Re-engineering India’s vaccination strategy

India handled the first wave of Covid-19 quite well with minimal deaths and comparatively low positive cases. In the first wave, Western countries like the US, Italy and Spain suffered maximum damage in the form of morbidity and mortality. However, the second wave hit us on a higher magnitude such that vaccination has emerged as the core prevention strategy from future waves of Covid.

India started vaccination with Covishield and indigenous Covaxin on January 15, with much fanfare for a target group of frontline healthcare workers and other identified groups. Initially, there was a lot of hesitancy for vaccination amongst the public, particularly as the cases and deaths had dropped significantly by end-January this year.

From February 1, vaccination was opened for the 60+ population, and from March 1 for the 45+ population. While many urban centres saw long queues, the rural vaccine centres were mostly deserted, with people openly refusing to take the jab. As demand from the younger generation mounted, vaccination was opened for the 18+ from May 1.

However, the vaccines for these were to be procured by State governments directly and the Central supply was to be used only for the 45+ population. This created a segmented market, with States vying to secure the maximum doses for themselves from the two vaccine manufactures in the country.

The government is putting in its best effort to secure imported vaccine supply, but most international players have already reserved the stocks for Western countries. Now, we are left with Covishield, Covaxin and Russian Sputnik, which is to be manufactured in the country. There’s optimism that Novavax, J&J, and ZyCov-D will be launched soon to address the supply-side concerns. The Centre aims to have 2.2 billion doses by December .

Sixty-three per cent of India’s population is above 18 years, which means we need to vaccinate 82 crore people in the country. Till May 27, about 20 crore had taken at least one dose. To achieve herd immunity, 60-70 per cent of the population needs to be vaccinated with two doses. Thus, there is a strong need to quickly vaccinate 42-50 crore more people, which would mean the need for about 100 crore doses.

Only by vaccinating this set can a possible third wave be averted or handled with minimal morbidity and mortality. And this is on the assumption that the virus will not mutate further, and the vaccine will be able to protect against variants effectively.

Distribution challenge

While supply side of the vaccine remains a constraint, the effective distribution and actual inoculation are a major challenge. Maintaining the effectiveness of the vaccine till inoculation through proper cold chain is a big challenge in hilly and forest areas of many States. Vaccine wastage, at around 6.3 per cent, has emerged as a major issue. This means in the process of administering 20 crore doses so far, 1.26 crore got wasted. There is a strong case to bring down the wastage rate by as much as possible.

Effective distribution and delivery can be achieved through a robust PPP mechanism, which can be developed by each State as per its situation. Regular training, hand-holding and strict monitoring with clear accountability at all levels down to the Primary Health Centre (PHC) could accelerate accomplishment of the vaccination target.

Currently vaccination is being carried out at specific centres with registration through COWIN portal. While this can be good for urban areas, it may prove counterproductive in the rural areas, as the digital divide will result in people being left out even when they want to get the jab. There’s a need to have spot registration and inoculation at all the centres in rural areas, so that people get acquainted with the process by the time supplies stabilise. It may be difficult to get people to vaccine centres later if the message goes about pre-registration requirement in villages.

Governments tend to opt for socialistic and proportionate distribution of available vaccine doses to all the districts, thus places with high viral positivity, population density, and probability of infection are likely to be left out from the priority list depending upon the doses available for the district.

Further, there is a need to prioritise the high risk groups — like vegetable vendors, shop owners and workers, transport workers, bank and other office employees, construction workers, essential service providers, and residents of congested slums — and vaccinate them first. Places with high viral positivity and high mortality rates during the second wave need to get preference. Dedicated vaccination camps for such target areas are required if lockdown is to be withdrawn earlier and possibility of the population turning super spreaders is to be averted. Once seamless supplies are ensured then we can go for traditional equal distribution for all.

Vaccine shopping

The new tendency of “vaccine shopping” — that is, choosing a particular vaccine, which is seen more among urban people — needs to be controlled through proper communication strategies. Many are waiting to get a particular company’s or country’s vaccine, in the process putting themselves in danger of infection.

Vaccine hesitancy is there in all countries. But the situation in India is more complex as cultural and religious factors come into play creating stiff resistance. The seeds of doubt need to be nipped in bud through sustained and strong communication strategies. Religious leaders, faith leaders and celebrities could be requested to guide their followers about the vaccination and its benefits.

Also, a sort of compulsory vaccination programme for all government scheme beneficiaries may be in order to reduce the impact of the pandemic. Local civil society organisations, NGOs, and eminent citizens need to be involved in this effort. It’s only through proper targeting of the population in the next three months the vaccination drive can achieve maximum impact.

Kulkarni, IAS, is Divisional Commissioner, South Chota Nagpur; and Sivasankaran is Associate Professor at XLRI, Xavier School of Management, Jamshedpur. The views are personal

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