Adult TB Vaccination in India: The ASHA’s Dilemma

The Accredited Social Health Activist (ASHA) program in India is one of the world's largest community health worker initiatives, comprising women aged 25 to 60. ASHA workers are essential links between public health systems and local communities, each serving about 1,000 residents. They receive extensive training in health care delivery and are compensated through honorariums and performance-based incentives.

A new BCG revaccination study targeting high-risk adults has commenced in multiple Indian states in a "programme implementation study mode." Despite limited evidence of the vaccine's efficacy in preventing TB—highlighted by previous studies in Brazil and Malawi and a WHO advisory against revaccination—without further study, the Indian government has proceeded with this approach.  The reason - a traditional trial would be too time-consuming. The ambiguous nature of this approach, whether it is a vaccination campaign or a clinical trial, complicates matters.

ASHA workers are tasked with conducting surveys to identify eligible community members and mobilize them for vaccination. This places ASHA workers in a challenging position, as their training has not transparently communicated the study's details. The author’s conversations with ASHA’s revealed that they were unaware if this intervention was a study or of the potential side effects of the vaccine and its limited benefits. Additionally, some ASHA’s were also unaware that the nature of participation was voluntary and required a written informed consent.

This comic aims to voice the concerns of ASHA workers and highlight the ethical dilemma they face while balancing their public health duties with maintaining community trust.

Edited by Parth Sharma.