COVID-19 vaccines: Too many hurdles, still

Relevance: Vaccination is the only way we can control the pandemic.

Synopsis: The road to complete vaccination in India is riddled with various challenges. Where we are going wrong and what can be done!

Background

Here is how things have gone so far wrt vaccination drive in India:

• Development of indigenous vaccine: India was one of the very few countries that managed to develop an indigenous vaccine in record time. By  December 2020, the country was all set with its COVID-19 operational guidelines to ensure a smooth rollout of the vaccines.
• Vaccine shortage: More than 60 million doses to be exported or donated to other countries between January and March.
• Vaccination extended to cover all adults under 18 years: While people across the country struggled to secure vaccination slots on the national CoWin dashboard, the Centre worsened the situation by deciding to extend the vaccination net to include all adults under the age of 18 years.
• States fail to procure vaccines: It was decided that the additional vaccines will be procured by the state governments, which clearly failed because of the global shortage and the fact that states have never procured vaccines in the past. Some of the states even unsuccessfully tried to float global tenders to forge deals with vaccine manufacturers. When the desperation peaked, the Supreme Court had to step in.
• Universal vaccination announced: On June 7, amid criticism of the government’s confused vaccine policy, the Centre announced universal vaccination.

Present situation

• Target: India has the daunting task of vaccinating its entire adult population of nearly one billion by the end of this year. This will require almost two billion doses.
• Actual situation: In the first six months, the country has managed only 0.25 billion doses.
• Requirement: To be able to deliver the 1.75 billion more doses in the remaining half of the year, the country needs at least 250 million doses a month.

However, according to a Press Information Bureau release, only 120 million doses have been sanctioned for June, suggesting that the progress remains slow.

Challenges with vaccination drive

Major challenges are associated with timely delivery and rollout of the vaccines in India.

• Uncertainty in delivery: India is relying on Serum Institute of India, Bharat Biotech and import of Sputnik V vaccines. But, the delivery of Sputnik V vaccine has already been delayed from June to August.
• Speedy delivery of doses: Under the current universal immunisation programme, the country administers some 390 million doses to newborns and pregnant mothers in a year. For COVID-19 relief, the country will need to deliver an additional 250 million doses a month for the rest of 2021.
• Requirement of new infrastructure: The country will need new infrastructure and more importantly skilled health personnel to deliver the extra doses. A vaccination center needs at least five people, including a trained vaccinator.
• Increase rate of vaccine delivery: India will also have to ramp up its rate of vaccine delivery. Rolling out COVID-19 vaccination without fixing the delivery challenges will lead to distinct problems: the vulnerable population will be left out (which can lead to possible mutations) and vaccine quality will take a hit due to limited availability of cold storage facilities and human resources.

Suggestions/Measures

The five pillars on which the global vaccination  policy should rest

Ensure adequate supply

• Free up technologies through TRIPS waiver, C-TAP (COVID-19 Technology Access Pool by WHO for sharing intellectual property, technology and data to increase access to medical products)
• Increase production facilities
• Promote collaborations for raw materials
• Dose stretching: The government has the option of dose stretching to reduce the demand. For example, studies now show that people who have been infected by the virus might remain safe by taking a single dose.

Set a system for equitable distribution via COVAX

• Restrict hoarding
• Fund the facility
• Increase transparency on industry deals

 Protect people

• Increase transparency in trials
• Set up a system for monitoring adverse effects
• Set up a compensation system

Improve delivery

• Provide the vaccine free of cost
• Ensure access and increase rate of delivery
• Manage issues around the digital divide

 Improve pandemic preparedness

• Monitor variants
• Provide rational treatment
• Promote pandemic-appropriate behavior to control spread