Once COVID Vaccine Is Here, How To Ensure All Indians Are Covered?

Apart from complexities of regulatory approvals for vaccines, deploying the vaccine will see 4 key challenges.

Balancing the ever-increasing number of COVID-19 positive cases being reported every day and unlocking the lockdown imposed in March is proving to be a tough task for the government. The only hope for the resumption of operations in these areas appears to be a vaccine. Yet, deploying the vaccine when it becomes available is going to be harder than sending out guidelines for unlocking services.

Leaving aside the complexities of regulatory approvals for vaccines, we think that deploying the vaccine will consist of four main challenges:

1. Estimating the need
2. Securing vaccines
3. Choosing a delivery channel
4. Post-delivery surveillance

‘Prioritisation Strategy’ Makes More Sense For COVID Vaccine

The deployment of vaccines cannot be a half-hearted attempt. Deploying to a small part of the population will bring no benefit in terms of either saving them from contracting the disease or safe resumption of services. We recommend that 80 percent of the population be vaccinated.

Due to lack of production capacities globally, this will be impossible to achieve in a single go. Vaccination will have to be completed in phases which means some people will get the vaccine before others. While randomisation is the best way for equitable distribution, given the nature of the pandemic, a prioritisation strategy makes more sense.

Two strategies are likely in this scenario:

• One, where disease vulnerability determines the prioritisation so that vulnerable age groups receive the vaccination first
• The other, where we manage the pandemic while ensuring business continuity

Since the efficacy of vaccine candidates in this age group is not well known and restarting the economy will have positive trickle-down effects on people apart from the vaccinated groups, we recommend the second strategy. This approach also allows for a phase-wise rollout of vaccines as they become available from production facilities, and further prioritisation funnels can be utilised if vaccine supply is heavily constrained.

How To Get Enough COVID Vaccines For India’s Population Without Delay?

Current research and clinical trials are using multiple methodologies for vaccine development. When choosing a vaccine for deployment, considerations about the number of doses required for an effective immune response, logistical challenges of last-mile delivery, and the method of vaccination delivery will have to be weighed in apart from the cost of the vaccine per dose. At currently available prices, vaccinating 80 percent of India’s population would cost in the range of Rs 50,000-250,000 crore, depending on the cost of the vaccine (USD 3 for the Oxford Vaccine or USD 10 for Moderna).

This is well within the range of the annual expenditure that the Government of India incurs for its schemes such as MGNREGA, and even those incurred by political parties for a General Election (Rs 55,000 crores for 2019).

While India is the largest producer of vaccines in the world, our combined production capacities stand at 12.3 crore doses a month currently.

Given a scenario that the chosen vaccine requires two doses to be effective, we estimate that we would require a total of 240 crores doses and can only complete population-wide vaccination in 20 months when multiple vaccines are available and approved.

Shortening of this period can be achieved through the purchase of vaccines from a foreign manufacturer, which is likely to be expensive, or increasing manufacturing capacity locally.

We recommend incentivising local manufacturers to increase production capacities through faster approvals for imports of technology, equipment, reagents and publishing a model contract that assures market access, quick resolution of disputes and terms of the partnership that will boost manufacturers as well as public confidence.

Mechanisms For Vaccine Deployment

A vaccine for COVID-19 is a public good with positive externalities. However, deploying the vaccine for free will increase instances of pilferage, corruption and immediately increase the expenditure of the government amidst falling revenues. We therefore, recommend that vaccines be made available at a cost, which the government can transfer back to the household just like LPG subsidy is currently being done. As an exception, 100 percent cost may be transferred back, while households that do not require the subsidy can choose not to avail the benefit.

Current mechanisms of vaccine deployment only cover a small section of the population such as infants and children. Since this will be a population scale deployment, innovative solutions will be required.

We recommend a mission-mode approach to be undertaken by the National Health Agency that comprises staff from the Election Commission (EC) and public healthcare establishments. Organisational skills of the EC can be used to set up booths akin to a general election, taking vaccines to the people, where the public healthcare setup provides the technical expertise for delivering the vaccine in line as per standard protocols.

We envision a booth to cover not more than 1000-1200 people a day to follow social distancing norms and avoid overcrowding during the deployment.

What To Do Once All Indians Are Vaccinated Against COVID

Merely vaccinating the population will not be enough. Since most vaccines will carry emergency use authorisations (EUA) for quicker access, post-delivery surveillance will be necessary.

The NHA can create a national database specifically to record data regarding people who are vaccinated with details of the vaccine manufacturer, the ‘lot numbers’ used, and the date of vaccination.

This could be further enabled with Aadhaar to enable accurate identification of the individual to prevent excessive dosage as well as take corrective action due to ineffective or faulty batches. The data can also be anonymised to study the efficacy of the vaccines used. All data stored in this database must then be deleted at the end of the health emergency, or the manufacturer can determine a surveillance period of within five years from its creation, whichever is earlier.

Acquiring and deploying the vaccine is going to be a major challenge in a vast country like ours. Strategy for deployment needs to be well thought-out and communicated soon to avoid last-minute surprises, and achieve high coverage of the population.

Testing for COVID-19 was rolled out slowly. We cannot afford the same mistakes when it comes to vaccine deployment.

(Disclaimer: The article is based on this Discussion Document – work undertaken at the Takshashila Institution, a Bengaluru-based think-tank.)

(A molecular biologist by day and a blogger by night, Ameya Paleja writes about genetics, microbes and the future of technology at Coffee Table Science.  Scientific research and policy making are also areas of his interest. You can tweet to him at @ameyapaleja. This is an opinion piece and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)