A Covid-19 vaccine will be found. Plan for delivery – analysis
Most experts say we are 12-18 months away from an approved coronavirus vaccine (Covid-19), and even longer from having one available at scale. Despite the fact that vaccine development is at this uncertain stage, India must immediately start planning how to administer a Covid-19 vaccine.
When a vaccine becomes available, everyone will have to go through the largest and fastest mass vaccination campaign in history. India will have to vaccinate approximately one billion people to reach the level believed to confer herd immunity for Covid-19. Every day of the uncertainty caused by the virus paralyzes the economy and imposes immense human costs. India should do everything possible to save critical days, weeks or months.
There is a working group on the development of coronavirus vaccines, drug discovery, diagnosis and testing. The focus of this group is diffuse. Even in the area of vaccines, the group’s focus is primarily on vaccine development, not delivery. Immunizing a billion people in a country as diverse as India will be a staggering operational challenge. To be successful, we need a powerful group to plan the delivery of the vaccine now.
To accomplish this, India can draw lessons from two large and successful campaign-style exercises. Every five years, India holds the world’s largest general election, with the participation of up to 900 million voters. Election rules state that there must be a polling place within two kilometers of each room. India employs 11 million poll workers to ensure that all eligible Indians can vote. Each vote is cast electronically through more than 1.7 million machines. Despite these formidable challenges, India successfully conducts elections, widely considered free and fair.
The polio campaign is the second example. As recently as 2009, India had more than 60% of all global polio cases. With an annual birth cohort of 27 million children, high population density, poor sanitation, inaccessible regions, high population mobility, and high disease burden, the obstacles to achieving zero polio status seemed insurmountable. However, India has not had a single case of wild poliovirus since 2011, and declared itself officially polio-free in 2014. The victory was achieved through government ownership, partnerships with private and social sectors, innovations in the delivery of programs, technical advances and massive social mobilization.
There are more than 90 vaccine candidates in the trials, six in human clinical trials, with more added every week. Vaccine candidates encompass approaches based on viruses, viral vectors, nucleic acids, and proteins, which means they will require different technologies and processes to manufacture them. We still don’t know if an eventual vaccine will require temperature control, ultra-cold temperature control, or will not require cooling to maintain its potency. We do not know whether it will be packaged and administered via conventional syringes or a new innovative delivery mechanism such as a microneedle patch. We do not know the duration for which a vaccine will eventually confer immunity. We do not know its effectiveness; Of the people who get vaccinated, what fraction will be protected against the disease? We do not know how this efficacy will vary between different populations: will it be as effective for older people as for younger people, for populations in North India and South India?
Despite these uncertainties, there is much for a Vaccination Task Force (VTF) to focus productively on this time.
First, for each of the key uncertainty factors, VTF can determine plausible ranges and identify the most likely options. These can be used to develop a set of scenarios for detailed planning. The VTF can monitor how vaccine development progresses. As more information becomes available, the ranges for uncertain key variables may decrease and the order of priority and details of plans may be revised.
Second, practicing through “war games” will allow decision makers to react quickly and correctly to changing circumstances. An example: How to react to the possible tragedy of a small group of deaths in one state, probably due to vaccine-related side effects? Such “war games” are standard practice for the military, and corporations are increasingly using them to enable decision makers to improve their responses.
Third, no matter how quickly production can be increased, there will be initial periods when only a limited supply of vaccines will be available, and demand will exceed supply. The VTF can develop allocation and prioritization rules. For example, the first high-risk populations, such as health workers; then vulnerable populations such as the elderly; thereafter, individuals are likely to be potential “superdiffusers”; and finally, the general public.
The VTF can also represent India in global agreements for equitable vaccine allocation and agree rules for timing and allocation of supply within India compared to export to other countries.
Fourth, India stands out in a critical dimension: vaccine manufacturing. Only India supplies 60% of the vaccine doses purchased by the United Nations Children’s Fund (UNICEF) each year. The Serum Institute of India is the world’s largest vaccine manufacturer, producing and selling more than 1.5 billion doses a year.
Even if Indian manufacturers are part of global agreements to ensure equitable access to Covid-19 vaccines for all countries, India can be assured of a strong negotiating position, as it brings critical production capacity.
The VTF can work collaboratively with local manufacturers to understand how many doses can be made in what time frames, provide the necessary support to increase the quantity, and establish agreements to purchase a minimum quantity of doses at an agreed price.
Finally, coherent, clear and resonant communication will be a fundamental pillar to build trust and guarantee public receptivity and cooperation for a vaccination campaign.
If planning for vaccine delivery begins now, India will have a well thought-out playbook to execute when the vaccine is ready.
Sidharth Rupani is a consultant specializing in the design of public health supply chains.
The opinions expressed are personal.