Many lessons to be learnt from the first five days of COVID vaccination drive

The first five days’ experience of the ‘world’s largest vaccination drive’ in India has given several insights. “Vaccine hesitancy” has emerged as the biggest roadblock while the operation as a whole presents a case of speeding up of its implementation, providing training to a larger number of health workers, greater care at inoculation centres by eliminating all kinds of carelessness of all the persons involved, strengthening tracking and accountability framework, enhancing the preparedness for any future eventualities, and to continuing with all the precautionary measures at least for four years to come to avoid the contagion.

The situation is evolving fast, and therefore everyone needs to be alert.

The first phase of vaccination drive which began on January 16 in India in which international agencies such as WHO, UNICEF, UNDP, WFP, UNFPA etc are also participating in various capacities, will take at least eight months to complete. It is expected that inoculation of 30 million people in this phase could be completed only by August 2020, if we could conduct the drive as planned. The actual number of inoculation is much slow.

India could vaccinate only 6.31 lakh health workers in the first four days across the country in 11,660 sessions. Union government cites ‘vaccine “hesitancy” as its primary reason. The Centre has urged the states to address “vaccine hesitancy” among some of the priority group, as if the whole problem lies with the states.

The reality is that the Union government is mainly responsible for this situation. The vaccines were given ‘emergency use approval’ at the time when further trials were required. Further, the dos and don’ts, were reportedly violated both by patients and the health professionals implementing the drive in some places, resulting in adverse effects, though at a very low level.

Needless to say that the medical protocol and advisories framed by experts and the vaccine producers must be followed to reduce any adverse effects to a negligible level. A doctor, if he cannot improve the condition of a patient, must not deteriorate it by his faulty decision. Any slack decision adds to “vaccine hesitancy” and a doctor must be more careful than the patients most of whom are unable to accurately report their actual conditions as someone ‘fit to receive the emergency vaccines’.

Before the vaccination is extended to the larger population we must eliminate errors and adverse effects. “Vaccine hesitancy has to extinguish before the pandemic extinguishes,” says Union health secretary Rajesh Bhushan. He also said that states have been directed to engage with beneficiaries. However, government needs to do much more.

If the government acts properly and fast, “vaccine hesitancy” can be removed, since adverse effects are very small in number. Only nine adverse events were reported that required hospitalization so far. Minor adverse effects were also only 0.18 per cent across the country. Requirement of hospitalization following immunization was only 0.002 per cent.

This is in fact the lowest in the world so far as we know, and in this sense both the vaccine Covishield and Covaxin made in India are better than many others in the word. This is precisely the reason for which these vaccines are much in demand all over the world, and India has pledged to supply the same to other countries.

“The vaccination drive will further be accelerated,” says Dr V K Paul, who heads the high-level national expert group on vaccination administration. However, the speed of vaccination is very slow at present, and at this rate India will need at least four years to vaccinate all its population. Slow vaccination has its own problems, and therefore the whole operation needs to be accelerated to cover the entire population in the shortest possible time. It can only be done by employing greater financial and human resources in an equitable manner.

It cannot be done smoothly without supply of reliable information. The manner in which rumours spread during the initial days of the drive underlines this need. Communication and advocacy efforts must therefore be enhanced to ensure the dissemination of factual information to stakeholders and communities. Strengthening tracking and accountability framework will help improve the situation which will not only be helpful for common people but also the healthcare professionals and other administrative officials involved in the operation in infection control, prevention and psychological support.

Awareness raising programmes are necessary to dispel misgivings among the intended recipients of the vaccines. The initial experience suggests that people are under the grip of safety concerns. In the first state of the first phase, only 10 million healthcare professionals are to be inoculated. When healthcare professionals and staff are found to be apprehensive about safety, one can just imagine the level of safety concerns among the common people. It slows down the speed of the inoculation drive.

Though the vaccination drive is underway, the continued rise in infection and deaths, risks of new strain and other factors along with too much time to be taken in inoculation of the whole population, unrelenting vigilance against the pandemic and preventing its spread remains as important as ever. Tracking cases, cluster investigation, isolation, clinical care, and quarantining to break the chain of transmission are still required. We as individual, communities, and government must keep the three W’s – Wear a mask; Wash hands; and Watch distance – underscored.

The critical failings in our pandemic alert and response including the early hiccups in the inoculation drive highlight India’s need for a new framework. It is more so because the critical elements are found to be slow, cumbersome, and indecisive. Information, both right and wrong, is travelling faster than our system cam formally report on them.

The system for alert and response needs to be rescued from the present trappings that are primarily analog in a digital age. We must change it as soon as possible with proper training and changed mindset. It also should be kept in mind that viruses travel in minutes and hours rather than days and weeks. Therefore, speeding up is the need of the hour.

(IPA Service)

(Views expressed are personal)