New Delhi: Maharashtra is looking to increase the number of vaccination centres, while Andhra Pradesh is eyeing an awareness campaign to tackle low turnout. Uttar Pradesh has called a meeting led by Chief Minister Yogi Adityanath to chalk out a strategy, and Chhattisgarh says it is all ready to widen the beneficiary pool.
Come 1 April, India’s Covid-19 vaccination programme — already the largest in the world — is set to get even bigger as vaccinations open up for all those aged over 45 years. In the run-up, states and Union Territories are busy taking stock of their resources and making preparations for the expected surge in footfall at vaccination centres.
While an exact figure for this section of the population is not available, some estimates suggest it could double the targeted beneficiaries.
The initial plan was to vaccinate only healthcare and frontline workers, senior citizens and those with comorbidities — an estimated 30 crore people.
In a letter to states and Union Territories dated 23 March, Union Health Secretary Rajesh Bhushan wrote: “Based on the recommendation of NEGVAC (National Expert Group on Vaccine Administration for Covid-19), the government of India has now decided to expand the privatised age group to include all persons aged 45 years and above for Covid-19 vaccination from 1 April 2021.”
“Accordingly there will now be no need for a comorbidity certificate for people aged 45 to 59 years from 1 April 2021,” he added, saying the CoWIN software is also being suitably modified.
He then requested states/UTs to direct the officials concerned to immediately undertake necessary measures for the expansion of the vaccination drive.
One of the epicentres of India’s second Covid-19 wave, Maharashtra has 2,97,26,000 people above the age of 45, according to information available with the state health department.
Of these, 4,27,589 people aged 45-59 years and with comorbidities, and 19,60,000 above the age of 60 have been vaccinated so far.
Speaking to ThePrint, state immunisation officer D.N. Patil said they have asked the central government to increase the number of vaccination centres in Maharashtra.
“The Centre has assured us that they will make certain changes in the CoWin app… Additionally, we have instructed all district administrations to identify more primary healthcare centres and sub-centres that can administer the Covid vaccine too,” he added.
“Districts will find such centres where there is electricity, internet availability, a proper place, availability of a medical officer to administer the vaccine, and other staff. Once we get a list from the districts, we will send a proposal to the Centre,” he said.
Maharashtra has sent the central government a proposal to allow 367 private and government centres to administer Covid vaccines. Of these, 209 have been approved so far.
The state had been considering vaccinating everyone aged above 45 years since before the central government order.
Currently, there are 2,567 vaccination centres in the state — 1,933 government centres, and 634 private facilities.
The state health department has decided to scale up their daily vaccination count to at least 3 lakh/day. Currently, the state is vaccinating around 1.3 lakh people a day, on average.
Facing a problem of low turnout, the state government’s focus is on spreading awareness to increase the turnout at village and mandal levels. In villages, the government is planning candle rallies, microphone announcements, and door-to-door intimations.
“Andhra Pradesh never had a problem with supply or staff. In fact, we have the highest number of ANM (auxiliary nurse midwife) workers and all of them have been involved in the process, as per requirement,” Andhra Pradesh Health Commissioner Katamaneni Bhasker said.
“We have 17,000 vaccinators — that should suffice for the entire population since it is done in batches. And as per guidelines, all our government and private medical institutions are already operating as vaccination centres. The issue is only with low turnout,” he added.
Each primary healthcare centre, Bhasker said, will take up one village at a time in their area and vaccinate all the eligible candidates. In addition to this, gram panchayats will be engaged for assistance. Ambulance services are being set up to cater to emergencies (if any) after a candidate takes the shot.
In Punjab, around 750 vaccination sites — 450 government, 300 private — are engaged in the drive, which currently focuses on healthcare and frontline workers, those above 60 years of age, and people aged above 45 with comorbidities.
So far, the state has vaccinated 1.29 lakh healthcare workers, 1.35 lakh frontline workers, and 2.5 lakh people in the latter two categories.
Dr Rajesh Bhaskar, the nodal officer for Covid-19 control in Punjab, said the state government has as an estimated 75 lakh people aged above 45 years. For the drive beginning 1 April, he added, the number of vaccination sites will be increased to 3,000 government facilities and 600 private ones. “These will include rural dispensaries, homoeopathic and ayurvedic dispensaries, health and wellness centres, besides government health sub-centres,” he said.
“We already have 4,500 trained ANMs who will be at these sites for vaccination. Right now, 700 ANMs are working in the vaccination programme. ASHA (accredited social health activists) workers will be engaged to mobilise people,” Bhaskar added.
This, he said, is the tentative plan drawn up after the state’s first meeting in this regard Wednesday. “A clearer picture will emerge in a few days from now,” he added.
The widening of the vaccination pool comes amid reports of shortage in Karnataka. “There has been a short supply of the vaccine in the past three days,” said Dr Ravindra, a former president of the Private Hospitals and Nursing Homes’ Association (PHANA).
According to the state health department, they are expecting more stocks from the central government within the week. Karnataka Health Commissioner K.V. Trilok Chandra said the state has been waiting for 12 lakh doses of Covishield and they should receive them this week. So far, Karnataka has received 31 lakh doses of both Covishield and Covaxin.
As of Tuesday, Karnataka had vaccinated 27,58,715 people, of which 12,86,722 are above the age of 60.
