The last couple of weeks have seen such large crowds at Nagaland’s Covid-19 vaccination centres that state immunisation officer Ritu Thurr described it as a “nightmare”. “They are always calling me and asking why no slots,” said Thurr.
But things were completely different not too long ago, recalled Thurr. Even healthcare workers in the state did not want to get the shot when vaccination began for them in January. The numbers bear that out: till date, almost 40% of the state’s health care workers are yet to be fully vaccinated.
“To be honest, there was a lot of hesitancy in the first and second phase,” said Thurr. Most of it stemmed from “unnecessary social media messages”. “The vaccine carried satanic number, blah blah…very funny funny things,” said Thurr, referring to the contents of the anti-vaccine messages.
Apart from social media misinformation, residents say “prayer warriors” who claim to treat illnesses with a concoction of faith and herbs have been actively dissuading people from being vaccinated.
A senior office bearer of the Naga Baptist Church Council described them as “independent preachers”. “They don’t belong to our order,” said the office bearer who did not want to be identified. “We are actively supporting the state’s vaccination drive.”
In Meghalaya, too, fringe Christian groups have been linking the vaccine with an evil force. “There is this idea among certain fringe groups that the vaccine is also part of some sort of controlling mechanism,” said Reverend Kyrsoibor Pyrtuh of the Khasi-Jaintia Presbyterian Church in Meghalaya. It is being compared to Aadhaar, which too was seen as akin to being marked by the devil by some Christian groups in the North East, said Pyrtuh.
Officials in Manipur also claimed to have experienced higher vaccine hesitancy in the state’s hill districts compared to the other parts of the state. “There was hesitancy everywhere, but in the hill areas, even stronger,” said Th Nandakishore Singh, the state’s nodal officer for immunisation. “There seemed to be a belief that the Bible would save them.”
Both Nagaland and Meghalaya are Christian-majority states. Over 40% of Manipur’s population identify themselves as Christians, most of whom live in the state’s hill districts.
Laggard North East
A crippling shortage of vaccines has meant India has been able to administer the first dose to only 25% of its adult population. Yet, there are some states which seem to have done better than others. Rajasthan, for instance, has administered around 70% of its 45-plus population at least one shot. The corresponding number for Tamil Nadu, a state with a similar population size, is hardly 17%.
These variations among states do not seem to neatly correlate with any particular indicator such as literacy levels, economic well-being or geography of a state. But if one trend emerges, it is the below-par performance of most states in the North East.
While the region’s largest state Assam has vaccine coverage well below the national average, the situation in Nagaland, Meghalaya and Manipur is particularly striking. This is because most other small states with similar population levels are among the best performers when it comes to vaccine delivery. Nagaland, Meghalaya and Manipur, on the other, have barely managed to jab 30% in the 45-plus age group, considerably less than the national average.
Interviews with health officials from these states suggest this is to a large extent an outcome of vaccine hesitancy, some of it flowing from religious dogma that was not adequately addressed by the authorities in the early days of the vaccination drive. Much of it is on the decline as Covid-19 cases surge in the North East, but a slow uptake and shortage of vaccines in the country currently has meant these states are now struggling to catch up.
“Because the cases started increasing, eagerness is coming now,” said Thurr. “But for so long they adopted [a] wait and watch policy.”
Vaccine hesitancy – loosely defined as the phenomenon of people refusing to get inoculated despite the presence of a safe and effective vaccine – is complex and driven by several factors. The extraordinary circumstances and the crunched timelines under which the Covid-19 vaccines were developed makes it even more complicated.
Thus, experts believe it is only natural for people to be apprehensive. Around the world and in India, there have been varying degrees of hesitancy. The North East is no exception. In fact, the “wait and watch policy” that Thurr spoke of in the context of Nagaland was advocated even by several public health activists and doctors when the vaccines were first approved in India.
Fringe groups, conspiracy theories
But apart from these understandable fears common across the country, some areas in the North East seem to be contending with fringe Christian groups’ anti-vaccination propaganda too.
Roderick Wijunamai, a Naga social scientist from Manipur’s Kangpokpi district, whose areas of research includes Christianity in the North East, pointed out a couple of such groups.
The “millenarians”, for instance, who are “always very suspicious about universal bio-politic schemes, including the Aadhaar project”. “This is related to their belief that the non-believing – meaning non-Christian or satanic worshippers – corrupt forces will create and use opportunities to inscribe/implant regulating objects/marks in their bodies,” said Wijunumai who teaches at the Royal University of Bhutan in Thimphu.
This belief, Wijunamai said, stemmed from “a very conservative/dogmatic interpretation of some verses from the Bible”.
