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For vaccination success, govt must form adverse event monitoring units, involve local people

A universal vaccination programme requires mobilisation at an unprecedented scale. A battle-weary govt system will be under tremendous pressure to do it alone.

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The battle against the Covid-19 pandemic has been a long one and the light at the end of the tunnel is finally visible. Through the initial travel restrictions and lockdowns to the second phase of intensified testing and tracing, we have now entered the much-awaited vaccine era. As we move towards more promising times, we must combine all tools — vaccines, smart testing, tracing and appropriate preventive strategies — for effective infection control, instead of overleveraging our hopes on vaccines.

Compared to earlier pandemics like the 1918 Spanish Flu or even the 2009 Swine Flu, the efforts for Covid-19 vaccine development and the funds invested have been unprecedented. More than $40 billion funding has been secured by different entities, and in six months, more than 170 vaccine candidates have been identified and fast-tracked. Thirteen vaccine candidates are now in the human clinical trial stage, and of these, at least four hold high promise. Some of the frontrunners in this vaccine race include candidates from Pfizer-BioNTech, Oxford-AstraZeneca, Sputnik V, and Moderna. The United Kingdom has already started vaccinating its citizens, going ahead with the Pfizer-BioNTech vaccine.

Also read: ‘Europe’s moment’ — EU to start Pfizer-BioNTech Covid vaccinations 2 days after Christmas

Need for an empowered body

As Covid-19 vaccines become a reality, countries will now face the complex task of delivering them to the people, especially to the most needy and deserving. Even though India has significant experience with mass immunisation drives, a vaccination programme for Covid-19 may throw new challenges. Now is the time to revisit the pillars on which successful vaccination programmes rest.

The first step is to constitute an empowered body with scientists, administrators, and financial experts to objectively evaluate and identify the right vaccine or group of vaccines. Besides efficacy, the cost-effectiveness, storage criteria, and ease of administration should be the guiding principles for selecting a vaccine. It is reassuring that India had the foresight to establish a national-level task force on vaccine  in August. As a follow up, the Covid-19 Vaccine Intelligence Network (Co-WIN) will be launched soon for real-time monitoring of the vaccine administration.

Also read: ‘Europe’s moment’ — EU to start Pfizer-BioNTech Covid vaccinations 2 days after Christmas


Identifying groups that need vaccination on priority is next. Healthcare workers, frontline workers, elderly, and people with underlying health conditions should occupy priority in that order. Creating a database of these groups is a massive exercise that needs to be carried out before a vaccine is rolled out, and state governments should be encouraged to take lead. Under instructions from the central government, many states have already started this exercise.

It is also important to undertake and view this task through a lens of access and equity to ensure that the poor, vulnerable and hard-to-reach populations are not left behind. Ensuring that the vaccines reach the last mile is not just a logistical issue but an essential requirement of equitable health access.

Also read: Delays, allergic case — First hiccups emerge as US rolls out Covid vaccine

Transport, storage infra and manpower

Another critical requirement is to strengthen the supply chain for procurement and transportation for seamless movement of vaccines. Efficiently run cold chain systems are essential to preserve the potency of the vaccine. India’s existing cold chain infrastructure caters to the universal immunisation programme for children and has a capacity to store  8 to 10 crore doses, which may prove inadequate for vaccinating 30 crore people identified as priority group in the first phase. Through planning and preparation, this capacity has to be augmented by optimisation of other cold chains such as those dedicated to agricultural produce and pharmaceutical supplies.

It is also prudent to immediately commence recruitment and training of an army of health workers because the demand for such trained personnel will quickly escalate when a vaccine is unveiled. This must be supplemented with a robust communication strategy to earn the confidence of the people. Public trust can only be built through dissemination of accurate information on the importance of vaccines, and precautions around it in an open and transparent manner. The polio eradication campaign is an excellent example of effective communication strategy that succeeded in driving public opinion. Similar strategies need to be formulated for positive messaging on the Covid-19 vaccine to guard against organised campaigns by pressure groups opposed to vaccination.

Also read: ICMR’s chequered role in Covid pandemic — from 15 August vaccine deadline to plasma flip-flop

The right messaging

Involving local communities and self-help groups will be crucial for mobilising the beneficiaries at the vaccination centres. Until now, the Covid-19 response has primarily been driven by government functionaries, right down to the health worker level, and participation of communities has been markedly absent. But a universal vaccination programme requires a mass mobilisation at an unprecedented scale. A battle-weary government system will be under tremendous pressure to do it alone.  Involvement of ground-level champions among women and youth of the community will add strength to the national effort.

The government should also quickly set up adverse event monitoring systems right down to the district level for prompt intervention in case of adverse reactions from the public. Without this system in place, even a small incident will balloon cosmically into a negative press story, and alter the perception of the beneficiaries.

Last but important is to ensure consistent messaging about universal availability of vaccines to people, a promise made earlier at the highest level. The recent press announcement by senior health functionaries that only a critical mass of the population needs to be vaccinated to break the chain of transmission through herd immunity is inconsistent with the earlier statements of the government and has severe ethical implications. Such vague statements from policy makers even before the launch of a vaccination programme have the potential to create chaos and instil fear among the masses, pushing them to use influence to be among the chosen few to get inoculated. In the process, the most marginalised amongst us will suffer from exclusion, which goes against the basic tenet of universal coverage.

And until vaccination becomes accessible to the majority population, the thrust on prevention of infections through smart and equitable testing and tracing needs to continue. The government needs to focus on strengthening its testing strategy based on evolving technologies and the changing dynamics of Covid-19 spread to safeguard people and mitigate the spread of the virus.

The author is a former Health Secretary, Government of India. Views are personal.

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