Table 2 Broad categorization of ownership and fostering of CE by vaccine decision makers in India, 2018

1.

CE as a community empowering role

“Some journalist misinterpreted and had adverse reports. Honestly, we didn’t get that much support from authorities in my headquarters but my CAB met within few days and went ahead and said that we are willing to give out rejoinder to this news report because we know you have been very very meticulous about protecting the individuals, have been transparent and sensitive to community.”

2.

CE as vaccine delivery with the help of frontline workers

“I always appreciate my workers. The hard work that our ANMs and field staff are putting in in is tremendous. So, if we have coverage of 90%, it is not my contribution, it is all because of my field workers who are doing a great job”

3.

CE as a part of the organizational structure

“There was the country and the regional programs where there were advocacy efforts to engage the community. There was a representative in the senior management team from the CRP. Representatives of the Board of Directors, who in one capacity or the other were the advocates of the community.”

4.

CE as a proactive social and altruistic responsibility

“I remember there were two places in Tripura where the vaccines were transported through helicopter. First time Government of India gave that fund. Although the beneficiary children were only 15 I argued that if 100% children are to be immunized you have to somehow send the vaccines to this remote place. Else, it will take 7-8 days to reach there.”

5.

CE to comply to GOI and/or global mandates

“Since we did not have any great experience in vaccine trial and community engagement it (CE) was introduced to us through our sponsors and collaborators like National Institute of Health”

6.

CE as a duty delegated to the States and lower offices

“No no, we do not do that part. Government of India does not run the programs at the peripheral levels.”

7.

CE as vaccine imposition/delivery

“When children were dying and Japanese encephalitis vaccine was introduced, people were fighting to get the vaccine. There was a firing in three places. People got a notion that if the vaccine stocks were finished, we will go and their child will not get vaccinated, and so the rush and the panic ‘me first’ ‘me first.”