The “prayer warriors” in Nagaland and the hills of Manipur could be compared to Hindu preachers who “have extreme faith in cow urine, cow dung, etc”, said Wijunamai.
“Prayer warriors are a contender to health care,” explained Wijunamai. “If someone is sick, they are taken to the prayer mountains, where they fast and pray to be healed. Occasionally, or many a time, it also involves using herbs, usually a continuum of traditional ecological medicines, which work to heal the sick.”
Wijunamai, however, said he suspected more than religion, it was “the conspiracy theories” on social media that were fuelling vaccine hesitancy. “Some of which would claim that Covid is a hoax, others claim the vaccine makes one more sick, or susceptible to other forms of illness, including death.”
But, as Meghalaya’s experience shows, the two may not be mutually exclusive. Pyrtuh of the Presbetryian Church said it was a “mix of scientific and religious” misinformation that was fuelling vaccine hesitancy in Meghalaya’s Khasi and Jaintia hills.
Residents say anti-vaccine WhatsApp messages citing American right-wing conspiracy theories have been doing the rounds in the state since last year. “A lot of it is closely linked to evangelical groups,” said Avner Pariat, a writer and spokesperson of the newly-launched political party, New Dawn. “Here people are educated and have access to the internet, so they are accessing a lot of American right-wing propaganda about everything including things like climate change scepticism.”
The United States has a long history of anti-vaccination movements, many of which are closely linked to evangelical groups. Such groups have come in the way of the country’s Covid-19 inoculation drive too. As a result, shots are going unused in many parts of the US.
As Meghalaya struggled to vaccinate even its healthcare workers, the state health department commissioned the Indian Institute of Public Health in Shillong to conduct a study. The preliminary findings, accessed by Scroll.in, revealed that “messages on social media” was one of the major drivers of hesitancy.
In a recent editorial, The Shillong Times also spoke of the region being “influenced by anti-vaxxers from the West” more than other parts of the country.
Inaction by governments
Not all of the North East is struggling with vaccine hesitancy. Tripura has vaccinated nearly 90% of its citizens above 45 years of age. The state’s Christian population is less than 5%.
Health officials in the laggard states seem to be leaning on this demographic difference to explain the slow uptake. “You can’t really compare Meghalaya to Tripura where the indigenous tribal population is very low,” said Sampath Kumar, Meghalaya’s health secretary. “Nagaland is a more similar state.”
But some observers say this is a cop-out. “It was clear that there was hesitancy way back in January but for the longest time there the health authorities did very little to address it,” said Tarun Bhartiya, a trade unionist and editor of the Shillong-based bilingual webzine Raiot. “It is a failure of communication. You have to work around people’s religious beliefs.”
Social scientist Walter Fernandes tended to agree. “Some fundamentalist groups known as revivalists are resisting the vaccine, not the mainstream churches,” he said. “But they are a small minority. I would attribute low vaccination to inaction by the government and only secondarily to the revivalists.”
In fact, the study commissioned by the Meghalaya government also points towards this failure. The most common reason healthcare workers in the state cited for their hesitancy was lack of “trustworthy sources of information”.
A community-driven approach
What further shows the limits of attributing vaccine hesitancy to religious belief alone is the fact that not all Christian-majority states in the North East have fared badly. Mizoram, with nearly 90% Christian population, has managed to vaccinate nearly 70% of its 45 plus citizens.
Mizoram’s Christians are divided between the Presbyterian and the Baptist churches. The former is the dominant group in Meghalaya’s Khasi and Jaintia Hills, while Nagaland is almost entirely Baptist. Therefore, it is not like Mizoram’s high vaccine coverage is a result of its people following a different branch of Christianity unlike in Goa where most people are Catholics.
Apart from its smaller population, Mizoram’s community-driven approach in handling the pandemic seems to have paid dividends. It also moved quickly in quelling doubts that were floating around. “The coordination between the churches, the community organisations and the government is very strong here,” said Eric Zomawa, the director of the state’s National Health Mission. “Whatever issues were there, we thrashed them out very quickly.”
Even Tripura’s impressive numbers, according to health officials, was a result of a lot of work at various levels. “There was a lot of hesitancy in our state also,” said Siddharth Shiv Jaiswal, who heads the state’s National Health Mission. “What we did then was we convinced our senior doctors to take the vaccine, made videos, got them to say a few lines and circulated it. We got senior religious leaders to do the same.”
In addition, personalised letters by the chief minister exhorting people to get vaccinated were distributed in over three lakes households, said Jaiswal. “Initially, there were a lot of challenges here too,” said Jaiswal. “But we did whatever we could.”