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As India approaches 100 crore Covid jabs, celebrations — and some lessons

K Srinath Reddy writes: Experience gained through this vaccination programme will be valuable for the design and delivery of other public health programmes across the country

In terms of single-dose vaccinations, we are ahead of the United States (66 per cent)

That we are nearing the landmark of 100-crore Covid inoculations is certainly a morale booster, especially when we look back at the first half of 2021, when there was uncertainty about the planning and pace of the programme amidst a devastating second wave. While there is a need to complete second doses for many, which the government is addressing as a priority, we can draw satisfaction from the fact that over 70 per cent of the population has received at least one shot. Combined with the natural immunity that may still be lingering among those infected in the Delta-charged second wave a few months ago, a large number of Indians may presently be protected against serious illness and death from the virus.

In terms of single-dose vaccinations, we are ahead of the United States (66 per cent). This is because anti-vaccine resistance is minimal in India, where apathy and the feeling that the “worst is over” are greater barriers than political or religious opposition. As immunity from the first dose or natural infection fades, we need to ensure a second dose is administered to all eligible persons by March 2022. We should aim for 100 crore more vaccine shots, building on the momentum.

Progress in Covid vaccination is a tribute to the success of science, in India and the world, in producing effective vaccines in record time and to the unprecedented mobilisation of resources to undertake the largest ever mass vaccination of adults. Around this time last year, vaccines directed at the SARS-CoV-2 virus were in different stages of development. Vaccines against this new virus were developed and trialled globally and in India with amazing speed. This portrays the spectacular success that biological sciences and public health can achieve by partnering when backed by committed resources. The multi-disciplinary response from scientists has been truly commendable.

The commitment from policymakers was a key catalyst in providing direction and speed to the vaccine yatra. Our vaccine supply chain is now rapidly expanding with increasing quantities of indigenously developed as well as internationally developed vaccines licensed for manufacture in India. This has helped to ramp up daily vaccination rates. Investing in domestic manufacturing capacity, permitting globally approved vaccines that were cleared by credible foreign regulators and direct central procurement and distribution helped to overcome supply constraints. Effective communication strategies helped motivate and mobilise people for vaccination. A large number of vaccinators were trained and deployed. The logistics of the supply chain were closely monitored. Though manufacturing was slow initially due to the US government’s export restrictions on raw materials and ancillary equipment, they were overcome through diplomatic interventions. The manufacture of vaccines was scaled up by enabling more production centres. Inter-ministerial and inter-agency cooperation provided a coordinated response. Development partners, including UN organisations, played a supportive role in assisting in supply chain logistics, training and vaccine confidence campaigns. Civil society organisations and the private sector partnered with central and state governments to craft a collective social response to a major public health threat.

As we build on these creditable achievements, we must also recognise errors to avoid them in the future. Frequent changes in our vaccine procurement, distribution, prioritisation and pricing policies, which occurred between April and June 2021, created challenges in Centre-state coordination. Lack of clarity on the private sector’s capacity to deliver vaccines beyond the metros resulted in a larger than realistic role assigned to it. Order and efficiency were restored when the central government resumed its role as the sole agency procuring vaccines from domestic and global manufacturers.

Communication by the regulators to the public and the media was not crisp and clear when emergency approvals were provided to two vaccines in January 2021, thereby generating avoidable controversy and scepticism. The coherent communication of technically guided policy decisions, to the lay press and public, is an essential skill that must be instilled into techno-bureaucrats, who have to convince the public about policy decisions.

Civil society and community-based organisations were not adequately engaged early in the campaign. While mass media campaigns are useful and have been well delivered across the country through a variety of channels, neighbourhood conversations and peer persuasion are important pathways for influencing levels of vaccine confidence. It was only later in the campaign, as the second wave surged, that community-based organisations were mobilised and actively engaged. Such partnerships are essential for the successful delivery of public health programmes, especially during major public health emergencies which stretch and strain the resources of the government machinery.

India is rightly viewed as the pharmacy of the world and a vaccine production powerhouse, with a credible and creditable record to back these claims. Even in the unprecedented scale of global demand for Covid-19 vaccines, India stepped forth to supply the world. After the ferocious second wave of the pandemic struck the country during March-May 2021, India had to prioritise the domestic vaccination programme. With the domestic situation now vastly improved, India has resumed international supplies of vaccines. That is needed, both as a gesture of solidarity with other countries and as an act of public health realism to prevent the emergence of vaccine-evading variants in under-vaccinated populations.

We must, at the same time, gauge our own requirements carefully as the vaccination programme extends to persons below 18 years of age and increasing research and real-world evidence provides guidance on when and in whom booster doses will be needed. Careful calibration has to be done on the basis of periodic reviews, with the policy subject to revision according to the need of the times. We need to help the world but the world too must recognise that we can do so effectively only when India is safe and stable in its pandemic control.

This journey has bolstered our confidence that mammoth mass vaccination programmes can be efficiently undertaken. It has also given us insights into areas that need to be improved. Experience gained through this programme will be valuable for the design and delivery of other public health programmes across the country. A rapid learning experience with Covid-19 has given us the organisational grammar to combine various elements of public health action, across multiple locations and through several agencies, into a coherent and impactful statement of public health success. We can now build on that experience and expertise for future narratives of public health policy and implementation.

This column first appeared in the print edition on October 21, 2021 under the title ‘Our vaccine milestone’. The writer, a cardiologist and epidemiologist, is president, Public Health Foundation of India (PHFI). Views expressed are personal

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