A health worker inoculates a young woman with a dose of Covishield vaccine at a school used as a vaccination centre in New Delhi on May 11. (AFP) Exclusive
A health worker inoculates a young woman with a dose of Covishield vaccine at a school used as a vaccination centre in New Delhi on May 11. (AFP)

How to vaccinate 10 million people a day

It is an ambitious, but not unachievable, goal which requires coordination and partnership at various levels. Operate on a war-footing
By Neeraj Aggarwal
UPDATED ON MAY 13, 2021 05:26 PM IST

The second wave of the pandemic has hit India hard. Its rapid ascent over the past few months has caused unparalleled adversity to our people. The majority of discussion and deliberation on social media, the news and otherwise puts a spotlight on the here-and-now elements. The circumstances, however, make it crucial for us to aggressively plan and work towards being in a better place, six months from today. Recent lessons from around the world reiterate that to forge ahead and fight the virus, we need to vaccinate our citizens quickly.

We need to think of a moonshot. How can we build the capability to both create supply and vaccinate 10 million Indians every day. The task is daunting and will demand significant work. But if we put our minds to it, we can take the first steps towards reaching the goal as early as August.

Existing and future candidate-vaccines are in three groups. Those which are already approved (Covaxin, Covishield, Sputnik) in India. Others (e.g. J&J, Pfizer, Moderna) which are being deployed outside but are not yet present in India. And the ones in advanced stages of development (e.g. Covovax, ZyCoV-D, Gennova, Bio E protein subunit, DBT nasal vaccine). For ramping up to 10 million doses a day, we need to expand capacity of current vaccines to meet 50-60% of the required supply. To bridge the gap, we need to accelerate both the development of vaccines in advanced stages and bringing other vaccines into India.

We have administered 170 million shots so far. As per the recent run rate, we will likely reach about 450 million shots by the end of July. Imagine a different reality. If we start vaccinating 10 million per day beginning in August, which is admittedly at least three times the current run rate, by the end of October we will reach 1.35 billion shots. This means vaccinating 80% of our entire adult population (roughly 850 million people, 1.7 billion shots) by the end of October.

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Vaccinating 10 million a day takes us close to what countries such as the United States (US) and the United Kingdom (UK) accomplished at their peak (at least 1% of the population per day). This throughput also bolsters our capability to administer booster shots every six months for variants of the virus. It will also enable us to cover the population beyond adults — all those above 12 years, a trend we are seeing in countries that were early movers.

This goal vis-à-vis timelines, though far from current reality (we all know from trying to book vaccine slots) is not unachievable. Admittedly, we have an overstretched health care system, which must be augmented. While mere incremental efforts will not work, our collective might can make the moonshot a reality.

To do this, we need to implement seven big ideas.

One, operate in a mission mode and on a war-footing. The US launched Operation Warp Speed in May last year and is now benefiting immensely from it. We need to implement an operation of a similar proportion to de-bottleneck constraints, address supply challenges and take rapid-fire decisions.

Two, build an unprecedented partnership between the government and the private sector. Pure market solutions will not suffice. We will need to work collaboratively to recognise industry constraints and de-bottleneck accordingly – e.g., advance purchases, shore up access to critical items like adjuvants and vials which are in short supply, indemnify vaccine manufacturers.

Three, capitalise on the Indian pharma industry’s manufacturing strength. If deployed adequately, we have, by far, the largest capacity in the world. We will need to take stock of all domestic vaccine-manufacturing capacity and plan how this can be retrofitted and scaled up – both for Indian vaccine candidates and others.

Four, leverage our diplomatic relationships — e.g., tap into excess doses of high-income countries, expedite COVAX delivery, fast-track tech-transfer partnerships, unlock critical raw material imports. A plausible step is to strike bilateral arrangements with countries such as the US which is building a huge stockpile of vaccines. We could guarantee future capacity to them in exchange for our current needs.

Five, develop a coordinated approach between the Centre and states. For this to succeed, both the entities must become partners— to plan, source the vaccines, and deploy them. These efforts could be jointly reviewed under a framework akin to the GST council.

Six, implement a tiered vaccination delivery network in each state. Integrate mass vaccination sites e.g stadia, shopping areas, drive-ins, with schools and primary health care centres. Augment with precision delivery mechanisms to cover gaps and ensure equity e.g., mobile vans, outreach campaigns as was done in the case of polio. Design a public awareness campaign; leverage celebrities and medical community leaders to address vaccine hesitancy concerns.

Also Read | Over a quarter of EU adults would refuse Covid-19 shot: Survey

Seven, leverage the best digital technology — Aadhaar-based facial authentication to pre-populate the data, and analytics-driven model for zero wastage and high speed.

The agenda is an ambitious one, but difficult times call for bold action. If well executed, this will enable India to build capacity to make in excess of 20 million vaccines a day by January 2022. It can be a game-changer to flatten future waves and revive our economy. And, more importantly, to change the narrative and uplift the national mood.

“No one is safe until everyone is safe,” has never been truer for the world. With this plan, we will not only improve the outcomes for our country but also play a pivotal role in shaping the trajectory of the pandemic globally. And we will make a critical contribution to ending this crisis by 2022, not letting it drag on until 2024. That may sound like a dream but to paraphrase John Lennon, I am not the only one.

Neeraj Aggarwal is the chairman, Asia Pacific, at BCG

The views expressed are personal

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