Getting vaccine from factory to frontline

The fight against Covid-19 will only be a success if the government has a comprehensive plan for vaccine distribution and administration.

There is a famous quote by Benjamin Franklin: “By failing to prepare, you are preparing to fail.” With vaccines, the battle against COVID-19 has come to a turning point. But preparation for distribution will determine its impact on 135 crore Indians – whether for a chosen a few or for all. In the coming months, the distribution model, in order to be effective, must be able to deliver vaccines immediately to all possible administration endpoints, while remaining flexible enough to accommodate a variety of factors, including varying demands, manufacturing timelines and volumes.

One of the strongest correlates for the success of a vaccination programme is its acceptability. Vaccine acceptability may differ according to several demographic characteristics. But, even though addressing the drivers of vaccine hesitancy and the barriers to vaccine acceptance is a complex matter, vaccine acceptance resiliency is an essential condition to achieve the intended objectives. In this regard, close collaboration between the government and stakeholders to make the most of high levels of trust, and reducing suspicions about the vaccine are very important. US President-elect Joe Biden received the COVID-19 vaccine on live television. Three former US presidents — Barack Obama, George W Bush and Bill Clinton – also volunteered to get their COVID-19 vaccinations on camera. Microsoft chief Bill Gates and celebrity Tom Hanks have also offered to take the vaccine publicly to shun fear and instil faith among people. But, if the result is reversed or not optimal, that shakes the confidence of people like in the case of Haryana Cabinet Minister Anil Vij, who took the vaccine (half dose as per Covaxin manufacturers) but yet was infected with COVID-19. Such issues need to be addressed for public confidence.

With the vaccine myths, intended to create an atmosphere of fear, spreading all around, particularly on social media, the government should have a counter-strategy to inform and educate people. The polio drive could be successful in India because people were convinced about the vaccine and the lack of trust had to be overcome. A similar massive awareness campaign, including in local languages, should be run by the government to counter false narratives. Community leaders who can persuade people to drop their inhibitions could be involved.

Second, India needs to accelerate the production, distribution and administration of COVID–19 vaccines. More than 23 lakh people across the world have already received vaccines. Whereas countries like the US, UK, China and Russia have rolled out detailed action plans for vaccination, a concrete COVID-19 vaccine distribution plan is yet to take shape in India. Our strategy is still in bits and pieces. According to Credit Suisse analysts, India would need about 1.7 billion COVID-19 vaccine doses to vaccinate a majority of its adult population. This massive immunisation programme will require a robust cold-store mechanism. So far as our existing cold chain infrastructure is concerned, India’s current immunisation programme handles around 600 million doses and the private sector has a capacity of about 250-300 million doses. With this infrastructure, India can administer 550-600 million doses annually. India has some 27,000 “cold chains”, which may not be adequate. Most of the cold storage units are in urban areas and transportation to the hinterland is another major challenge. With more than 65 per cent of the population living in rural areas, much of the success of the vaccination programme depends on rural penetration.

The government is exploring using the Election Commission infrastructure for mapping and modifying railway coaches to transport the vaccine – but such ideas will not be successful in isolation unless we connect the dots in the distribution model expeditiously. To ramp up the capacity to administer vaccines, the government should utilise the existing universal immunisation programme infrastructure and manpower with adequate augmentation. Horrifying stories of beds being not available, healthcare workers not being paid and budgetary provisions not available should not cast a shadow on vaccine administration.

Third, distribution and administration of the vaccine should not follow the path of hollow political sloganeering. Before the Bihar Assembly elections, the BJP, for political mileage, had promised free vaccines for all the people of Bihar. Now, the Health Secretary has come on record to say that the government does not promise to vaccinate the entire country. The Bihar Cabinet has approved the free vaccine proposal sans any action plan on modalities and budgetary provisions. The focus should be on vaccinating the last woman/man vaccination rather than on ribbon-cutting.

Fourth and most important, the administration must ensure that vaccine cost does not deter the less fortunate. The Supreme Court has upheld “affordable healthcare” as a fundamental right under Article 21 of the Constitution of India. According to the World Economic Forum Report, some 220 million Indians sustain themselves on an expenditure level of less than Rs 32/day. As per the NSSO data, 22 per cent of India’s population is poor. The “donations” received in the mysteriously-guarded PM Cares Fund must be used by the government to distribute and administer the COVID-19 vaccine to the poor and weaker sections. This will ensure inclusiveness and parity in vaccine administration.

Lastly, vaccine diplomacy can wait till all the Indians are vaccinated. India has assured countries like Bangladesh, Myanmar and Nepal of vaccine coverage as part of its global outreach programme. A dozen nations have also requested vaccines from India. India has more than 26 crore people who are in 50-plus age group, 73 million diabetics and one in eight Indians suffers from hypertension. Therefore, with more than 10 million infections, nearly 1.5 lakh deaths, demographic structure, comorbidity factors and the imminent threat of COVID 2.0, India should focus on total vaccination before reaching out to other countries.

With the arsenal of vaccines, we can win the COVID war provided we do our preparations right and set our priorities in order with an effective distribution model. Both God and the Devil lie in the details. A vaccine distribution mechanism that can effectively manage the mapping, transportation, tracking and safekeeping of vaccines from the point at which they are purchased to the point they are administered needs to be developed. We were witness to the consequences of faulty implementation of notebandi, GST and the lockdowns, but humanity cannot afford another mistake this time and thus, attention to every detail is a must.

The writer is a Supreme Court lawyer and National Spokesperson, Indian National Congress

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