Bharathi, a 56-year-old domestic worker, lives with her husband, son and daughter-in-law in Gandhi Colony in Secunderabad in Telangana. She has been an alcohol addict for several years. Despite her family members repeatedly requesting her to take a vaccine for COVID-19, Bharathi was reluctant to do so, as it would entail stopping drinking for a few days. With her unique reason, Bharathi is one of the many voices from vulnerable communities in Telangana expressing vaccine hesitancy despite acknowledging the detrimental impacts of COVID-19. Bharathi’s story may epitomise the image of the “undeserving poor”, but as Michel Katz’s book powerfully argues, classifying poor people by merit is an enduring conspiracy.

Bharathi represents just one individual story amongst millions, especially amongst migrant, far-flung communities, or chronically sick and elderly populations, who could slip through the attempts to achieve universal vaccination because of a lack of outreach or vaccine hesitancy.

Powered by the belief that “No one is safe till everyone is”, ActionAid Association (AAA) with the People’s Vaccine Alliance has been involved in vaccination promotion drives and campaigns across India. In Telangana, AAA has been actively campaigning in urban localities in Secunderabad. Starting in December 2021 and till May 2022, AAA led door-to-door campaigns, meetings with local leaders and awareness generation meetings with community members. In this period, outreach efforts ensured that 74,258 people secured the first dose of the vaccination while 72,331 received the second dose. These campaigns focused on marginalised communities, including Dalits, other backward castes (OBCs), scheduled tribes and minorities from low-income groups working in the informal sector.

The success did not come with its difficulties. For example, it was challenging to convince persons like Bharathi, addicted to substance abuse, to take the vaccine even after a good amount of counselling and regular follow-up. However, after persuasion and sustained outreach from the field staff and auxiliary nurse midwife (ANM), such people were convinced to receive the vaccine. In other cases, superstitious beliefs that the vaccine would cause health issues prevented community members from receiving a dose. Ganga Bhavani, a 32-year-old woman who lives with her husband, son and daughter in Gangaiah Basti, was one such case. Ganga was afraid that she would be unable to look after her kids and family and conduct her daily chores if she fell ill from taking the vaccine. AAA teams gave her counselling by providing the facts and advantages of vaccination, and after a long conversation, Ganga was finally convinced.

In February 2022, when the Omicron variant spread like wildfire, six colleagues associated with the vaccine promotion campaign were diagnosed with COVID-19. It is a credit to the team, who managed with the remaining members and took adequate measures to prevent the spread of COVID-19 to the rest of the team.

A lesson learnt during the implementation of this project is that sustained efforts in counselling and follow-up by local field staff have been beneficial to administering vaccines. For Shaheen Begum, a single woman living in Laxmi Nagar Basti whose husband died due to ill health, unrelenting and continuous counselling was valuable. Shaheen has a differently abled daughter who stays home and cannot attend school. Shaheen works as a helper at the local school. Shaheen was not able to take her vaccine as she was finding it difficult to find the time from her daily chores to get vaccinated and was, as in the case of Ganga, afraid that she would get sick if she took the vaccine and that there would be no one to look after her daughter. The AAA team recognised Shaheen’s unique challenges and offered to take care of the child or ask a relative to do so while she went to take the vaccine in the PHC. At last, Shaheen accepted.

In another instance, Laxmi, a daily wage worker for Durgaiah Gurden who wanted to take the vaccination, heard a lot of rumours from her village, including that three people died after taking the vaccine. The vaccine promotion team was finding it difficult to get her consent for vaccination. The team persisted with in-depth counselling and conducting camps, including some held near Laxmi’s workplace. The objective was to show that all sections of society, cutting across age and gender, were receiving the vaccine. The team introduced Laxmi to other women who took the vaccine from the same locality, interactions with them finally convinced Laxmi of the health benefits, and she agreed to get the vaccine.

Along with facilitating vaccine outreach campaigns, AAA has also been cultivating cooperation with the local administration, including maintaining excellent relationships with the District Medical and Health Officer (DMHO), Immunisation officer, State Public Health Officials (SPHO) and Medical Officers of all Primary Health Centres (PHC). AAA organised meetings with the field team, the PHC staff and local community members and set up camps to plan vaccinations. The nurses, Accredited Social Health Activist (ASHA) workers and Auxiliary Nurse Midwives (ANM) were also in regular contact with ActionAid Association field teams during the vaccination camps.

Field teams were mostly women from the local areas, and they went above and beyond what was expected of them. In many cases, they experienced backlash from the community. At the outset, house owners and people in the areas did not treat them with respect and dignity, and it was a very tedious effort on the part of the teams. People who were not interested in getting vaccinated would give the wrong phone number or lie about their vaccination status. Some were very rude to the extent that they let their dogs on them, while others rebuked and scolded, closing their doors in the face of the field teams. Despite these challenges, field teams relentlessly followed up on the work by taking surveys and gathering data.

When Omicron resurfaced on the streets, the field staff continued to tirelessly conduct their work and slowly, people started recognising their worth and gave them the correct information during data collection. Thus, their commitment to the vaccination project paid the field staff and ActionAid Association rich dividends. As most of the field staff have only basic educational qualifications, AAA trained them to be effective in the vaccination promotion campaign, including listing and tracking people vaccinated. As a result, the field staff caught on fast and are now leaders in their areas. They have learnt a lot regarding their neighbourhoods and local communities, and the local administration recognises their sustained efforts to ensure vaccine equity.