COVID-19 Vaccination Outreach to Vulnerable and Remote Communities in Bihar, India: Lessons from an Assessment of an Innovative Program

Background and objectives During the peak of the COVID-19 pandemic, equitable delivery of COVID-19 vaccines was one of the major challenges in policymaking. In search of innovative solutions, Project Concern International (PCI), with support from the Packard Foundation and the Government of Bihar developed and tested a human centric design to vaccinate the populations in disadvantaged geographies and from vulnerable subgroups. This study aims to examine the association of the intervention on improving vaccination coverage in the project area as well as across various population subgroups. Data and Methods The study is based on a quasi-experimental design with intervention and comparison arms comprising of 100 villages each. Data on COVID-19 vaccination coverage and other socioeconomic correlates was collected through cross-sectional household survey in July 2022. The survey covered five randomly selected intervention districts (Arwal, Kaimur, Katihar, Madhepura and Jamai). Descriptive statistical analysis, logistic regression, and propensity score matching (PSM) techniques with diagnostic checks are applied to discern the association of the project intervention on COVID-19 vaccination coverage. Results There was a significant improvement in vaccine uptake of two or more doses of vaccine in the intervention arm (intervention-83%, comparison-74%). 56% of pregnant women, 82% of the people suffering from critical illness and 82% of the differently abled people received two or more doses in the intervention arm. Women, educated individuals, and those with access to mobile had higher likelihood of vaccine coverage. The PSM analysis confirms that the intervention area had about 10%-point higher coverage of COVID-19 vaccination then the comparison area. Conclusion The RECOVER Bihar intervention was significantly associated with increased uptake of the COVID-19 vaccine among all categories of beneficiaries, including vulnerable categories. The learnings from the program design can be adopted in other programs to reach hard-to-reach and vulnerable populations. This will help to increase access to vaccination among vulnerable communities in various low-income and resource-poor settings.