What is the solution for India's COVID Vaccine Woes?

By Arunima Rajan

The first phase of India's COVID vaccination policy was launched on January 16, 2021, and centred on protecting healthcare workers and front line workers.

Phase-II launched on March 1 2021, and April 1, 2021, and concentrated on guarding the most vulnerable, i.e. people more than 45 years of age.

Liberalised pricing and Accelerated National COVID Vaccine strategy came in to effect from May 1, 2021, under which COVID vaccination was opened for persons between 18-44 years.

But only a tiny percentage of the population has been able to get themselves vaccinate due to a shortage of vaccines. Hospital beds, ventilators, oxygen, doctors and nurses have also been in short supply.

A strategy paper of EY estimated that India might need 1.3 lakh-1.4 lakh vaccination centres, ~1 lakh healthcare professionals (as inoculators) and ~2 lakh support staff/ volunteers for mass-inoculation of prioritised individuals (30 crore people as identified by the government, includes healthcare professionals, frontline workers, people above 50 years and also people with co-morbidities) by August 2021 and the entire adult population (80 crore) by the end of 2022.

It is nevertheless vital to consider India's specificities, including India's large size, weak healthcare infrastructure and the political imperative to drive the inoculation programme forward.

Can India boost its domestic vaccine production? Will roping the private sector improve availability? What other measures can magnify vaccine accessibility?

In an exclusive interview with Healthcare Executive Magazine, Dr Harish Pillai, CEO of Aster India, Aster DM Healthcare, talks about steps to ensure smooth vaccine rollout in the country.

What do you think is the cause for the surge in the number of COVID cases in India? Is vaccine the solution for India?

The main reason for the increase in the number of cases in India has been due to the total sense of complacency by the population. The citizens are themselves responsible for the state of affairs. They have forgotten that we are living during a pandemic. I think COVID related fatigue had also set in due to which protocols such as the compulsory wearing of masks, social distancing, hand hygiene were all ignored. Partly the sense of complacency was also enhanced due to cultural facets of participating in wedding celebrations, birthday parties, religious festivals and of course, the largest festival of it all is our democratic process. So, all these significant factors contributed to this surge that we see in India.

What do you feel needs to be done regarding the pace of India's vaccination? Is it a positive move to open vaccination for all age groups?

It is very important to get all the vaccine manufacturers on board to understand the bottlenecks to increase production capacity where there are any physical challenges or other capacity challenges. This is one thing that the regulators and the manufacturers need to sit down and thrash out. We have to cut through the entire red tape and ensure that the maximum possible capacity in logistics and distribution is also created to have a threshold of at least 10 million vaccinations per day. Yes, I agree that the key is to rapidly vaccinate as much population irrespective of the demographic age groups.

Do we have enough supply to meet the new demand? Would States get enough supply?

No, we do not have the supply to meet the present demand because the Central Government already takes 50% of the supply. Another 50% is mainly taken up by the various State Governments who have ordered huge quantities from the manufacturer. So, very little is left for the private players.

Currently, the Central Government is supplying to those States from its quota, but eventually, once production ramps up, States will start getting their supply.

Would the opening up of all age groups lead to inequitable distribution?

Hopefully not, because the central and state governments would absorb the entire cost and give it through government hospitals and PHCs for free to the neediest of the population. Those who can afford to pay can go to a private hospital and pay a reasonable amount to get their vaccines.

What are the sort of steps to ensure smooth vaccine roll out of COVID-19 vaccine to all above 18?

The first step is to ensure the ramp-up of vaccine manufacturing capacity. To widen the distribution network using not just hospitals but also PHCs and well-equipped pharmacies. We should also open up community-based vaccinations with the help of residential associations and also corporates and factories. We should try as much as possible to prevent crowding in the vaccination centres and go into a mass immunisation regime as we did for the Polio vaccine earlier.

What are the hurdles for effective vaccine roll out in the country?

The No. 1 hurdle is the current capacity of manufacturers. So, we need to prioritise and increase capacity, and we have to focus on enhancing the actual vaccination to reach 10 million doses per day.

Would compulsory/coercive measures help it? Will it be counterproductive?

Yes. We need to get people and educate them to spread the message of the effectiveness of vaccinations across the country. What we need to remember is no single person will be saved till all are vaccinated.

There are reports about a triple mutation strain. What does this mean for India?

This is inevitable. The specific virus is well known for mutations and is a very stealthy virus that tries its best to overcome whatever defence is put up. So, we can expect more mutations which might make it up even more transmissible.

The price of the COVID vaccine would be higher in private hospitals from May 1. Would this have an impact on the vaccination drive?

So far from the customer demand and direct community members, we don't feel price would be an impediment.

Should we have universal free COVID vaccination? Or should it be one drug, one price, one country?

It may not be fair due to the physical challenges our government is facing. There are millions of people who can afford to pay for the vaccinations. The Govt. of India should focus on universal free vaccinations for all categories in the BPL segment as per their Aadhar notification. In contrast, those who can afford to pay should pay a fair price and avail the vaccination.