India had launched inoculation of its population with domestically manufactured COVID vaccines since January 2021 but the rate of vaccination has fallen over the last two weeks. The government has adopted a phased approach in vaccinating the population — first the high-risk citizens, then those above 60 years of age, all above 45 after that and from April 28 onwards, everyone over the age of 18 will be eligible. A digital platform, CoWIN, has been set up to register beneficiaries for the vaccine in order to plan, implement and monitor the vaccination drive.
As of April 22, India has delivered more than 13 crore doses of COVID-19 vaccine, emerging as the fastest country to reach this mark. However, through the course of the vaccine rollout in the country, there have been active discussions on the need to scale up the speed of vaccination delivery. India needs to vaccinate too many people, and the only way to reach that target 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 safety, quality and integrity in the process. Let us look at the crucial factors involved in the purpose — product availability (vaccine supply), people (trained vaccinators) and places (vaccination centres).
Regarding 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 COVID-19 vaccines hovers around the range of 70-80 million doses a month and certainly there are plans in place to ramp up production. Many countries are also depending on India to export vaccines for their urgent needs.
However, vaccine production is a complex process and manufacturing capacity cannot be created within 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. A boost in production capacity must necessarily be in tandem with the ability of manufacturers to ensure adherence to GMP.
Secondly, there is a need to deploy sufficient trained vaccinators. 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 vaccines; organising COVID-19 vaccination sessions and AEFI (Adverse Events Following Immunisation) monitoring. Also, there has to be an active collaboration with doctors, nurses and technicians from private facilities to meet vaccination needs.
Training healthcare 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 and primary field staff like ASHA workers. All these aspects need adequate support and engagement to ensure that there is 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 along with private health system have executed a herculean task in this regard which deserves to be greatly appreciated.
Most importantly, 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 population is the need of the hour, with the number of active cases on the rise once again, opportunity to vaccinate an increasing number of citizens, who are often asymptomatic spreaders also needs to be paid due attention.
Similarly, as partnerships with the private sector occurs for rapid scale-up, affordability has to be considered a key factor so that maximum number of people have equitable access to the vaccine. To be vaccine agnostic is also important to ensure ease of access, especially for the most marginalised, vulnerable groups.
In the long run, bringing more affordable, global vaccine alternatives to market may be explored too, while simultaneously stimulating indigenous production. In a pandemic, however, demands for market-driven exports and 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 vaccines will be available in abundance and there will be no shortages. That time has not yet come.
Over the last year, an unprecedented collaboration among governments, civil society, private sector, scientists, vaccine manufacturers, healthcare personnel, media and citizens has helped minimise death and sickness from this virus to a considerable extent. Today, we have a better idea on how to treat the severely sick patients, as well as have access to quality anti-virals, antibiotics and effective vaccines to fight this pandemic.
Nonetheless, as the second wave of the pandemic unfolds, the only way to break 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 enormous vaccination exercise is initiated, each individual’s behaviour in managing his own health risk and exposure will be critical for communities and the country to overcome this devastating pandemic.
(Dr Anjana Kannankara is the chairperson at CSA, director of TGL Foundation, senior director at FWO and Editor of The International Journal)