State Health Minister Jai Pratap Singh told ThePrint that the state government is holding an interdepartmental meeting to roll out the expanded vaccine programme. “The CM will convene the meeting and directions will be issued thereafter. We are currently vaccinating people six days a week. If required, we will increase the number of vaccination centres,” he said.
Not wishing to be named, an official in the state health ministry further explained the steps being taken. “Population estimates of different age groups have been collected, district-wise data has been collected too. The state (Covid-19) task force met to draw up estimates for vaccine requirement,” the official added. “We have one week for preparation, we will do it in an organised way. The sudden pandemic surge is a big issue so we are focussing on that as well.”
Efforts to double the number of vaccination centres in the national capital were already under way when the central government announcement came Tuesday. The Delhi government aims to set up around 1,000 vaccination centres, including at nearly 260 dispensaries, at the earliest.
A senior government official in the Delhi Covid-19 vaccination task force told ThePrint: “We were anyway in the middle of sprucing up our vaccination facilities so the announcement hasn’t taken us by surprise.”
However, district officials said the number of vaccinators might be a concern. Chestha Yadav, the district magistrate of Northwest Delhi, which is the largest in terms of area, said from vaccinating about 4,000 people a day, they are now expected to vaccinate 10,000/day for Covid-19.
The district, she added, will most likely have to outsource some vaccinators/lab technicians to meet the demand.
The timings for vaccination have been increased from 9am to 9pm at hospitals and dispensaries, instead of 9 am to 5pm, as it was earlier.
Another district official, who didn’t wish to be named, said resident welfare associations (RWAs) are being engaged to enhance mobilisation for vaccination. Sub-district magistrates are directly coordinating with the RWA presidents in this regard, the official added.
Officials in the health department said the number of ASHA workers engaged in the process will have to be increased in the coming days. Staff from RI (routine immunisation) will also be directed towards Covid-19 vaccination, said a second Delhi government official.
Private hospitals in the capital expressed confidence about their preparations for the expanded Covid vaccination drive.
“Twenty hospitals (Fortis branches) across India have a capacity to do 300-500 vaccinations each per day. We can expand the hours and increase capacity,” said Anil Vinayak of Fortis Healthcare. The hospital group, he added, is also considering conducting camps outside hospitals as well as corporates, where permitted by local health authorities. “Gurgaon has already started RWA camps, for example,” Vinayak said.
Max Hospital said it has 10 sites across Delhi where it is conducting vaccinations. “We have one inoculator, the person who gives the vaccination, that can be increased to two per site. On any given day, we are ready to inoculate around 2,000 people. Our infrastructure is in place — our waiting area, our billing, our nursing, our supporting stuff,” said Dr Sahar Qureshi, Medical Superintendent, Max Smart Super Speciality Hospital, Saket.
The state health department is grappling with a low turnout, but is expecting an around 30-40 per cent rise in foot fall — at least for the first week — when the new session of vaccination begins 1 April.
Officials in the state government said there is no need to increase the number of vaccination centres, but the number of counters in a few areas may go up in the coming days to cater to the growth in demand.
“We have a sufficient stock of vaccines to meet a 30-40 per cent rise in footfall from 1 April. Currently, we have nearly 1,500 centres in the state with a target of 1,00,000 vaccinations per day but we are not able to meet this target. It’s only 70,000 at present,” said Dr Amar Singh Thakur, the state vaccination in-charge, adding that low turnout is an issue.
“This may rise to one lakh after 1 April. We will be able to face the load easily with the same strength of workforce from the health department.”
Dr Omkar Khandwal of Raipur Medical College said their was the largest vaccination centre in the state, “with 700 shots being administered per day”. “Considering this, we have tripled the counters and vaccinators to meet any challenge from 1 April,” he added.
He said efforts are also being made to prevent crowding at the hospital, for which they are employing a “unique Queue Management System (QMS)”.
“It involves online token distribution to those willing to be vaccinated. Those getting tokens at home will be allotted time for vaccination so that they can come straight to the centre at a fixed time instead of staying here and waiting for their turn,” he added. “This will save their time and also keep the centre crowd-free.”
Much like its sister state Andhra Pradesh, Telangana is grappling with a low turnout for vaccination in rural areas, while the response in urban pockets is described as “good” by health officials. To this end, the state government is planning to engage more ASHA workers in rural areas.
The state currently has over 560 vaccination centres, including both private and government. The government plans to expand the programme to primary health centres, upper primary health centres and more private facilities in keeping with the requirement, according to Telangana Director of Public Health Srinivas Rao. Private hospitals, too, have scaled up their vaccination capacity and are training more staff to involve them in the process in the coming days.
“Initially, there were server issues and all, but now it’s all sorted,” said Dr Lingaiah Amidayala, Director of Medical Services, Yashoda Hospitals Group.
“We are geared up to make it to 1,000 a day easily… That being said, there is still awareness required among people. Initially, we had 500 people a day, but now only 300 people are turning up. But, we expect the number to go up in the coming days.”
Inputs from Chitleen Sethi, Prithviraj Singh, Rishika Sadam, Manasi Phadke, Rohini Swamy, Aneesha Bedi, Prashant Srivastava
Edited by Sunanda Ranjan