In Covid vaccinations, India must scale up and distribute widely and equitably


India has been vaccinating its citizens with domestically manufactured COVID vaccines since January 2021. The government has adopted a phased approach in vaccinating its population — first the at-high-risk populations, then the 60-plus and from April onwards, everyone over the age of 45 years is eligible. A digital platform, CoWIN, has been set up to register beneficiaries for the vaccine at the front end and for planning, implementation and monitoring of the vaccination drive at the backend.

As of April 10, India has delivered more than 100 million doses of the COVID-19 vaccine, the fastest country to reach this mark. However, through the course of the vaccine rollout in the country, there have been — justifiably — frequent conversations on the need to scale up the speed of vaccination delivery. India needs to vaccinate many people, and the only way to get to that quickly is to have a greater number of vaccinations happening daily. At the same time, it is equally important to understand that the rationale for any scale-up strategy must be based on a scientifically directed approach while maintaining process safety, quality and integrity. Let us consider this from the perspective of these three pillars — product availability (vaccine supply), people (trained vaccinators) and places (vaccination centres).

First, take the production and manufacturing of vaccines. India is a global hub in vaccine manufacturing — and has been a leading vaccine supplier to the world. Estimates suggest that the indigenous manufacturing capacity for the COVID-19 vaccines is hovering in the range of 70-80 million doses a month — and there are plans in place to ramp up production. Many countries are also looking to India to export vaccines for their urgent needs. However, vaccine production is a complex process and manufacturing capacity cannot be created in a short timeframe. Besides putting together the requisite financial resources, specialised skilled human resources and systems in place — such as the import of select raw material from countries abroad — most crucially, Good Manufacturing Practices (GMP) for biological and pharmaceutical products have to be followed thoroughly by all manufacturers. Scaling up of production capacity must be in tandem with the ability of manufacturers to ensure adherence to GMP.

Second, there is a need to deploy sufficient trained vaccinators. The authorities were aware that the Universal Immunisation Programme’s workforce would not be enough to roll out the COVID-19 vaccination programme. All health workers involved in the implementation of vaccination need to have adequate knowledge and skills to ensure safe and efficient vaccine administration. Training must be robust and complete and must cover a wide range of aspects — including knowledge on storage, handling, delivery and waste management of COVID-19 vaccines; organising COVID-19 vaccination sessions and AEFI monitoring. And there has to be an active collaboration with doctors, nurses and technicians from private facilities to meet vaccination needs.

Training health workers is also critical to address vaccine hesitancy and build public trust. However, this training agenda is itself a mammoth task involving state and district programme managers, medical officers, vaccination officers, information, education and communication officers, cold chain handlers, supervisors, data managers, ASHA workers, and Mahila Arogya Samitis. All these aspects and actors need adequate support and engagement to ensure that we have a skilled and trained workforce to deliver COVID-19 vaccination to the country’s citizens. Over the past few months, the government and the public and private health system have done herculean work in this regard. This has been done quietly and behind-the-scenes, and needs to be appreciated.

Third, we need vaccination centres that are accessible and acceptable to people. The centres also need to have adequate space for mandatory monitoring for any adverse events immediately following vaccination. In the first phase, authorities have been leveraging the infrastructure of the UIP for COVID-19 vaccination — a network of nearly 82 lakh vaccination centres. Now, private sector facilities are also open for administering the vaccine. This requires an extraordinary level of coordination and preparedness at each centre.

Critical to all this is vaccine equity. While prioritising vulnerable populations is the need of the hour, with numbers of cases on the rise once again, we also need to consider opportunities to vaccinate an increasing number of citizens, who are often asymptomatic spreaders. Similarly, as we strengthen partnerships with the private sector for rapid scale-up, we also need to keep in mind affordability — so that the maximum numbers of people have equitable access to the vaccine. We have to be vaccine agnostic to ensure ease of access — especially for the most marginalised, vulnerable groups.

In the long term, we can also explore a “cafeteria approach” of bringing more affordable, global vaccine alternatives to market, while simultaneously stimulating indigenous production. In a pandemic, however, demands for market-driven exports and market-driven prices of foreign vaccines that are not available in the public immunisation programme pose not just ethical challenges but could lead to unnecessary questions and doubts about the quality of vaccines being administered by the government health system. Such demands are best avoided till a time — in the future — when hopefully an abundance of vaccines will be available and there will be no shortages. That time has not come.

Over the last year, an unprecedented collaboration between governments, civil society, private sector, scientists, vaccine manufacturers, healthcare personnel, media and citizens has helped minimise death and sickness from this virus. Today, we are fortunate to have a better idea of how to treat the very sick patients, as well as accessible, quality anti-virals and antibiotics and effective vaccines to deploy against this pandemic. But as the second wave of the pandemic unfolds, the only way to cut off the chain of transmission is to focus on relentless adherence to COVID-appropriate behaviour and continued emphasis on testing and tracking, alongside vaccination.

As this mammoth vaccination exercise is rolled out, each citizen’s behaviour in managing their own health risk and exposure will be critical for communities and the country to overcome this devastating pandemic.

The writer is former director general, Indian Council of Medical Research

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