Bringing Vaccines to Millions in India’s Stigmatized Communities

“Our partnership with Swasti has been a great example of quick, agile action while working through a wide-ranging public health crisis,” says Deepali Khanna, Rockefeller Foundation Vice President, Asia. “Swasti didn’t just step up to the challenge; they thought outside the box to reach the farthest corners of the communities they serve. That’s equity. Enabling access is where it begins for me.”

“As Covid-10 vaccine supplies are finally reaching countries that need them most, The Rockefeller Foundation’s Global Vaccination Initiative is focused on reaching at-risk populations,” added Dr. Bruce Gellin, Chief of Global Public Health Strategy, Health Initiative. “But you can’t just deliver vaccines to clinics. You also need to understand the community’s perspectives and invest in communication and connection—as they are in Bengaluru—to help people understand why they need them.”

The participatory process used to design the #VaxNow program was led by Dr. Angela Chaudhuri, who has logged nearly two decades of public health accomplishments in India and internationally and has worked for Swasti since 2004. She also helped create an extensive Rockefeller Foundation-supported “Covid-19 Playbook” to offer methods to meet and surpass vaccination targets.

The playbook, drawing on critical learnings from the India campaign that could be helpful globally, addresses why stigmatized and “last-mile” communities are often left behind in public health efforts, how to draw them in, the role of clinical and non-clinical staff, and various crucial decisions ranging from timing, location, advocacy materials and more.

One day, a government healthcare provider and a senior bureaucrat saw crowds at a #VaxNow site and asked Dr. Chaudhuri how she did it. Their vaccination efforts, they noted, had not been as successful. That exchange may encourage government public health leaders to partner more frequently with community groups, which would be a valuable outcome, she noted.

What that meant practically, he said with a laugh, is that “I was organizing chairs, counselling clients, cleaning up the venues—doing everything except giving vaccinations, but only because I wasn’t trained for that.”

Some 25-30 people staffed each pop-up vaccination site, registering patients, overseeing the process, helping maintain social distancing, administering vaccines, and providing counselling. Even obtaining permission to use school or religious centers as vaccination sites for a day was time consuming—only one out of every ten places they approached agreed.

She began to consider suicide but then found someone with whom she had her first relationship. When his family objected, and Jasmine’s parents died within six months of one another, she moved to Bengaluru.

There, she had a roommate who soon moved out, leaving her unable to afford the rent. She began working in a temple as a janitor in exchange for food. Then she became a sex worker, making a meagre salary of about 8000 rupees a month—but at enormous cost. She describes, for instance, a time when a client came with several companions who had all been drinking, and they raped her, forcing her to have unprotected sex multiple times.

One day, sitting in Cubbon Park in central Bengaluru, she was approached by someone from Samara Society Yeshwanthapur, a sexual and gender minorities rights nonprofit that partners with Swasti. This chance meeting marked a turning point; Jasmine began visiting the Samara office, where she was eventually hired to clean and run small errands for 800 rupees a month.

She went on to become a peer educator, an outreach worker and finally a community counselor, where she now makes as much as she once did as a sex worker. And eight years ago, she underwent gender-affirming surgery.

“We appreciate the outreach to the transgender community during Covid,” Jasmine said. “But people should know we are like any other human beings, and equal in front of the law. If they started accepting us, then we could live respectful lives like anyone else.”