WikiJournal Preprints/Vaccination drive could be affected by frequent change in vaccines, guidelines, policies, interdisciplinary conflicts of medical sciences, mistrust, evil propaganda over Government data

Covid-19 vaccination Programme


With frequent reports coming through media, social networks and several other communication channels as well as individuals stating that even after proper vaccination with 2 doses as per guidelines and protocols of Ministry of Health & Family welfare, Government of India, there are cases of deaths as well tested covid-19 positive is a growing concern and a very big issue as addressed by accredited big channels. In such a report published by news18.com the channel reported that more than 2000 police staff in Uttarakhand tested positive for covid-19 in the second wave and 93% of them have received both the doses of covid-19 vaccines? Naturally after reading and viewing such reports people will ask how many people have covid-19 after proper vaccination and how many of them died? Why are they covid-19 positive & died after proper vaccination? Naturally it will produce fear among vaccinated and non-vaccinated individuals which should be addressed timely and properly to ensure safe and smooth vaccination drive in a densely populated country like India having poor infrastructure and underdeveloped healthcare system.

Added to this recently I have read a report published in scroll. In that WHO is reviewing data of Seychelles after some vaccinated residents tested positive for the coronavirus last week had been fully vaccinated, reported by Reuters. The mistrust for vaccines is growing day by day as there may be no public policy working at ground level to address the situations particularly in rural areas where most of the population is dwelling.

One such report published in India Today, June, 2, 2021 states people think that those who take the vaccine die, such rumours will definitely hamper Covid vaccination drive in rural India. All such mistrust and fear if not properly addressed in time will make it difficult for India to achieve the target of total vaccination by December 2021. Government should take proper action on oil-soap seller business tycoon cum quacks and self claimed natural healers and babas who are not having any scientific backgrounds and advertising evil propaganda against modern medicine(vaccine is a kind of modern medicine) on television channels regularly to sell their products which seems to affect a large section of population and even such act have produced hatred for healthcare personals which will affect vaccination programme negatively in short and long run. Why the government is silent over such issues is largely unclear and I am expressing my concern about divergent action of the government in response to such events which should be addressed properly and timely to create an environment of trust in the vaccination and healthcare system of India.

Another fact is that the vaccination policies, protocols and guidelines are changing time to time creating panic and misinformation and if it is not addressed properly and timely how India can achieve the full vaccination. We know that the change is required as per new findings of global scientists but the country must take the public's confidence before applying the changes. Another fact is that vaccination for a particular group starts at say 18-45 years and after some time it is declared that the vaccine is not available. Such a situation is creating panic and concern as well as mental trauma which should be addressed timely to avoid future conflicts and mis happenings. The old people who have taken the first dose and not getting the second dose are especially vulnerable groups to be addressed adequately regarding new guidelines such as getting second dose after 3 months etc. as most people think that it’s extended only due to unavailability of vaccines. Any new trial should be properly displayed on websites as well as addressed to the public properly to gain the public's confidence without which it is impossible to achieve full vaccination.

Properly, timely, adequate and well coordinated as well as focused strengthened risk communication efforts to mitigate barriers of covid-19 vaccination programme by regulatory agencies, important stakeholders and policy makers could help improve the situation. Governments should stress the safety and importance of vaccines through all the communication channels with transparency over all the issues and must suitably agree on common lines to explain and address scientifically as well as in common languages or local languages adverse events that have occurred with the vaccines or due to other reasons and similar problems that are emerging with other COVID-19 vaccines. Communication from experts to the public should be understandable, transparent, simple, and consistent as well as technical terms should be addressed in local languages as much as possible. All statements and facts about the risks associated with the vaccines administration should detail perspective, acknowledging the risks associated with COVID-19 and other common medications and substances, demonstrating with data, IEC etc, that how extremely rare these risks occurs, and referring to current evidence that the approved vaccines are safe, effective, and key to ending the pandemic can help to change the scenario of mistrust and panic at the same time addressing the concerns of the population.

