With a COVID-19
number of cases that has exceeded 10 million people, India is the second country in the world most affected by coronavirus pandemic, behind only the United States.
But its goal is to emerge from the crisis in the coming months with a massive vaccination campaign, which will cover almost the same number of people as the entire US population in its first phase.
The government of Indian Prime Minister Narendra Modi has identified 300 million people to receive the first doses of the vaccines. The priority group is made up of 30 million health workers, police, soldiers and volunteers, and 270 million vulnerable people, mostly citizens over 50 years old and another 10 million with serious comorbidities.
Producers of three leaders coronavirus vaccine candidates have applied for emergency use authorization and all require two doses to provide sufficient immunity. That adds up to a total of 600 million shots, and the Modi government wants to complete the entire process by August.
That is an incredibly ambitious undertaking, especially for a developing country with poor rural infrastructure and an inadequate public health system that is already collapsing under tremendous pressure from the government. coronavirus.
But India also has its own advantages. As a global center for vaccine manufacturing, its mass production lines can produce coronavirus Vaccines, developed either by Western pharmaceutical companies or domestically, faster and cheaper than most other countries.
When it comes to the actual vaccination process, India already has an extensive network established under its Universal Immunization Program, inoculating about 55 million people per year. Modi has also suggested that the country can draw on its experience in organizing the largest democratic elections in the world, adopting an integrated society approach that involves the participation of states, districts, civil society, citizens and experts.
“All Indians who need to be vaccinated will be vaccinated,” Indians Health Secretary Rajesh Bhushan told a news conference on December 8.
Which coronavirus will vaccines be released first?
Of three COVID-19 Vaccine candidates pending approval by Indian regulators, two are being manufactured locally in India. One of them is Covishield, a vaccine developed by the University of Oxford and AstraZeneca and produced by the Serum Institute of India, the world’s largest vaccine manufacturer.
The other is the first homegrown from India. coronavirus vaccine, Covaxin, jointly developed by Bharat Biotech and the government-run Medical Research Council of India.
Pfizer India has also applied for an emergency use authorization for coronavirus vaccine developed by Pfizer and BioNTech, Dr. VK Paul, head of the national group of experts on COVID-19 vaccination, confirmed to CNN.
Adar Poonawalla, executive director of the Serum Institute of India, said his company currently produces 50 to 60 million doses of Covishield per month, with production increasing to 100 million doses per month after January or February.
“I think everyone knows that the Ministry of Health wants 300 to 400 million doses by July 2021, so we are trying to reach that goal,” he said at a press conference last month.
A family business started by Poonawalla’s father 50 years ago to bring cheaper vaccines to the masses, the Serum Institute of India aims to produce hundreds of millions of coronavirus vaccines not only for India, but also for other developing countries.
But Poonawalla has made it clear that his company will focus on immunizing India first before shipping the vaccines abroad.
“It is very important that we take care of our country first, then we go to COVAX and then other bilateral agreements with countries. So I have kept it at that priority,” Poonawalla said in an interview with CNBC-TV 18 last month. , according to Reuters.
COVAX is a global initiative supported by the World Health Organization to ensure the rapid and equitable distribution of COVID-19 vaccines to rich and poor countries alike. But it was rejected by the United States, in part because US President Donald Trump did not want to work with the WHO.
According to the Serum Institute of India, Covishield could be sold to the Indian government for around $ 3 for two doses, and then $ 6 to $ 8 on the private market. It is likely to be much cheaper than the Pfizer-BioNTech vaccine, which is sold to the US government for $ 19.5 for a single dose, although Pfizer India has not announced the price for India.
Covishield has another advantage: It should only be stored at standard refrigerator temperatures of 2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit). Pfizer’s vaccine, on the other hand, requires an ultra-cold storage temperature of -75˚C (-103˚F), infrastructure that India lacks and must be used within five days of being refrigerated at higher temperatures.
“India has a lot of storage infrastructure” for temperatures of 2 to 8˚C, Poonawalla said. “It has a little less storage space for -20 and almost none for -70.”
What preparations are being made in India?
