NEW DELHI – As from 6 pm on January 20, the fifth day of the launch of the COVID-19 vaccine, India inoculated a total of 786,842 people. In the coming weeks, it plans to inoculate 30 million health professionals and other frontline professionals and, in mid-August, plans to vaccinate another 300 million people with the help of two vaccines – Covishield from Oxford University / AstraZeneca being manufactured in India the Serum Institute, based in Pune, the largest vaccine manufacturer in the world, and Covaxin, a vaccine created internally by Bharat Biotech, supported by the government.
“This vaccination campaign scale has never been tried in history and it shows India’s capacity,” said Prime Minister Narendra Modi during the opening of the vaccine launch on 16 January.
India’s challenges in the run-up to deployment were twofold – its population size, second only to China; and the scale of the pandemic in the country, second only to the United States, with 10.5 million people infected and 151,000 dead.
However, it managed to vaccinate 224,301 people in the first two days compared to China, which had inoculated around 73,000 people in the first two days and plans to vaccinate 50 million people by mid-February. The US was able to vaccinate one million people in the first 10 days, starting on December 14.
So far, so good – but India is also taking a huge risk.
One of the biggest challenges is a growing anti-xxx movement in a country that generally leads the world in mass vaccination plans. The Indian government announced in January that one of the two vaccines chosen was Covaxin, which has not yet completed the third phase of its human testing. An appeal filed with the Bombay High Court said that vaccine manufacturers have not yet published test results and data in any newspaper.
People who have received Covaxin so far have had to sign a consent form that says “in phase 1 and phase 2 clinical trials, COVAXIN has demonstrated the ability to produce antibodies against COVID-19. However, the clinical effectiveness of COVAXIN has not yet be established and is still being studied in phase 3 clinical trials. Therefore, it is important to recognize that receiving the vaccine does not mean that other precautions related to Covid-19 do not need to be followed “.
The form also ensures that any adverse reactions to the vaccine will be compensated and recipients received a form to note any problems with the vaccine.
“This is crazy – someone would understand if there were no other vaccines available, or if there was a shortage, but that is not the case,” said Indranil Mukhopadhyay, health economist from New Delhi, who teaches at OP Jindal Global University.
But Modi’s nationalist government has been vocal about Made in India vaccines since the pandemic began. And if the bet is worth it, India may play an important role in immunizing a large part of the developing world – especially those with weak vaccine logistics networks – with Covaxin, which can be stored at normal refrigeration temperatures from 2 to 8 degrees centigrade.
During his January 16 speech, Modi dismissed concerns about vaccines as “advertising, rumor and misinformation”, but it remains a fact that Covaxin is still in clinical trial mode and its inclusion in the vaccination program has meant that , while in September, around 13 percent of Indians did not want to be vaccinated – in December that number had increased to 69 percent.
For the vaccine to be effective across the country, it is essential that the majority of the population follow the government’s plan to get it.
“It is a situation of waiting to watch now. As confidence in vaccines grows, we can overcome hesitation, ”said Neeraj Jain, Indian national director of PATH, which is part of COVAX, a global effort to ensure equitable access to COVID-19 vaccines.
But India’s challenges in the future are enormous, given that its public health system has been in shambles for decades because of a lack of resources. Total health spending in the USA is 16.9% of GDP, while in India it is 3.6%. There was a shortage of 600,000 doctors and 2 million nurses in the country, since the last report of 2019.
But India outperforms any other country with its long experience in mass immunization programs, despite the lack of resources. She runs one of the largest immunization programs in the world, which administers vaccines to more than 26 million newborns and 29 million pregnant women.
This program ensured an established network of cold chains and transport and storage facilities for vaccines and an army of health professionals trained to administer and reach those vaccines to the last mile. It has also successfully carried out immunization campaigns against polio and smallpox. Smallpox was eradicated from the country in 1975 with the help of a campaign called Meta Zero, while the country was declared polio-free in 2014.
Known as the pharmacy of the world, India manufactures over 60% of vaccines sold worldwide. Based on these experiences, India began preparations for the launch of a vaccine across the country as early as August, establishing a group of experts to oversee the administration of the vaccine for COVID-19. In December, the government issued a detailed operational guideline that left nothing to chance – including the layout of vaccination centers and the specific role of each vaccinator.
In the run-up to the launch, more than 100,000 vaccinators were trained with the help of numerous simulated exercises, including three trials to identify flaws.
“I think we are ahead of most countries in terms of planning,” Jain told The Daily Beast. “I’m looking at the rest of the world and how vaccine launches are being treated, even in smaller populations, and I think we’re doing brilliantly.”
The vaccine logistics network in India – according to this report – comprises 27,000 points in the cold chain, 76,000 items of equipment in the cold chain, 700 refrigerated vans, 55,000 cold chain handlers and 2.5 million healthcare professionals. Cheers. But that network is currently dealing with around 60 million of the population and will have to be expanded rapidly to cover 1.35 billion people in the coming months.
“If you’re talking about scale, it’s not that big yet, but it will be huge when we enter the second and third phases, in addition to health workers and the front line,” said Mukhopadhyay. “And my fear is that they may cost stopping routine vaccination services or other health activities.”
When the pandemic broke out in India, the government diverted its entire health force to focus on reducing the spread of the virus – which interrupted other health services and distribution, including existing immunization programs.
The Indian government had predicted these consequences since the first months of treatment of the COVID-19 pandemic and in a statement said it ordered states to carry out COVID-19 vaccinations four days a week “to minimize disruption to routine health services.”
But, Mukhopadhyay said, gradually the burden of vaccination will fall on health professionals. “The pandemic exposed the limitations of our public health. We have to grow quickly to fill these critical gaps, ”he told The Daily Beast.
India is the country in the best position to do just that. All Modi needs to do now is to ensure that Covaxin’s effectiveness data is released while there is still time for him to convince about a billion people to trust the solution developed in-house in India.