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India should recall a key learning from the smallpox and polio vaccination campaigns

The only way out of the Covid pandemic is by vaccinating. Social distancing, masking and a reasonable degree of hand hygiene will help, primarily in buying time for the vaccine to be given to the vast majority of Indians. But as with other infectious diseases, vaccination is the only sure route to health security.

The present rate of vaccination is too slow. To make matters worse, the government’s policy pronouncements on the process ahead have sown confusion. The slow rate and confusion will be disastrous for India and the world at large. For the millions who will get Covid. For those Indians with other medical conditions who cannot receive timely treatment in dangerously stretched healthcare facilities. It could also be disastrous for those outside India who could be exposed to more rapidly transmitting and fatal forms of the virus that could incubate and spread from our shores.

India has had success with vaccination programmes in the past, but it is hard to escape the conclusion that given our governance and the size of our population it will be years before 80% of our population are vaccinated – if we assume 80% is the threshold that might induce herd immunity. India’s dedicated and accelerated smallpox vaccination programme began with the National Smallpox Eradication effort. It was supposed to be completed in three years. It took from 1962 to 1977 to eradicate smallpox. The polio campaign began in earnest in 1993-94, with Kerala and Tamil Nadu taking the lead. Polio was finally eradicated in India in 2011-12. In both cases, it took about 15 years to win the fight.

Since then, Indian capabilities have no doubt increased in producing and giving vaccines, in surveillance and follow-ups, and in contacting and persuading people to take the jab. However, India’s population has also increased. In 1962, when the smallpox programme began India’s population was 469 million. In 1993, when we got serious about polio vaccination, it was 927 million. In 2019, our population stood at 1.366 billion. We are closing in fast on 1.4 billion. That’s the enormity of the task ahead.

How long will it take to fully vaccinate 80% of 1.4 billion, that is, 1.12 billion Indians? That will require 2.24 billion jabs (two jabs per person). By May 11, India had given 170 million jabs in total including those who received the second jab. The vaccination drive began four months ago, so about 42 million jabs were administered per month. At that rate, it will take 50 months to give everyone two jabs (add in a month or two to deal with the increase in population over 4 years).

How can we speed things up? The biggest constraint is India’s ability to produce enough vaccines. At this point, the only way is to buy vaccines abroad and to expand vaccine capacity in India, at warp speed. The immediate option is to buy abroad. Our arrogance in being so dismissive of the Pfizer vaccine when it was offered to us has now come back to haunt us. Yet, we can still correct course: We can and should buy every vaccine on offer, even the Chinese vaccines approved by WHO, without going through a long Indian approval process. If we can buy Chinese machine parts after the Ladakh crisis and import their medical supplies to deal with the surge in Covid cases, why can’t we buy their internationally approved vaccines?

Four years is too long for India to fully vaccinate. In those years, mutations will multiply. It is time to treat vaccination as no other public policy challenge India has ever faced. What we need is not the prime minister, who has no expertise, but rather a public health czar to head a super taskforce with only one mandate: Vaccinate, vaccinate, vaccinate.



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Disclaimer

Views expressed above are the author’s own.



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