CME INDIA Presentation by Dr. S. K. Gupta, MD (Med), FICP, CFM (France) Clinical Asst. Professor GS Medical College, CCSU, Uttar Pradesh, India. Visiting Consultant, Max Super Specialty Hospital, New Delhi.
From hoisting the Tricolor on Red Fort to announcements in public places, the Union government has lined up large-scale celebrations as India achieved the milestone of administering 1 billion doses of Covid vaccines.
India launched its Covid-19 vaccination drive on January 16. Of the doses given so far (at 6 PM on the CoWIN dashboard), the proportion of second doses was 28.8 per cent, effectively taking the share of India’s fully vaccinated population to ~30per cent. By now, 74 per cent of the eligible population of India (aged 18 and above) has received their first dose of the Covid vaccine.
India joins the Billion Doses Club
India has administered more vaccine doses than any other country in the world apart from China. With no other country having a population of anything close to 500 million, the billion-doses club would consist of only these two countries.
Journey of 1 Billion Jabs the landmark comes in the face of several jerks and hurdles.
- India faced huge supply bottlenecks. Despite India being the biggest producer of Vaccines, manufacturing capability got stuck by supply chain disruptions caused by export ban on vaccine filters by US Govt.
- Unfair amount of vaccine hesitancy by various religious leaders especially Muslims – at least in the beginning.
- One of the biggest challenges came from India’s Political Opposition who managed to run anti-vaccine propaganda to project it as BJP Govt Failure in tackling the pandemic. Their ill-conceived designs had the support of some media houses too.
- Transportation, distribution and storage of vaccines at specific low temperatures posed huge additional hurdles in a country lacking in an elaborate cold-chain network.
- Add to this the fact that for more than three months during this period, India was in the midst of the worst phase of the pandemic, anywhere in the world, one that had crippled the very same health system that was supposed to administer vaccines as well.
- Apart from vested interest it was geo-demographic challenges. Our vaccinators had to tread the rugged terrain, deep waters, brave the heavy rains and scorching heat of Sun.
So, reaching the 100-crore milestone is a no small achievement.
- The 100-crore milestone was achieved in about ~ 275 days – the first vaccine doses were administered on January 16.
- On six days, more than 1 crore doses were administered, with a record of 2.5 crore being achieved on September 17.
State-wise Vaccination
- States with ~100% Vaccination Coverage: In states, such as Sikkim, Himachal Pradesh, Goa, and in the Union Territories of Jammu and Kashmir, Ladakh, Chandigarh, and Lakshadweep, almost every individual above the age of 18 has already received at least one dose of vaccine.
- States with ~90% Vaccination: Some of the larger states, with much larger populations, such as Gujarat, Kerala, Delhi, Madhya Pradesh and Uttarakhand have also managed to vaccinate over 90% of their adult population with at least one dose.
Rural Areas too equally Vaccinated
- No evidence to suggest that rural areas are lagging in vaccinations. Data show that these 243 districts have, on average, provided over 80% of their populations (Census 2011) with at least one dose of the vaccine, much higher than the national average.
No Complacency, Challenges Ahead
- India is aiming to:
- Fully vaccinate its entire adult population by the end of this year. That means an additional 90 crore doses have to be administered between now and December 31. That is about the same amount of work, as accomplished till now, but in one-fourth of the time.
- Childhood vaccination: Forty Crore Population Children below 18 years to be vaccinated.
- Third Booster Dose might become the challenge in another six months from now.
- India being the largest manufacturer of Vaccines, World looks up to India to supply its Share of Vaccines in Covax and to the third world countries to rescue the mankind from Virus.
Some people born with negativity, would never praise India
- Many Indian and international media still continue to frown and project Anti-India Image. Better they learn to appreciate the milestone and accept India as an emerging Superpower under Namo.
Future Course of India’s Vaccination Journey and Backstage Preparation Snippets
- The vaccination journey began on 16 January, and it was designed to be the world’s largest vaccination program. India started with 200,000 injections per day and then started accelerating; and accelerated to a speed that not many people had imagined, reaching one hundred crores doses in such a short span of 275 days.