India not only produces more than 60% of all vaccines sold worldwide, it also runs one of the largest vaccine schemes in the world.
Its Universal Immunization Program vaccinates more than 26 million newborns and 29 million pregnant women annually against diseases such as polio, measles and hepatitis B, and each year more than 9 million immunization sessions are carried out in all of India, according to WHO.
“We have the advantage of having implemented a very large universal immunization program across this country,” said Professor K. Srinath Reddy, President of the Public Health Foundation of India. “Up to a point, our healthcare system is quite well prepared.”
But vaccinating 55 million people in one year is still a long way from the goal of 300 million in just eight months.
The country currently has 239,000 vaccinators under the Universal Immunization Program, but less than 65% of them will be deployed to administer coronavirus vaccinations, to avoid excessive disruption of routine vaccinations, according to Bhushan, the health secretary.
He said the central government is working with states to organize additional vaccines, but did not reveal how many more employees will be added.
“Getting an adequate workforce of people to give the injections, monitor for side effects, and then make sure people come back for the second injection as well, I think that’s going to be the challenge we have to face,” Reddy said. said.
According to government guidelines released Monday, 100 to 200 people per session per day will be vaccinated and monitored for half an hour after receiving the injections to examine any adverse effects, CNN affiliate News 18 reported.
A digital platform, the Covid Vaccine Intelligence Network (Co-WIN) system, will be implemented to track enlisted participants and delivery of COVID-19 vaccinations
The government is also increasing its stocks of cold chain storage equipment, such as cold rooms and freezers, ice lined freezers and refrigerators. Currently, the country has more than 80,000 pieces of cold chain equipment in some 29,000 locations, which can store enough COVID-19 vaccines for the first 30 million front-line workers, Bhushan said.
“All the necessary vaccination resources have been delivered to the states,” he added.
Manufacturers are also racing against time to increase supply of syringes. Rajiv Nath, managing director of Hindustan Syringes and Medical Devices, said the company was producing 560 million syringes per year as of June.
“We are currently producing a capacity of around 700 million pieces per year and we plan to increase the production rate to one billion pieces per year by the second quarter of next year,” he said.
From the electoral machinery
India’s decades-long Universal Immunization Program has traditionally focused on children and, to a lesser extent, women. Their coronavirus However, the vaccine campaign will be focused on adults and faces challenges in terms of the large number of injections and bringing people together to receive them, Reddy said.
And that’s where India’s electoral machinery to mobilize the country’s huge adult population can come in handy, he said.
“We do have a well-oiled machinery, which does it in phases in different parts of the country,” Reddy said. “That is a very orderly process, moving very smoothly, even in the most remote corners of the country. So in terms of mobilizing adults, it is a fairly well-tested process.”
In the 2019 general elections, India mobilized 900 million voters in less than six weeks. The entire voting process was staggered into seven phases and was distributed throughout the country.
“The same identification and alignment process can be easily replicated here (for the vaccination campaign). Of course, the administration of the vaccine itself will have to be done by people who are trained in that,” Reddy said.
And Reddy believes that training new vaccinators will not be a difficult task.
“It’s just a matter of training people to safely give intramuscular injections and watch for side effects,” he said. “In fact, we can recruit people with science backgrounds, preferably science graduates … who can easily train and enter the process as supervised vaccinators.”
Vaccinate 1.3 billion people?
As the second most populous country in the world, India’s strategy is to vaccinate “a critical mass of people and break the transmission of the virus” so that it does not have to vaccinate the entire population of 1.3 billion, according to Balram Bhargava, director General of the Indian Council of Medical Research.
Health Secretary Bhushan also told a press conference last month that “the government has never talked about vaccinating the whole country.”
Reddy from the Public Health Foundation of India said that after the first phase of vaccinating 300 million people, experts can better assess how threatened the virus persists and then decide how many more people will need to be vaccinated.
“This is an evolving epidemic. And our response will have to be adaptive even in terms of deciding how many and when we will be vaccinated.” Reddy said.
“Conditions may change, and by that time the virus may not be as big of a threat as it is right now … But over a period of time, I think about 60% to 70% of the population would need be immunized, “he said.
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