In the fight against the COVID-19 pandemic, the year 2021 started on optimistic note with the licensing of two COVID-19 vaccines in India. Two weeks later, a nationwide COVID-19 vaccination drive was launched on 16 January 2021. However, the initial excitement did not last long. The widespread hesitancy towards the vaccines impacted the coverage amongst the targeted beneficiaries. Contrary to the need for stringent crowd control, the beneficiaries had to be encouraged to visit the vaccination centres.
Five weeks since then, though the situation is relatively better, India is conducting nearly 300,000 vaccination per day, a far lower rate than what is needed to scale up to achieve the proposed target of vaccinating 30 crore people in the next 5-6 months.
In comparison, around the same time, the United States of America has been administrating nearly six-fold — or 1,700,000 vaccines — per day.
‘Vaccine Hesitancy’ & The Way Forward
India has made around 10,000 COVID-19 vaccination centres functional against nearly 50,000 which are proposed. Two weeks from now, the COVID-19 vaccines will be offered to additional population. It is high time to reflect, revisit and re-strategise.
Tackling vaccine hesitancy is the top priority.
Vaccine hesitancy during large scale campaigns is not a new phenomenon.
Even before COVID-19 pandemic, in 2019, the World Health Organization (WHO) identified vaccine hesitancy as one of the top 10 challenges in public health.
It was also faced during the polio elimination program in India. There are learnings and expertise on how to tackle vaccine hesitancy. Communicating vaccine science and answering/responding to key concerns in common parlance, by experts and influencers who people trust, has helped in tackling vaccine hesitancy.
A similar approach needs to be used here. The local adoption of the national communication strategy, along with the engagement of key stakeholders is bound to help.
Beware of Laxity While Ramping Up Vaccine Drive
For covering additional target groups, more session sites, trained vaccinators and other non-health human resources would be required. However, an overzealous attempt to increase the vaccine centres / sites and achieve a high vaccination number should not result in laxity in adherence to the protocols for vaccination.
Ensuring adherence to COVID-19 appropriate behaviour at vaccination sites, provision of sufficient space for 30-minute waiting on site, and commensurate increase in adverse events following immunisation (AEFI) management centres (where people who develop serious AEFI should be given treatment) should be the top focus.
Private sector facilities and human resources should be used appropriately for additional vaccination sites and AEFI management.
The COVID-19 vaccination process is going to be a long haul — at least over 6-8 months. During this period, continuity of routine health services should be assured and should not be reduced due to the involvement of health staff in vaccination drive.
Should Vaccines be Free or Come With a Price Tag?
People (ideally) should not have to pay for vaccines.
The COVID-19 vaccines, like other vaccines in the past, are a public good with positive externalities, where an individual getting vaccinated will benefit the entire society by reducing the transmission and burden on healthcare facilities.
Therefore, the central government must clarify whether the vaccine will be free of cost for the targeted 30 crore beneficiaries or not.
Although an allocation of Rs 35,000 crore in the Union Budget 2021-22 for COVID-19 vaccine has been made, there is no clarity on how this allocation will be used.
Going by the ‘vaccine hesitancy’ trend till now, offering the COVID-19 vaccines gratis, for eligible beneficiaries, becomes even more imperative. If people have to pay for the vaccines, many families, even though affordable for them, may weigh their risk against the cost of vaccines, and may opt out.
Why Vaccine Sale in the Private Market is Not a Good Idea
Of late, there has been a lot of lobbying for the sale and use of COVID-19 vaccines in the private market. The core argument is that India has ‘more than enough’ vaccine production capacity. ‘Availability of COVID-19 vaccine for purchase from the market’ is not an idea whose time has come.
The current COVID-19 vaccination strategy of India has specific purposes — of protecting those at high risk of infection (health workers and essential services workers) and for reducing the mortality (by vaccinating high risk populations like the elderly).
Therefore, the sale of vaccines in the private sector, at least at present, does not make much sense.
If the purchasing power of an individual has to be an option, then it defeats the entire purpose of prioritisation of the target groups. Moreover, it would result in ‘vaccine inequity’ (where those who can afford but are not in the priority list will get vaccine) and may drive up the vaccine price.
No, We Don’t Have Enough Vaccines — Yet
Second, the fact is that the COVID-19 vaccine production is finite and not enough.
The vaccines — a product of science — are a global public good, for every country. Therefore, even if India has a few million more doses than it can use at present, it is ‘morally’ or ‘ethically’ wrong to use the COVID-19 vaccine indiscriminately for the non-priority population, within the country. The front-line healthcare workers in most low- and middle-income countries across the world are fighting the pandemic and waiting for their vaccine shots. Many of those countries do not have local vaccine production capacity. They depend upon other countries to protect the health workers in their settings.
In this context, the Indian government’s ‘Vaccine Maitri’ initiative to donate or offer vaccines on sale to other countries, is a step in the right direction.
This is how global health challenges such as the COVID-19 pandemic should be fought – together and with solidarity. No country can claim to be safe till all countries are out of the pandemic.
Need to Tackle Operational & New Epidemiological Challenges
A few operational challenges have been identified and need to be addressed. As an example, in the early part of the pandemic, essential services workers were rightly celebrated for keeping the society functioning. Now, there are reports that these workers, especially those outside the government system — the grocery store staff, vegetable venders, delivery persons, private bus drivers, newspaper vendors and many others — have been excluded from the COVID-19 vaccination priority list.
Most states have limited clarity on their inclusion in the current vaccination list. The vaccination of essential services workers, especially those outside the government set up, should be prioritised alongside frontline health workers or soon after.
Similarly, there doesn’t seem much merit in allocation of vaccination sites and dates through software. People should be given the choice to select the vaccination date on a first-come-first-serve basis, from the available slots. Though the selection of the vaccination centre may not be feasible or pertinent as it may equate to the selection of a vaccine; however, people can be given a choice on locality of the vaccination sites, which may help in reducing travel time.
Tailored Vaccine Strategies Required For Different Areas
In the wake of emerging SARS CoV-2 strains from different countries, experts need to consider if certain settings — such as cities with international airports (and where risk of the mutant strains entering India exists), and states like Kerala and Maharashtra where the virus is spreading extensively — need a different vaccination strategy.
For example, an accelerated vaccination approach for a much wider population, including healthy adults, with the purpose of reducing transmission, could be the approach in Mumbai and Pune, and the state of Kerala.
A ‘vaccine dose in vial’ does not protect from the disease; however, ‘a shot in the arm’ does. This is a war against the COVID-19 pandemic. In a war, a well-thought and agile strategy (to ensure that the vaccines reach the arms) is far more important than the size of the army and how fast it moves.
(Dr Lahariya is a medical doctor and public policy and health systems expert. He is the co-author of ‘Till We Win: India’s Fight Against The COVID-19 Pandemic’. He tweets @DrLahariya. This is an opinion piece. The views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)
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