- It had been an incredibly successful journey.
Experts who steered the world’s largest vaccination journey now lift the curtain from backstage preparations. They also unfold the future plans of Journey.
Dr. Balram Bhargava, Director-General, ICMR:
Q. In 2022, will we still be wearing masks, even if everybody was inoculated?
A. The mask will be the last thing to go. Hope that we will have a much brighter 2022.
Q. WHO panel has recommended administering a booster dose. Is India thinking on those lines?
A. There are certain points about booster doses – antibody levels, cellular immunity, mucosal immunity, many of these abilities which cannot be measured as well. A few countries have approved booster doses, mainly for immunocompromised people or people suffering from various diseases. With the current status of the pandemic in India, with a positivity rate of less than 2 percent, if one looks at the statistical significance of requiring a booster dose, it is probably not justified at the moment.
Dr. V. K. Paul, COVID-19 Task Force Chief vaccination:
Q. Drive is no more marred by hesitancy. How things have changed?
A. Those who have not been connected till now, it is not necessarily hesitancy. It’s Govt’s duty to reach out to them directly for vaccination.
From Requesting to Persuading
Future Vaccination Journey will be in a mission mode. The government is going to locate people Vaccinate them using an army of health care workers.
This is our mission:
1. Those who have not yet received the first dose should receive it.
2. Those who have received the first dose must take the second one. And that’s the challenge we will work towards.
Q. Now that India has vaccines in surplus, what percentage of vaccine doses does the government plans to export?
A. Govt policy is to balance our own requirements and then offer the additional supplies to the WHO COVAX system and other nations. India will play a very important role in vaccinating a very vast part of humanity. And that will be the noble credit that India should rightfully get and should work for. A large number of vaccines will be available next year for the rest of the world.
Dr. R. S. Sharma, CoWIN chief:
Q. How has the vaccine journey been through the CoWIN lens?
A. CoWIN is a very robust platform. No platform in the world has accelerated to this big number in such a short time.
Q. When CoWIN was launched, there were apprehensions whether it would reach rural India. How did the government bridge the digital divide?
A. CoWIN is a people-centric, inclusive and transparent platform that reduces and eliminates information asymmetry. CoWIN has managed to become a household word now in a very short period. We hear these phrases in every home. “CoWIN pe register kar dia kya”, “CoWIN pe dekho, vaccination slot khali hai kya?”.
Q. What has been the biggest challenge for CoWIN?
A. Data Entry Errors! In many areas, operators were committing data entry errors, and CoWIN was being blamed for it. For example, I got my first jab using my mobile phone and my second jab using my wife’s. So, the system treated it as two first jabs, and people started saying they had got two first jab certificates. CoWIN is a software. There is a principle called ‘GIGO’, Garbage In, Garbage Out. So, if you feed the wrong data, the false result will come out.
Q. Can Vaccination Certificate Errors be Fixed Now?
A. Yes. You can now correct any errors in the vaccination certificate, and you can use your passport with the vaccination certificate, and so on.
Q. What was the biggest CoWin challenge?
A. Govt wanted to ensure not even a single jab in this country was administered without recording it on some digital platform. Otherwise, there would have been chaos. How many people would have known that their first dose was, say X, and their second dose had to be X as well, with a Y-week gap? All these factors required a Robust but Handy platform.
Q. How can CoWIN help India to build digital infrastructure for the public health system?
A. CoWIN can be repurposed for a number of things like universal immunization programme, blood banks, organ donations etc.
Dr. N. K. Arora, chief of National Technical Advisory Group on Immunization (NTAGI)
Q. When will vaccinations for children begin?
A. Like adults, Govt plans to immunize country’s nearly 44 crore children in a very short period of time. Govt is preparing a list of commodities for children who are at three to seven times higher risk of severe disease. Children with these comorbidities will be prioritized. As soon as their immunization is complete, healthy children will be taken up. Campaign for healthy children more than two years and above will start in the first quarter of 2022. The preparation for today started in February 2020.
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