68 Time February 28/March 7, 2022
India, especially in rural areas, these community
workers have played a crucial role in the pandemic,
creating awareness about the virus, tracking and
monitoring cases, and then rolling out the vaccina-
tion program. In Dhari, this well-earned trust led
locals to buy into the idea that they needed to get
vaccinated to protect themselves and their fami-
lies against COVID-19—even if it meant trekking
hours through steep terrain.
The success of Dhari’s COVID-19 vaccina-
tion campaign was also built on years of outreach
within remote communities, especially among
women and children, notably through India’s ro-
bust universal immunization program that reaches
around 26.7 million newborns and 29 million
pregnant women each year. That program relies
on a broad network of district hospitals, primary
health centers, government health workers, and
community volunteers. It’s also credited with the
country’s incredibly successful polio- vaccination
campaign, which began in 1994, when India ac-
counted for around 60% of
global polio cases. Millions of
frontline workers took on the
task of vaccinating 170 million
children under 5, twice a year.
In 2014, two decades after the
campaign began, India was de-
clared polio-free.
India’s immunization pro-
gram for children may be “a
well-oiled machine,” says Rajib
Dasgupta, who heads the com-
munity health program at Jawa-
harlal Nehru University, but
the system still needed to be
adapted to deploy COVID-19 vaccines to adults.
Kandpal and his team of 13 ANMs and 46 ASHAs
consulted with village heads across Dhari to tweak
the existing immunizing infrastructure to address
the practical issues around travel and the lack of
smartphones. First—and long before most areas
in India began doing so—they decided to send out
mobile teams to villages because not enough peo-
ple were coming down to the two walk-in centers.
Although the polio- vaccine program includes a
follow-up door-to-door campaign, this was a sig-
nificant scaling- up to cover the entire adult pop-
ulation. These new mobile teams were capable of
trekking into the mountains to get closer to iso-
lated communities, where they established pop-up
vaccination sites designed to get more shots into
arms—both for those people who already want the
vaccine and for those who aren’t so sure.
Kandpal’s team added fully equipped ambu-
lances to the mobile teams in case of adverse reac-
tions to the vaccines, a data-entry operator to reg-
ister the villagers on the government vaccine app,and a pharmacist to hand out acetaminophen and
advise people on what to expect after their shots.
Kandpal also set up a WhatsApp group between
local health workers and the village heads, posting
the weekly vaccination schedule so village heads
could communicate with villagers. “COVID taught
us to think out of the box. The systems it forced us
to create will go a long way in the future, too, to cater
to this population,” Kandpal says. “We have taken
an existing but old resource and modernized it.”On Sept. 4, nurSe-midwife Renu Sharma—a
member of Kandpal’s team who has been work-
ing with the Dhari population for 13 years now—
traveled with a team of health care workers from
Padampuri to the remote village of Aghariya. There,
she received a warm welcome. She knew lots of the
women by name, having vaccinated their children
years earlier, and in a mock-stern voice told them
to come and get their own COVID-19 vaccines at
the camp now.
Before the arrival of Sharma
and her team, the nearest place
for Aghariya residents to get
vaccinated was the camp in
Dhanachuli—a tough journey
along an unpaved path that
could be particularly treach-
erous whenever rain loosened
the rocks and soil. That’s why
Sharma and her team decided
to set up a temporary pop-up
vaccination site in Aghariya.
They were quickly inundated,
and by the afternoon the line
for vaccines continued to grow.
While administering shots, Sharma noticed a
group of three elderly men who had spent the day
sitting at the pop-up vaccination clinic. During a
lull in activity, she approached them. “Bubbo, have
you registered?” she asked, using a local term of
respect meaning grandfather. The men demurred.
“No, no, we came here just to see what’s happen-
ing,” one said. “We don’t want to take the vaccine.”
Undeterred, Sharma continued to press: “Look
at me, bubbo. I was one of the first ones to take
the vaccine. Has anything happened to me?” she
said. At that point, others in the village who had
gotten a shot joined in, saying they too had suf-
fered no serious side effects. Finally, the men re-
lented. Sharma marched them to the registration
table with a triumphant smile and went back to
her station to open up another pack of vaccines.
“Sometimes you have to persist with them a bit,”
she said. “I have had to persist for days and weeks
with some people.”
At the end of the day, Sharma consulted her list
of village residents and checked it against thoseWORLD
‘You have to bemindful of thecommunity’ssentiments. Wedon’t push toohard. It takes time.’
—RENU SHARMA, A NURSE-MIDWIFE
WHO WORKS IN THE DHARI AREA