Vaccinating India

Covid-19 inoculations pose an unprecedented challenge

One unintended benefit of the extended time drug-makers are taking to deliver a Covid-19 vaccine is that it offers the government the breathing space to plan a workable vaccine delivery programme in conjunction with the states. The dimensions of the issue are daunting because post-liberalisation India has not faced a public health challenge of this magnitude. In an interview to the The Indian Express, Nandan Nilekani outlined the task at hand: Reaching 1.3 billion people in two years amounts to delivering 2.6 billion vaccinations (assuming it is dual dose), or more than 3 million vaccinations a day. The numbers may be slightly lower if those who have acquired immunity after contracting the virus are excluded. Mr Nilekani’s suggestions for the private sector to take responsibility for inoculating their employees and for the government to extend the Corporate Social Responsibility mandate to Covid-19 vaccine programmes would certainly relieve some of the pressure on the Centre and states. 

But two basic problems will remain and urgently need the government’s attention and planning. The first is creating and training the manpower to administer the vaccine and the second is mobilising India’s grossly inadequate public health system to deliver it. The challenge increases in rural and tribal areas where primary health centres are either unstaffed, understaffed, or non-existent. According to the World Health Organization data, 60 per cent of the country’s 2 million health care workforce caters to urban India, though over 65 per cent of the population lives in rural India. This means that governments will not only have to mobilise existing networks but expand them exponentially and train millions of people in short order. The anganwadi network of rural childcare workers and helpers — some 2.4 million at last count — would be a useful starting point. While it is true that their experience lies mainly in delivering infant vaccination programmes (polio, diphtheria, and so on), upgrading their skills to administer injections should be easy. But it is an open question whether their numbers will be sufficient. The Union health ministry has said it expects to receive and utilise 400-500 million doses for India to cover approximately 250 million people by July 2021. A crash training programme for a cadre of temporary health workers may be in order. The government is reportedly planning to change the rules to rope in pharmacists who are reasonably trained to administer injection.

In that context, Expenditure Secretary T V Somanathan’s assurance that there would be no budgetary constraints on the vaccination programme is encouraging. There would be a significant fiscal outgo on this account, and the government will need to be prepared by taking the states into confidence. The health ministry has directed the states to draw up plans for vaccine storage and delivery. Since these vaccines need to be stored at temperatures of between two and eight degrees Celsius, the states need to quickly set up workable cold chains — storage units and refrigerated delivery vans. This may, ultimately, turn out to be the bigger headache. As the agri-industry has complained for decades, the lack of a viable cold chain network creates a high level of fresh produce going to waste. It would be interesting to see if the states can overcome this deficit in the next few months. Inadequate preparedness could increase the cost and delay the economic recovery.