COVID Vaccine Trials Continue, But How To Vaccinate All Of India?

An exercise of this scale requires close coordination at all levels of govt and multi-sector collaboration.

Image used for representational purposes.

(Photo: Shruti Mathur / The Quint)

Several COVID-19 vaccine candidates are currently at different stages of clinical trials. While the first and most important milestone is developing a vaccine for use at scale which is both safe and effective, plans to distribute the vaccine to the entire population are also being drawn up in parallel.

This is important because vaccinating such a large population in a reasonable timeframe will undoubtedly be a mammoth task.

However, it is not an impossible one, and can be enabled by a focus on the following elements.

Prioritisation Of Population For Vaccination Against COVID

Firstly, a high-level distribution plan needs to be developed based on the number of people who are to be vaccinated against COVID during different phases of the immunisation programme across all States and Union Territories of India. The prioritisation frameworks developed by the World Health Organization (WHO) and the US’s Centers for Disease Control and Prevention (CDC) specify the population groups which are at the highest risk of contracting the disease or developing severe symptoms.

These include health workers, including those providing allied services like sanitisation, followed by people with underlying conditions like cancer, heart disease, chronic kidney disease and diabetes.

The next major category in the vaccine prioritisation frameworks is social and employment groups like slum dwellers and low-income migrant workers whose living or working conditions inherently make it difficult for them to practice physical distancing.

COVID Vaccine Programme: Micro-Planning & Decentralisation Required

While evidence till date suggests that the risk of severe disease or fatality is higher among men, the WHO and CDC prioritisation frameworks recommend giving due consideration to existing gender-related disparities in access to healthcare and social standing which might adversely impact the equitable distribution of the vaccine.

The Central Government is building a comprehensive list of health personnel across the country who will be the first to receive the vaccine once it is available, along with other frontline workers.

A similar exercise will need to be carried out for the other high-risk population groups as well.

Further, while high-level planning will inevitably take place at the Central and State levels, management of the COVID vaccination programme should be decentralised to districts so that they can formulate and implement plans which are best suited to their local context. Such micro-planning is an integral part of the Pulse Polio Programme as well.

Detailing Delivery Sites For COVID Vaccine

Another key aspect of decentralised management is constitution of district-level task forces for overseeing all aspects of vaccine roll out. Similar governance mechanisms were put in place as part of Mission Indradhanush, a programme launched by the Central Government to enhance routine immunisation coverage among pregnant women and children.

A district-level implementation plan which covers details of resource mobilisation from various sectors within and outside the government, modalities for capacity-building of all concerned personnel as well as a community outreach and communication strategy, should be prepared.

The plan should also detail the delivery sites for the vaccine including facilities like schools, colleges and pharmacies which may be repurposed in order to prevent overcrowding at health facilities.

Leveraging Technology

Third, technology needs to be leveraged extensively for several key functions such as informing beneficiaries about their immunisation schedule and vaccine delivery site; tracking the number of beneficiaries who have been vaccinated along with the number of doses administered as well as monitoring the vaccine stocks, cold-chain temperatures and supply chain.

The Government is planning to upgrade and customise the Electronic Vaccine Intelligence Network (eVIN) which has been used in the Universal Immunisation Programme for digitising vaccine stocks and monitoring cold-chain temperatures.

While eVIN currently geo-tags health facilities, its ambit would need to be expanded to include schools and other types of facilities that could be utilised as delivery sites for the COVID vaccine.

Further, technology has a vital role to play in developing and delivering online training modules for health personnel and other stakeholders in a situation when offline training sessions cannot be organised due to physical distancing norms or are less efficient given the scale at which capacity building needs to be undertaken.

Need For Customised Awareness Programme

Fourth, an awareness creation plan which can be customised to the local context in different parts of the country, must be formulated.

The plan should detail strategies for addressing any apprehensions about the vaccine as well as dispelling misconceptions. Even though some vaccines have been part of the routine immunisation programme for decades, boosting demand and quelling myths still remains an important challenge.

The COVID vaccine, in fact, will be completely new, making community engagement, through mass media as well as local communication channels, even more crucial for ensuring the success of the immunisation programme.

Additionally, heightened efforts should be made to identify any unexpected adverse reactions experienced by individuals post vaccination. While such surveillance is routinely carried out for any drug or vaccine, it is especially vital in the case of a newly developed vaccine for a novel disease.

Coordination At All Levels Of Govt – And Multi-Sector Collaboration

Fifth, an exercise of this magnitude cannot be undertaken successfully without close coordination at all levels of the government as well as collaboration with the private sector and civil society.

One of the reasons behind the success of Mission Indradhanush, was the mobilisation of a large number of ministries including Women and Child Development, Panchayati Raj, Human Resource Development and Minority Affairs.

The Ministries of Defence and Railways were also involved with transporting supplies and expanding the delivery channels. Strategically involving multiple sectors and actors to generate adequate financial resources, strengthen vaccine supply chain management, distribution and community mobilisation is imperative.

Covering well over a billion people with a vaccine in a pandemic situation is never going to be straightforward, however, it is doable if the aforementioned ingredients come together.

Reinventing the wheel completely is not necessary. We must leverage the tools and networks of previous and ongoing immunisation programmes as well as invest in partnerships, training and technology on a war footing.

(Urvashi Prasad is a Public Policy Specialist with NITI Aayog. She's writing this in her personal capacity. She can be reached at @urvashi01 on Twitter. This is an opinion piece. The views expressed in the article are the author’s own. The Quint neither endorses nor is responsible for the same.)