Given the size of India’s population most things in the country happen at scale. The COVID-19 vaccine drive exemplifies the mega logistics of just about everything done in the world’s largest democracy. Here is a look at how it will play out in a nation where things are not done by the million, but by the billion.
Manufacturing
When it comes to vaccine making India is a powerhouse. 60% of the world’s vaccine is made in India. Pharmaceuticals firm Serum Institute of India is the largest vaccine manufacturer in the world. It will produce 100 million doses of the Oxford–AstraZeneca COVID-19 vaccine to be supplied in India and abroad.
This should come as no surprise. India has a vast 42-year old immunisation program which is one of the worlds largest. It encompasses 55 million newborns and pregnant women. The program supplies 390 million free doses of vaccines annually to protect against a dozen diseases. India has an efficient electronic tracking system to monitor stocks and delivery of these vaccines.
COVID-19 vaccine drive
The vaccination campaign in India is underway. It is planned to vaccinate a quarter of the population by August. Prime Minister Narendra Modi stated that the first 30 million people to be inoculated will be healthcare providers, police, and other frontline workers. For the next batch of 270 million people the authorities will focus on those aged over 50 and those who suffer from conditions that might make them more vulnerable. The rest of the population will be immunized subsequently.
The Co-Win app will track the inoculation drive and ensure that nobody is left out. An initiative of this magnitude requires an army of trained personnel. Much of India is still rural. This is why the vaccine drive incorporates the training and organizing of 154,000 nurses and midwives. They will be sent out to administer COVID-19 vaccines at field vaccination sites. All major hospitals in India are participating. The Vaccination program will be closely supervised and monitored.
The vaccines
The country’s drugs regulator has approved the use of 2 vaccines. Covishield is developed by AstraZeneca with Oxford University. Covaxin is produced by Bharat Biotech, an Indian firm. The vaccines must be stored and transported in a narrow temperature range from 2-8C. 29,000 existing cold storage facilities will be used to stock the vaccines in what is being called the ‘cold chain’. Cold storage facilities are already available in agricultural and animal husbandry research centres in Indian states such as Haryana, Karnataka, West Bengal and others. The vaccine doses produced by Serum Institute will only be given to the government, at a price of INR 200 (AUD 3.55) per dose, for the first 100 million doses.
Challenges
The reception to the vaccine drive has not been uniform. A recent survey of 18,000 people by AFP found that 69% were in ‘no hurry to receive the vaccine’. Less than ideal public health systems and low transport connectivity to very remote parts of the country are other issues. Storing the vaccines at low temperatures will be challenging as the dreaded Indian summer approaches. The country is preparing by installing cooling equipment at scale. 45,000 ice-lined refrigerators, 41,000 deep freezers, and 300 solar refrigerators are planned.
Experience
India has drawn upon its vast experience with large scale diseases and vaccination. In the 1960s almost 60% of the world’s smallpox cases were reported in India. In 1958 the World Health Assembly (WHA) passed a resolution to eradicate smallpox. In 1962 India started the National Smallpox Eradication Programme (NSEP). Its objective was to vaccinate the entire population in the next 3 years. This proved difficult. After 5 years of running the program coverage remained low and outbreaks were still being reported. The main challenge was to access the vast remote population.
During 1967-1968 the smallpox eradication strategy was reformulated. There was increased focus on surveillance, epidemiological investigation, and rapid containment. By 1969 the vaccination technique had been upgraded from the antiquated ‘rotary lancet’ method to the ‘bifurcated needle technique’. In 1971 a more potent, heat-stable, and freeze-dried vaccine replaced the old liquid vaccine. These changes simplified the process and increased the vaccine uptake significantly.
The last case of smallpox to be reported in India was in 1975. Surveillance continued thereafter. India was declared smallpox-free in 1977. The eradication of smallpox left a legacy of improved health systems, trained vaccinators, cold chain systems, and a network for the surveillance of vaccine-preventable diseases. This legacy and experience is now helping India vaccinate 1.3 billion against COVID-19.
NRIs in Australia
A vast Indian community lives overseas in Australia. Their priority is to send international money transfers as remittances to their families back in India. Traveling back to India to get vaccinated is not practical. However it is not necessary either. Pfizer’s COVID-19 vaccine has been approved for use in Australia, and will be rolled out in February. The Astra Zeneca vaccine may also be used, although it is still to be approved. The entire population of Australia is expected to be vaccinated by August 2021. Non-resident Indians (NRIs) in Australia can get vaccinated in their host country. Australia is likely to mandate vaccination for all residents.
About the author:
Hemant G is a contributing writer at Sparkwebs LLC, a Digital and Content Marketing Agency. When he’s not writing, he loves to travel, scuba dive, and watch documentaries.
