Behavioural segmentation of hesitancy to assist India’s vaccination program

Credits: IndiaSpend

Context driven hesitancy

India unlike other economies, has a public health mandate on vaccination restricted to child immunizations and not adult vaccines, and also does not face any major ideological opposition to vaccination. In India, where conventional assumptions in health-seeking behaviors around care management, therapeutics, service delivery etc. are constantly challenged, looking at vaccine decision as a simple Yes or No can prove to be ineffective.

Demand Variability and Vaccine Allocation

From late march onwards, when the COVID cases shot up exponentially, India found itself needing a disproportionate number of medical supplies including vaccines. Understanding hesitancy as a non-binary phenomenon and where context can create different kinds of hesitancy can help social planners forecast demand more closely. Though at an aggregate level there is an absolute number of total shots that needs to be purchased for the population to see this pandemic off, the infrastructural constraints warrant local officials to manage order and allocation based on consumption patterns, wastage, and expected demand. At any point of time, there exist cohorts who are vaccine confident, those who are fearful and waiting for some kind of definitive assurances, those who think vaccines are not relevant right now, those against the inconvenience vaccine registration/uptake brings with itself, and those who are not willing to take up the vaccine. Target population moves between these boundaries depending upon the context within which they find themselves at that instance. Someone who is willing and confident of vaccine might delay their appointment and move into the category who feel vaccines are not relevant now. For instance, when 65+ age group was opened up in January, understanding hesitancy could have led to anticipation of lower-than-expected uptake leading either to a more focused communication campaign to mitigate fears for the senior citizens or opening up of 45+ age group to channel the available supply towards their unmet demand.

Hesitancy at the heart of vaccination program

What we have been seeing is a conventional demographic based vaccination program. Such an approach does not recognize the nuance of confidence and hesitancy between and within the demographic segments which leads to a sub-optimal program where programmatic efforts are not fine-tuned to the needs and fears of the population. As a result leading to a failure to drive demand and also give rise to supply side problems where allocation cannot be ascertained effectively.




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