Fear and faith

The attempt to inoculate Himachal’s Malana village amid vaccine hesitancy

Bai Ram, a 63-year-old resident of Malana village in Himachal Pradesh, reacts as he takes the first dose of Covishield on 28 May 2021. That day was the second attempt by the health department’s medical team to vaccinate people in Malana.
Photographs and Text by Sayandeep Roy
18 June, 2021

Situated to the northeast of the Kullu Valley in Himachal Pradesh, Malana is a small, remote village nestled in the Himalayas. It is located in the Jari block of Kullu district and stands separated from the rest of the region by the Malana river, also called the Malana nala. To reach Malana village, one has to travel on a mountain road up to a gate which says, “Way to Malana village.” The car drops you at that point. From there, one has walk downhill to the river, cross a bridge, and then hike up to the village on the other side of the valley.

In May 2021, I came across a news report that villagers of Malana were resisting vaccination against COVID-19, citing a diktat from their local deity. There were no COVID-19 cases in the village. I decided to travel to Malana. I wanted to explore how vaccination was unfolding in Malana, and to document the efforts of healthcare officials in carrying out the process in this remote village. The difficulty of such projects in mountains and remote regions of India often goes unnoticed.

Vials prepared for routine immunisation of the children of Malana lie at the community health center in Jari, on 28 May. The medical team administered the children’s standard vaccinations on the same day as the COVID-19 vaccination because travelling to Malana with the medical kits is a challenge in the remote, mountainous region.
On 28 May, before they headed to Malana, the medical team labelled the vials of COVID-19 vaccines at the community health center in Jari so that they do not get mixed up with the vials of routine immunisation of children.

In Malana, the belief of villagers that their deity warned against the vaccination added to the challenge. The people of Malana worship a deity named Jamdagni Rishi. According to the villagers, the deity speaks to them through a medium—a person or people chosen by the deity. They refer to these people as “Gur.” The Gur conveys the deity’s directions to the villagers. To many, the deity’s words are final. Villagers I spoke to said the deity had communicated to them that they should not be vaccinated. Prem Singh, the medical supervisor of Jari also told me that villagers had told him of their reluctance to get vaccinated because of the deity’s message.

On 19 May, before I headed to Malana, I got in touch with Sapna Sharma, the block medical officer of Jari. She is leading the healthcare team responsible for vaccination in Jari. She told me that after multiple attempts they managed to convince the villagers to take the vaccine and would start the drive as soon as possible. She was worried that any delay might lead to further resistance from the villagers. She had spoken with the village pradhan and sent her team to talk to the residents, to explain that the vaccine is safe.

The medical team’s car makes its way through the rugged road to Malana. After Jari, the route is an alternating combination of smooth patches and mud-roads.

On 22 May, they attempted the first vaccination drive. That day, Sharma herself went with the team hoping to convince more people once they reach. The village panchayat had taken the responsibility of registering as many villagers as they could and managed to get more than 70 people onboard. However, only 36 people took the vaccine that day. One of the primary obstacles the team faced was the fear of the villagers. “They don’t trust us,” Sharma said. She referred to Nirma Devi, an Accredited Social Health Activist, or ASHA worker. “Even Nirma, who is one of our primary contact points in the village, demanded that we give written confirmation that there will be no fatal side-effects,” Sharma said. Eventually, they managed to convince Devi. They persuaded her by saying that Sharma and her medical team had also taken the vaccine and that they were doing absolutely fine. Devi went on to register some more villagers after that, often walking around the village and going door-to-door. After the first attempt on 22 May, Sharma decided to send her team to Malana again within a week’s time.

On 24 May, I reached Bhuntar, a town near Malana. I met with Sharma and Singh. Singh told me that he has been in regular contact with Raju Ram, the village pradhan, to make sure he tries to motivate more people. “Pradhan ji is an understanding person, he has been much more accepting than the villagers,” Singh said. “I have kept in touch with him and requested him to tell more people to come for vaccination, repeatedly.” Ram had been the first person from the village to get the jab.

Vials of vaccine and medical kits being transported to Malana, seen in the distance, by a system known as the “gravity goods ropeway,” along with bags of bricks for regular construction use.

On 26 May, two days before the second vaccination attempt would take place, I went to Malana. On the way to the village, I met three locals who inquired about the purpose of my visit. Two of them suggested that outsiders should not go to the village at the moment as it puts locals at risk. The village has tried to keep outsiders away since the COVID-19 pandemic began. “Our deity has promised to protect us as long as we don’t mingle with outsiders much,” a villager told me. “This is a holy place,” the villager added. “Jamlu Devta’s blessings have kept us safe.” Locals also refer to Jamdagni Rishi as Jamlu Devta. I explained that I have got myself tested and was working to document the efforts of the medical team of Jari. Another woman I met from Malana confirmed to me that villagers are afraid of the vaccine as they believe their deity has told them not to take it.

