The new year couldn’t have come with better news. Two vaccine candidates have been given the approval for emergency use by India's drugs regulator, Drugs Controller General of India (DCGI). The first vaccine to get the nod from an expert group was Covishield, the Covid-19 vaccine developed jointly by AstraZeneca and Oxford University. The vaccine is manufactured in India by Adar Poonawalla’s Pune-based Serum Institute of India. A day later, the expert group cleared Covaxin, the indigenous vaccine developed by Bharat Biotech and Indian Council of Medical Research (ICMR). Finally on January 3, the DCGI gave the final nod for roll-out to both the vaccines.

But on the ground, the preparations for the roll-out of the vaccine are in full swing. Using the expertise and insights of the election process, as well as the universal immunisation programme, India will begin vaccinating the first 300 million of its healthcare workers, frontline workers, and the ‘at risk’ population who are over 50 years and have co-morbidities.

Managing session sites

Based on Covid-19 vaccine roll-out plans of the government of India, updated on December 28, 2020, there are clear and concise guidelines given to states for managing session sites.

Once the vaccine is allocated and sent to the regional vaccine store in the district, the next step is to send the vaccine, based on allocation to a specific vaccination site, under security using existing and upgraded cold chain infrastructure.

According to government sources, there will be three types of sites. Under the first category come the fixed session sites which would contain all the facilities of a primary health centre (PHC), under a doctor’s supervision. Second are outreach session sites, which are sites other than a health centre, such as a school or a panchayat building, a cantonment or even an empty marriage ground. These outreach sites are for frontline workers, and under the third category comes the special mobile units, meant for hard to reach areas, or those areas which have a high concentration of migratory populations, or are on international borders, etc.

A screen grab from the government document
A screen grab from the government document

The timings of the sessions when the inoculation programme would be conducted would be between 9 a.m. and 5 p.m., government sources say.

The vaccine will only be offered to pre-registered beneficiaries. There is no provision of pre-registration to be done on the site.

A screen grab from the government document
A screen grab from the government document

In Gurugram, for example, Dr. Virender Yadav, chief medical officer (CMO), speaking to Fortune India, argues that site preparations have been on in full swing. “181 sites have been prepared, this is both in rural and urban Gurugram. These sites are primary health centres, community health centres, government institutes, auditoriums of private hospitals, schools, panchayat bhavans, etc., have been identified and prepared as sites for Covid-19 inoculation,” the CMO says.

A screen grab from the government document
A screen grab from the government document

According to Yadav, the preparations for the vaccination drive has been going on since the last four-six weeks. “Since the last four-six weeks, we have been preparing our teams at the district and block level. The District Task Force meets every Friday and the Block Task Force meets every Monday to assess the preparedness and to address issues as and when they arise,” he says.

A screen grab from the government document
A screen grab from the government document

Yadav argues that because Gurugram has a regional vaccine store, it enables the health personnel to store and dispense vaccines to at least five districts every week. “Gurugram has a regional vaccine store, so we can store and dispense vaccines to five districts every week, including areas like Palwal, Gurugram, Faridabad, and Rewari. We have both walk-in deep freezers and Ice Lined Refrigerator (ILR) to service all our sites,” he says.

The team of vaccine warriors

As per government sources, every state has mobilised its teams for vaccination. Healthcare workers, doctors, Ayush practitioners, and nursing staff have all been trained by state governments on the process to be followed. Apollo Hospitals, too, has trained around 10,000 of its staff across India to be able to help in the vaccination process.

A team of five will manage the site, with a supervisor looking after three to five sites, depending on the distance between these sites.

The personnel within the vaccination site would be classified as follows:

1. Main Vaccination Officer: Trained for injectables. The volunteer should be a doctor/BDS, staff nurse, pharmacist , ANM, LHV. Will give the actual vaccine to the beneficiary who has been authenticated. This personnel will also check and mark the date and timing of opening the vaccine and keep the anaphylactic kits with injection adrenaline, exactly as done in the universal immunisation program. The personnel will ensure safe disposal of medical waste. The personnel will also be in charge of updating the vaccination status of the beneficiary after vaccination.

2. Vaccination officer 1: To check pre-registration status of the beneficiary and confirm with photo identification. This class of personnel will primarily be drawn from the police, the home guard, civil defence, NCC, NSS, etc. The personnel will be responsible for crowd management, or to manage queues.

3. Vaccination Officer 2: To authenticate and verify the documents on Co-Win, the app especially prepared by the government for the inoculation drive. The election model will be used for verification.

4. Vaccination officers 3 and 4: Crowd management and guiding unregistered people. Ensuring that every person who is vaccinated waits for 30 minutes to monitor for side effect for any mild to severe adverse event following immunisation. If the load is more at the site, another officer will need to be deployed. This class of personnel will have to ensure all Covid-19 safety measures, like wearing a mask, hand sanitisation, and social distancing norms are maintained.

A  govt school in Gurugram identified as a potential site of vaccination.
A govt school in Gurugram identified as a potential site of vaccination.
Image : Chief Medical Officer

At the end of the session, each beneficiary gets a certificate of vaccination online along with the date of the next dose.

But what about the training of the personnel? Yadav argues that as of now, at least 331 government vaccinators and 1,200 private sector vaccinators have been prepared. “Teams of five as prescribed by the NEGVAC (National Expert Group on Vaccine Administration for Covid-19) are ready. Although each site will only vaccinate 100 people a day, depending on vaccine availability, we can vaccinate 18,000 people a day,” he says.

He further points out that the entire financing of the the Covid-19 vaccination programme has been sanctioned by the government of India’s universal immunisation programme (UIP). The UIP was launched by the Indian government in 1985 and in 2005 became a part of India’s National Rural Health Mission.

A school identified as a potential site for vaccination.
A school identified as a potential site for vaccination.
Image : Chief Medical Officer

Who goes first?

As per government sources, the planning for vaccination beneficiaries has been done and the preparations are underway for beneficiary registration. As per NEGVAC—the government body tasked with preparing a plan for the roll-out of the vaccine—approximately 300 million people are expected to be vaccinated in the first phase. The beneficiaries are further divided broadly into three segments.

Under the first segment comes the healthcare workers, which is numbered approximately at 10 million, and contains workers from both public and private hospitals. This segment also includes Integrated Child Development Services (ICDS) workers. The second segment to be vaccinated will be the frontline workers, state and central police departments, air force, home guards, prison staff, disaster management volunteers, civil defence organisations, and municipal workers. The third and last segment of beneficiaries contains those who are in the age group of over 50 years, and those with co-morbidities like lung disease, diabetes, asthma, and blood pressure. This group will be identified from the electoral rolls of Lok Sabha and legislative assembly elections.

As per Yadav, a total of 36,000 healthcare workers, of which roughly 4,600 are in the public sector and rest in the private sector, have already been enrolled for phase 1. Yadav argues that for the first phase, workers from private laboratories, hospitals, nursing homes and all the staff working in healthcare, which includes Anganwadi and ASHA workers, have all been enrolled on the Co-Win software.

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