Can direct money transfer incentivize vaccination in India -Ashwajit Singh

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What is free with a Covid-19 vaccine?

A raffle, gift cards or a golden pin!

Making a statement, supporting the cause and encouraging people to get vaccinated are businesses, communities and governments in every country. Truly a paradox where, while on one side countries like Serbia, Israel with surplus vaccines convince people to get vaccinated, on the other are those like India who face stretched vaccine stocks for meet changing immunization goals.

With a supply of doses that should decrease by July-August with around 10 million doses available per day, can we also follow their example?

Maybe not easy.

For India to meet its ambitious goal of immunizing at least all of its roughly 945 million adults by the end of 2021, the country must administer at least 1.88 billion doses in total, of which nearly 89 % still need to be administered. Simply put, an approx. 238 million doses per month starting June 21, which only increases to 359 million doses per month if we included those under 18. Admittedly, this is a big challenge given that some vaccines are still in phase 1 and their availability can take time. Also, according to CoWin’s data itself, the fastest rate India has vaccinated so far is 3.8 million doses per day (based on a seven-day moving average) . Therefore, even though 5 million people vaccinate per day from July, it will not be until April of next year for the adult population and October 22 for everyone to be vaccinated.

It is not only the supply, but the distribution, and the dynamics of behaviors also affect immunization in the country. With more than 12 billion doses of vaccine announced by all manufacturers for release in 2021 subject to authorization, inclusive and effective distribution of safe vaccines will be imperative to protect lives. While the good news may be the recent increase in vaccination rates, this is largely due to the intensity of Wave 2. And, even here, a large rural population remains unattended, especially as a result of the virus now hitting these areas. How to manage the supply of vaccines which is anyway biased towards urban areas? How do we push the rural population largely motivated by factors like will, perception, trust, standards before they decide to take a hit? As of mid-May, only around 15% were vaccinated outside urban areas and the number of cases in rural areas exceeded 60%!

We seem to be moving forward.

The recent government decision to allow requests to import and supply COVID-19 vaccines approved for restricted use by the United States FDA, the European Medical Agency (EMU), the United Kingdom ( Regulation of Medicines and Health Products (MHRA), Pharmaceuticals and Medical Devices Agency (PMDA) Japan or that are listed in the WHO Emergency Use List (EUL) within three working days is a Welcome step. The decision will not only speed up India’s access to these foreign vaccines, encourage imports, including import of bulk drugs, but will also speed up vaccine manufacturing capacity and full availability of drugs. vaccines in the country. With a third wave expected to hit children, talks with Pfizer are underway to vaccinate them just as quickly (possibly from July). State governments are also following suit. also their share in rural India with information campaigns, target messaging and the opening of more sites.

But will this be enough?

A more participatory and collaborative public-private partnership can be a game-changer. For example, with an accelerated vaccination campaign, a large number of inoculators will also be needed. The private sector may well integrate here to fill the labor shortage. They can complement government efforts and help create new vaccination sites, mobilize workers / volunteers for accelerated driving, and leverage technologies such as blockchain and IoT to ensure smooth last mile delivery.

With the decline of the 2nd wave and the next one looming, relying on frontline workers like trained army medics, AYUSH medics and ASHA / Aanganwadi workers can greatly contribute. to accelerated rural growth. We can learn from the success of the polio eradication mission in the country. The state of Uttar Pradesh alone had nearly 65% ​​of polio cases worldwide in 2002 with strong reluctance to vaccinate. UNICEF’s aggressive engagement with social mobilizers and celebrities has gone a long way in alleviating this fear.

A streamlined vaccine registration process to bridge the rural-urban divide, push for behavior change that has the potential to overcome vaccine reluctance, training of frontline workers coupled with tighter surveillance for reduction in vaccine delivery. Vaccine wastage in the country which stands at nearly 5% against the global average of 1% could be additional measures.

Learn from global experiences

Incitement to inoculation? Yes, Israel’s Green Pass program gave access to gyms, hotels and restaurants and Belgrade gave gift cards to the first 100 at their walk-in centers in a mall, many US states have also encouraged vaccination after their numbers have started to drop. New York’s Vax & Scratch Program Could Make Someone $ 5 Million; California’s Vax for the Win program (billed as the country’s largest) offered $ 116.5 million in incentives; Ohio’s Vax a Million Could Award Someone a Full Four Year Scholarship!

Returning home, the Indian community of goldsmiths in Rajkot, Gujarat state, also offered more than 45 women and men gold nosepins and hand mixers respectively to get a vaccine in their camp. vaccination.

Can we not borrow from these examples?

It may be worth considering the option of a direct cash transfer program to beneficiaries of the country’s public social protection programs. The transfer could be conditional and given either in part with each injection or immediately after the person has been fully immunized. This can be a time-limited and conditional cash transfer. Take an example here, of a successful money transfer program called Bolsa Familia (family allowance) in Brazil where the government only transfers money to poor families if they agree to send their children to school. , at the health center and vaccination. The cash transfer could also give a minimum income in the hands of people to help them live in dignity. Something the NREGA is already doing. With reverse migration and declining family incomes due to the pandemic, around 25.6 million households have already applied for work under NREGA as of April 2021, about 91% more than ‘last year.

While critics may say that providing money for jabs is like giving kids candy, it’s worth noting that the concept isn’t new. Financial incentives are given to participants for clinical trials, donating plasma or stopping unhealthy behaviors. Some may also say that in the context of rural India where people don’t trust vaccines anyway, may think the payment is a reconfirmation of its unreliability.

But, the spirit behind the cash transfer program for a jab is to encourage vaccination in the country and to help achieve collective immunity. Globally, nearly 100 targeted cash transfer programs have been launched, 50 of which are new, notably in response to Covid-19 in countries such as Ecuador, Peru, Iran and Italy. There is no doubt that every incentive must be accompanied by the right checks and balances. This is where data transparency and vaccine safety education become essential for an evidence-based approach to achieve desired results.

We are in the slog overs. The call is to improve our game. Word of mouth helps, but money can be a motivator.

Disclaimer: The opinions expressed in the above article are those of the authors and do not necessarily represent or reflect the opinions of this publisher. Unless otherwise indicated, the author writes in a personal capacity. They are not intended and should not be taken to represent official ideas, attitudes or policies of any agency or institution.


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