? PhtoAs we write this, India is heading towards 60 lakh confirmed cases of Covid-19 with over 93,000 deaths. Though we are also witnessing good recovery percentage, the overall battle against the pathogen is far from over. It end can come only two ways, either the virus die down on its own or we get a vaccine. We can’t be sure if the virus will get obsolete on its own. But we can be sure that a vaccine is coming by next year. But even if it comes, will all of us get it instantly? How the entire process of getting the vaccine will be? What are the challenges for India? In this article, we shall discuss all these aspects.
#COVID19 | Leading vaccine scientist Gagandeep Kang has said rolling out an eventual vaccine safely across India’s 1.3 billion population will be the country’s biggest challenge in fighting the disease https://t.co/mEgKEZjhqX
— Hindustan Times (@htTweets) September 23, 2020
Covid-19 vaccine production & distribution: All issues explained in 7 points
1. What does the WHO say about vaccine distribution?
There is also a plan developed by the WHO, which by contrast, begins with 3 per cent of each country’s population receiving vaccines, and continues with population-proportional allocation until every country has vaccinated 20 percent of its citizens. In June 2020, WHO had said that healthcare workers should be given priority first followed by adults older than 65 and those having comorbidities such as cardiovascular disease, cancer, diabetes, obesity, or chronic respiratory disease.
2. What is the “Fair Priority Model”?
Consequently, a three phase plan for vaccine distribution, called the ‘Fair Priority Model’ has been developed by a team of nineteen global health experts. What this model aims to do is create a methodology, which reduces premature deaths and other irreversible health concerns arising out of Covid-19. The model works on three levels – to benefit people and limit harm cause by the virus, prioritising countries already disadvantaged by poverty or low life expectancy, and avoiding discrimination.
Phase 1 of the model focuses on curtailing the premature deaths arising from Covid-19. This is determined by calculating “standard expected years of life lost,” which is a commonly used global health metric. In the next phase, the overall economic improvement and the extent to which people would be spared from poverty upon receiving this vaccine will be taken into consideration and the last phase will focus on countries with higher transmission rates.
3. Where does India stand at present?
India is still developing its vaccine distribution strategy. While it stands united in saying that the frontline health workers directly interacting with Covid-19 patients will be the first recipients of the vaccine, there seems to be no clarity on who will come next.
Given the vast population of India and complex social, economic, and humanitarian contexts of India, it is necessary to develop a model that is customised for ensuring effective distribution. India has past experience with vaccinating large populations and eradicating diseases such as small-pox and polio. This experience will come in handy while developing an India specific Covid-19 vaccine strategy. In India, at least seven Indian pharmaceutical companies are working to develop a vaccine and two have progressed to human trials, according to this report. Dr VK Paul, member of NITI Aayog, is heading the expert group committee tasked with building a strategy. E Sreekumar, chief scientific officer at the Rajiv Gandhi Centre for Biotechnology, in a report said, when the vaccine will be ready, there’s a possibility that the Centre may conduct a seroprevalence study to understand the prevalence of infection among the country’s population. The seroprevalence data may help to weed out people from having Covid-19 vaccine shots who have already developed antibodies against the virus.
4. What is the Centre planning now?
The Principal Secretary to Prime Minister, PK Mishra, recently chaired a high-level government meeting where top officials discussed the formulation of an effective Covid-19 vaccine distribution system. The need for district health action plans for long-term management of the disease and the stage of vaccine development—besides the overall Covid-19 strategy of the country—were also among the issues discussed.
Health Secretary Rajesh Bhushan spoke about the eVIN Platform which monitors the vaccine supply chain, a beneficiary enrolment system, and the delivery system once the vaccine is available. The Health Secretary highlighted the status of states in terms of case trajectory, testing numbers and case fatality rate. NITI Aayog member Dr V K Paul made a presentation on case projections based on various models. “…the Principal Secretary directed all concerned to build on the knowledge and analysis that has been developed over the last few months…,” the release said. The meeting was attended by the Cabinet Secretary, the Principal Scientific Adviser, Empowered Action Group Convenors and department secretaries.
