Administering 100 crore vaccine doses in less than 10 months is a remarkable achievement for a country as vast and diverse as ours. Vaccine aatmanirbharta (self-reliance) has helped India achieve this remarkable feat. The country is well-placed to vaccinate its 94-crore adult population by the end of this year.
This remarkable feat has been made possible by the concerted efforts of scientists, entrepreneurs, industry leaders, administrators and government. The country has taken crucial steps to strengthen the basic science research infrastructure in the last two decades, which helped in ramping up facilities for the development of vaccines. In March 2020, as soon as the pandemic struck the world, India invested huge funds to create an ecosystem that encouraged scientists as well as entrepreneurs to collaborate and take up the challenge of developing vaccines in such a short time. There were transformations in the research ecosystem: Major investments were made in high-risk projects, collaboration between academia and industry was proactively encouraged and infrastructure to support vaccine development was bolstered.
India’s already-existing vaccine manufacturing infrastructure came in handy. The vaccination programme began in less than a year. Today, four vaccines are manufactured in India — Bharat biotech’s Covaxin, Serum Institute’s Covishield, Cadila Zydus ZycovD vaccine and Russian-developed Sputnik V.
Since the vaccines were developed in a short time and accorded emergency-use authorisation, people had initial concerns about safety and efficacy. But it’s not too well-known that to ensure safety, scientists across the world had started discussing possible side-effects of the vaccines around June-July 2020. By September-October last year, India had set up an expert panel including general physicians, pulmonologists, cardiologists, neurologists, hepatologists and other specialists to monitor Adverse Events Following Immunisation (AEFI) at the national level. The investigation and causality training for AEFI members across the country was organised in October-November and by December, most of them were trained to identify and address common adverse events as well as possible conditions that could theoretically have occurred with any new vaccine. Any clinical event or disease that occurs within 28 days of administering a dose of the vaccine is to be reported as AEFI. Unfortunately, the system is only able to capture events occurring in the first four-five days after the vaccine is administered. The AEFI surveillance system surely has a lot to improve on in the coming weeks and months. Routine AEFI surveillance, though, has improved and active surveillance systems have been set up at 20 to 25 sites across the country, both at hospitals as well as community sites. This is helping the system to rule out the possibility of long-term effects of the vaccines.
At every vaccination centre, a waiting area was set up where people can be observed for 30 minutes post-vaccination. The objective was to manage any severe reaction promptly and refer them to the nearest health facility. This approach has saved several hundred lives. Equally important is the role IT has played in the smooth delivery of vaccines.
Along with making vaccines available, it was important to convince people about the need for the shots and assure them of their safety. Initially, misinformation and rumours created vaccine hesitancy. Politicking complicated matters. But the country’s experience during the long campaign for polio eradication came in handy while dealing with misinformation around Covid-19 vaccines. Communication experts were roped in to draft social mobilisation programmes in October last year. Iconic personalities, religious leaders, community leaders were also involved in awareness programmes.
Social media was scanned systematically so that rumours and misinformation could be countered methodically. Like an infectious disease, vaccine hesitancy can spread rapidly from one area to another unless there is prompt action. The proactive approach has turned hesitancy into vaccine eagerness.
India’s vaccination campaign has been a well-coordinated operation involving several departments other than the health departments. India has even inoculated more than 2 crore people in a single day. Infrastructure for such a large-scale project does not come up in a short period. The country has already shown the capacity to immunise over 17 crore children with polio drops within seven days.
Covid vaccines were never available in unlimited quantities anywhere in the world. While all-out efforts were made to develop indigenous vaccines and manufacture locally under an international licence, attempts were also made to arrive at advance arrangements with international vaccine manufacturers in late 2020. The lessons from these negotiations reinforced India’s resolve to bank upon locally manufactured vaccines. Many complained about the initial pace of immunisation but it was calibrated according to vaccine availability, beneficiary prioritisation and building the delivery infrastructure.
Mid-course corrections were amongst the highlights of the campaign. Each challenge was taken as a step towards making the programme more people-friendly.
Hundred crore doses is an important milestone. But the fact is that there is still a long road to effectively control Covid. A substantial number of adults, and all children, are yet to be vaccinated. The last mile could be a difficult road as we may come across pockets of vaccine hesitancy but concerted efforts to address contextual factors will help the country achieve full immunisation.
Covid immunisation will go a long way in protecting our population from developing severe diseases and mortality due to Covid-19. Equally important will be people’s compliance with Covid-appropriate behaviour. Keeping a tab on the emergence of any new variants in the coming weeks and months and preparing the health system for any future upsurge of cases will help win this battle against Covid-19.
The overarching philosophy of vaccine aatmanirbharta will hold the key to accomplishing the tasks ahead.
This column first appeared in the print edition on October 26, 2021 under the title ‘After milestone, a long road’. The writer heads the National Expert Group on Vaccine Administration