Universal vaccination in India : Challenges and way forward – Explained, Pointwise

Introduction

The daily cases of Covid-19 infections are breaking new records. India is almost touching 4 lakh cases per day. Moreover, India’s health care infrastructure is also falling short of taking care of that many cases at once. Thus, the majority of experts are of the opinion that the only way out of this crisis is universal vaccination in India.  It means the majority of the population should be administered vaccines to achieve a herd immunity.

India started its coronavirus vaccination drive almost three months ago. According to the data from the Ministry of Health and Family welfare, so far, India has vaccinated only 146 million people (less than 2% of the population has received both the doses). With the universal vaccination in mind, India recently released a new vaccination policy. But to vaccinate the remaining population, India has to face various challenges and need innovative solutions.

India’s vaccination policy so far

• India so far released three phases of vaccination policy
• The first three phases vaccinated healthcare workers, frontline workers, and those above the age of 45.
• The Centre procured the entire quantity of vaccines from manufacturers Serum Institute of India and Bharat Biotech(Covishield and Covaxin respectively). The centre then distributed them to states for vaccination.
• The states distributed the stock to government vaccination centres. These government centers administered the vaccine free of cost. Private hospitals charged recipients Rs 250 per dose.

Salient features of India’s new vaccination policy

The new vaccination policy is the fourth phase of India’s Covid-19 vaccination policy. Under this phase, there are few changes,

1. Changes for Citizens:
   • All adults over the age of 18 will be eligible for vaccination starting from May 1.
   • Those eligible in the earlier phases can continue to get the free doses provided by the Government of India.
2. Changes for distribution:
   • Under the new rules, the Centre will automatically receive only 50% of vaccines produced by manufacturers. It will allocate these to states based on the extent of infection (active cases) and performance (speed of administration).
   • The remaining 50% can be acquired by the states directly or by private hospitals and industrial establishments.
   • The Centre will allow the imported, fully ready-to-use vaccines to be entirely utilised in the other-than-Government of India channel.

Other steps taken towards universal vaccination in India

• Electronic Vaccine Intelligence Network(EVIN): It is an innovative technological solution aimed at strengthening immunisation supply chain systems across the country. The EVIN shows real-time information on vaccine stocks and flows and storage temperatures across all cold chain points in the country. During the Covid-19 vaccination, the delivery system will use this EVIN solution.
• CoWIN platform and CoWIN App: It is a digitalised platform launched by the Ministry of Health and Family Welfare (MoHFW). It aims to help agencies to keep a track of the Covid-19 vaccination programme in real-time. Further, the app also allows Indian citizens to apply for a Covid-19 vaccine shot. The app also provides a QR based Certificate once the person is vaccinated.
• Further, India’s drug regulatory authority relaxed Imports restrictions on COVID-19 vaccines. Also, it approved the restricted use of vaccines, which are already approved for restricted use by the US in emergency situations.

Need for achieving universal vaccination in India

1. Reducing daily caseload and eliminating Covid-19 altogether: At present India’s daily caseload is the highest in the world. India will soon register half a million cases each day. Universal vaccination will not only reduce the Covid-19 cases but also help India to achieve Covid-19 free status.
2. Reducing infection to the vulnerable sections: Covid-19 infects senior citizens and people having comorbidity such as diabetes, blood pressure, etc. By vaccinating them India can prevent the life of countless individuals.
3. Vaccines are the most effective health intervention against Covid-19: Universal vaccination in India will prevent various health intervention costs and economic cost of the Indian economy. Universal Vaccination will provide relief to
   • Heavily burdened health infrastructure and health care professionals.
   • The Covid-19 induced lockdown and associated economic losses, etc
4. Can help to achieve herd immunity before universal vaccination: ‘Herd immunity is the indirect protection from an infectious disease if a population is immune either through vaccination or immunity developed through the previous infection. WHO supports achieving ‘herd immunity’ through vaccination. India needs to vaccinate around 70-75% of its population to achieve herd immunity. So, in process of Universal vaccination, India can reach herd immunity.
5. Past Experience: Vaccination is the most effective way to reduce the impact of epidemics and pandemics. Universal vaccination in India has eliminated smallpox, polio. They also reduced the impacts of serious diseases including measles, mumps, rotavirus, etc. Further, India’s Universal Immunisation Programme (UIP) provides free vaccines against 12 life-threatening diseases, to 26 million children annually. But achieving a similar feat against the Covid-19 is not an easy task.

Challenges to universal vaccination in the Covid-19

The population of India is 1.3 billion. If the Covaxin and Covishield require two doses then India needs to vaccinate 2.6 billion doses across the nation. This itself is a challenge.

