Immunization is a global example when discussing success stories of health and development. Over the years, it has been recognized as a human right and a key component in primary health systems. It is a critical process for disease prevention and a health investment that secures our future. When we look at recent times, COVID-19 vaccines were life-saving inventions that underline the importance of vaccination and the immunization process.
While there are miles to go and more goals to achieve, Indian vaccination initiatives have gained momentum and given us some great headlines. Be it India’s drive for COVID vaccination, with more than 2 billion vaccines being administered, or its Universal Immunization Program (UIP), one of the most extensive public health programs that target approximately 2.67 crore new-borns and 2.9 crore pregnant women annually, there have been lessons and success stories for us to grow and adapt with.
But these achievements cannot be celebrated without applauding the cadre forming the first link of the bridge between community and health systems—the frontline workers.
COVID-19 was a stark example for us to realise the importance of resilient health systems, withstand such emergency situations, and respond while avoiding disruptions in routine services.
Working in remote villages and far-flung hamlets, these women providers were always at the forefront of controlling the pandemic, ensuring safety in aftereffects, and furthering community vaccination drives.
Frontline workers, especially in low- and middle-income countries like India, play a critical role as intermediaries for last-mile service delivery. In the Indian context, it is evident that the frontline workers are usually the first responders for emergencies and the first port of call in rural areas.
For communities to understand the importance of being vaccinated and rise above misinformation that takes over in situations such as the COVID-19 pandemic, female frontline workers, often in their trademark pink sarees, served as a case study across global platforms.
Vaccination, be it part of routine immunization processes or in the context of COVID-19, requires adequate planning and strategy to counter the challenges around scale and efficiency. These frontline workers were at the forefront in rural India—they spread health information about the need for vaccines, dispelled myths and misconceptions, and persuaded people to vaccinate. Most importantly, they delivered the vaccines.
The frontline workers’ perseverance and resilience allowed them to provide last-mile connectivity to guarantee vaccination for communities, even if this meant traversing forested tribal areas, hillsides, or extreme climatic and weather conditions.
They even played an invaluable role in countering vaccine hesitancy issues, convincing people and communities with lower literacy rates or low access to information, even at the personal risk of facing abuse or violent situations.
The efforts of women frontline workers in India have been cited as a case study exemplifying transformative work in the literature and research surrounding the COVID response, its aftereffects, and vaccine uptake.
Through Immunization Agenda 2030 (IA2030), India and the world are setting steps towards achieving the global vision and strategy for vaccines and immunization for 2021-2030. Acknowledging and drawing lessons from the impact and incredible contribution women frontline workers have made is essential.
Among other factors, the resilience of the public health system and its intervention at the primary level relies heavily on the shoulders of female frontline workers. So, if we want to reach the IA2030 vision, we need to be aware of how gender affects the resilience of systems. We also need to build more support for women to help them improve their skills, working conditions, and access to resources, and we need to give policy space for the problems they bring up.
Shikha Rana – Senior Research Manager, Sambodhi