India faces 'challenges' in nationwide virus vaccination

As the UK becomes the first country to approve a coronavirus vaccine for widespread use, India may have to battle several challenges before it completes vaccination, health experts say.

With a population of 1.3 billion, India is currently battling the COVID-19 pandemic and is ranked second in infections. With fresh cases reported daily, it is now developing a strategy for effective vaccination.

Health Minister Harsh Vardhan said a vaccine is likely to be available in India by the first quarter of 2021.

“The main challenge is to work with a new vaccine and provide it across age groups, unlike the current vaccination program which focuses primarily on pregnant women and children. It will require working at scale across the country to reach all target populations, and ensure both the infrastructure and human resources are available to enable this,” Dr. Anant Bhan, a researcher at Global Health, Bioethics and Health Policy told Anadolu Agency.

He said India requires adequate resourcing and preparing the ground for the effective distribution of vaccines.

Dr. T. Sundararaman, the coordinator of the People’s Health Movement in New Delhi, said for a country like India, there are challenges in vaccine delivery, logistics, manufacture and availability.

“In vaccine delivery, the challenge is ensuring there is a demand for services in those who are most at risk. There is also the challenge of prioritization. There are issues related to financial and human resources required and expansion related to cold chain infrastructure,” he said.

Ten vaccine candidates have been supported by the Department of Biotechnology and five are in human trials, including the Russian Vaccine Sputnik-V, according to the government.

Speaking at an an all-party meeting to discuss the vaccination strategy on Friday, Prime Minister Narendra Modi said the government was developing a comprehensive vaccination strategy.

He said about eight potential vaccines currently in different stages of trial will be manufactured in India, including the three indigenous vaccines.

Noting that a healthcare database, as well as frontline workers, cold chain augmentation and syringe and needle procurement, were in advanced stages of preparation, he added that a national expert group had been formed to run the vaccine campaign.

Last week, the government announced a third stimulus package of Rs. 900 crore ($121.6 million) for the Mission COVID Suraksha (safety) -- the Indian COVID-19 vaccine development mission -- saying the aid would help accelerate the development of several vaccine candidates.

“This will help accelerate development of approx. 5-6 vaccine candidates and ensure that these are brought closer to licensure and introduction in the market for consideration of regulatory authorities for introduction in public health systems, to combat further spread of COVID infection,” according to a statement.

While the UK approved the Pfizer vaccine Wednesday for use next week, experts say it may not be suitable for India because of its cold chain requirements.

“India cannot manage Pfizer vaccine because of cold chain requirements,” says Dr. Lalit Kant, former head of the Epidemiology & Communicable Diseases Division of the Indian Council of Medical Research (ICMR). “Of the three front runner vaccines whose Phase III interim results have been made public globally, two are mRNA vaccines, which have to be stored at sub-zero temperatures. These may not be the ideal for India.”

K. Srinath Reddy, president of the Public Health Foundation of India think-tank, told Anadolu Agency several questions lie ahead, including knowing a “fully regulated, approved efficacious and safe vaccine” and what volume it will be available.

“Whether it is going to be produced in India or has to be imported from outside and once it is available, who will be first one to receive it, who will be second one to receive and how will we sequence it,” he said. “The big question is what volume the vaccine will be available in the initial stages and what will be the volume later on [...] and if we are not able to get a vaccine in adequate amounts in India, from where we will be procuring it from. Those are the issues which will come up.”

-‘Entire India may not need vaccination’

While India is making plans with states about vaccination, with the National Expert Group on Vaccine administration for COVID-19 preparing a detailed blueprint for storage, distribution and administration, senior health officials say India may not need to vaccinate its entire population.

A top official also said the “government has not spoken about vaccinating the entire country.”

The ICMR’s Director-General Dr. Balram Bhargava said Tuesday during a news conference: “If we are able to vaccinate a critical mass of people, and break that virus transmission, then we may not have to vaccinate the entire population.”

Modi, however, had said in October that everyone would be vaccinated and no one left behind.

While Vardhan said healthcare workers and those older than 65 would be given priority for the vaccine, the government said the country would get 400 - 500 million doses of a vaccine by July-August.

Modi, during meetings on coronavirus vaccines, has suggested that a vaccine delivery system would be developed on the lines of "conduct of elections, involving all levels of governments and citizen groups.”

Experts say that India's past experiences with mass immunization could help authorities with COVID-19 vaccination.

“India’s immunization program is geared to deliver childhood vaccination. There is no adult vaccination except that of pregnant women. Given its large population, no one vaccine manufacturer may be able to meet India’s needs. The immunization program was able to immunize children in hard to reach areas; teams had to travel by boat, on foot, on camel back to reach the children. India can do it again,” said Kant.