1. Infrastructure challenges:  This is one of the biggest hurdles in India’s universal vaccination programme against the Covid-19. This includes,
   • Unequal distribution of cold storage facilities among states. For example, out of the 28,932 cold chain points, half are in the five southern states, Maharashtra and Gujarat. Whereas the eight states in the North and Odisha that account for over 40 per cent of the country’s population have only 28 per cent of the cold chain points.  
   • Other Infrastructure challenges: Both the Covaxin and Covishield requires to stored within a temperature of 2-8 degree Celsius. But the temperature-controlled boxes face challenges like frequent power supply interruption, lack of storage facilities at the remote location, etc.

2. Challenges related to affordability:

   • Under the new vaccination policy, vaccine producers can sell 50% of their production directly to State governments and private hospitals. Further, the price of vaccines to state and private is not fixed.
   • So, the private manufacturers may make a huge profit. This creates problems in affording the vaccine. This is evident as both vaccine manufacturers hiked their prices after the launch of the policy. For example, the Serum Institute mentions Rs 400 for state government and Rs 600 for private parties.
3. Creation of Interstate equality: With the new vaccination policy states are responsible to vaccinate their people. With every state individually contacting the suppliers and bargaining price and supply, the discretion will be with the supplier. So this will create interstate inequities and make poorer states suffer more. This is a clear deviation from universal vaccination in India.
4. Production-related challenges: The world’s largest vaccine maker, Serum Institute of Technology initially promised to supply 100 million doses of vaccines a month. But in reality, it only provided between 50 million to 60 million doses. India so far exported 66.4 million vaccines(As of April 27). With the government commitment to export vaccines along with the production gap, India is facing a delay in universal vaccination and facing a demand-supply mismatch.

5. The issue of vaccine hesitancy: 

   • In simple terms, it refers to delay in acceptance of vaccines or refusing vaccines despite their availability. In the past three months, only 40 percent of the 30 crore high-risk population were vaccinated, partly due to the initial vaccine hesitancy.
   • There is a non-transparency of data related to the two vaccines proposed for use in the program. 
   • Furthermore, acquiring the data for under the 50s with comorbidities will also a challenging and difficult one. 
6. The Issue of Vaccine wastage: According to the RTI information, India has wasted more than 44 lakh of 10 crore doses(Till April 11). Tamil Nadu wasted over 12 percent, followed by Haryana (9.74%), Punjab (8.12%).  Ideally, a vaccination centre must have 10 recipients to make optimal use of a single 10-dose vial. If the person is not available then that vaccine vial becomes a waste.

Suggestions to improve universal vaccination in India

1. Conducting a detailed demand-supply analysis: To conduct a calibrated expansion of the eligibility criteria India needs to conduct a detailed analysis including the vaccine manufacturers’ real-time production capability, the supply chain delays, etc.
2. Reducing vaccine hesitancy: The only way to counter that is to be open and honest about adverse effects and make available relevant information in the public realm. So, both the state government and the centre need to be more transparent in the Universal vaccination process.
   • India can establish an independent team of experts under the aegis of the WHO to ensure adherence to recruitment standards, consent conditions, adverse event record management, compensation standards. This will improve public confidence and provide enough data for the future policies of the government.
3. Encourage stakeholder participation: The government have to rectify the issues with the new vaccination policy with better stakeholder participation.
   • Stakeholders should include not only state governments but also the local bodies that are struggling to control the pandemic.
4. The government can ask private companies towards cartelisation: (It means the group of industry participants coming together to fix the price of products and services.). Since the foreign players are also producing vaccines, India can work towards the cartelisation efforts. This will fix the price of Covid-19 vaccines. In case of any failure in the process, India can invoke compulsory licensing and reduce the vaccine prices towards universal vaccination in India.
5. The move towards zero-wastage: The state governments have to use each and every vaccine in an effective way. States wasting the vaccine can follow zero-wastage states like Kerala, West Bengal, Himachal Pradesh, etc. For example, the Kerala model includes the following steps. such as,
   • Training health care staffs including ASHA workers towards the importance of vaccine usage
   • Creating efficient inventory management for managing vaccines.
   • Mobilise beneficiaries after they register for the vaccine.

Conclusion

“None of us will be safe until everyone is safe”, so the government has to take necessary steps towards universal vaccination. The need of the hour is a winning strategy against an epidemic that has drained us economically, socially and psychologically. The winning strategy is feasible when all the stakeholders come together to address the grievances.