Polio, BCG infra to power vaccine plan

India plans to use the expansive network of its 42-year-old universal immunisation programme to manage the logistics of administering Covid vaccines next year.

Officials involved in the planning process said on condition of anonymity that the existing infrastructure and human resources will be sufficient to vaccinate the first 30 million Indians, primarily health care workers and first responders, when the country starts vaccinating people early next year.

“Out of the 2.39 lakh-strong force of vaccinators of the existing immunisation programme, at least 1.5 lakh workers will be used for administering Covid vaccines to the first two priority groups tentatively from January to March 2021,” said one of the officials, a top government official.

“The existing 29,000 cold storage facilities should be enough to store and distribute 60 million doses required for the priority groups during this period,” he added.

The universal immunisation programme comes under the health ministry, and covers 25 million children every year, vaccinating them against a range of diseases including measles, polio, and tuberculosis.

“For us, Covid vaccines will be an extension of our routine duty. Our universal immunisation programme started in 1978 and every year we vaccinate 25 million children in India for pulse polio, BCG, Hepatitis B, MMR, and other diseases,” said a second officer overseeing the infrastructure and logistical preparation related to the Covid vaccines.

The Union health ministry has also written to all states and Union territories to identify people who can be utilised for the mass Covid-19 vaccination drive. “As you are aware, government of India has initiated preparations for introduction of Covid-19 vaccine, upon its availability. As part of the preparations, one of the activities is creation of database of health care workers (HCWs) who will be prioritised for Covid-19 vaccine… It is reiterated that the potential vaccinators amongst the HCWs need to be identified for support during the Covid-19 vaccination drive,” said the letter senton November 23by Vandana Gurnani, additional secretary, ministry of health.

The first vaccine available in India will likely be the one developed by AstraZeneca and the University of Oxford, and manufactured by Pune-based Serum Institute of India (SII). While late-stage trials are on in India, interim data from Phase 3 trials elsewhere has already shown that the vaccine is effective (62% on one dosage regimen, and 90% on another). SII’s Adar Poonawala said on Sunday his company would apply for emergency regulatory approval for the vaccine.

While three other vaccines (developed by Moderna, Pfizer/BioNTech, and Russia’s Gamelaya Institute) have also shown efficacy in Phase 3 trials, India doesn’t have agreements yet with any of these companies. Two Indian vaccines are in Phase 3 of clinical trials.

To be sure, as the vaccination coverage expands — the first to be covered after the priority groups will be the elderly — the government will have to substantially enhance capacities beyond its universal immunisation programme. There are around 260 million Indians who are over the age of 50 – a demographic segment considered especially vulnerable to the disease.

The expert group on vaccine development and procurement headed by Niti Aayog member Dr VK Paul and co-chaired by Union health secretary Rajesh Bhushan has identified four priority groups.The first comprises doctors, nurses and other medical staff; the second includes front-line workers such as the police, municipality staff, and others directly involved in the country’s war against Covid. The third group comprises people above 50 while the fourth group is of people under 50 years of age but with co-morbidities.

The second official cited above confirmed that while the vaccine programme will be tightly controlled by the Union government, the premises of private hospitals will also be used for administering vaccine. “Private hospital officials or their people will not be allowed to give vaccines but their premises will surely be used as it is done now.” The government does not want to use the entire workforce of its immunisation programme because it does not want any disruption in the ongoing vaccine programmes.

The big challenge, officials acknowledged, would come when India needs to give Covid vaccines to the next priority group – the 260 million above the age of 50. “Around March or April, we will need more vaccinators to cater to the third priority group. But we will wait and see what needs to be done for that period,” said the first official, hoping that there may be a sharp fall in infections by then.

The recent concession to corporates allowing them to use CSR funds for supporting vaccine programme may come in handy at this stage. The government hopes that many companies will fund additional capacity in storage chains and freighters. The Union health ministry has already sent the specifications of cold storage and deep freezes required to the ministry of corporate affairs and a few other ministries so that companies interested in spending CSR funds appropriately can do so. Indian rules require companies to spend their corporate social responsibility (CSR) funds on research and development (R&D) for finding vaccines, medicines and medical equipment to combat Covid-19 pandemic. The Companies Act requires firms with a net worth of ₹500 crore or more, or turnover of ₹1,000 crore or more, or net profit of ₹5 crore or more in the immediately preceding financial year, to mandatorily spend 2% of average net profit of the preceding three years on CSR.

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