Kerala govt should prepare to deal with vaccine hesitancy: Former Addl Health Secy

Kerala is reeling under the surge of COVID-19 cases after its Onam festival and the strategy of the government has been grabbing national attention for all wrong reasons. At this juncture, Mathrubhumi approached Rajeev Sadanandan IAS(Retired), former Kerala additional chief secretary (health) to know his reflections on the surge and other allied patterns in the state.

Edited excerpts of telephonic interview:

If we compare Covid-19 surge in Kerala after Onam 2020 and Onam 2021, how different is it?

On 27th August, the Friday before Onam in 2020, the COVID reproduction number "R" number (R number reflects ability of the virus to spread) in Kerala was 1.1. On September 10 2020, after Onam, R became 1.24. Meanwhile, this year Onam was on August 21 and by August 28 itself it reached 1.24.  That means infectivity has reached last year’s level way too early. It is also pertinent to note that in 2021 we are having delta--a super infectious variant of Covid-19 virus. So naturally the number of people getting infected will be more. But the good thing is that around 40 to 50 percent will have developed antibodies to the coronavirus in 2021, compared to seroprevalence (the percentage of people in a population who have antibodies to an infectious agent) in 2020, which was below 20 percent. 

Likewise, more people might have been fully vaccinated with anti-viral jabs than last year. So, likely, only the individuals who are not fully vaccinated or have comorbidities are more prone to hospitalization or death.

Last year too, the R value was in 1.24 range for two months after Onam and it gradually reduced. It did not hamper our health infrastructure then. So if the trend goes the same, then things will not go weary.  However, I doubt whether people have become complacent in ensuring Covid etiquettes compared to last year. So I am not sure whether it may contribute towards a surge.

Not just specific to Kerala but also considering a country like India, should we conduct mass scale testing at ward level to identify cases or clusters?

It is a good thing to test more people if we can trace the primary contacts of the person who turns positive. But I don’t think we are now focused on tracing as it was during the initial period. I am not sure whether even the primary contacts of a person hospitalized due to Covid-19 is being traced.  So just increasing the number of tests will not be beneficial. We will get the number of persons tested positive but we will not have a check on the spread. Also, considering the Test Positivity Rate to judge success or failure of Covid handling at this juncture is naive as we are only getting data about hospital seroprevalence and not population seroprevalence. Basically, it is just an assumption based on a specific target population.

You mentioned that there are chances that people might have become more complacent and it may contribute towards surge. So, do you think sociological perspective needs to be pondered upon?

Yes. Sociological perspective need to be pondered upon. If we look at Kerala’s case, we could see that change in behaviour of people initially played a crucial role in containing the spread. I would even say more than the government's intervention, the way people responded is worth appreciating. There is a pattern, and the pattern is after surge, people themselves modify to reduce the surge. And historically people here are proactive to seek medical care, unlike many other states. That is something positive. Also, the last government increased the strength of our health infrastructure by imbibing more health professionals into the system.

But, now I think there are aberrations.  I even doubt whether the attitude of people has changed. I also doubt whether the government itself sidestepped from considering citizens as a crucial partner. We started Covid brigade and all, but not sure whether they are functioning. Similarly, I am not sure whether we have considered civil society inputs like we did in Kerala Floods 2018. Actually in a state like Kerala, we could have leveraged on our social capital for processes like contact tracing, so that health workers are less burdened.

So are you telling the government backtracked from sensitizing people?

The government was successful in creating awareness about the Covid-19 virus. An average citizen is aware by now. But I don’t think there is a wrong perception among many people that vaccines ensure full protection to the population against the virus. That is wrong. Even a fully vaccinated person can spread the disease. Government for sure has pushed the message that guards should not be down even after being fully vaccinated. But I don’t think it has reached the grassroot level.

Meanwhile, exposure to the internet without critical thinking is also counter-productive. Without realizing the context fully, they imitate methods followed in other countries. They never cross verify whether such methods were successful or not. There are some people who still believe people in the US and Israel are leading normal lives without masks after getting fully vaccinated. But they miss the fact that both countries reinstated the use of masks, even when individuals are fully vaccinated.  Media also has the obligation to convey the right message to the public. Even if we wear masks and are fully vaccinated, there is a 10% chance of risk.

Despite the high literacy rate of Kerala, do you think there will be vaccine hesitancy in the state?

We cannot rule out the chance of vaccine hesitancy. I am not sure whether the government is prepared to address it. Like we say in ‘Diffusion of Innovation Theory’, we can expect 10% of the population who will be reluctant. In every part of the world it will be like that. But, even for that 10% we need to take measures to persuade them.  And if we have more than 10% of the population who are reluctant, then we will be in trouble. It is too early to say at this point how things will turn as vaccination has not yet reached 50% of the population in Kerala. In the US vaccine hesitancy came to light when 60% of the population were vaccinated. Even in the child immunisation program, Kerala has witnessed hesitancy. But our interventions reduced the hesitancy. It is time to learn from that experience and start preparing to deal with vaccine hesitancy now itself and not wait for it to become obvious.