Odisha should chart its own vaccination course
By Dr Sambit Dash
It has now been well understood that the only way to come out of the Covid-19 pandemic is through vaccination. The horror of India’s ongoing second wave of the pandemic has made this point abundantly clear. However, botched up policies of the Union Government has placed speed breakers on this road out of the pandemic. Vaccine shortage is a harsh reality that the entire country is dealing with right now. The opening up of vaccination to all adults in India has exposed its acute shortage. Added to it, the hitherto untried, vaccination via registration through app, has only exacerbated the problem.
While most of these problems have been the making of the Union Government, it is now important that States, which are responsible for the delivery component of the issue, take matters in their hands. To be able to vaccinate a large population, in shortest possible time, amidst a huge supply constraint, there is a need for shift in vaccination policy. The first step to embark on a more evidenced-based policy making would be to collect evidence. The data on the demography of infections need to be presented clearly. There are conflicting reports about the new variants of the virus, with some stating that it is affecting younger population at a higher rate, while others, including Union Government sources, stating that the rate isn’t higher, and it is just a manifestation of large total numbers. State-wise and district-wise data need to be analysed.
Similarly, data on deaths should not be suppressed, rather should be used for informed policy making. Urban-rural divide, spread via inter-State travellers and other such micro level data, need to be collated accurately. This data will then help finetune the vaccination policies, with the more vulnerable groups being vaccinated ahead of others.
The second step is to rethink and redefine the ‘frontline worker’ category. Odisha Government, in a welcome move, declared journalists to be frontline workers. Those professions which require a larger interface with public, be it auto-drivers, vegetable vendors, people in hospitality sector and the like need to be prioritised. This exercise also needs to be decentralised. For example, auto-drivers in Bhubaneswar might be at a higher risk compared to that in Malkangiri, and thus these plans should be drawn preferably at district level.
The third step is to rationalise the vaccine supplies. Odisha Government has ordered the majority of vaccines, more than 99 per cent, from Serum Institute of India, which is sending vaccines in batches. In the past week, Odisha received 1 lakh doses while another 7 lakh doses is due by mid-May. Since the Union Government has washed its hands of this responsibility and asked States to coordinate, it is important that Odisha Government gets a clear message both from SII and Bharat Biotech, and plan allocation accordingly. The Government has also made the smart move of focusing on municipal corporations like Bhubaneswar, Cuttack, Sambalpur and Rourkela where test positivity is more than 20 per cent and will logically send supplies in that order. At the same time, to inculcate confidence, the Government has to explain to the rest of the people the rationale behind such moves.
The fourth move should be to rethink vaccination gap. While the Indian Council of Medical Research (ICMR) has now set a 6-week gap for taking Covishield, in other countries, which use the same AstraZeneca vaccine, there is a gap of 8-12 weeks, the latter having shown greater efficacy. Currently, Odisha Government has declared that it will prioritise those waiting for the second dose, about 17 lakh of those above 45 years of age, which is the right thing to do. However, and it will take a lot of clear and effective communication, based on sound science, there is a need to think whether creating an extra gap of 2 weeks could help in providing more single doses to more vulnerable population. While implementation concerns remain, the Government should not take off this policy option from the table.
The number of cases in Odisha are on the rise and will continue to do so. Policies like stricter lockdowns, as has been implemented by many States now, are on the cards. Such infection-slowing down policies are desirable at this juncture but certainly are not sustainable in the mid or long term. The only way out thus is vaccination but the execution of it is constrained by lack of steady supply. With hands tied, and vaccination going to be an extended affair, States need to prioritise their needs and not follow Union Government’s diktats. Redefining frontline workers, micro level vaccination management, clear negotiations with suppliers and rethinking gaps between doses are some of the policy options that the State Government may consider.
__ The author is Assistant Professor, Department of Biochemistry, Melaka Manipal Medical College (Manipal Campus). He comments on public policy, healthcare and issues of social interest. He tweets at @sambit_dash