Monday, April 19, 2021

Widen network, say experts as India aims to boost drive

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The government is planning to more than double the number of coronavirus vaccination centres and reach deeper into rural parts of the country, targeting a massive expansion that experts believe is possible only if policies are relaxed and India’s vast immunisation infrastructure is tapped into.

Government data shows 1.4 million doses were administered on Thursday, a record for the country, but a breakdown shows only about half of this number (700,000) was of people from the general public who became eligible to get doses on March 1. The remaining were health and frontline workers, who were the first in line to get doses when the drive began on January 16, and 330,000 were second booster shots.

The roughly 20,000 centres being used for the vaccine drive at the moment are hospitals, private as well as public, while many primary and secondary health centres at present are kept out of the programme.

The makers of the two vaccines India is using, Serum Institute of India (SII) and Bharat Biotech, told the Delhi high court on Thursday that they have excess stocks but supplies can be made available only upon permission of the Union government.

“Currently there are about 20,000 vaccination centres functional across the country, and the plan is to take it up to at least 50,000 and eventually it could even be 100,000. The numbers will automatically increase to reach closer to the target of 5 million vaccinations per day,” said Dr NK Arora, member, National Task Force on Covid-19 matters.

“The focus will be on adding more centres in smaller cities and rural areas as bigger cities already have adequate number of centres functioning. Also, not just increasing centres, the focus will also be on effective utilisation of existing centres. If you see, we have been able to utilise just about half of our capacity at the moment and that needs to be ramped up first,” said Arora.

In all, India has given about 18 million doses of Covaxin and Covishield to people in three priority groups: health care workers, frontline workers (such as police and military), and people above the age of 60 (or those older than 45 with a certain set of illnesses that raise their risk of death in Covid-19 infections).

Experts, however, say the pace is still significantly short of what India needs not only to cover its vast population of high risk groups but also avert a second wave of infections.

“Although it is heartening to see an increase in pace, it is sort of under accomplishment to go at this rate as India has the capacity to cover 7-10 million per day. Covering 10 million a day will ensure that we will cover the entire vulnerable population within a month,” said Dr Giridhara Babu, head, epidemiology, Indian institute of Public Health. “Given the proactive and strong leadership shown by India so far in tackling Covid-19 so far, the ambitious goal to cover within 30 days will take us ahead of the virus. This ambition is a necessity, not for any records,” he added.

In absolute terms, the 14. million doses given on Thursday in India has only been eclipsed by the US, which has been administering roughly 2 million doses a day on an average over the last week. Both countries have a similar target population at the moment: India is seeking to cover 300 million most at risk while the US is aiming to get doses to its entire population of 330 million.

In India’s case, however, after the immediate target is achieved, a larger section of the remaining 1 billion population will still need to the vaccinated.

“It (vaccine drive) is being scaled up and the number of vaccinations has increased significantly over the past few days. In fact, between March 1 and 4, the numbers have gone up from about 600,000 to at least 1.4 million. It will further increase in coming days,” said Rajesh Bhushan, Union health secretary.

Arora, too, said the country was easily capable of vaccinating people at a much faster rate. “For polio we vaccinated at least 170 million children in a week, so 300 million is not an impossible number. It is very much doable and we will do it,” he added.

A second expert said tapping into the immunisation network for Covid-19 may not be easy. “For Covid immunisation drive, the government has involved private players in a big way, unlike the universal immunisation programme that is largely government dependent. It would have been a good idea to involve national immunisation network resources but we need to keep in mind that there is also routine immunisation to take care of. The government needs to balance out Covid vaccination drive and routine immunisation drive,” said Dr K Srinath Reddy, founder, Public Health Foundation of India.

A third expert highlighted the need to ensure adequate supplies. “The scale up is happening and if you see the numbers during the past few days, the numbers have grown significantly; almost doubled. The government focus is also to reach rural areas and while opening it up like they do under regular immunisation programme will be ideal, it also depends on the vaccine supplies. They can’t expand unless the vulnerable population is covered,” said Dr Naresh Trehan, founder, Medanta Hospital.

Another expert flagged the need to ensure vaccine coverage across the country is more equitable. “Once we get to rural India, there may be less demand and also weaker supply channels. That could slow down the coverage,” said Ramanan Laxminarayan, director, Centre for Disease Dynamics, Economics and Policy.

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