Learnings from polio on how to vaccinate 50 million

With several promising experimental coronavirus disease (Covid-19) vaccines likely to be available by early next year, India has begun preparing to immunise 200-250 million people by July 2021.

“In the next few months at the most we should have a vaccine and in the next six months we should be in the process of delivering the vaccine to the people of India,” said Union health minister Dr Harsh Vardhan in his comments at the Annual General Meeting of Indian Red Cross Society (IRCS) and St. John’s Ambulance last week.

Most of the potential Covid-19 vaccines will have to be given in two doses to offer protection against infection or reduction in disease severity, which would mean that 400-500 million jabs of the vaccine will have to be given within six months. Is this possible?

Deepak Kapur, who is Rotary’s National PolioPlus chair for India, said it is achievable. Kapoor, who took over this role in 2001, led a team of volunteers who advocated and supported government to reach marginalized and migrant populations where many children were being missed, which was leading to the wild poliovirus surviving in India. The mammoth effort led to 170 million children getting vaccinated against polio on every national immunization day.

“When the polio eradication initiative began, and even towards the end, experts from across the world thought that India may not be able to do it at all, and if it did, it would be the last country in the world to actually do so. But we defied all odds, and despite a huge population, insanitary conditions and a whole lot of other factors like malnutrition, India delivered,” said Kapur.

The last polio case was recorded in India on January 13, 2011. And on 27 March 2014, the World Health Organization (WHO) declared India polio free, since then no cases of wild polio have been reported for five years.

In the week leading up to World Polio Day on October 24, Kapur, who is also a member of India Expert Advisory Group that advises the health ministry on keeping India polio free, is optimistic. “It is possible, it will require a great deal of training in vaccine delivery because the cold-chain has to be adequate, and from what I understand, there are those (Covid-19 vaccines) that are okay at about minus 30-degrees Celsius and those that are okay at minus 70-degrees Celsius. Quite obviously, India will have to go with the ones that can be maintained at minus 30-degrees Celsius because our cold chain is geared to that,” he said. A cold chain is a temperature-controlled supply chain to ensure no vaccine spoilage.

Work has already begun in India, which is identifying warehouses and deploying its indigenously developed Electronic Vaccine Intelligence Network (eVIN) that digitizes vaccine stocks and monitors cold-chain temperatures to ensure quality and efficacy are not lost to temperature variations. Health centres are geo-tagged and sensors in refrigerators and freezers storing vaccines automatically inform a central database when temperatures change, signalling that the equipment needs to be repaired or replaced.

A major learning from polio is to be prepared to rapidly dispel misinformation and rumours that may lead to people refusing to get vaccinated. With misinformation spreading within seconds on social media, quashing rumours must be swift. “Even one or two unfortunate side effects, like fever and pain in injection site, can feed rumours about vaccine safety, leading to refusals in some regions. It happened during the pulse polio programme, and more recently, with measles immunization. We have begun tracking people’s concerns about safety and preparing campaigns to counter false information,” said a health ministry official, requesting anonymity.

Unlike polio drops that were given by volunteers, Covid19 vaccines are injectable and can be administered only by health workers. The public sector cannot do it alone, we need partnerships, like the ones that played a role in polio eradications, tandem to reach vaccination goals.

“I believe it must become a people’s movement, with community involvement and door to door outreach. The supply may be there, but unless the beneficiaries are willing and ready to accept immunization, the reach will not be possible. I don’t believe any of these are insurmountable if we go into an emergency preparedness mode right now and lay the groundwork,” the official said.

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