At Malana, I met Devi who was going door-to-door to try and get more people registered. As I accompanied her, she went on to register a total of seven people in the next two hours. In most cases, she had to provide reassurances that there are no serious side-effects of the vaccine and that people would not die after taking it. “It takes up to half-an-hour at times to convince one person,” she said. “Even after long conversations, some people don’t comply.” By the end of that day, she had managed to get more than 20 people registered.

Shichi Angmo, Kanta Devi and Pratibha Thakur, part of the medical team, make their way uphill towards Malana, after crossing the Malana river.
Nirma Devi, the only ASHA member from Malana, speaks to two villagers prior to getting their name registered. “It takes up to half-an-hour at times to convince one person,” she said. “Even after long conversations, some people don’t comply.” The fear that their deity does not want them to get vaccinated and lack of knowledge about the vaccine continue to be obstacles for the healthcare team.

On the morning of 28 May, at around 8 am, the medical team set out for the second vaccination drive. I accompanied the team. Singh started from Bhuntar along with his wife Shichi Angmo, a health worker. They made a stop to pick up Kanta Devi and Pratibha Thakur, both community health officers, who joined the team. Upon reaching the community health centre in Jari, the team picked up the vaccines and changed vehicles for the rest of the route.

From Jari, the road moves further north and the stretch becomes rugged. Along the route, one sees dense forested hills and overhanging rocks. As you cross the Malana check post and the dam, the path takes a sudden steep uphill turn. After crossing a few more hairpin bends, you get the first glimpse of Malana, perched on a hillside, seemingly secluded from any other sign of civilization. What meets the eyes is a cluster of homes amidst dense greenery. 

In Malana, villagers believe that their deity has warned them against vaccination. The people of Malana worship a deity named Jamdagni Rishi. According to the villagers, the deity speaks to them through a medium—a person or people chosen by the deity.

On the way, the car stopped in front of one of three “gravity ropeways” that transport goods to and from Malana. It is a system used in many mountainous villages across India and Nepal, where the ropeway works by the means of gravitational force. Different products are transported via different ropeways, depending on where they need to reach in the village. This also helps the people of Malana to avoid stepping out of the village unless necessary. The team decided to transport the vials of the vaccines using the gravity ropeway so that they would not have to carry them during the hike to Malana.

As we drew closer to Malana, the car dropped us almost opposite the village. From that point, we went down to the Malana river and then hiked up to the village. The route takes about forty to fifty minutes. After reaching the village, the team headed to the village primary school, which doubled up as the COVID-19 vaccination centre. Along the way, some elderly villagers who were already convinced that the vaccine is harmless, inquired if this was the vaccination team and tagged along. Seeing their positive attitude, Singh suggested that they bring along more people. Ram, the village Pradhan, soon came to greet us.

That day the team also conducted on-the-spot registration. A new problem emerged. Vaccine registration requires the phone number of an individual. Some villagers were not aware of their phone numbers. Others who had been registered by Devi did not know which phone number they had provided. The medical team then had to take the villagers’ phones, one by one, and make a call to one of their own phones to check the number of the incoming call. As a result, the process took longer than expected and the verification was taking up to three minutes. This situation was a testimony to the technology-based primary structure of the vaccination system that ignores the realities of remote and rural India.

A villager speaks with the Prem Singh, the medical supervisor of Jari block and a member of the vaccination team, prior to getting himself and his wife vaccinated. Singh explained the post-vaccine protocol to many villagers, including the usage of medicines in the event of side-effects.
Vaccines and medical kits kept in front of the vaccination room at the primary school in Malana. The school doubled up as the COVID-19 vaccination centre.

The team had 150 vials of the vaccine. By 4 pm, only 27 people had taken a shot. Angmo sent Devi to try one last time to convince more people. However, Devi was not hopeful as many had already declined. After another half an hour, she informed the team that no one else was willing to come along. The village pradhan was there throughout the process. I asked him about the deity’s warning. “This is medication, why would our deity forbid it,” Ram said. “It’s actually the fear of villagers as they don’t know how the vaccine works.” I also asked him about allowing outsiders into the village. “We had strict security at the entry points to the village when the numbers of cases rose and will think of implementing the same in future for people coming from containment zones if needed,” he said.

As the second vaccination attempt wound up, I asked the medical team about their next plan. Sharma said she would wait for some time before deciding when to send her team for a third attempt at vaccination. “We shall keep up our effort and make sure to vaccinate everyone,” Singh said. “We are not giving up.” As of 17 June, Malana village still had no COVID-19 cases.

Many villagers who were registered beforehand did not know their own phone numbers. As a result, the vaccination team had to make a call from the villagers’ phones to their own phones, to confirm the registered phone number.
A group of women wait for their turn in the shade of a building adjacent to the vaccination centre.
A man wears his sweater back up after taking the vaccine.
Village pradhan Raju Ram discusses plans for vaccinating the 18-44 age group with Singh and Angmo, while waiting for more people to turn up for the vaccine. On 28 May, only 27 people took the first dose, taking the total count of people vaccinated in Malana to 63.
Two elderly men wait for their turn on the roof of a building adjacent to the vaccination centre.