New Delhi: India’s Covid vaccination programme — the largest in the world — is overseen by the government. While the central government is handling the overall procurement, state and union territory administrations — aided by district authorities — act as intermediaries for hospitals in their jurisdiction.
How many vaccines a hospital gets is determined by the demand they raise, but there are other factors at play as well. In Andhra Pradesh and Telangana, for example, the government decides the number of vaccinations a hospital can handle and distributes vaccines accordingly.
The Covid vaccine distribution exercise operates at two levels.
At the local level, a hospital approaches the district authorities with their demand, which is then sent to the state/union territory administrations. The Union government, meanwhile, routinely places orders with the companies (Serum Institute of India and Bharat Biotech) manufacturing the two vaccines currently in use in the country — Covishield and Covaxin — based on certain assessments about the Covid situation in different states/UTs, such as vulnerable population etc.
Based on the central government’s demand, the companies dispatch vaccines to different states/UTs by air, and a cold chain kicks in — perishable goods are transported via a temperature-controlled supply chain, which helps maintain their quality, from the point of origin to the final consumer. The vaccines then reach their destination at various hospitals, where they are administered to beneficiaries.
By and large, hospitals describe the chain of functioning as smooth, with private facilities calling it an ideal example of public-private partnership.
The Indian Covid immunisation drive entered a new chapter Thursday as a new section of population — all those aged 45 and above — became eligible to get the shot.
As Covid-19 cases surge again amid a new wave, India is trying to speed up its immunisation campaign and further simplify the process. The country has been reporting more than 50,000 infections for the past few days, with the number for Tuesday recorded at 56,211.
Also Read: How states/UTs are getting ready to roll out Covid vaccine drive for the 45+ from 1 April
How vaccines are procured
In Delhi, the health department is handling the vaccine distribution.
Dr Sourabh (he goes by one name), district immunisation officer for Southeast Delhi, said government hospitals in the national capital usually receive their share of doses daily. “However, it could differ depending on the consumption of each hospital. If the consumption isn’t as much, then the vials last for over two days too,” he added. In such a case, he said, they might alter the daily number of vaccine vials to be supplied to a hospital.
A sub-district magistrate in the national capital said private hospitals often order in bulk. “Some private hospitals order doses for up to a week (at a time), while others, where the consumption is even higher, procure vaccine for three days.”
A Delhi health department official told ThePrint that the proximity of a hospital to a cold chain point plays a role.
“If the hospital has a cold chain point, there is no reason for worry. If it isn’t located close to a cold chain point, then sending supplies daily sometimes becomes an issue,” the official said, not wishing to be named.
Dr Sourabh said there had been a lot of wastage across districts because “people are still not coming forward for vaccination in the numbers we expect”.
To address this problem, several district magistrates told ThePrint over the past week, efforts are on to make more dispensaries operational as vaccination centres. Since dispensaries are located in many more locations, they hope the easier access will draw more people to get vaccinated.
Payments
In Chhattisgarh, the District Immunisation Officers (DIOs) only allot vaccines to hospitals if they are registered under the Pradhan Mantri Jan Aarogya Yojana (PMJAY), even though Union Health Ministry guidelines allow other criteria for hospitals to qualify.
The DIOs visit the hospitals and verify if they have the space and infrastructure required to carry out vaccination sessions.
State vaccination programme head Dr Amar Singh Thakur said, “Private hospitals get vaccines from the state government through DIOs. Although these hospitals are supplied vaccines as per their demands, but final say is that of DIOs. Their vaccination drive is monitored by DIOs.”
The hospitals, he added, pay for the vaccines through a bank account provided by the Union Ministry of Health and Family Welfare. “All the payments are made in advance,” added Thakur.
Private hospitals, unlike government hospitals, pay Rs 150 for vaccines, and are allowed to charge beneficiaries another Rs 100 towards expenses.
Once hospitals transfer the money, they receive a slip with a number. This number is then shared with the district immunisation officer, who ensures they receive the vials based on the demand.
In most states, delivery usually takes a day or two following payment. The hospitals then need to go to the cold chain point nearby with the receipt to collect the stock.
Suneela Garg, professor of excellence at the Maulana Azad Medical College, Delhi, who has been advising the government on the vaccination drive, said there was no requirement to fill multiple forms in the process.
Also Read: Don’t believe doomsayers. Vaccines will end the pandemic
Public-private partnership
In Andhra Pradesh and Telangana, private hospitals cannot buy beyond their capacity, and the capacity is adjudged by the state governments following discussions with the management at different facilities.
“Government decides how much capacity a hospital has to vaccinate people/day and, accordingly, vaccine doses are distributed,” Dr Veera Prakash of Apollo Institute of Medical Sciences and Research, Hyderabad, said. “For instance, if any hospital is seen to have a capacity of 200 doses/day, only so many doses are given at a time. Even if hospitals can afford to pay five times more — they’re not given extra doses. It is regulated,” he added.
An official from another private hospital in Hyderabad said hospitals did experience a lack of stock and supply issues in the beginning, but these have been rectified.
In Uttar Pradesh, the Chief Minister’s Office (CMO) carries out coordination instead of the state health department.
Dr Richa Mishra, MD, Shekhar Hospital, a private hospital based in Lucknow, described it as “a smooth process”.
“We make the payment on the basis of the amount we procure or the consumption at the end of the day. After the registration, we send the slip to the district CMO office daily and we receive the supply every evening,” she said.
Dr Bhavna Ahuja, in charge of vaccination at Fortis Hospital Mohali, said the procurement of vaccines was a “smooth, unhindered process”.
“We let the district health authorities know about our requirement, after which we deposit the money in a dedicated account. We pick up the vaccines, maintaining the cold chain from the government store to our store.” The system, she said, “exemplifies almost a public-private partnership”.
Inputs from Rishika Sadam, Rohini Swamy, Chitleen Sethi, Prithviraj Singh and Prashant Srivastava
Edited by Sunanda Ranjan
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