“COVID-19 Vaccination – A Missile in the War on the Pandemic”

Vaccination will likely be part of a multi-faceted public health response to the future emergence of a pandemic illness. In addition to other measures designed to respond to and control a pandemic, such as surveillance, communication plans, quarantine, and disease treatment, deployment of effective vaccines has the potential to protect lives and limit disease spread. Not all disease threats, however, have a corresponding vaccine, and for those that do, there are significant challenges to their successful use in a pandemic. The availability of a safe and effective vaccine for COVID-19 is well-recognized as an additional tool to contribute to the control of the pandemic. At the same time, the challenges and efforts needed to rapidly develop, evaluate and produce this at scale are enormous.

Vaccination offers India the best exit strategy from the COVID-19 pandemic. To accomplish this objective, achieving high population coverage of COVID-19 vaccination is essential. However, despite the good safety and efficacy of vaccines, public scepticism about them persists. In India, the COVID-19 vaccination programme continues to gather pace andsoon will give a rare pandemic win if it catches up speed. Vaccine hesitancy is pervasive, especially amongst health care professionals and geriatric population, threatening to undermine the pandemic response. To avoid disrupting the vaccination programme’s success, developing strategies that address vaccine scepticism is essential. The vaccine-hesitant represent those who are uncertain about getting vaccinated, but remain open to it if they are convinced that vaccines are safe, effective, and necessary. In the vaccine-hesitant, it is essential to differentiate between vaccine-associated misinformation andmistrust.

As real-time evidence continues to emerge, and mass vaccination campaigns approach vaccine-hesitant groups, tailored risk communicationand influential community leaders are required to continuously inform, update, and reassure the public. COVID-19 vaccines are unlikely to be made mandatory. Nudging individuals through choice-offering strategies incentivises vaccination and aligns intention with actions. Public health experts proactively listening to concerns of subgroups and sharing risks and benefits in a manner that does not impose, but persuades, will improve voluntary cooperation. As there are genuine concerns regarding their record-breaking timescales, alleviating uncertainties about vaccine safety and efficacy is essential.

Vaccines stand at the crossroads between an individual’s decision to accept an intervention and the public health benefits achieved when uptake is sufficiently high. At a time when unity is crucial, additional strategies are required to reach diverse communities, build civic awareness, develop a sense of collective purpose and, ultimately, arm the population with the information needed to defeat COVID-19, the latest vaccinepreventable disease we face.

The distribution of the vaccine has its own challenges. However, India has prior experience with large-scale vaccination programs. India’s Universal Immunization Programme (UIP), which immunizes approximately 26.7 million new-borns and 29 million pregnant women annually, against 12 vaccine-preventable diseases, is one of the largest public health programs globally. It also achieved two major milestones, with the eradication of polio in 2014 and maternal and neonatal tetanus elimination in 2015.

India launched the world’s largest COVID-19 vaccination program on January 16, 2021, and has so far administered 65 million doses, covering approximately 5% of the population compared to >35% in the UK and US as of 31st March, 2021. At the current rate, it will take India 3.1 years to cover 75% of population. Also, India has so far exported approximately 58 million doses of COVID-19 vaccine, which considering India’s manufacturing potential and the fact that the country fulfils 50% of the global demand for various types of vaccines, is certainly not where you would expect it to be. The COVID-19 vaccination rates and export figures clearly suggest India’s need to strengthen its distribution within the country and export vaccines to the rest of the world. But less than two months into the rollout, India is making significant progress, from roping in around 10,600 private facilities, providing vaccines 24×7 to easy registration, free vaccination for the poor, and affordable pricing for others.

The biggest challenge for successful immunization will be the distribution and administration of vaccines across India. The government needs to implement multiple innovative ways to make vaccines easily accessible. “Decentralization of vaccination” is paramount for increasing coverage in urban areas and reach rural India. There are various successful models which India can replicate such as drive-through centers, building temporary vaccination camps, roping in large pharmacy retail chains, and private healthcare clinics. Mobile health clinics can play a very important in rural areas, which lack the necessary health facilities.

“Mobilization”will increase convenience and in turn help overcome the reluctance to take the vaccine. This would not only relieve the stress from the limited private and government hospitals and avoid over-crowding, but will also prevent delays in other health services. This would not be easy considering the supply-chain requirements and supply-demand mismatch at the vaccination sites. However, the government needs to plan and take steps to maximize coverage and minimize wastage. Also, all these arrangements will be only worthwhile if we have enough doses to administer through these sites.

The biggest question remains – Will “Made in India” vaccine supplies be enough to inoculate the entire population, considering India is also exporting the vaccine? India has already received accolades for its strategies in containing the spread of COVID-19 and vaccine manufacturing capabilities. Innovative approaches from the government can lead the way in making this the world’s largest successful COVID-19 vaccination campaign and create history in the process.