Lessons from the vaccination programme

As the latest numbers around the Covid-19 pandemic suggest a possible plateauing in India, it is critical not to let the initial optimism coming with it slip into complacency. This is especially significant in view of the not so encouraging trend globally. Despite the fact that daily global infection have seen a 30 percent decline since in the last two months, around 10.7 million (1.7 crore) fresh cases are surfacing every month with around 50,000 weekly new deaths. Recently, the total official global figures crossed 250 million (25 crores) since the onset of the pandemic.

The difference between India’s situation during the second wave and now in the fight is the tremendous bulwark of vaccination that has been built, with an underlying conviction that full vaccination coverage remains the best strategy to prevent the pandemic from rearing its ugly head. With India’s vaccine coverage crossing the mammoth 1.1 billion mark (1,14,46,32,851 vaccine doses as on November 18, 2021), it is important to reflect on the state of vaccination programme, and consolidate the gains made in the quest to vaccinate all eligible citizens of India.

From the standpoint of public health, universal vaccination is as critical against Covid as it is for the continued success of general health programmes. Universal vaccination coverage guards against the possibility of a future conflagration, and consequent large scale diversion of medical resources away from non-Covid general health programmes such as routine immunization, surgeries, essential health care for infants, elderly, women and vulnerable sections of the population. While Covid has overwhelmingly dominated our mindspace around health care in the past 20 months, the extent of its deleterious collateral impact on non-Covid general health programmes has been as calamitous as the pandemic itself. It is in this context that India’s billion vaccination coverage needs to be commended and commented, and further strengthened.

The lessons from the pandemic has enforced the need to think about problems of public health in new ways, as old ideas fell short. The focus has to be in capacitating the health system to swiftly respond to unexpected challenges. Apart from human resource management, the success of the new strategies will be dependent on our ability to harness the power of artificial intelligence. In this respect, a key lesson from Covid vaccination programme— which can be synergised with other public health programmes— is the leveraging of digital innovations in mitigating a public health emergency. The introduction CoWIN app and its integration with Arogya Setu and Umang India (platform to access all e-governance services) enabled laying new markers in vaccine tracking and management, otherwise not possible through manual efforts. The example presents a roadmap for the future of public health system on how a digital transformation can facilitate human medical capabilities in a crisis setting. Instead of accepting technology as an inevitable substitute for human labour, it uses it as an aid.

Although India’s routine immunization programme over the years has tasted success in servicing the needs of more than 26 million newborns, under-fives and 29 million pregnant women, however, an adult vaccination drive of such an enormous scale in the midst of a virulent pandemic is an altogether new experience which came with its own set of challenges. From production to logistics to fighting hesitancy to administering through the length and breadth of the country has set new benchmarks in the history of India’s public health achievement. The magnitude of the task force was to administer an average of 3.4 million vaccine doses per day. Of the total vaccinations administered till date, around 75 crore have received their first dose and 36 crore both. By this estimate, close to 80 per cent of the adult population has been vaccinated once and 40 per cent fully vaccinated. The current trends indicate that 80 per cent of the adult population will be fully vaccinated by the end of 2021, with all adult population vaccinated at least once. On 17 November, a milestone was reached when for the first time since the start of vaccination programme, the number of people fully vaccinated surpassed those who are partially vaccinated. Additionally, it is estimated that the large section of the adult population which contracted the Delta mutant during the second wave will have varied levels of immunity for protection.

The vaccination numbers not only suggest highest receptivity of Covid vaccinations in the world, but also a record time in which such coverage has been achieved. It has to borne in mind that crossing a billion milestone had taken more than 2 decades for arguably the most famed programme of polio eradication. Not surprisingly, India received widespread global admiration for this achievement, including from the WHO, which has been relying on India for supplies to its global vaccine-sharing platform COVAX. Prime Minister Narendra Modi aptly described the achievement as a truly bhagirath effort involving all sections of the society.

Moving ahead, the task of expeditious inoculation of children has been bolstered by the prospect of having available four vaccines— Covovax by the Serum Institute, Cobervax by Biological E, and two vaccines from Bharat Biotech and Zydus Cadilla. The first phase, likely to begin anytime soon, would prioritise children with co-morbidities. While evidence showing very low hospitalization rates among children—who otherwise experienced asymptomatic or mild symptoms—is encouraging, the risk of post disease complications have been raised.

As India approaches one year since the start of vaccination programme, issues related to the booster dose will have to be addressed as vaccine induced antibodies will likely begin to tail off. As we enter the cusp of last mile in adult vaccination, it is important to supplement the gains of vaccine coverage through continued adherence to appropriate behaviour.

The writer is a medical doctor and Vice-Chancellor, Aligarh Muslim University