Plan for vaccine roll-out: India can learn from the US that is already doing scenario tests

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September 19, 2020 6:15 AM

India can learn from the US that is already doing scenario tests

India should probably take a cue from the US, where the Centers for Disease Control is already running test scenarios for vaccine roll-out and is reported to be working on finalising prioritisation guidelines.India should probably take a cue from the US, where the Centers for Disease Control is already running test scenarios for vaccine roll-out and is reported to be working on finalising prioritisation guidelines.

A key responsibility of the government—both the Centre and the states—in the run-up to a Covid-19 vaccine becoming available is to draft a watertight roll-out plan. One of the first tasks, for the initial period when the vaccine supply is thin, will be to decide on the target population and prioritise groups for receiving the shots. There seems to be a consensus among countries that the first recipients have to be healthcare workers dealing with Covid-19 cases—in India, where there is pronounced shortage of doctors, the Indian Medical Association says 382 doctors have already died of the disease. There are various factors to consider, some of them vaccine-subject- and vaccine-specific. For instance, while the elderly are a high-risk group, their immune response to vaccine may be weakened due to age. How best to minimise their vulnerability while ensuring that the potential decreased immune-response doesn’t become a vaccine-availability constraint? Considering a vast target population—even the most-vulnerable population (elderly, people with co-morbidities, frontline health workers) is estimated at 400-500 million—and what can be realistically expected of the vaccine pipeline, prioritisation will be key. While Dr Reddy’s Labs has been contracted to produce 100 million doses of the Russian vaccine, Sputnik V, Serum Institute of India (SII) is likely to produce 300-400 million vaccine doses by the end of the year. Bear in mind, while SII will be working on stockpiling two major vaccine candidates—the Oxford vaccines and US-firm Novavax’s candidate—it is in agreements with Gavi, The Vaccine Alliance, and WHO for the Covax programme to supply to low-income countries.

The Centre set up a national task force for vaccine distribution in August, under Niti Aayog’s VK Paul, but there is no publicly available information on a plan taking shape yet. India has an outstanding vaccine/immunisation implementation apparatus—as is evident from the considerable success of the flagship immunisation programmes. But Covid-19 will be a different ball-game given the severe constraints the disease imposes on physical proximity etc. There will be challenges of storage, dispatch to the site of vaccination, etc, to contend with as well. There are other problems that the country must deal with, like the lack of data on co-morbidities and the afflicted population. And there will be tricky geographical prioritisation questions—should a Delhi be preferred, going by number of cases, over Mumbai, or should it be vice-versa, going by number of deaths? Former additional secretary of health Deepak Gupta, writing in this newspaper, had talked about a sero-survey just before the roll-out to see if the population with antibodies (even if temporary) can be made secondary in prioritisation. Against the backdrop of all this, the government’s decision to create digital infrastructure, as reported by Business Standard (BS), to manage various data regarding Covid-19 is a significant step forward.

India should probably take a cue from the US, where the Centers for Disease Control is already running test scenarios for vaccine roll-out and is reported to be working on finalising prioritisation guidelines. The White House has also asked state administrations to submit roll-out plans. In contrast, as per BS, the Centre and its advisors are believed to favour a centralised procurement and distribution method, advising states against having “separate pathways”. States must be brought in as stakeholders given the last-mile implementation will depend on their machinery.

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