Vaccination for all: 3 main challenges for Mumbai’s hospitals | Mumbai news - Hindustan Times
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Vaccination for all: 3 main challenges for Mumbai’s hospitals

ByJyoti Shelar
Apr 28, 2021 01:04 AM IST

On Tuesday state health minister Rajesh Tope said that the state will need 120 million doses for 57

On Tuesday state health minister Rajesh Tope said that the state will need 120 million doses for 57.1 million residents in the ages of 18-44. The state currently has a few hundred thousands as part of the national Covid-19 inoculation drive, which is currently open to those above 45, health care and frontline workers. It remains uncertain that the drive, which was to open to all adults starting May 1, will begin. However, vaccine stock is not the only challenge that Mumbai faces. The expanded rollout will nearly double the city’s target population, requiring the government as well as the private sector to add more centres, decentralise procurement and ensure crowd management.

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Mumbai currently has 132 vaccination centres including 42 civic-run, 17 state-run and 73 privately run centres. Its current target population above 45 years is around 4 million. With the addition of the population between 18 to 44 years, another 4 million people will be added to this pool. Mumbai has so far administered over 2.8 millon doses – nearly 60,000 on Tuesday itself. HT spoke to several experts and asked them one main question: What will it take to ensure effective vaccination of all adults?

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DECENTRALISING EFFORTS

“Mumbai’s current vaccination capacity is 85,000 doses per day,” said Dr Mangala Gomare, executive health officer of BMC. “We have administered a maximum of 67,000 doses in a day. As the vaccination stock gets streamlined, we can achieve the total capacity and expand further,” she said.

According to Gomare, the Ministry of Health and Family Welfare (MoHFW) has now allowed states to directly sanction private hospitals as vaccination centres, where earlier, proposals needed to be sent to the ministry for approval. “As more private hospitals are added, vaccination drive will be decentralised gradually,” she said.

The guidelines issued by the Centre last week also confirmed that manufacturers of Covid-19 vaccines will be free to supply 50% doses to states and in the open market – which can be procured by hospitals or corporates directly – and the manufacturers will have to make an advance declaration of the price before May 1. States will, however, need to monitor the hospitals that have procured stocks, and declared them on the COWIN app. Thus, apart from the vaccination drive that the state will carry out, procuring stock from the Centre, and from manufacturers, private hospitals will also be able to buy vaccines and vaccinate people.

The civic body is also considering the possibility of using large community halls, schools and other such spaces for vaccination. Augmentation of vaccination booths in the currently functional jumbo vaccination centres is also a priority.

However, the big challenge that poses the BMC, and other authorities is to ensure that as new vaccine centres get approved, they stay true to the guidelines laid down by the National Expert Group on Vaccine Administration for Covid-19 on the procedure and guidelines for administration of the vaccine at state and district level.

For example, every centre must necessarily have an area where those who have just been vaccinated can sit for at least 30 minutes to ensure that in case of any adverse effect detected, they can be treated immediately. It must also ensure safe storage, transportation and delivery of vaccine doses, which should be maintained at the right temperature.

According to Gomare, bigger health facilities will be able to make such arrangements. “The problem is with dispensaries and urban health centres which have very small spaces. But we are in the process of shortlisting centres which may have large halls or open grounds nearby, that can be linked to the centres and converted into post and pre-vaccination waiting areas,” she said.

SCALING UP INFRASTRUCTURE

The BMC plans to scale up the jumbo facility at the Bandra Kurla Complex so as to double the number of vaccination booths from 15 to 30. The BKC facility is among the largest civic-run centres with the capacity to carry out 8000 vaccinations per day.

On Tuesday, municipal commissioner Iqbal Singh Chahal directed civic officials to identify locations for additional 227 vaccination centres in the city -- one in each electoral ward. Chahal has directed these centres to tie up with local hospitals nearby where citizens will be rushed in case of any adverse effect.

“We have administered a maximum of 6800 doses in a day,” said Dr Rajesh Dere, who heads the facility. “Given that we have a large space, increasing the capacity further will be easy for us,” he said. The facility built on the MMRDA grounds has structural stability up to May 31. A structural stability assessment is carried out by engineers to ascertain if the structure is safe and can withstand internal activities as well as seasonal changes. An audit will be conducted to ensure monsoon preparedness, as well.

Private hospitals too have begun discussions on increasing their capacity. “We currently have five booths and we are looking at adding another five as vaccination opens for all adult populations. The question is if we will have enough stocks,” said Dr Gautam Bhansali from Bombay Hospital. “Our hospital is also considering 24/7 vaccinations,” he said adding that the space management will be easier with online slots.

At Parel’s Global Hospital, authorities are looking at doubling the number of vaccination counters. The hospital currently has three counters and has carried out an average of 220 vaccinations in a day. “We expect the numbers to go up to 450-500. The number of doctors, nurses and associated staff will be accordingly increased,” said Dr Jigna Shrotriya, deputy general manager (Medical Services), Global Hospital.

PRICING

Dr Santosh Shetty, chief executive officer of Kokilben Dhirubhai Ambani Hospital said that securing doses for the private sector seems to be the biggest challenge. “We have spoken to the manufacturers and they have commitments to the centre and states up to May end. Accommodating the private sector is likely to happen only after the third week of May,” he said, adding that their hospital has administered nearly 800 doses in a day when the supply of stocks was good. “We can easily double our capacity by simply adding more hours. Space is not a problem at our hospital.”

“We don’t know how soon the stocks will arrive after we start the process,” Bhansali said. India is currently administering only two vaccines: homegrown Covaxin by Bharat Biotech and AstraZeneca’s Covershield manufactured by Serum Institute of India. The Centre is procuring them at 150 per dose and distributing them to the states.

But from May 1, the states will also make their own purchases and private sector hospitals too will have to procure vaccine doses from the manufacturers. The vaccine manufacturers have quoted different selling prices for the Centre, states and the private sector. “The centre has offloaded the pressure onto the states. This will have significant implications on the vaccination drives, especially in high burden states like Maharashtra,” said Soumitra Ghosh, assistant professor at the Centre for Health Policy, Planning and Management, Tata Institute of Social Sciences. “Shifting away from the centralised model leaves the manufacturers with an upper hand. This decision will lead to profiteering, chaos and confusion over the coming days,” he said.

Private hospitals will have to further work out their pricing based on storage, handling and manpower costs. “If the need arises, we will cap these costs in the private sector,” said Dr Subash Salunkhe, advisor to the state on Covid-19.

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