COVID-19 vaccination coverage and breakthrough infections in urban slums of India

By Nidhi Saha, BDSNov 30 2021Reviewed by Danielle Ellis, B.Sc.

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020. According to researchers, people living in overcrowded slums in metropolitan areas are at high risk for contracting COVID-19. In India, the divide between the affluent and the poor is becoming more apparent as the coverage of the COVID vaccination campaign spreads across the country.

Study: Covid-19 vaccination coverage and break through infections in urban slums of Bengaluru, India: A cross sectional study. Image Credit: Mr Subir Halder/Shutterstock

Some factors contributing to this divide include lack of access to cellphones, digital illiteracy, expensive immunizations, and skepticism about vaccines. There is an increased risk for the spread of COVID-19 among people living in urban slums where the general populace are migrants, who are less aware and lack access to health services. Vaccinating these high-risk individuals can help curb the growing epidemic by lowering the disease burden.

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Slum dwellers' reluctance to get vaccinated is a pressing issue that needs to be addressed. The COVID-19 immunization campaign in India mainly relies upon digital registration, which presents a significant barrier for poor urban communities. Until recently, COVID-19 vaccination coverage had not been adequately assessed in the context of Indian urban slums. This facet of vaccination will help policymakers take necessary actions to promote vaccine uptake, coverage, and achievement of desired national targets and mitigate the COVID 19 pandemic.

The study

A new study published in the medRxiv* preprint server aimed to identify COVID-19 vaccination coverage, examine the factors responsible for COVID-19 vaccination coverage and vaccine hesitancy, study adverse events following immunization (AEFI) pattern after COVID-19 vaccination and determine the prevalence of breakthrough infection after COVID-19 vaccination in Bengaluru, India's urban slums.

This study obtained data from 1,638 participants using a predesigned, pretested, structured questionnaire after receiving institutional ethics clearance and consent from study participants.

This cross-sectional community research was performed in urban slums belonging to the Urban Health and Training Centre, Department of Community Medicine, Akash Institute of Medical Sciences and Research Centre, Bengaluru Rural District, Karnataka, India.

Findings

Overall, 35.5-% of the study participants had received COVID-19 vaccinations, of which 91.42% were partially vaccinated. The remaining 8.5% were fully vaccinated (corresponding to data collected at the state and national levels during the study period).

The vast majority, 98.45-%, had received vaccinations at government health centers. However, 63.65% of Covishield vaccine recipients experienced side effects, while only 18.6% of Covaxin vaccine recipients reported side effects

Women reported adverse events more frequently than males, a finding that held true across all age categories.

Vaccination coverage was the highest among the 18-45 age group (37.75%), men (64.86%), Christians (47.05%), graduates (95.67%), clerical and skilled employees (70.75%), and the upper-middle socioeconomic class (72.41%).

Breakthrough infections were detected in seven out of 583 vaccinated individuals, depicting a prevalence of 1.2%.

Breakthrough infections were extremely common among partially vaccinated individuals (85.71%), as opposed to those among completely vaccinated individuals (14.28%). These were exclusively recorded in individuals who were immunized with Covaxin.

This investigation has a few limitations, such as – although the study examined the sociodemographic determinants of vaccine coverage in great detail, it did not examine the impact of critical issues such as misinformation related to vaccine safety and effectiveness. The relationship between vaccine uptake and trust in other sources of information, such as healthcare sectors and the media, has also been overlooked. In addition, the study participants' recall of the kind and duration of adverse events following the vaccinations could have been skewed.

According to the findings of this cross-sectional investigation, COVID-19 vaccination coverage was low in urban poor/slum neighborhoods. This study discovered a higher rate of breakthrough infections in the country compared to previous reports. Individuals who were just partially immunized had a much higher rate of breakthrough infections than those who were fully vaccinated.

The primary reason for vaccine hesitancy in the subcontinent is the possibility of experiencing mild or severe side effects following vaccination, which may pose the greatest obstacle to the global response against the pandemic.

The most probable cause for the widespread vaccine hesitancy in the country could be the rapid development of COVID-19 vaccines. Thus, a trusted, centralized source of information on vaccine safety and efficacy is desired to promote vaccine uptake by the general public. Furthermore, the spread of misinformation regarding COVID-19 vaccinations must be curtailed. This necessitates deploying interventional educational campaigns targeting populations at a higher risk of vaccine hesitancy.

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.