The recent rise in COVID 19 cases in six states, accounting for 85% of reported new cases, is disturbing. The concerned State Governments and the Union Ministry of Health need to seriously soul search and quickly arrive at a plan of action to quell the resurgence by vaccination. The resurgence is most likely due to: the general public throwing caution to the wind – discarding the disciplined use of masks, hand hygiene and physical distancing; and engaging in activities leading to mass gatherings – including weddings and funerals – that are conducive to spreading the virus. Opening up of transport services in general and suburban train services in Mumbai in particular, would have contributed to the resurgence.
Regulatory agency authorised emergency use of two COVID-19 vaccines on January 3. On January 16, both were made available to healthcare professionals, the first priority, followed by those in essential services. From March 1, the second phase has begun when senior citizens and those above 45 with co-morbidities are the next priority for vaccination; the Government is expanding the coverage in a phased manner, starting with selected segments of society and expanding to cover more. India’s COVID vaccination programme will be world’s second largest because we have the second largest population in the world. However in the face of the resurgence of cases in six states, should there not be a change in strategy?
The right goals
Setting goals for wide vaccination coverage systematically is an administrative activity. Health management approach would have a different goal. Since health management has two arms, public health and healthcare, each would have its own goal – a healthcare goal and a public health goal.
The healthcare goal is to mitigate adverse disease outcomes, the hierarchy is, for preventing: death; disease becoming severe to require intensive care; hospitalisation per se and finally, symptomatic disease. Here, need-based vaccine coverage has to begin on the basis of vulnerability to these outcomes – hence vaccination should be prioritised for oldest down to 65 years; all below 65 with co-morbidity – obesity, hypertension, chronic heart, lung, kidney or liver disease, people with malignancies whether or not on treatment, etc.
The public health goal is to reduce the speed of coronavirus transmission, thereby reducing the community burden of COVID-19. For this vaccination drive should be targeted to the six states in which the speed of transmission is highest – Maharashtra, Punjab, Haryana, Gujarat, Madhya Pradesh and Delhi. In these States, vaccination ought to be undertaken on war footing, even taking the help of the army, for implementation. While vaccine-war progresses in these six States, other States should continue targeted healthcare vaccination of the elderly and the vulnerable.
To overcome the economic impact of the pandemic, civil administration should set up its own independent goals. Priority ought to be for step-wise and safe revival of all stalled activities in various systems – education, law and order, transport, sanitation and general administration. A systematic targeted vaccination plan and platform should be designed for this purpose in relevant locations. Economic revival demands the opening up of all industrial and agricultural activities, and India’s human personnel in these areas ought to be vaccinated systematically.
The attempt to meet this demand by having vaccination centres working 24/7 is a step in the right direction, but more innovative steps need to be taken in order to reach vaccination to the people in rural India. Countries like the U.S. have started using mobile vaccination centres and have established vaccination centres in supermarkets to rapidly cover the entire population. In India a similar approach, especially mobile vaccination units, can rapidly cover many villages.
Even now it is not too late to define goals for public health, healthcare and the administrative segment and plan appropriate strategy and tactics to achieve their respective goals. The three should function in a well-oiled, co-ordinated and seamless manner to achieve their targets.
The public, including healthcare professionals, apparently misunderstood that the vaccine roll-out was premature without stating its purpose or it was for political reasons – to showcase one of the world’s largest vaccination programmes by making it a well-orchestrated drill. But when unaccompanied by sharing of authentic and authoritative information, it led to wide-spread vaccine hesitancy. Public health programmes rely heavily on information-education-communication – after all if people understand that vaccination is for their own good and for the benefit of the entire nation, they will willingly cooperate.
So, concurrently with planning the revised strategy, there should be a health education blitzkrieg about the benefits of the vaccination for the individual and for the community – so that people may knowingly and willingly participate in it. It can easily be accomplished since we are well-versed in vigorous campaigns for various purposes.
If India demonstrates its ability to set-up this model, and execute the world’s second largest vaccination programme to perfection, it will be worthy of emulation in all countries of the world.
(T. Jacob John is retired professor of clinical virology, Christian Medical College, Vellore. M.S. Seshadri is retired professor of medicine (endocrinology), CMC and medical director of Thirumalai Medical Mission Hospital, Ranipet. )
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