The coronavirus pandemic is like no other pandemic that we have witnessed in the last hundred years and the second wave was particularly devastating. Just as we started breathing easy, literally and figuratively, after the catastrophic second wave of COVID-19, it appears we may be heading for a third wave.
To me, it is clear that we will have to live with COVID for quite some time and the only effective way to do it is through strict implementation of COVID appropriate behaviour of masking, distancing, hand washing, avoiding large crowds, and mass vaccination of all eligible citizens at the earliest.
Vaccination is one of the most powerful tools that we have, to not only reduce the spread of COVID but also reduce the morbidity and mortality of this viral infection. Though the vaccination process started in the right earnest in mid-January this year, we have had a few hiccups in between. But, we have still managed to vaccinate about 500 million (50 crore) people so far, with at least one dose of the vaccine. We need to speed this up to register about one crore vaccination per day, ideally.
There are many steps we urgently need to take to make this possible. These include:
1. Ensure Vaccine Availability
The most important step is to make vaccines available in sufficient numbers and work out the logistics of transport and infrastructure to vaccinate a large section of the population, especially in the semi-urban and rural areas.
2. Fight Vaccine Hesitancy
Based on what we have seen so far, there is significant vaccine hesitancy, especially among the rural population, and the vaccination rates have been very low. So far, after six months of the vaccination programme, only about 50 crore vaccine doses have been administered. Much of the public discussion regarding the slow pace of vaccinations has centered around the supply-side barriers like shortage of vaccines, lack of infrastructure, logistics, and equitable access to vaccines. The demand-side barriers like vaccine hesitancy for various reasons are less debated.
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Even before the emergence of COVID-19, WHO recognized vaccine hesitancy as one of the 10 leading threats to global health. In our country, misguided hesitancy and fake information about vaccines are a substantial impediment to the elimination of the pandemic and achieving herd immunity against the infection. So, all our efforts should be directed towards getting rid of this hesitancy and we should even consider mandatory vaccination, at least in some select groups. A carrot-and-stick policy would be needed to achieve this. It is very important to remember in this pandemic that “no one is safe till everyone is safe”.
3. Fix Inequitable Distribution of Vaccines
Sorting out the inequitable distribution of vaccines among the various sectors of the society—rural versus urban and private versus government facilities—is an absolute must.
Statistics show that although the distribution of vaccines between government and private sector is 75:25, the private sector vaccines have not been fully utilised and there is shortage in some government facilities. It is of paramount importance that there should be no wastage of any vaccine, which is an extremely precious commodity. The private sector should work with the government for an equitable distribution of any available vaccine.
Further, there may be many reasons for underutilization of vaccines in the private sector. First and foremost being the vaccine is more expensive in private sector facilities as compared to the free doses in the government sector. Second, since most large private sector hospitals are in cities and the vaccination coverage is better here as compared to rural areas, there may be less demand for vaccination in urban centres.
Although there could be some extra vaccines available with the private sector, I do believe that water will eventually find its level and the private sector would procure less vaccines if there is no demand for them.
4. Subsidise Vaccine Cost in Private Sector
One of the options available is: subsidise the cost of vaccines or make it free in the private sector facilities using CSR funds, donations from philanthropic and social organisations, and encourage the well-to-do to donate vaccines to the needy whenever they get vaccinated.
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This will substantially address the issue of using excess vaccines available with the private sector in the cities. But it would still not address the problem of vaccination coverage in rural areas because most large private sector hospitals are in bigger cities and metros.
5. Push Rural Vaccination Drive
The vaccination drives in the rural and hinterland India would have to be an effort either by the government or through a PPP model between the government and rural medical colleges and social service organisations. Since many districts now have medical colleges, both private and government, attached to the district headquarters hospital as a teaching hospital, the services of these could be requisitioned for vaccination drives in talukas and villages that are in the jurisdiction of these hospitals and medical colleges. The government could also rope in the services of small- and medium-sized nursing homes and medical practitioners in these areas with a viable model to accelerate the vaccination drive.
If all these measures are taken up and implemented vigorously, it would give a major boost to our fight against COVID-19.
The author is Chairman, Manipal Hospitals. The views expressed in this article are those of the author and do not represent the stand of this publication.
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