In Conversation With Dr. Sanjay Kapur

Please tell us about - MOMENTUM Routine Immunization Transformation and Equity and its work specifically in promoting vaccine circulation in India?

MOMENTUM Routine Immunization Transformation and Equity Project funded by USAID, integrates vital components like demand generation, risk communications, community engagement, private sector partnerships, cohesive working with National and State Governments – SBCC, Data Analysis, Supply Chain Logistics.

The Project has focused on reaching marginalized and vulnerable populations and identifying the obstacles that these groups face to receiving vaccination. The program works with local non-governmental organizations to reach such groups including older people, people with disabilities, transgender, and members of the hijra community, and otherwise marginalized ethnic groups. MOMENTUM Routine Immunization provides technical assistance to support the Ministry of Health and Family Welfare / Universal Immunization Programme technical management and rollout of the COVID-19 vaccine in the country.

· The project works across 18 states and covers approximately 50 million beneficiaries in 241 districts.

· 14 million of those beneficiaries are targeted for primary series or booster vaccine doses through our association with local NGOs.

· Since November 2021, through USAID-support, the Project has helped more than 4 million people in 18 states receive their last recommended dose of a COVID-19 vaccine (April 2022).

· Additionally, the project has trained more than 14,000 people on a range of topics, including supply chain and logistics, vaccine service delivery, and community engagement.

· The Project also supports microplanning, including digitizing tools to facilitate real-time data use, promoting efficient vaccines use.

What is MOMENTUM Routine Immunization Transformation and Equity's contribution to the strengthening of the Indian healthcare system?

The project provides technical assistance to support the (MoHFW) / Universal Immunization Programme to support and ramp up the COVID-19 vaccination implementation in 18 States and Union Territories targeting senior citizens 60+ years, 18-59 age group, and the newly added 12-18 age group.

Besides working with MOHFW, the project work closely with USAID, WHO, United Nations Children’s Fund, Bill & Melinda Gates Foundation, Gavi, and other immunization and public health partners, to improve the quality of services and support the national as well as state level Government’s ambitious COVID-19 vaccination goals.

Reaching the last mile: leaving no one behind. What is MOMENTUM Routine Immunization Transformation and Equity doing in this regard, and which set of vulnerable groups is it aiming to reach?

USAID/India, along with its implementing partners John Snow Inc India and Catalyst Management Services - COVID Action Collaborative have launched a mobile vaccination program to reach vulnerable and underprivileged members of the society. The program is being operationalized in partnership with two leading private organizations Give India (one of India's largest donation platforms) and 3M (an American multinational conglomerate corporation) along with a private mobile vaccination player - Vaccine on Wheels.

75+ mobile units, accompanied by doctors & nurses would be rolled out in the 22 most underserved districts in the country across Jharkhand, Maharashtra & Tamil Nadu. These units will go from one village to another, with a target to deliver 6 Lakh+ doses in the next 3 months.

This private sector engagement is in line with the government’s “Har Ghar Dastak” program which aims to reduce inequity of access by taking vaccination doses nearer to vulnerable and marginalised communities.

Vaccination through mobile van is one of the modes proposed to achieve 100% vaccination coverage in the country.

How did MOMENTUM Routine Immunization Transformation and Equity partnered with the health system and private partners to make vaccines available to vulnerable groups?

We aim to facilitate strategic partnerships between the public and private sectors through establishment of platforms, alliances, and advisory groups to reach to the targeted population in India.

With The help of partnership, we focus in three broad areas– Influencer engagement, PPP, and community-based engagement. The project collaborates with private sector, including state chapters of the CII, FICCI, and the Indian Medical Association to support vaccinations within and outside their companies as part of corporate social responsibility initiatives.

The team loop in the district community workers as they hold a great influence in their respective localities, Influencer-led beneficiary work includes engagement with Gurudwara Committees, Church Institutions, local Muslim authorities, The Federation of Obstetric and Gynaecological Societies of India, The Indian Military Academy and Indian Academy of Pediatrics.

Furthermore, the project partnered with various groups and organizations to generate more demand for COVID-19 vaccine. Like public and private schools and Colleges like Pdt. Ravi Shankar University, Department of Gender Studies, Boarder security Force, Tea Garden communities and Sickle Cell Institute. Partnership with the toll-free 181 Helpline has also been effective in spreading messages around the update of COVID-19 vaccination.

How is MOMENTUM ROUTINE IMMUNIZATION TRANSFORMATION AND EQUITY reaching, educating, and mobilizing communities at the ground level?

In a high-level meeting chaired by the Union Health Mister Honourable Dr. Mansukh Mandavya hosted by MOMENTUM Routine Transformation and Equity on October 27, 2021, the reasons for low vaccination coverage and the gap in the second dose uptake were discussed.

As a result, “Har Ghar Dastak” (knock on every door) campaign was launched by the Government of India to increase COVID-19 vaccination for people who are yet to be inoculated with a second dose and persuading vaccine-hesitant population.

· To reach the furthest corners and hard-to-reach terrains of India with more preparedness, the project conducted a situational analysis in North-eastern states to understand their vaccine uptake barriers.

· The diverse innovative communication tools used via partnerships and collaboration to mobilise communities included folk dance, art performance, street plays, games, wall writings, etc.

What are the challenges faced by the vulnerable population in Covid 19 vaccination?

COVID-19 pandemic is having a devastating effect on the lives of women, elderly, children, transgender, migrant workers, tribals, etc. One of the most challenging aspects of India’s COVID-19 vaccination campaign has been to mobilize and convince women to get vaccinated as the fear among women is higher compared to men. Especially by pregnant women, lactating mothers, transgenders, and migrant women workers

For example, transgender already faces a lot of social stigmas, violence, and denial of social benefits with access to the COVID-19 vaccination. Vaccination is not a priority among the group and beneficiaries are not fully aware of where and how to avail the service.

This community has various medical challenges and hormonal treatment, so they are clouded with doubts about the safety of vaccine estimate size of the population is 0.4 million. Also, fear of safety leading to hesitancy, myths around side-effects leading to potential loss of daily wages, busy schedules leading to missing out on awareness activities and vaccination camps.

Difficulties in mobilization and vaccination at workplaces has been a challenge for migrant workers. Hence, it is critical that vaccines are fairly distributed around the vulnerable populations and these challenges should be addressed to provide access to all.