COVID-19 Vaccination Challenges

Colonel B S Nagial (Retd)

The world is amid in COVID-19 pandemic. World Health Organisation (WHO) and member countries work together to respond by tracking the pandemic advising on critical interventions and distribution of medical supplies to needy. The world is racing to develop and deploy safe and effective medicines. Vaccines save millions of lives every year. Vaccines work by training and preparing the body’s defence mechanism by improving the immune system. Universal vaccination programs have eradicated various diseases, such as measles, mumps, rotavirus and polio. In coming months, India will witness another great event, i.e. the COVID vaccination exercise, this will be one of the most anticipated events in the country. This largescale universal vaccination programme might prove to be a herculean task
A vaccine has to pass the three stages to be successful, i.e. quality, ease of delivery and public acceptance. Quality again has three components, i.e.safety, efficacy and duration of protection. Initially, these vaccines are tested on animals and then on human beings through rigorous three-phased clinical trials involving a large number of persons.
In past India has run various immunisation programmes with great success.India makes roughly 62% of the world’s vaccines, have half a dozen of major pharma companies of the world including Serum Institue of India. There is no lack of ambition, either. India has plans to receive about 500 million doses of the COVID vaccines to immunise about 250 people of India by mid of 2021.
India has four Central Govt Medical Store Depots(GMSDs) located in Karnal, Mumbai, Chennai and Kolkatta for procurement and distribution of vaccines. And has 53 state vaccine stores to get supply through GMSDs and directly from the manufacturers. Further, well-established storage and distribution system exists at regional, districts and sub-districts levels. The vaccine management system has improved in the last few years, thanks to a real-time supply chain system known as Electronic Vaccine Intelligence Networks(eVIN). India is ranked between 51-75 percentile range among 89 countries in the world as per the WHO-UNICEF report of the year 2018.
Challenges are looming before the launch of the vaccine. Various challenges which could come in the way of procurement and distribution of vaccine are enumerated in succeeding paras:
Infrastructure and other ground realities. The magnitude of the task at hand is enormous for India. If 1.3 billion Indians have to be given two doses of the vaccine, then India is required to deliver 2.6 billions of doses of this vaccine across the country.
* Supply-Chain challenges. The supply chain of the vaccine has to be monitored strictly as vaccine tends to very sensitive to temperature variations. Storage of vaccines in controlled temperature boxes proves to be challenging keeping in view the electricity supply in India
* Infrastructure Challenges. Getting vaccines to people who need them will require over a billion vials to be manufactured, filled and shipped, at a very high speed and in some cases, under extreme stress. India needs to scale up its cold chain and distribution infrastructure for the last-mile connectivity. Cooling facilities in the final delivery stages and a lack of storage at clinics would pose the biggest challenge to delivering vaccines on a large scale.
* Inter-state disparity. There exist the inter-state difference in the distribution of the cold chain system. States like Jharkhand, Uttar Pradesh and Bihar are among the least served states as far as the infrastructure is concerned. Also, private cold chain system exists in metro cities only.
Challenges of access to the vaccine.
* Access and affordability. The distribution of vaccine poses another problem accompanied by the cost of the vaccine and who will pay for it. Also, this may lead to hoarding, corruption and other unethical practices.
* Safety and applicability of the vaccine.It is essential to assess the safety of the vaccine. Should it be administered to healthy persons? Safety is a matter of concern because some people have been affected adverselyafter taking the vaccines. The choices of vaccines, distribution, identifying groups for early vaccination, storage and more importantly, trained personnel, all play a role in the management of the system.
Monitoring. Uptake and monitoring of COVID vaccine are essential, require confidence in the vaccine and delivery network. Documentation, tracking and observation before and after the administration of the vaccine are an absolute must. Another essential factor is the vaccine hesitancy.
Challenges of ethics.
Any humanitarian crisis poses various ethical issues for the policy-makers, especially in setting up of a health-care camps, which often becomes dependent on external agencies for urgently needed care.
When resources, primarily staff, are scarce, decision-makers often choose among interventions – implicitly or explicitly – based on cost-effectiveness because they are seeking to maximise benefits. Major ethical issues facing the development and use of vaccines are:
* Requiring vaccination by law;
* Development and testing of vaccines;
* Informed consent about the benefits and risks of vaccination; and
* Equitable distribution of vaccines
Prioritisation. It is a matter of distributive justice which requires the fair allocation of scarce resources, such as shelter, food, potable water, and vaccines. Prioritised population groups include; health-care workers in both Government and private health-care facilities, Frontline Workers including personnel from State and the Central Police Department, Armed Forces, Home Guard, Civil Defence Organisations, Disaster Management Volunteers and Municipal Workers. Prioritisation can also be done based age group, which includes those who are above 50 years of age and having morbidities.
Vaccine nationalism. The most significant global challenge is ‘vaccine nationalism.’ It takes place when the country manages to get hold of doses of vaccine for its people and not ready to part-with other countries. This is done through pre-manufacturing contract by the govt with the companies producing the doses of vaccine. Certainly, vaccine nationalism is aginst the equitable distribution norms.
Way ahead.
‘An outbreak anywhere is an outbreak everywhere.”
The world urgently needs COVID-19 vaccines. To maximise the probability of success, we need urgent investment in a comprehensive portfolio of vaccine and a scale-up of production capacity. We know that the vaccine supply will be constrained for some time.
The vaccine pillar of the Access to COVID-19 Tools (ACT) of World Health Organisation(WHO) accelerator is launching a COVID-19 Global Vaccine Access Facility (Covax Facility), which will pool resources and share vaccine development risk. Demand guarantees for vaccine manufacturers will create access to substantial volumes of vaccines that will ultimately be safe and support the manufacturing and procurement of sufficient dimensions of vaccines to support equitable access globally. All countries will be invited to participate in the Covax Facility. This investment opportunity of US$ 2 billion will provide vital seed funding to the Gavi Advance Market Commitment for COVID-19 Vaccines (Gavi Covax AMC) to support high-risk populations in low-income countries (LICs) and lower-middle-income countries (LMICs), as part of the new Covax Facility. There is a need to send an urgent message to manufacturers that they should scale up production and reserve capacity for all countries.
Conclusion: Limited supply of COVID-19 vaccine calls for a strategy to strike a balance between utility, equality and fairness. We know that the vaccine supply would be a constraint for sometime. World Health Organisation(WHO) is developing the COVID-19 Global Vaccine Access Facility (Covax Facility) to address these unprecedented challenges. It will invite global participation to pool demand and resources to support the procurement of COVID-19 vaccines.
Decision-makers in India have to very logical and comprehensive to cater to all in society. The system put in place should be open to public scrutiny. There is a need to strike a fine and delicate balance between utility and equality rather than going forPrioritisation.
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