Covid vaccination : 156 Cr vaccinations means 42 lakh daily vaccinations !
Brief tale of one year vaccination drive

Dr Manohar Agnani *

One year, 156 crore vaccinations ! That means approximately more than 42 lakh vaccinations daily. Through this article, it is my endeavor to share with fellow citizens the story of the unparalleled journey of an extraordinary achievement of “Team Health India”.

We are all aware, how several subject experts and intellectuals had in the time preceding the world’s largest vaccination drive, expressed many doubts and misgivings, based of course on their experiences, facts and the many hypothesis. For instance,

o Will we be able to make vaccines available as per the needs of the country ? Even if they are made available, does our country possess adequate storage capacities for such huge numbers !
o It will take too much time to develop such huge capacities.
o Even if storage is taken care of, do we have the necessary transport arrangements and trained manpower ?
o Does anyone have an idea as to how much time it will take to ready the trained manpower for the vaccination of such a large population ?
o Up until now, the country has not undertaken the vaccination of adult population. So far, under the National Immunization Programme, vaccination had been carried out only for children and expectant mothers who constitute a very small percentage of the country’s population.
o Which child received which vaccination and when. We haven’t even digitized this information.
o How will we address the apprehensions of the people regarding Covid vaccination ? How will we address vaccine hesitancy ?
o How will vaccine be reached timely and safely to far flung regions ? Who will vaccinate them ? etc. etc…

Amidst this environment of criticism and disbelief, “Team Health India” gathered its spirits and set out to work on a well laid out strategy. We were confident that we could carry out the job as we already had on our side:

o Years of experience of running our National Immunization Programme.
o Experience of more than 25 years of administering polio drops to almost about 10 crore infants within a short span of time during Pulse Polio Campaigns.
o The capacity to vaccinate more than 35 crore children upto the age of 15 years against measles and rubella.
o The experience of storing our vaccines in more than 29,000 cold chain points and reaching them to far flung areas with consistency.
o Successful implementation of monitoring the storage and distribution of vaccines as per prescribed standards through e-Vin (Electronic Vaccine Intelligence Network).
o The experience of implementing the ‘Mission Indradhanush’ strategies to mop-up and vaccinate the left out children and expectant mothers.

The most important reason behind this self-confidence was the unshakable conviction of Hon’ble Prime Minister in the hidden potential and capabilities of the citizens of our country, which became the greatest strength of “Team Health India”.

With this background, the team first focused on resolving the expectations and doubts raised by the subject experts and the intellectuals. The Ministry of Health & Family Welfare in the Government of India, the Health Departments of the States and Union Territories, the Non-Government Organizations working in the health sector, International organizations etc., all of them participated in endless marathon meetings, not only ideating and consulting on every aspect of the vaccination drive, but also taking these to logical conclusions in the form of various strategies and guidelines.

It was exactly a year ago from today, before the launch of the World’s largest vaccination drive by the Hon’ble Prime Minister, that we set the stage having finalized the basic guidelines and having completed the necessary trainings.

Though the formal launch of the drive had yet to happen, at this point, “Team Health India’ was brimming with confidence and there were reasons for this. We were ready with all the necessary preparations much before 16th January, 2021, and foremost among these were:

o The operational guidelines for Covid vaccination.
o Identification in sufficient number of necessary manpower for carrying out the vaccination and their training.
o Building systems for reaching the vaccines safely to the vaccination centres and for extra storage capacities.
o Formulating a communication strategy which focused on addressing vaccine hesitancy, eagerness, Covid Appropriate Behaviour and other similar subjects.
o Setting up of the CoWIN platform to collect necessary details in connection with the vaccination in a digitized system etc.

A ‘dry run’ had been carried out in all States and Union Territories to ensure readiness. In fact, here I would like to share a personal experience. Even as we were set to launch on 16th January, on the night prior to that, of 15th January, the CoWIN teams in thousands of Covid Vaccination Centres across all States and Union Territories and teams stationed in State and Central headquarters had to keep awake the entire night.

There was some technical issue to resolve for which everybody had to be on vigil. It was extremely cold that night. I remember, the entire night, there was nail biting anxiety, almost akin to what scientists sitting in a command centre may experience on the launch of a space shuttle. Being the nodal office for the National Covid Vaccination Programme, I was also present in the headquarters, more to boost “Team Health India”.

Words fail me in describing those moments of anxious anticipation or the deep sense of satisfaction on resolving the glitch. CoWIN was successfully kick started on time and we are all witness to the many benefits of the extraordinary Indian digital platform, which has continuously adapted to the evolving requirements of the programme. By all means this is a unique gift both for the country and the world.

This was just the beginning. In the first phase, vaccine availability was limited and expectations were many. Rationalized distribution of the limited number of vaccines would pose a big challenge not only for the Government of India, but even at the level of States and districts. In such circumstances, criticism was inevitable.

“Team Health India” however, went on to implement this successfully. However, it wasn’t easy. To achieve this, there were virtual meetings for hours on end every day with vaccine manufacturers, vaccine transport agencies, storage centres, cold chain points and Covid Vaccination Centres. And the aim was one and only one-use of every drop of the available vaccines optimally as much as possible.

Next, imagine how the vaccines would have reached to the far flung and remotest areas of the country. Where there was no road, cycles were used; in the desert regions, camels came to the rescue; and boats helped cross rivers; in the hills, the vaccine carriers were carried on backs. Vaccines were not only reached, they were also administered. People were invited for vaccination with offerings of turmeric rice.

For those hesitant to take the vaccination, ‘Har Ghar Dastak’ or Door to Door calling was done. In all of this, we did not follow any western model. This was a purely an Indian model. The process bore the unique stamp of India’s ingenuity.

What makes the story of one year of vaccination unparalleled is that the preparations required were enormous and time too little. We kept learning from the experiences gathered from the field, the positive feedback and suggestions and we kept working on the programme, improving it and we strengthened our determination as we went along as well, much like ‘building the ship while sailing’.

In this single minded pursuit, “Team Health India” almost forgot their own personal time, their own needs, their families, their dreams and many in fact, even lost their dear ones to the Covid toll. But despite that, there was great pride and realization of the good fortune, “Team Health India” had in serving the Nation in a moment of crisis that comes but in a century and in upholding the dignity of the noble profession. Yes, “Team Health India” also received a lot of appreciation in return.

What I saw or write, is but the tip of the iceberg. For “Team Health India”, there would be countless such moments of struggle and satisfaction, examples that are symbols of humanitarianism, examples that impart a sense of deep gratitude and examples that give a sense of hope.

To conclude, I would like to remind that health is considered a ‘Public Good’ and in the exemplary story of the Covid vaccination drive in India, the role of the Government machinery has further strengthened this belief. Jai Hind.

(views expressed are personal)

* Dr Manohar Agnani, IAS, wrote this article for The Sangai Express
The writer is Additional Secretary in the Ministry of Health and Family Welfare, GoI and the nodal officer for the COVID-19 vaccination drive.
This article was posted on January 18, 2022.

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