By Dr Suresh Singh
Let me give an analytical view as well as remedial measures in a shortened format to enhance the COVID-19 vaccination process as far as practicable as below:
Material planning and management: I wish our experts have some knowledge about it. Your writer, having undergone an MD in health administration, has at least some ideas. There are many modern management techniques like Gantt charts where activities and timeline are charted. There are other methods available. State and Central governments can take help from management institutions or rather should have taken help in the first wave itself and apply the same with medical experts. Sadly, it is still lacking. India has to do it without further loss of time.
Vaccination for all ages: With public demand, the government has approved vaccination for all above 18 years of age from May 1. The same should have been done once first and second phase targets of vaccination were not achieved. I wish it will be modified to 15 and above shortly. Though late, we have to appreciate it. Calculate the clients: India is 17.7% of the world population, i.e. 1.38 billion out of 7.8 billion. Of this, 15 year and above consists of about 73 per cent of the total population, i.e. about 100.74 crores. Further, we have to vaccinate with a double shot – that’s roughly 202 crore jabs – a gigantic task indeed. In a few months we have to cover everyone 15 and above.
Vaccine choice: The government has already approved four brands i.e Covaxin, Covishield, Sputnik V and J&J. In addition, Bharat Biotech’s intra-nasal BBV 154 vaccine, ZyCoV-D of Zydus Cadila and Novavax with Serum Institute of India (SII) collaboration are in the pipeline. Indian regulators are too slow in their approval; one finds too much caution and unwanted delay. One wishes it is avoided now. Bharat Biotech’s intra-nasal BBV 154 vaccine should be encouraged and the approval process must be hastened in view of its nasal application without injection. This will have wide acceptance.
Rural and urban strategy: With the availability of many vaccine brands and opening to all ages above 18, urban hospitals/ health centres will be flooded with clients. But what about rural India consisting of 65% of the population? I don’t see any action plan about rural India. I am worried about it as a common citizen; our so-called experts should strategise it on a priority basis.
Available health centres and hospitals: Here lies the crux. Find out all health centres including hospitals. It will be easy for urban India. For rural India, find out the number of CHCs. PHCs, sub-centres and rural dispensaries and strategize accordingly. I find that it is not yet on the table of our experts. Proper scheduling has yet not been done; the sooner will be the better to chalk it out.
Incentives for the poor: Ignoring the various confusing definitions of poverty line, it is safe to state that 22-26% of India’s population are below the poverty line. In July 2013, based on the Tendulkar poverty line, the Planning Commission released poverty data for 2011-12, the poor were pegged at 21.9%. After this, India has never released official poverty estimates.
I am bad at statistics. But those in authority have to calculate how much is the percentage of the population above 18 years based on this presumption. The Government at States/Centre has to support these people by giving free vaccines. Those who can afford it, should not fuss about the price as it is below Rs 1,000. It is better if it is subsidised. In a government hospital for treatment, one spends in thousands of rupees and the figure rises to lakhs if you are in a private hospital. So those who can afford it (including your pensioner writer) should be reasonable enough and not fuss over the price further.
Enhance vaccine production: After the centre gave a Rs 65 crore grant, Bharat Biotech said it will double its Covaxin production by June and will manufacture 70 crore doses per year. The pertinent question is – why is it done only now? Why are babus sleeping for such a long time at this national hour of crisis? Not only the government, but one also has to blame Bharat Biotech – why didn’t the company take a loan from the bank to enhance its production capacity on its own? These are pertinent questions and will remain unanswered.
Now calculate the doses, consult with the already approved company/brands for the number of doses they can supply, give a timeline to supply and plan and fix the vaccination schedule accordingly.
Reaction treatment facility with ambulance referral services: This is one of the key aspects of the vaccination process. Imagine the chain of reaction we will have if some incidences of death occurred due to non-availability of specialist doctors to treat side effects. The whole vaccination process will be in jeopardy. That’s why I have always emphasised the presence of a specialist or a trained doctor at the vaccination site. When a situation arises, the client should be referred to a designated hospital for special treatment by a government ambulance. Earmark the referral hospital well in advance. Is it already in place? No, definitely not.
Decentralise vaccination centres: The good thing is that the central government has already initiated it by opening many centres. It still needs lots of improvement. I presume the defence forces have already done an excellent job, though I don’t have statistics. Give them responsibility for various villages situated nearby their camps. Villagers will be happy to comply. Ask Indian Railways to cover all its employees. The same should be true for other organisations/corporate, private and semi-government. Supply all available vaccine brands and fix a timeline. That is a practical modern management technique.
Babus overshadowing doctors: In my life, I have never seen such overshadowing of doctors by bureaucrats like in the Corona Control Programme now. I have never seen DGHS, New Delhi, appearing in any interview or in any circular. I wonder where he is. It is sad to see IAS officers giving medical interviews. Unfortunately, that’s how it is now, with the medical fraternity becoming too timid and unable to exercise their rights. Doctors have to blame themselves for this.
I recommend abolishing all corona-related committees including Covid Task Force. My suggestions:
i) Have a Corona Control Programme as is done in other Communicable disease Control Programme and strengthen it. Establish a Material Management Committee, as suggested above, to give us vaccine requirements, vaccine production, vaccine timeline and storage strengthening up to the periphery.
ii) Set up a hospital management committee at Centre and at every hospital to chalk out all requirements of concerned hospitals – bed occupancy, O2 supply, ventilators, medicines, ICUs, PPIs, testing kits, testing & delivery of testing results etc.
iii) Have a separate committee for rural areas starting from CHCs down to sub-centres to oversee all aspects.
iv) Have a central monitoring and review committee with the representatives of these committees.
Monitoring, evaluation and re-planning: This is the most weakened link presently. It is sad to see the prime minister monitoring even O2 supply. It seems our PM is over-burdened with many unwanted advisers. That’s why I suggest to fix responsibilities with “Heads will roll” for corona miss-management.
These are just suggestions. One can expand it with better ideas and that is welcome.
(The author is Ex-Director Health, Manipur, a public Health Specialist and WHO Fellow (Holland &UK). The views expressed are personal and not necessarily that of Financial Express Online).