India’s vaccination campaign will pose many challenges of logistics and governance
Following the approval of two vaccine candidates in India, the first lot of vaccines have reached the states for priority vaccination of healthcare workers. One can hear the immense sigh of relief that is widespread and already there is a sense of euphoria that the crisis is behind us and we can look forward to a quick return to normalcy even though it might now be the new normal. In my life — and I am over sixty years old — I have not seen a crisis of this dimension that has shaken the entire world. People have lost their near and dear ones and a lot has changed, including the imperative of moving to a digital economy, online education and work from home.
Many of these changes that the pandemic has forced upon us have shown hidden benefits which might enable them to continue in the future. But it must be emphasised that by no means is the pandemic over and there is no cause for relaxing precautions. I feel that the Government handled the crisis reasonably well but now is faced with the herculean task of administering the vaccine which presents a logistics and governance nightmare. In the order of priority set by the Centre, healthcare workers and frontline workers are to be vaccinated first, followed by those above the age of 50. One has to register to avail of the vaccine.
The first part of vaccinating the health care and frontline workers should not pose much of a problem as they can be easily identified and administered the two doses at requisite intervals. However, my experience of administration shows that administering the vaccine to those above 50 is not going to be that easy. In India, we are plagued by VIP culture and the most annoying habit of queue jumping which is likely to take place in a big way. I can visualise politicians and senior civil servants trying to get themselves and their families vaccinated on priority once they are convinced that the vaccine that does not have any adverse effects. District magistrates and directors of various hospitals will have to wrestle with this problem as it would be difficult to evolve a rational system for this.
It is possible to vaccinate people on the basis of a list drawn on the basis of the date of registration and that should be made public so that it is difficult for influential people to try and get preferential treatment. However, there are going to be numerous vaccination centres making it difficult to have such a simplistic solution. On the other hand, there could also be many people not wanting to take the vaccine as they are not convinced of its efficacy or fear the adverse effects. Further, with registration being a requirement how would those not having a smartphone or awareness of the online registration process avail of this facility?
The vaccine will be supplied in batches and the first question will be that of allocation between states. What should be the criteria of allocation? Should equal doses be given to each state or the amount should vary according to the level of the infection in a state or the fatality rate? The next stage would be the allocation of the vaccine to different districts at the state level where again similar questions will have to be addressed. Whatever the decision is, some people are bound to feel unhappy about it. The most important thing is to communicate the scientific truth about the vaccine to the people so that they take the vaccine and develop a rational attitude towards it.
We do not want a situation where a single adverse reaction may derail the entire campaign. Often such vaccines lead to allergies and provisions have to be made for immediate handling of these allergies so that it does not fuel the rumour mills. A close watch has to be kept on rumour-mongering through social media on deaths taking place which have no connection to the administration of the vaccine. It is important to inform the people and keep doing so on a continuous basis and thereby build an atmosphere of trust.
We can use celebrities as we did for pulse polio where we had Amitabh Bachchan re-enforcing the message of pulse polio continuously. That apart, government officers and doctors and experts whose voice has authority should be on media as well as social media to give authentic information about the vaccine and it’s likely after-effects. Communication will have to be done in all languages used in various parts of the country to reach the maximum number of people and sometimes I have found that such messages are best communicated through street plays, poems, storytelling and community events which involve the entire population in the campaign.
Any campaign succeeds only when the people own it and give it their total support. The objective of administering this vaccine is to control the pandemic and save the life of the people and as such would require sustained efforts over the next two years to reach a significant percentage of the population of the country. This work cannot be done by the health department alone and would need coordination amongst various departments of the state. The coordinating role will have to be performed by the district magistrate at the district level and the Secretary Health/Chief Secretary/Cabinet Secretary at the state or the Central level.
One significant point raised by many people is regarding the existence of cold chain points to ensure that the vaccine is kept at the right temperature. Former Health Secretary Sujata Rao recently wrote in an article that of the 28,932 cold chain points half are in the five southern states, Maharashtra and Gujarat while the eight states in the north and Odisha that account for over 40 per cent of the country’s population have only 28 per cent of the cold chain points. She has rightly pointed out that along with this uneven distribution and the fact that weaker states suffer from a shortage of doctors, health care professionals and medical equipment means that different states of India have different capacity to implement the vaccination program with quality and accuracy.
The same will apply to large states like UP which has huge regional imbalances. Moreover, it would be quite a task to ensure the second dose of the vaccine within the stipulated time and also to maintain the cold chain in extremely remote and backward areas. The Prime Minister and several chief ministers have been talking about implementing this campaign in an election mode. There is no doubt that conducting elections in such a vast and diverse country has been a tremendous administrative success. It is amazing how polling booths are set up in almost every village or mohalla and polling parties are nominated and sent there with all necessary equipment to conduct the elections.
Massive transportation and security arrangements are undertaken and free and fair elections conducted. There is no doubt that a similar level of commitment, dedication and organisation as well as the involvement of all concerned government officers are required to make the vaccination campaign a success. This is possible but the question is whether this momentum can be maintained for a period which is likely to be almost two years? Elections, at best, require this kind of sustained effort for about two months. Then if the entire government machinery is focusing on the vaccine campaign for such a long time, would not other aspects of governance and administration which are equally necessary to bring about economic recovery suffer in the process? Already because of the pandemic, the education of the children, the nutrition programs and handling diseases like TB have been adversely impacted. Ultimately, we all must rise above politics and ideologies and join hands to make this campaign a success.