Need to implement Covid-19 learnings to strengthen routine immunisation
The piece has been authored by Dr Rakesh Kumar, Former Joint Secretary, Ministry of Health and Family Welfare and Dr Yonette Thomas, Social Epidemiologist and Founder & CEO, UrbanHealth360, US.
India has administered close to 1.3 billion Covid-19 vaccine doses and is steadily marching towards the goal of 100 percent vaccine coverage among its eligible population. The national campaign has further intensified with the ‘Har Ghar Dastak’ initiative aimed at increasing the uptake of the first and second dose of Covid-19 vaccination while addressing the gender, and social barriers to vaccination. Even though there will be new challenges with the onset of the Omicron variant, this is a tremendous feat for a diversely populated country with a mass adult vaccination program being delivered for the first time. We have been building the ship as we sail, learning as we go. While there still many unknowns, the learnings from India’s Covid-19 vaccination campaign can go a long way in strengthening routine immunization programs in low- and middle-income countries.
India’s Covid-19 vaccination achievement has been a result of meticulous planning and joint efforts by the Centre and state government (s) on production, procurement, and supply of vaccines complemented by technological advances. The country was able to utilise its experience of over three decades of running large-scale immunisation programmes including Mission Indradhanush, reorient them to pandemic requirements, and create the same magic with the Covid-19 vaccination campaign. Further, the WHO’s approval of the indigenous vaccine-Covaxin for those 18 years old and above came as an early Diwali gift for the people of India. This recognition has given a boost to domestic production and international supply as the country will share more vaccines with others, in a bid to address equity issues through its ‘Vaccine Maitri’ initiative.
Given the large demand and production capacity, the Government of India turned to vaccine Atma Nirbharta (self-reliance) in March 2020. It ranged from supporting the scientific community, and manufacturers in developing and producing vaccines, building a delivery system for procurement and supply of vaccines, working on system preparedness, devising micro-plans, undertaking vaccine safety surveillance, modifying regulatory systems, initiating genomic surveillance for tracking emerging variants, and researching on vaccine efficacy. This all culminated in a large scale community mobilisation campaign to address vaccine hesitancy. The sharing of accurate information about the vaccine(s) and debunking myths to encourage uptake of the vaccines were critical to this achievement. The government kicked off its vaccination campaign on January 16 2021 and based on the availability of vaccines, recommended a phased prioritization of recipients. When the epicenter of the pandemic shifted towards India in April, the government emboldened the process and opened the vaccination drive to all individuals above 18 years of age.
Subsequently, vaccines such as Sputnik V, Moderna, Johnson and Johnson, Zydus Cadila, as well as Covishield and Covaxin, were given emergency use approval in due course. More vaccines are in the pipeline including a protein subunit vaccine, an mRNA vaccine, and an intranasal vaccine that builds epithelial immunity and prevents the spread of the disease. India has invited manufacturers from across the globe to produce vaccines in the country for the benefit of all nations. The department of biotechnology has opened its national laboratories and is working around the clock on vaccine research. The expertise of the private sector has also been utilised. The programme has also scaled many innovations. One such example is vaccine delivery through drone technology. It is being used in remote areas in the northeast to cater to the hard-to-reach population. Doorstep delivery of vaccines for differently-abled people, special sites for pregnant women and the LGBTQIA community, voting sites converted into vaccine sites, etc. are some of the other interesting highlights from the country’s mass vaccination campaign. Digital innovations such as CoWIN, an online registration platform, have enabled easier registration, administration, and monitoring of vaccinations. In line with the spirit of partnerships, India has begun sharing this technology through open-source software with nearly 50 countries from Central Asia, Africa, and Latin America.
As nations chart their path to recovery, many countries have found themselves in challenging situations concerning response and recovery, particularly those without domestic vaccine production capacities, in the Global South. These challenges, in turn, have provided a unique platform to introduce innovative solutions in the system.
India has already taken the lead in promoting regular cross-learnings in the Global South (Asia and Africa) through a USAID-funded collaborative learning exchange forum called ‘City-to-City COVID-19 Vaccination Learning Exchange (CoVLEx)’ initiative launched by the ministry of health and family welfare, Government of India and NITI Aayog. The platform aims to fill the vaccine knowledge gap by bringing together donors, governments, development organizations, and the private sector from Asia and Africa to offer valuable insights around their COVID-19 vaccination as the race to vaccinate populations gathers momentum around the world. Whether it is Nigeria’s whole family approach to vaccination, South Africa’s Electronic Vaccination Data System, Nepal’s J&J single-dose vaccine prioritized for disabled people, Cambodia and Vietnam’s rollout of Covid-19 vaccination for children; introduction of coupons and discounts to tackle vaccine hesitancy, and increase uptake among populations in multiple countries, to Bangladesh’s on the spot, walk-in and online registrations via Surokkha App and Univac campaign for the school, and university students, Covid-19 vaccination campaigns have introduced certain good practices that can and must be applied to all routine immunisation programmes around the world including adult vaccination programmes.
Through initiatives like CoVLEx, India intends to share lessons as well as learn from countries that go beyond the scope of Covid-19 vaccination and expands to include good practices and learnings from routine immunization and adult vaccination programmes. Collaborative learning platforms have the potential to add further impetus to every country’s national effort by sharing good practices, experiences, learnings, and making way for more equity in distribution while inspiring others to follow suit.
Vaccines allow billions of people to lead healthy lives and save 4 to 5 million lives annually. Stopping outbreaks of the vaccine-preventable disease depends on achieving critical mass with immunization campaigns. Covid-19 has created a platform and brought in a sharper focus on adult vaccination programs in India. The vaccination rollout has taught us that when there is intent, political will, and able leadership, nothing is impossible. Using already created additional capacities on cold chain and supply management for all vaccinations, using digital and Artificial Intelligence (AI) driven interventions such as drone systems, virtual platforms for capacity building, private sector engagement, and creating an enabling environment for multiple players in vaccine manufacturing, targeted risk communication strategies to address vaccine hesitancy and ensure equity among the different marginalised population, the introduction of multiple channels to get vaccinated (online, walk-in or doorstep), a learning platform such as CoVLEx to share learnings on RI for low and middle-income countries across the globe, etc. are some of the areas where learnings from COVID-19 vaccination campaign can be used to build and bolster resilient routine immunisation programs, primary healthcare, and help in advancing universal health coverage (UHC).
Collaboration and partnerships have always helped in averting any crisis. Covid-19 has given us many opportunities to address challenges innovatively driven by global solidarity, and greater collaboration among countries. We must not lose this momentum and offer our knowledge and tools to those who need it the most. Vasudhaiva Kutumbakam. (The whole world is a family).
(The piece has been authored by Dr Rakesh Kumar, Former Joint Secretary, Ministry of Health and Family Welfare. Dr Yonette Thomas, Social Epidemiologist and Founder & CEO, UrbanHealth360, US.)