5. Vaccine distribution: What are the major challenges for India?
The path to vaccine preservation, transportation and distribution won’t be a cakewalk for India given its huge population, complex social and economic set up and other factors. Here we list five major challenges our country might face.
A. We must develop an accurate directory of all available healthcare providers, in both the public and private sectors, and of health facilities, payers, geographic/administrative areas, and administrators. The directory will be required to plan and monitor vaccine distribution and delivery. A line list of all health providers in each health facility and geography on day one of the vaccination campaign will also help with prioritisation.
B. Along with the directory, a complete population enumeration will help identify vaccine requirements, draft geographical targets, develop vaccination schedules and monitor coverage. This will obviously be a huge effort, so the pandemic may justify the Indian government’s use of the 2011 census database, and we must debate and finalise the policies that will guide their use. A population enumeration will also help identify high-risk groups that in turn will help with prioritisation.
C. We need a single system to track vaccines from factories to health facilities to, ultimately, those who receive the vaccination. Such an end-to-end system is critical to ensure actual vaccination and prevent fudging of data. There are two ways to track the progress of the existing routine childhood vaccination programme, and they don’t talk to each other. So there is always an information discrepancy that results in an incomplete understanding of vaccination efforts. We should learn from our experience of these programs and create a unified system.
D. India needs to digitise all the data pertaining to (1), (2) and (3) or the scale of efforts could quickly get out of hand. We should fully develop and test digital systems before the first vial becomes available for public use.
E. We must procure the requisite resources – including human, hardware and infrastructural – on a timely basis, including those required to maintain cold chains, plus mobile phones and data plans for all frontline vaccinators to provide real-time data. We will also need to train providers to manage vaccine-related side effects at the primary level, provide educational and awareness materials for receivers in different languages, develop a citizen grievance mechanism and hire independent agencies for quality audits. As vaccination for Covid-19 will be technically be additional work for vaccinators, the state has to finalise an incentive system to motivate them. A coordinator could be identified from the existing cadre of public health officers at every district whose only responsibility could be to prepare the district for vaccination en masse.
In India, the cost of producing drugs and vaccines is relatively cheaper because of the availability of labour and also large scale manufacturing facilities. This report says, a rotavirus vaccine by Indian pharma giant Bharat Biotech, for example, cost one-fifteenth as much as rotavirus vaccines developed outside of India. Developing a vaccine that is prohibitively expensive will defeat the entire purpose. According to reports, India’s Serum Institute said it will price the shot at $3 (approximately Rs 221) per dose for the country and other emerging economies.
7. What is the vaccine maker saying?
Speaking about the next challenge for India in fighting the coronavirus pandemic, Serum Institute of India (SII) CEO Adar Poonawalla on Saturday asked if the central government has Rs 80,000 crore to spend over the next one year on purchase and distribution of Covid-19 vaccines.
Quick question; will the government of India have 80,000 crores available, over the next one year? Because that's what @MoHFW_INDIA needs, to buy and distribute the vaccine to everyone in India. This is the next concerning challenge we need to tackle. @PMOIndia
— Adar Poonawalla (@adarpoonawalla) September 26, 2020
“Quick question; will the government of India have 80,000 crores available, over the next one year? Because that’s what @MoHFW_INDIA needs, to buy and distribute the vaccine to everyone in India. This is the next concerning challenge we need to tackle,” Poonawalla tweeted, tagging the Prime Minister’s Office (PMO) as well. The Pune-based Serum Institute of India, the world’s largest vaccine maker by number of doses produced, is working on several vaccine candidates for the novel coronavirus, including potentially mass-producing the one from AstraZeneca-Oxford University that has garnered global headlines, as well as developing its own. The firm is also doing the clinical trials of AstraZeneca’s vaccine candidate in India. It received approval from the Drugs Controller General of India (DCGI) to resume local clinical trials of the vaccine candidate on September 16, after a week’s halt following serious side effect in a trial participant in the UK.
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