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Calling the shots: Who, when, where and how

TV Jayan | Updated on January 07, 2021

Safety in numbers: The availability of Bharat Biotech’s Covaxin will be limited to around 150 million doses till July this year   -  REUTERS/ AMIT DAVE

India is ready with two vaccines to beat the deadliest virus of recent times. The immunisation drive, however, is still in the planning stage. A quick overview

*Around 1 crore people — from doctors to ward staff — work in public and private healthcare facilities across the country

* Next in the queue are about 2 crore front-line Corona warriors — people in essential services in addition to armed forces, paramilitary and police personnel

* The names of those above the age of 50 will be taken from the electoral rolls prepared for Lok Sabha and Assembly elections

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First things first. Two Covid-19 vaccines produced in India have been approved for roll-out, subject to conditionality.

While social media is abuzz with reactions to the development, the question that is on top of almost every mind surrounds the order in which the vaccines will be administered to the people of the country. Health secretary Rajesh Bhushan told the media ealier this week that the vaccine roll-out would commence within 10 days of the drugs regulator’s approval. The vaccines received the green signal on January 3.

The young — below the age of 50 in this regard — who are free of lifestyle disorders such as diabetes, obesity and hypertension or chronic diseases such as cancer and respiratory ailments have to wait the longest for immunity from the virus that has claimed 18.5 lakh lives across the world so far.

To begin with, the availability of the vaccine is going to be limited in the next few months. The plan drawn up by the government prioritises 30 crore people for the vaccination. This would amount to 60 crore vaccine shots because both the vaccines in India for restricted use — Serum Institute of India’s (SII) Covishield and Bharat Biotech’s Covaxin — are two-dose vaccines. Beneficiaries need to take two shots four weeks apart for immunity.

The task is a mammoth one. Even the “priority” population to be vaccinated in India would be close to the entire population of the US. In comparison, the UK would be vaccinating only a tenth of the volume (3 crore, around 50 per cent of its population) in the first phase.

The SII has so far committed 100 million doses of Covishield at a discounted price of around ₹200 a piece to the government. It could, however, supply additional doses of the vaccine if the government orders more. According to SII CEO Adar Poonawalla, the biotech and pharma company has the capacity to produce 100 million doses of the vaccine every month.

Bharat Biotech MD Krishna Ella, on the other hand, said on Monday that the availability of Covaxin would be limited to around 150 million doses till July this year. The pricing of the vaccine is still not known, though.

There are other vaccine candidates, too. Two of those — Zydus Cadila’s ZyCoV-D or Russian vaccine Sputnik-V, produced domestically by Dr Reddy’s Laboratories — are undergoing clinical trials and are expected to be available, if efficacy is proven, by around March.

Since supply in the country will be regulated by the government, citizens cannot seek vaccination, even if they are willing to pay for it, unless the government allows them to do so.

First serve

For a smooth roll-out, the National Expert Group of Vaccine Administration for Covid-19 (NEGVAC) has drawn up a list of priority groups for the vaccination.

Understandably, medical staff are the first in line. About 1 crore people — from doctors to ward staff — work in public and private healthcare facilities across the country. Sheer exposure to highly infectious environments on a regular basis also makes the administrative staff and other support workers at these facilities eligible for early vaccination.

Next in the queue are about 2 crore front-line Corona warriors — people in essential services in addition to armed forces, paramilitary and police personnel. Among those who run the essential services range from sanitation workers at Covid-19 facilities, cleaners and waste collectors in cities to those who run public transport. Even municipal staff such as engineers, revenue officials and staff at crematoriums will be considered among front-line warriors.

The vaccination for these 3 crore people will be free, Union health minister Harsh Vardhan said at a recent media interaction.

When the government allows sale in the private market, Covishield will come for ₹1,000 a dose.

Around 30,000 session sites are likely to be set up across the country for Covid-19 vaccination. While most of them will be situated in healthcare facilities, schools, colleges, community halls, municipal offices as well as panchayat centres, too, might be engaged for the purpose. Mobile vaccination sites will cover difficult terrains, border areas or regions affected by militancy.

The government plans to launch a mobile app to enable self-registration once the process opens up for the non-priority groups. Any valid ID recognised by the government such as driving licence, voter card, PAN, Aadhaar, passport, passbooks issued by banks and post office and MNREGA job card can be used for registration. That apart, the government also plans to facilitate self-registration through the Common Service Centres, set up by the ministry of electronics and information technology to offer e-services in rural and remote areas.

Second set

People above 50 years of age and those suffering from serious co-morbidities that make them vulnerable to Covid-19 infection are enumerated to be around 27 crore in the country. Considering their high-risk status, their vaccine shots are fast-tracked, even though their lists are still in the making. According to operational guidelines for a Covid-19 vaccination strategy released by the health ministry last week, the names of those above the age of 50 will be taken from the electoral rolls prepared for the Lok Sabha and Assembly elections. In this priority group, too, there will be age-wise sub-categories, with senior citizens getting shots earlier than those between 50 and 60 years of age.

The task of choosing those with co-morbidities below the age of 50 is tricky. According to Vinod Paul, the Niti Aayog member who heads the NEGVAC, a team of 12 experts from various medical specialities including cancer, heart, kidney and lung will help the government draw up this list. “This [list] would be based on the severity of the ailments and vulnerability to be infected by coronavirus. People with mild to moderate hypertension, whose numbers may be around 30 crore, are unlikely to be covered in the prioritised group,” Paul said at a December 29 press briefing in Delhi.

Sticking point: Some experts are of the opinion that not everyone needs a Covid-19 shot   -  REUTERS/ FRANCIS MASCARENHAS

 

With uncertainties relating to availability and logistic hurdles, it is difficult to predict when people outside the prioritised groups will get the vaccine. Some experts in the field are of the opinion that not everyone needs a Covid-19 shot. According to epidemiologists, in pandemic as well as large-scale epidemic situations, herd immunity kicks in when around 60 per cent of the population is either infected or immunised with a vaccine or through a combination of both. Sero surveillance surveys carried out nationwide as well as selectively in many urban areas have shown that a sizeable percentage of the population has already been exposed to the virus. However, it is unclear if these findings will be taken into consideration for the roll-out.

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Published on January 07, 2021
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