in the non-senior adult age group can be indicative of three things:

1. the population being largely young;
2. vaccination of seniors started much before that for the non-senior adults; and
3. young people mostly belong to the working age group that could not spend time in long queues and needed the vaccination quickly in order to be able to use public transport for work commute.

Challenges in accessing vaccinations

Clearly, the reasons as to why so many people  were still unvaccinated even six months after the official vaccination drive were not just one, but many. These reasons became more clear during the SPARC drive, and below we outline some of the challenges people faced.

In one location, several men had been in legal detention during their first dose and had no mobile phone access, so their names were registered under the name of the prison staff. To be eligible to get vaccinated, you must be registered under a particular mobile phone number on an online portal and this number should be used for the second dose. Without that same number, it is difficult to locate the person for second dose, but doable. Most public vaccination centers have no time or patience to deal with such issues. The men were finally vaccinated at our camp, and the team located them on the portal.

Additionally, technological complications often intimidate and deter people from seeking important public services. Few among the poor have access to smart phones, fewer women among them even have access to or know how to operate a phone. But a public service that requires you to register on an online portal can put off people. At all SPARC camps, staff ensured that any person with an identity card and a mobile number (these are basic minimum to be able to register for vaccination) would be helped with registration and vaccination.

While there is some hesitancy, it is largely due to misinformation and distrust in the public systems. When residents saw people they knew running these camps, a part of that distrust dissolved. When they saw the Mahila Milan saying “I took it and I am fine, why should you worry”, a little more of that distrust dissolved. And when the drives repeated in locations where the demand was high, more people came forward.

Unusually, some people were already fully vaccinated per the system but had actually not received their second dose. At any public centre, they would not be vaccinated as the systemic requirements were met! Our teams ensured they got their doses.

Women with young children who could not be left alone found a camp close to home easier to access. Similarly, those with mobility challenges who were unable to reach vaccination centres were vaccinated by the team in their homes after medical approval.

These are only a few examples of the nuanced issues that resulted in many people still not being vaccinated despite many public centres in the city administering free vaccines. Public systems are not yet structured to absorb such nuances, which are essential to consider if we want to ensure that every single person is vaccinated.

Providing the last mile connectivity in Mumbai

We are proud of having been able to administer this service and have learned tremendously from it and can say that this was the ‘last mile connectivity’ thing for COVID vaccinations in Mumbai… with some guilt knowing that many other Indians and people abroad in the global south are still not vaccinated even with a single dose.