For India it’s also a critical time to think about properly structuring the current health system anomalies to establish an international reputation. The COVID-19 pandemic added with Mucormycosis epidemic continues to expose tremendous vulnerabilities of the country's health system and weakness of management. It also highlights deficiencies in existing conceptualizations and structural integrity of health systems that overlook health security and health promotion, epidemiology, social and behavioural sciences, nutrition and many other prospects of Public Health. The global spread of COVID-19 has focused attention on roles of health systems in managing and mitigating health emergencies. At the same time it’s important to consider that about 70% of deaths are now caused by non-communicable diseases and already the health system is overburdened by the load of NCD and other CD. Although India is investing a very little of GDP on health, as per current scenario investing in both health security and health promotion is acute, urgent and necessary if India wants to reap the benefits of demographic dividend. While considering the goals of health security, public health and health promotion separately, we should frame policy decisions as making investments in one or the other, which is a false dichotomy obscuring the interconnected and central role of health systems in addressing both goals and achieving universal health coverage.

A well established robust healthcare system can contribute to managing diseases, epidemics, creating healthy populations, which in turn are better able to mitigate continuing and future epidemics. For example, communities with high burdens of obesity and chronic diseases living in improper ways without keeping safe distance, sanitation, improper lifestyle etc have greater COVID-19 risks, whereas healthier populations with good lifestyle and understanding of preventive and social measures are less susceptible to COVID-19 infections. Hence we should have a broader focus on healthcare systems with coverage instead of a singular focus on managing and controlling health emergencies which can also limit efforts to create healthy populations. Added to this COVID-19 control measures have reduced physical activity, create social isolation, and cause economic hardship, domestic violence, reduced immunization and mental health issues among other implications.

All of us know the fact that COVID-19 will not be the last pandemic on earth. Hence health systems need to be prepared, restructured, and focused to be able to handle new and evolving crises as part of learning from the covid-19 pandemic. Policy makers and important stakeholders of the health system also need to be empowered to address health risks beyond the health sector to be able to incorporate and involve other sectors to get an Intersectoral multi-departmental approach to address and mitigate the issues and concerns. It is important to mention that predominant focus on individual health care within existing health systems frameworks has neglected community as well as  population engagement and ignored the importance of knowing how policies, programmes, and systems could be designed to address health emergencies at mass level for creating healthier populations and protecting them at the same time.

Health systems frameworks should be adequate and flexible to be restructured time to time as per requirements and situations. All the existing frameworks should be evaluated to be able to achieve the Sustainable Development Goals and deal with the present COVID-19 era, and instead of  focusing on delivering clinical services only should also be responding to people’s rightful demand for care. However, health systems should be restructured in light of the learning’s from failures in  pandemic to go beyond this, and better serve the purpose of preparing and responding to anticipated (and unanticipated) future hazards and risks, and to produce healthier and more resilient societies. This restructuring and renovation matters because frameworks shape policy and investments also need to be changed accordingly. Restructuring the health systems means, shifting future investments into those functions which are either not available or needed to strengthen health systems to prevent further fragmentation of competing parallel investments in health security and health promotion of the population to move towards universal health coverage and achieve Sustainable Development Goals to ensure health and wellbeing.

Declarations
-This paper has not been previously published and is not currently under consideration by another journal. The document is Microsoft word with English (United States) language & 1984 words Total.

- Ethics approval and consent to participate: Not applicable. This study has not involved any human or animals in real or for experiments.

-Consent for publication: Not applicable

-Availability of data and materials: The data & materials for study are available as reference.

-Conflicts of Interest/ Competing Interest: There are no conflicts / competing of interest

- Funding-Self sponsored. No aid taken from individual or agency etc.

- Authors' contributions: The whole work is solely done by the Author - Dr Piyush Kumar, M.B.B.S. - Sri Krishna Medical College, EMOC- General Medical Officer- Bihar Health Services- Government of Bihar, India.

- Acknowledgements- I am thankful to my wife Advocate Anupama and daughters Aathmika and Atheeva for cooperation.

- Author information: The author is currently working as general medical officer for the government of Bihar.

-Financial Support & sponsorship: Nil

'''The article preprint is also submitted as preprint to various preprint server and preprint is having doi as well as searchable on various search engine. The article is not published in any peer reviewed journal.'''

Author Information
Dr Piyush Kumar

Senior Medical Officer

Health Department, Government of Bihar, India

MOBILE - +919955301119/+917677833752,

Email drpiyush003@gmail.com

Acknowledgements
I am thankful to my wife Advocate Anupama and daughters Aathmika and Atheeva for cooperation.

Competing interests
There are no conflicts / competing of interest

Ethics statement
Not applicable. This study has not involved any human or animals in real or for experiments.