Vaccination for COVID-19: Challenges for India

As the year is drawing nearer to its end, there emerged something to cheer about by the pandemic-struck globe: four vaccine candidates have claimed to have high efficacy levels in field trials to develop immunity by producing antibodies against Coronavirus among those individuals who were given a vaccine shot. As Europe and America are in the process of undertaking vaccination to achieve herd-immunity by ensuring a threshold coverage, India, with more than 9 million confirmed Covid-19 cases, and a battered economy, is also drawing plans to vaccinate a population of more than a billion people twice. And, that too, quite rapidly, for that is believed to be the sure-shot way to arrest the pandemic spread. 

No doubt, India, as the world’s leading vaccine manufacturer, is in a better position vis-à-vis many other developing countries for accessing vaccines, but there are challenges galore: distribution logistics, supply of the right vaccine with a proven efficacy level with no accompanying side-effects and cost of the vaccine.

As the Prime Minister rightly emphasized during his meeting with chief ministers, there is an urgent need to ramp up efforts to expand our existing cold-chain capacity. Simultaneously, a sense of confidence to capitalise on our existing “vast and experienced vaccination network”—27,000 cold chain points, 76,000 cold chain equipment, 700 reefer vans, 55,000 cold chain handlers and 2.5 million health workers, which is ranked within 51-75 percentile range among 89 countries on effective vaccine management by the WHO-UNICEF global analysis report of 2018—for the current adult immunization programme against Covid-19, has also been expressed.

True, we have a robust vaccination network under our Universal Immunization Programme. But there are many glitches that need to be addressed immediately for executing population-level vaccination plans. For instance, there are disparities in the distribution of cold chain points across the states. In states like Jharkhand, Uttar Pradesh and Bihar, there is only one cold chain point to serve 100,000 people.  As against this, the vaccine developed by Pfizer/BioNTech based on an m-RNA technology needs to be refrigerated to nearly –70 ⁰C. Indeed, according to the WHO, Covid-19 vaccines that are under development can basically be grouped into three categories: one set requires storage temperatures between 2-8 ⁰C, the second one requires –20 ⁰C and the third category requires –70 ⁰C. Our system is reported to be well equipped to handle vaccines to be stored between 2-8 ⁰C, but any requirement above that particularly, –70 ⁰C is near impossible to provide. Thus, ensuring a consistent cold chain for mass immunization programme in a sprawling nation like ours with the existing infrastructure is in itself a big challenge. 

Secondly, the timescale for delivering the Covid-19 vaccine to about 300 million people identified as the vulnerable group consisting of health workers, ancillary staff, sanitation workers, etc., by the end of August 2021 vastly differs from the ongoing universal immunization programme for children and women which staggers over an entire year. It makes a heavy demand on the software of the system. The first question is: Who will administer the Covid-19 vaccine? Who will train millions of people required for giving injections, disposing of the used syringes, monitoring and managing the side effects, etc.? And, when the system is fully diverted for undertaking vaccination who would provide the normal medical care for the ill? So, undertaking Covid-19 vaccination programme along with the ongoing universal immunization programme for children and women will become that much more challenging…  

Thirdly, Covid-19 immunization programme poses another unique challenge: identification of beneficiaries, ensuring their presence on the day of vaccination, documentation for administering second dose after a month, and monitoring them for side effects if any in between calls for an effective and efficient micro-level planning.

It is equally important that people have confidence in the vaccines for their uptake, more so in the light of Covid-19 vaccines being developed so rapidly and regulators are rushing through the laid-down procedures to speed up their delivery. Indeed, many of them are adopting shortcuts—Emergency Use Approval—for making them quickly available. Reports indicate that many in Germany and the US are not showing any enthusiasm to get vaccinated, perhaps, fearing it may not be safe.  And, unless enough number of people accept the vaccine, the level of “herd immunity” required to arrest the spread of Covid-19 cannot be established.  

Cumulatively, the immunization programme against Coronavirus appears to be a mammoth task. Therefore, experts in the system believe that in the light of these constraints, India needs to expand its public sector vaccine distribution network capacity by two to three times forthwith. 

That said, we must also take into consideration the cost factor. The vaccines developed by both Pfizer and AstraZenca-Oxford are supposed to cost around $37-39 per dose, while the Sputnik-V of Russia may be made available at $20 per dose. The only silver lining is that the AsraZenca vaccine being manufactured by SII, Pune will be supplied at less than $3 per dose to the government and @Rs 1,000 a dose for private players. But to cover its entire population quickly and thereby breaking the pandemic, India needs to source the vaccine from even other producers, which means cost becomes another major constraint.  

The overall scenario indicates that India has a daunting task ahead, and the business houses have a vital role to play in managing it. Corporates must chip in to assist government agencies in creating an efficient cold-storage chain to deliver vaccine across the country. They must also deploy their marketing programmes towards creating awareness among the public about the importance of the immunization programme being implemented, besides creating confidence in people about the safety of vaccines chosen under the programme. It is only by joining all the right forces—both from private and public organizations—in implementation of the programme that India can surmount these challenges successfully.     

Next, citizens too have an equal responsibility in making the whole exercise a success: they must respond to the government’s plan under vaccination in a disciplined fashion. Secondly, it is equally important that we heed to what Dr Paul Offit, Professor of vaccinology, Perlman School of Medicine at the University of Pennsylvania said about vaccines: “People shouldn’t think of vaccines as the saviour. Vaccines are, along with hygienic measures, a way to get in control of this virus, but we need both. Vaccines are not going to be magical.  … You can’t abandon one in favour of the other.”