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COVID-19 | The many challenges before the phase three vaccination drive

The enormous load on healthcare sector will increase with the third phase of vaccination from May 1. The private sector needs to be roped in for planning, distribution and vaccination 

April 20, 2021 / 01:19 PM IST

India is going through its most sever health crisis since Independence. COVID-19 has returned with all its virulence, infecting hundreds of thousands every day, making India the leading nation with the maximum number of reported cases per day.

Though India started its vaccination programme in January, the percentage of citizens inoculated has been one of the lowest globally. The impact of the second wave could have been less if the vaccination drive was more prevalent. The Indian government gave priority to the elderly and front-line workers and subsequently opened up to everyone aged above 45; thus exposing, the majority of the population at the vulnerable cross lines.

There has been the demand for the universalisation of vaccination, and the April 19 late evening announcement by the central government to vaccinate the population above 18 years from May 1 is in the right direction. This decision could have been taken earlier, but better late than never.

The execution phase of the said policy comes with its challenges and need to be carefully monitored.

Vaccine Challenges


Adding another 45 percent of the total population (approx. 500 million) in the third phase of India’s vaccination drive will take it in the right, but most challenging, direction. We foresee four major challenges for this most-awaited next phase of our vaccination drive.

The first challenge is the availability of the vaccine. The stress on the already strained healthcare system including the infrastructure and the healthcare staff is seldom addressed. Another big challenge is the distribution of the vaccine, which needs to be scientifically decided through modelling studies or so.

With the May 1 timeline set, data from the field shows that India is facing vaccine shortage or there are serious supply chain challenges that need to be addressed. Given the prevailing COVID-19 situation, there will be a high demand from the young population. If the vaccines are not available in plenty, it could lead to chaos, acrimonious scenes at the vaccination centres and, more importantly, black marketing and inequity in the distribution. The lack of access to medicines and vaccines within a reasonable timeframe has led to black market transactions at present. Such development reflect a failed system. Inaccurate quantification of demand stemming from a lack of transparent procurement processes is a common reason for malpractices to develop.

With the fresh demand coming from a significant group, there's a rising fear of such developments amplifying if the supply side is not taken care of. There needs to be routine monitoring of access to vaccines and other data such as availability, expenditure and shortages, to inform policy decisions and better co-ordination among states and the Centre.

It is a welcome move that the government has sanctioned money to the vaccine producers without any bank guarantee; but the ramping up of production might take time to meet the demand. In the meantime, the government could think of importing more vaccines approved by the regulators abroad while conducting parallel trials among a small population to test for any adverse reactions. The government could also consider approving them and encourage domestic production.

Turn To Private Sector

There is already an enormous load on hospitals and front-line workers who have to cope with the exponentially increasing daily reported COVID-19 cases. Now, by opening up the vaccination drive, the pressure on an already stretched healthcare system will increase. This calls for the participation of the private sector where the number of trained vaccinators and the number of vaccination centres can be increased. Additional training and onboarding is the need of the hour to meet the challenges on this front. The supply chain and logistics management could also come under severe strain. Here again, private sector participation is crucial.

While removing the price capping is a well thought move, the spread of the virus is still uneven. The imminent challenge is to break the chain of the spread of the virus. In the early phases of the next round of vaccination, it could be an excellent strategy to inoculate the young population where the spread is leading to high mortality and putting a severe strain on the available healthcare facilities. This again requires constant data monitoring and daily improvisation of the data modelling.

With the participation of the private sector in testing, the availability and the quality of the data has improvised to a great extent. Here again, it is vital to have the participation of the private sector to set the models ready for every district and urban areas in India. With Aadhaar playing the connecting role in keeping the data intact of those who are inoculated, the IT infrastructure should be robust to handle the higher volume of the business on an hourly basis so that confusion, mistrust, and delays registering for the vaccination is avoided.

In the end, it is transparency, openness and partnerships that will make the world’s largest and most-extensive vaccination programme a success.
D Dhanuraj is Chairman, Centre for Public Policy Research, Kochi. Views are personal.
Nissy Solomon is senior research associate at Centre for Public Policy Research, Kochi. Views are personal.
first published: Apr 20, 2021 01:01 pm

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