Dr Rajnesh Kumar
Second wave of Covid -19 Pandemic has caused tremendous amount of sufferings and loss of lives. Not only lives have been lost but there has been an immense physical, emotional and psychological breakdown and financial hardships among the families and communities who have suffered losses. Health care workers are having burnouts and breakdowns. We are struggling to get to the means to get out of this situation.
Public health tools like Covid-19 guidelines, lockdowns and Covid appropriate behaviours including Physical distancing, masking, hand washing and use of sanitizer though have the potential to breakdown the chain of transmission but in Indian context they don’t look like sustainable solutions in this long war against Covid-19. Lockdowns Impact Livelihoods while other measures like masking, physical distancing etc. have elements associated with them like drop in cases leading to complacency making people to abandon the Covid appropriate behaviours leading to rise in cases and newer waves. It is nearly impossible to tame the “Hum Nahi Sudherenge” attitude of Indian population, no matter what we do.
Vaccinating population is the only tool in hand to control this pandemic effectively. Vaccines have shown a great promise to arrest the transmission and disease progression to its severity. But given the size and proportion of the population that needs to be vaccinated and that too as quickly as possible is really a herculean task. This task becomes even more challenging because of factors like gap in demand and supply of vaccine doses, vaccine hesitancy especially due to vaccine being new, extra work force that is needed to vaccinate all population above 18 years. Challenges are manifold but we need to find out ways to navigate them, vaccinate our population and protect our country from such a situation in future.
Optimal Utilization of Community Health Officers & Health and Wellness Centers can play a big role in vaccinating a majority of rural population in a relatively short span of time. As of now more than 75, 000 Health & Wellness Centres (HWCs) are operational across the country. We can provide vaccine through all these HWCs as some of these HWCs are already providing the same very efficiently. Government can think of recruiting more Community Health Officers either directly from open market from those Nursing colleges who have integrated Certificate course in Community Health in the final year curriculum of BSc. Nursing or by relaxing some of the rules and regulations of Certificate course in community Health conducted by IGNOU in collaboration with NHM. Vaccination can also be done through sub centers.
The current vaccine policy for Covid-19 has inbuilt challenges in it; in terms of procurement, pricing, involvement of private sector and paid vaccines. Considering the size of population to be vaccinated and workforce required for the same we cannot simply keep private sector away. Private sector is very robust in urban areas therefore we can involve and leverage its strength to deliver vaccines to urban population effectively, but we need to address the issue of payment for vaccines. Many people in India are poor and lack affordability to pay for two doses of vaccine and hence will remain unvaccinated and vulnerable. Even though many State Governments and administration of UTs have announced that they will provide free vaccine to all citizens above 18 years, but still there are apprehensions whether all State and UT Governments will provide free vaccines especially for age group of 18-45 years.
One way could be that govt. can provide vaccine free of cost through the public and private sectors for BPL population while those who can afford, can pay for the vaccine. Prime Minister can make an appeal to the people for voluntary payment as he did in his previous term for giving up gas subsidy. This can be boasted as a contribution on part of citizens in this war against virus.
On the policy front Government should act fast on the issue of compulsory licencing under Indian Patents Act 1970 and TRIPS (Trade Related Aspects of Intellectual Property Rights) agreement so that pharmaceutical companies can increase the production of vaccine doses rapidly. In the absence of adequate production, the programme will not serve the purpose and we won’t be able to avoid subsequent attacks by virus. Whatever national or international legal hurdles if any are there; must be addressed by government as soon as possible. In a public health emergency situation like the one we are dealing with ethical considerations must prevail over the legal ones.
India has decades of experience in vaccination and there are public health professionals with years of experience in leading India’s Universal Immunization Programme. Services of these public health experts need to be utilized at this point in time to effectively roll out the vaccination programme. Enough of this IAS Babus at the top for now, let’s give the charge to ones who understand the field and situation inside out and have the capacity to deliver.
Time is the key in all this, our deadline was yesterday, we cannot afford to lose out more time to act fast.
The author is Programme Officer:
Jhpiego – A Johns Hopkins University Affiliate