Vaccine Rollout: Steps on how Indian Govt can plan to tackle the crisis

An effective response to the second wave of the pandemic requires a three-pronged approach: (a) treatment of the affected population; (b) tracking and slowing the spread of the virus; and (c) protection of the rest of the population who are still not exposed to the virus, and therefore, more vulnerable.
This article offers the following recommendations for systematically tackling this crisis:
  • Strategic monthly planning: Both Centre and states must initiate specific monthly schedules for vaccination. This will help in monitoring the progress of vaccination across geographies and evaluating bottlenecks in the vaccine delivery process in a timely manner. Such a system will also make governments responsible for the proper and timely resolution of issues. Complete transparency must be introduced in the allocation to states to ensure greater trust and coordination. 
  • Targeted vaccination campaigns and Risk communication: Given the vaccine shortages that have been reported across the country, the high-risk populations as well as potential super-spreader groups among the active and mobile populations need to be actively identified and inoculated in an intensified campaign mode. India has a history of having a substantial proportion of the population remaining unaware of even the flagship schemes of the government. 
Local governments, health workers, and community, political as well as religious leaders will have to be incentivised to help identify and vaccinate the most vulnerable. India should remain vigilant in the enforcement of appropriate social distancing behaviours, preventing large gatherings, increasing testing levels, and tracking the spread of the virus by targeted genome sequencing and sharing of data. This will help prevent future waves.
  • Countering the gender and income divide: There is a national gender gap of four percent, in favour of males, in India’s COVID-19 vaccination programme. Current data shows that only four states have a higher female-to-male vaccine dose ratio, while states such as Delhi and Uttar Pradesh have a male-female gap of more than 10 percent. Furthermore, anecdotal evidence suggests that many smaller towns and villages are seeing a shortage of vaccine doses for their domestic population, as people from urban areas have been getting inoculated there, taking advantage of the first-come-first-served principle of COWIN portal’s online registration. Apart from the obvious equity concerns, such gaps in vaccine delivery may allow for mutation of the virus within people who are not vaccinated, possibly leading to the virus becoming immune to the vaccine, and new variants attacking urban areas again. 
The digital divide should not be allowed to get translated to a vaccine divide. The government must consider eliminating dual pricing between the Centre and States and keep providing the vaccines free in all government facilities, and for INR 250 in private hospitals. Under the current circumstances, allocating national resources to the COVID-19 vaccination drive could prove to have the highest return on investment for the Indian economy. 
In the course of the pandemic, many Central Acts have been invoked, including the Epidemic Disease Act 1987, Epidemic Diseases Amendment Act, 2020 and Disaster Management Act 2005. In the spirit of the key coordinating role of the central government, access to COVID-19 vaccine for all needs to be seen as a Central government responsibility. The onus of vaccine procurement, whether domestic or international, should be with the Central government. States must be allowed sufficient flexibility in their respective distribution strategies.
  • Proactive procurement and expanding manufacturing capacity: In light of the lukewarm response to the global tenders floated by state governments, the Centre should step in and initiate bulk procurement. Amidst a global shortage of vaccines, fragmenting purchasing power may mean that the states end up with outcomes that are both iniquitous and inefficient. Government agencies must start engaging constructively with vaccine developers and producers to anticipate raw material requirements and ensure maintenance of necessary supply lines. 
This also means fast-tracking development and regulatory approvals with regard to the vaccines currently in different stages of development and trials. Advance orders beyond July should be made, to ensure future supplies, and provide liquidity for the vaccine producers. By the end of 2021 or beginning of 2022, India should enhance its vaccine manufacturing capacity to the extent of addressing the global requirement of vaccines, and for that, drastic measures are required, like reviving large PSU facilities such as HLL Biotech, with a state-of-the-art vaccine complex.
  • Focus on rural regions and planning for new variants: For a country as vast and resource-constrained as India, quick universal vaccination may not be practical. The country indeed must try to pre-empt new variants through quick and comprehensive vaccination rollout, but given the vastness of the geography and the numbers that need to be covered, the system must be ready for pools of infection spawning new variants. 
As case numbers go down, sequencing of a sufficiently large sample size from sub-district levels should be aimed for, and proactive funding of further research and development of new vaccines to handle new variants should be conducted in parallel, along with strategies for providing booster shots as and when required.

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