India’s COVID-19 vaccine pace is inspirational to lower income countries, says vaccine alliance official

Gavi is co-leading COVAX, the global effort to securing a global response to COVID-19 that is effective and fair. It is working with countries to support COVID-19 response and to maintain and restore routine immunisation. The Alliance is also co-leading global efforts on equitable access to COVID-19 vaccines. Anuradha Gupta, deputy CEO of Gavi, the Vaccine Alliance speaks about India’s vaccination journey and how it’s a case study for the world.

Do you think COVID vaccination experience can serve as a critical threshold for the public health policy and implementation in India to take a leap?

There is always a risk with these pandemics. When they hit, everybody wakes up. Once they fade, they are soon forgotten. Memory is short-term. It will be extremely important for any country, not just India, not to waste this crisis: to ensure that learnings out of this crisis are used to improve our health systems and make them pandemic-proof.

Certain solutions have proved so compelling that they will outlast the pandemic. For example, I see CoWIN being repurposed for routine immunisation services and other healthcare programmes. For instance, in tuberculosis programmes, there has been a persistent challenge of tracking patients who went to private healthcare services and discontinued their treatment. That can be solved with a shared database on platforms like CoWIN, enabling effective exchange of information between public and private sector providers, and proving extremely helpful in addressing diseases that cause deaths, morbidity, and medical impoverishment.

Another important lesson coming out of this pandemic is that we should have more distributed manufacturing of life-saving commodities, geographically speaking. So, whether it is personal protective equipment (PPE), syringes, vaccines, drugs, or testing kits, the more distributed manufacturing we have across the globe, the better it is for the world. India has demonstrated a lot of strength in creating indigenous capacities for production of these necessary products, which has made it self-reliant.

The country has the potential not only to serve the domestic population, but also people across the world — by becoming an exporter of such essential commodities.

Finally, India will need to reflect on how to build public-private partnerships in the healthcare sector that are mutually reinforcing. Most discourses around the roles of the private sector and public sector in healthcare have positioned the two as mutually exclusive options, in an “either/or” manner. But models like Gavi, for instance, show that there are ways to create highly effective public-private partnerships and craft win-win models for all stakeholders. In a country as large and diverse as India, we need both the private sector and public health systems, supported by effective regulation and technologies fostering trust through transparent systems.

It is such a proud moment for India to have hit this one billion inoculations mark. The country deserves to celebrate the distance it has covered amid extreme uncertainties. We are hopeful and confident that India will build on this success and contribute to the global good by making vaccines available to other countries, where even the most vulnerable populations are still waiting to access COVID-19 vaccines.

What are the major steps you think have most contributed to achieving its vaccination coverage?

First, the huge political commitment to vaccination, and very decisive leadership. I think that makes all the difference. Once India decided that vaccination needed to be ramped up, particularly after the second wave hit the country, we immediately saw tremendous progress.

Second, India has a huge advantage coming out of systematic investments that have been made in strengthening public health systems since 2005, under the National Health Mission, previously National Rural Health Mission. The one million ASHAs (Accredited Social Health Activists) on the ground, the Anganwadi workers, the ANMs (Auxiliary Nurse Midwives), and the health infrastructure really reaching out almost to the last mile, gave India the strength to very quickly mobilise millions of health workers to carry out this ambitious drive.

Past investments in supply chain — cold chain equipment, vaccine transportation, vaccine storage, trained manpower, supervision ability — came in very handy in mounting a vaccination response at this scale.

Third, India’s historical strength in building indigenous vaccine manufacturing prowess inspired confidence among the global community to transfer technology for manufacturing COVID-19 vaccines to Indian manufacturers like the Serum Institute of India (SII). SII’s capability and track record gave institutions like Gavi the confidence to provide financial backing and pre-payments to enable the ramp-up in production of COVID-19 vaccines so that both domestic and global demands could be met rapidly.

Fourth, the public confidence in vaccines, institutions, and the provincial and national governments made this journey possible. The tone was set at the top; people believed in that message, and they actually came forward to get vaccinated.

Vaccination happens when three Vs come together: the vaccine, the vaccinator, and the vaccinee. In India’s case, we saw the vaccine, meaning the vaccine production and the logistics; the vaccinator, meaning the entire health workforce and its capability to deliver that vaccination; and the vaccinee, meaning the public confidence, built through the intense communication campaign, come together to make this drive a success.

Does India’s COVID vaccination experience have a few lessons for other countries?

That India has been able to deliver one billion inoculations at such a rapid pace is inspirational, particularly for lower-income countries. It’s also a great case study, on how to quickly activate health system capacities to vaccinate, overcoming several weaknesses. One of the most important takeaways from this experience is the exemplary use of digital innovations, and the ability to continuously adapt in a crisis setting.

CoWIN is a brilliant example of digital innovation which helped India organise its vaccination efforts in a remarkable way, enabling vaccine tracking and vaccine management, otherwise not possible through manual efforts. The use of CoWIN sends a powerful message to the world: that digital technologies can actually be leveraged very fast –at lowcost, but to great effect. We at Gavi are very proud to have funded and supported CoWIN at an early stage. The large-scale use of technology in vaccinations has been a big game-changer for India, introducing a great deal of transparency. In many other countries, where digital technologies are not mature, even prioritisation of populations for vaccine eligibility can be a very big challenge.

India also did exceptionally well to actually keep its ear to the ground, identify and solve problems as they unfolded, and continue to adapt. It had its own set of challenges, such as initial reluctance among health workers to get vaccinated and high wastage of vaccines in some places. But the government remained alert, vigilant; pulled together information from the ground from every district; conducted very intensive monitoring to understand the exact issues; confronted them; and then took very concrete steps to improve. That’s what made this journey a success.

Are there any specific lessons, knowledge gains that can really be transferred to other infectious disease programmes or public health space in general?

One of the lessons that has emerged very clearly from this pandemic and India’s response is that public health system capacities need to be continuously bolstered. With the large, dense population, the pandemic could have been devastating for the country.

To expect so many poor people to maintain physical distancing, hand-washing hygiene — when some of them struggle for clean drinking water — is unreasonable. Also expecting them to buy sanitiser and masks daily, when they are trying hard to make ends meet, is beyond logic. If India hadn’t systemically invested in and developed its health infrastructure over the past decade, probably the story would have been different. That highlights the importance of further increasing investments in public health, pandemic preparedness, and resilient health systems.

India has repeatedly committed to increasing investments in public health beyond 1% of GDP. It is time we honour that commitment, because this is not the first or the last pandemic.

The second lesson for the country is to continue to strengthen the force of frontline health workers, including the ASHAs, and take an integrated public health approach to protecting and promoting good health. The pandemic has demonstrated the value of ASHAs and the high community confidence they enjoy.

For any kind of pandemic preparedness and response, communities play a very important role. Frontline health workers are an important interface between the government and communities, and therefore that bridge needs to be continuously strengthened.

The third lesson for us is to use technology as an enabler across healthcare programmes. We at Gavi supported RISE (Rapid Immunization Skill Enhancement), a digital training programme to build the capacity of health workers that was adapted to include COVID-19 vaccination protocols. Electronic Vaccine Intelligence Network (eVIN), which is a digital system to track and trace vaccines, their movement, and storage, is another brilliant example of how digital technology can be used to enhance efficiency and effectiveness of health investments and their reach. eVIN paved the way for CoWIN, and I am personally very delighted having conceptualised and rolled out eVIN with Gavi support.

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Printable version | Dec 8, 2021 9:53:45 PM |

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