Marium Imtiyaz’s second child, Meisha, a girl, was born on 15 April, just a month after the outbreak of the coronavirus pandemic in Kashmir was confirmed and cases had begun to emerge.

At that time, cases were relatively fewer and a harsh lockdown was enforced across the Valley. Ms. Imtiyaz, a resident of Wazbagh in uptown Srinagar’s Hydperpora area, was unable to register her daughter for vaccination in a government-run dispensaries vaccine programme.

“She has not been registered at the local dispensary because it was closed during lockdown,” said Ms. Imtiyaz. “We could only get two vaccines done till now, for Hepatitis B and DTP (diphtheria, tetanus toxoids and pertussis) vaccine.”

At first, Ms. Imtiyaz had wanted her daughter vaccinated at a private healthcare facility just like her older child was; she has a mistrust of government-run hospitals since the increase in the COVID-19 cases and did not want to take chances with her children.

However, as the lockdown continued, Ms. Imtiyaz was compelled to visit the nearby government run health center in Narkara. A graduate by qualification, Ms. Imtiyaz has, since then, been deeply anxious about the well-being of her infant. “The situation was better, and safer when my first child was born,” she said. “This time, it is different.”

Owing to a continuous lockdown and the lack of public transport, the 36-year-old homemaker has not been able to take her daughter for regular health checkups owing to the uncertainty arising out of repeated and abrupt lockdowns. “I don’t even know whether she is healthy or not,” said Ms. Imtiyaz. “I am scared for her life and I cannot take her to a place where getting infected is so easy.”

Immunity worries

Far from the Srinagar city, where healthcare infrastructure is comparatively better than the rest of Kashmir, 30-year-old Mir Abdur Rauf, a government employee from south Kashmir’s Pulwama district, struggled to get his twin babies vaccinated.

“I kept calling the [government run] vaccination clinic in April for the vaccination of my twin babies but they kept stalling,” said Mr. Mir. “I called all [medical] helplines to find out whether we should be worried because of the delay [but got no response].”

As a result of the delay, Mr. Mir said that his children have missed most vaccination shots that were not available at any hospital during the lockdown. He is now hoping for the situation to ease so he is able find a way to secure the vaccines for his children.

As the world over discussed immunity to and the possibilities of a vaccine for the COVID-19, the immunization of children against older and established diseases—more importantly, against which vaccines have long been developed—was halted.

The vaccination process that starts at the time of child birth lasts till the child reaches the age of ten. With the outbreak of COVID-19, the Jammu and Kashmir administration had halted the process of vaccination, only to give in as there seemed no signs of the pandemic withering out any time soon.

Dr. Muzaffar Jan, who heads the pediatrics department at Srinagar’s prominent GB Pant Hospital, worryingly noted that “the ratio of babies getting vaccinated is lesser than before [the outbreak of COVID-19].”

According to Dr. Jan, parents were scared of visiting the often crowded government run hospitals with their children, fearing the risks of contracting the coronavirus. Additionally, public transport has been off the roads since the lockdown began, leaving many with no option of travelling to health care facilities far from their homes. “So they avoid the vaccination process,” he said.

Dr. Jan said that it was imperative for parents to get their children to hospitals and get them vaccinated on time, failing which would lead to “a bigger problem”. He added: “If a child doesn’t die of COVID-19, he or she will die of some other communicable disease if the vaccination is not done.”

If babies are not vaccinated on time and a disease spreads in the community, said Dr. Jan, the children would be vulnerable. “If the vaccination isn’t allowed [by parents] on time, vaccine preventive diseases could come back and harm children,” he said. “Then things can get really complicated.”

Failure to get children vaccinated can lead to serious illnesses among children and countries, where there is public opposition to vaccination—for instance, in Pakistan—have reported high cases of diseases like polio—which India has eradicated years ago.

On 15 July, the United Nations warned against the decline in the number of childhood vaccinations because of COVID-19. According to a recent survey conducted by UNICEF, the UN’s child welfare body, the World Health Organization and Gavi, a public-private partnership by the Bill and Melinda Gates Foundation, “the likelihood a child born today will have all recommended vaccines by the age of 5 is less than 20 per cent.”

The survey was conducted over eighty-two countries, including those with advanced healthcare infrastructure, where it was found that the vaccination process has disrupted due to the pandemic. “The avoidable suffering and death caused by children missing out on routine immunizations could be far greater than Covid-19 itself,” said the WHO Director-General Tedros Adhanom Ghebreyesus.

For Srinagar resident Fatimah Beigh, however, despite getting her baby vaccinated she was not at ease. “The biggest fear that one has is that the doctor vaccinated every baby wearing the same gloves,” she noted with worry. “One cannot be sure when a mishap happens.”

Ms. Beigh had given birth to her first child during the pandemic. Due to the unavailability of vaccines in private healthcare facilities, she decided to take her newborn to the GB Pant Hospital.

“I decided to take my daughter to the hospital because one cannot risk keeping the baby waiting for the vaccine till all of this ends,” she said. “I was quite apprehensive to take her there but what other options did I have?”

A system in dysfunction

Records of vaccinations are kept by several hundred Anganwadi workers–community based voluntary healthcare workers in rural areas, tasked with providing basic health care–go door-to-door to remind parents when their children’s vaccination is due. 

Besides keeping a track of the vaccinations, these workers also educate pregnant women about the nutritional needs of their children and distribute food among the pregnant women and nursing mothers.

Before the lockdown, Suraiya Tabasum, 38, an Anganwadi worker in downtown Srinagar’s Zainakadal, would see at least twenty-five children every day, conducting their basic health checkups and vaccination records. After the COVID-19 lockdown, the rush of mothers and children had completely stopped.

“Currently, no mother is visiting our Anganwadi center with their children,” she said. “People are scared because of the pandemic. They do not even come to take the food for their children anymore.”

According to Ms. Tabasum, many parents do not get their children vaccinated due to the fear of getting in contact with a positive person. “We conduct surveys and visit families. During the lockdown, we faced a lot of problems initially,” she said. “I kept going from door to door to convince them how important the vaccination was no matter what the circumstances were but the families did not even open doors to us.”

“I remember once visiting a family for the sake of knowing about the vaccination process of the recently born baby. They didn’t open the door for me, I kept knocking and I kept trying to convince them that we only wanted to talk about the vaccination,” said Ms. Tabasum.

Anganwadi workers along with their helpers are now trying to spread awareness about the importance of vaccination of children for the immunization of children and are also delivering the food to the doorsteps of families.

“Families are reluctant to come to Anganwadi centers, take the food for their children and to even get the children vaccinated. So we continue to do it by going door-to-door because this is our job and we do this for the people. COVID-19 has scared everybody,” said Ms. Tabasum. “We want to make them understand that we take all necessary precautions.”

The cover story was originally published in our 10 – 16 August 2020 print edition.