The prioritisation of 10 million workers, 20 million central and state frontline workers, and 270 million citizens either above 50 years of age or with co-morbidities is broadly in line with the approach being talked of nearly across the globe.
The target of inoculating 300 million Indians against Covid-19 by July 2021 means the government must urgently finalise its vaccine strategy. To that end, the recommendations of the National Expert Group on Vaccine Administration (Negvac), announced on Tuesday, are a significant step forward. The prioritisation of 10 million workers, 20 million central and state frontline workers, and 270 million citizens either above 50 years of age or with co-morbidities is broadly in line with the approach being talked of nearly across the globe. The proposal to train 65% of the country’s 239,000 auxiliary nurse-midwives (ANMs) for Covid-19 vaccine administration will allow others to be available for routine health and vaccination services. Nevertheless, there are several loose ends in other areas that the government needs to tie up and fast.
The primary concern is that of vaccine procurement and availability. The government has talked of eight vaccine candidates in various stages of trial for deployment in India. However, the US, Japan, Canada, and the UK have already struck deals with the three leading vaccine candidates (AstraZeneca, Moderna and Pfizer) to cover their entire populations and still have some to spare, as per a recent analysis of Duke University data by Quartz; India has an agreement with just one (AstraZeneca), for doses that will cover 18.5%. Though this roughly covers Negvac’s priority-population, the herd immunity threshold needed to beat Covid-19 is pegged at 60-70%. Read against vaccine efficacy and the duration of protection from a vaccine, unless the government steps up procurement, the remainder of the population will have to wait for access or look for other alternatives, which has serious implications for overall vaccine coverage.
The government must also be more transparent on vaccines being fast-tracked for licensing under emergency use authorisation (EUA)—two of the eight vaccines listed by the government, AstraZeneca and Bharat Biotech, have applied for this under the New Drugs and Clinical Trial Rules 2019 which allows for approval in “special situations … where relaxation, abbreviations, omission or deferment of data may be considered” with consideration of only preliminary data. Negvac co-chair, VK Paul, called for trust in the scientific rigour of authorisation of vaccines; given how transparent communication is central to this, the government needs to put out existing data on the candidates being considered for EUA in a digestible manner, and follow this up with regular communication on data for those that receive EUA. Some manner of calendar for such candidates meeting the standard trial requirements after receiving EUA is desirable. The government has also said that the existing cold chain capacity can store up to 3 crore additional vaccines (above the regular vaccines stored); this means a simultaneous roll-out for the prioritised groups will require large additions to the present capacity.
Managing this mammoth exercise is going to take superlative coordination, and this is where the government seems to have scored big. Experts had recommended deploying technology for managing the roll-out, and the government seems to have paid heed. The Co-WIN platform will aid both the vaccine administration as well as the recipients in management of the roll-out. One aspect of this will be a mobile app to record vaccine-recipient’s data upon self-registration. Persons wishing to be considered for the vaccination programme can register via the app. There will also be a dashboard that will give out relevant vaccine-storage/availability information for the cold-chain points to those managing the programme at different levels. The Co-WIN Beneficiary Management will track a vaccine recipient and manage the planning of vaccination sessions.