Context: Ahead of the rollout of coronavirus vaccine on January 16th, Prime Minister Narendra Modi interacted with chief ministers of all states to discuss the COVID-19 situation and the vaccination roll-out in the country. It was the first meeting between the Prime Minister and the CMs after the Drug Controller General of India gave restricted, emergency-use approval to two vaccines Oxford Astrazeneca's vaccine Covishield, being manufactured by the Serum Institute of India and Bharat Biotech's Covaxin. Prime Minister Modi said India is entering a decisive phase of vaccination in the fight against COVID-19, asserting that the two approved made-in-India COVID-19 vaccines are more cost-effective than any other in the world and have been developed as per the country's needs. He announced that in the first phase, the cost of vaccination for the 3 crore healthcare workers and frontline warriors would be borne by the central government.

• Although India will not need to vaccinate its entire population, it would have to vaccinate at least 30-40% of the people to develop herd immunity fully. Even at a minimum scale, approximately 1 billion doses of Covid-19 vaccines will be required, given that most vaccines need a booster dose.
• Moreover, other factors, like allocation, distribution, financing, communication, etc., will be impediments to Covid-19 vaccination drive. Therefore, deploying a robust vaccine development & distribution policy will be very crucial for India.

Associated Challenges

• Allocation: Most nations will vaccinate healthcare workers first. They treat those who are infected with Covid-19 and vaccinate the remaining population. After that, it seems logical to prioritise the elderly, who have a higher infection fatality rate.
• However, premature death costs a young person more years of life than an older adult. This is a more significant concern for India, as 80% of its population is below 50.
• Distribution: Moving vaccines from companies to warehouses will be relatively easy, but moving it from warehouses to distributors to end-users will be tricky, given the difficulties with cold chains and storage facilities.
• Financing: In the United States, the United Kingdom and Europe, vaccines are likely to be entirely free and administered publicly.
• However, given the tight fiscal situation, the Indian government faces the dilemma of whether to finance vaccinations publicly or privately.
• Human Resource: Administering 30-40 million immunisations (under regular vaccination drive) a year is very different from vaccinating 600 million people in a year.
• Sourcing the trained human resources necessary to deliver intramuscular shots, without diverting from existing priorities, will not be easy.
• Public Confidence: “Optimism bias," as it is called, makes vaccination seem unnecessary to them. Concerning diseases, a lot of people tend to think that their risk is low.
• However, this behaviour can prove fatal in battling a pandemic like Covid-19 pandemic.

Road Ahead

Vaccine Prioritisation: The protective benefit from vaccination is much lower if one has immunity from a prior infection. Hence, the allocation of the vaccine among the working-age population should consider two factors:

• It may be prudent to screen people for Covid-19 antibodies and prioritise vaccination of those without antibodies.
• Areas closest to herd immunity even without suppression require the least number of doses to return to regular economic activity and have higher returns from vaccination.
• Strengthening VaccineSupply Chain: Enhancing Electronic Vaccine Intelligence Network (eVIN) system will enhance real-time information on vaccine stocks and storage temperatures across all country’s cold chain points.
• Bridging Human Resource Gap: Engaging medical students, phlebotomists, paramedics and pharmacists can be rapidly and reliably trained to administer vaccines, will bridge the human resource gap.
• Hybrid Financing Policy: India will need a hybrid strategy, where the majority of the population (economically challenged) is vaccinated for free publicly while allowing private markets to operate for rich people.
• Effective Communication: A good communication strategy that envisages removing myths associated with Covid-19 vaccine should be science-led, involve regular communication, utilise respected community leaders to widen reach, and clamp down on the spread of misinformation.
• Need For Vaccine Certification: To resume normalcy and allow free movement of people, every country will need an internal set of protocols regarding proof of vaccination that is interoperable with norms elsewhere.
• In other words, proof of vaccination in India or Tanzania must be acceptable to Singapore Airlines or Qantas.
• This will also require multilateral bodies to play an active role in creating frameworks, around which digital platforms can be developed.

Road Ahead

• India’s Covid-19 vaccine drive will be a monumental mission, not just in terms of vaccinating its own population, but also vaccinating a large part of the world thanks to its position as the world’s leading vaccine producer.