This article is a candid account of where we stand, having just crossed the stupendous 100 crore vaccination milestone. Some verifiable stories of grit and ingenuity will show how difficult it was.
Six factors are majorly responsible for last week’s achievement. First, all states were eager to immunise eligible citizens. That matters. Second, India had the manufacturing capacity to produce the vaccines. Most of the world does not. Third, despite avoidable confusion around May, once the central purchase of vaccines for those above the age of 44 commenced, the process of procurement, cold chain upgradation, logistic planning and online training of vaccination teams (cascading down to millions of health workers) was executed splendidly across both the public and private sectors. Fourth, every jab was linked through the Aadhaar card to the CoWin app, making tracking easy and fudging impossible. Fifth, local teams showed imagination to overcome enormous geographic obstacles. Sixth, there was unanimous public support — crucial for success.
First, the big picture. Goa, Himachal Pradesh, Sikkim and the Union territories of Chandigarh, Jammu, Kashmir, the Andaman and Nicobar Islands, Lakshadweep and Dadra and Nagar Haveli (DD & H) have achieved 100 per cent vaccination. Their smallness must not diminish the success of complete immunisation executed in the most inaccessible habitations. Reaching small, isolated groups of tribal people living on different islands in the Andaman archipelago and persuading them was far from easy. Up north in mountainous Himachal Pradesh, hundreds of minuscule settlements dotting the mountain cliffs, visible only from a helicopter, had to be reached somehow. In the west, the tribal people of DD &H, mostly unseen, living within forest groves, had to be located and jabbed. Achieving 100 per cent immunisation in such inaccessible pockets was not tiny.
Among the large states, Kerala, Uttarakhand, Gujarat, Madhya Pradesh, and the UT of Ladakh have achieved 90 per cent coverage with the first dose. The story, however, is not very encouraging for Bihar, Uttar Pradesh, Jharkhand, and the Northeastern states of Manipur, Meghalaya, and Nagaland where only 65 per cent of the population or less, have been vaccinated with the first dose. This is worrying because the populations of UP, Bihar and Jharkhand alone represent one-fifth of India. The remaining large states fall somewhere between the 65 per cent and 90 per cent levels and the speed of immunisation does not appear to be in top gear. In fact, the CoWin app clearly exhibits how tardy the offtake of the second dose has been — almost everywhere. Summing up, a little more than 30 per cent adults are fully vaccinated, about 45 per cent have received only one dose and 25 per cent have not had even one dose.
Even so, behind millions of successful inoculations lie stories of great resilience. Examples from two high-performing states illustrate this. Madhya Pradesh has only half the population density of the national average. The state is home to 46 tribal groups. Mohammed Suleman, the state’s additional chief secretary (health), told me, “We realised that even as the urban areas were getting saturated, the rural areas were lagging. The district administrations then identified schools and community halls in every settlement, following the electoral polling booth strategy. Based on detailed mapping, each district scheduled outreach camps for two days for each hamlet falling within the gram panchayat. Each team had to vaccinate 5,000 adults within two weeks. One example will explain the challenge. Gawaria Faria hamlet has just 400 inhabitants. It falls in Sogat village, located some 60 kilometres from the Alirajpur district headquarters. Reena Sengar, the local auxiliary nurse midwife, led the team on an 8-kilometre uphill trek after which they camped in a primary school. They conducted scores of vaccinations each day, which is the story of hundreds of interior villages in Madhya Pradesh.”
Amitabh Avasthi, the principal health secretary in Himachal Pradesh, recounted an experience involving vaccine hesitancy. The people of Malan, a remote village in Kullu district, had refused vaccination until their deity (devta) agreed. The Deputy Commissioner walked for six hours to personally convince the deity. After much persuasion, the devta finally approved, after which 1,000 people got vaccinated in a single day. In another village Bara Bhangal, unconnected by road, the DC requisitioned the state helicopter to enable the vaccines to be administered.” Avasthi, however, added, “Without support from the Gompas (religious leaders) and his Holiness the Dalai Lama, it would not have been possible. Himachal’s 100 per cent vaccination was rewarded with special congratulations from the PM.”
If remoteness in India is a challenge, so is population density. The Mumbai Municipal Commissioner I S Chahal told me, “Mumbai reached close to 100 per cent single-dose vaccination by adopting a unique model. BMC’s tripartite Memorandum of Understanding with the corporates, the private hospitals and the Corporation resulted in free vaccinations being administered by private hospitals to 10 lakh slum-dwellers. That helped.”
In Delhi, with a population of over 25 million, Monica Rana, director, family welfare, explained, “Delhi has covered more than 85 per cent of its adult population with at least one shot and 46 per cent with two shots. With thousands of unorganised pockets, it would have been impossible to provide vaccination services within walking distance. Take, for example, a densely populated area like Mohan Garden in southwest Delhi, with a population of around 1.2 lac people. We had to operate six vaccination sites simultaneously every day using two local schools to vaccinate more than 1,200 people on a good day — all within walking distance.”
Battles are being won every day. But the war is far from over. Presently the CoWin app displays huge peaks and troughs state to state and week to week. In the last few weeks, the vaccination numbers have fallen steeply everywhere. Whatever the reasons — festivals, vaccine availability, organisation, staff or something else — maintaining the momentum will be the biggest challenge for India’s vaccination drive.
A billion jabs have rightly given cause for celebration. While saluting everyone who had a hand — big or small — in this feat, it is good to remember that we have miles to go before we sleep.
This column first appeared in the print edition on October 27, 2021 under the title ‘Taking vaccines to the people’. The writer was former secretary, Health Ministry