Third anniversary the of world’s largest Covid vax drive: The inside story

Today is the third anniversary of the beginning of the journey of the world’s largest Covid-19 vaccination drive, a testament to the exceptional teamwork and collaborative spirit in the face of an extraordinary emergency. At the outset it is important to counter the simplistic notion that Covid-19 vaccine development and production represented a significant new advancement, while inoculation merely fulfilled societal expectations of the healthcare system. As we all know that collaborative efforts for this drive involved consultations with various state governments, Union Territories, supporting ministries, NITI Aayog, National Health Systems Resource Centre, Empowered Planning and Monitoring Groups, Civil Society Organisations, Development Partners, vaccine manufacturers, infrastructure suppliers for vaccine storage, syringe manufacturers, Covid vaccine testing centres and government vaccine storage centres at the state, regional, and district levels.

This list is not exhaustive and only illustrates the diverse stakeholders involved in the vaccination programme. One of the most complex challenges that arose amid the high demand for vaccines was the prioritisation of beneficiaries. The approach adopted to solve this challenge was rational and ethical, focusing on achieving public health goals of preventing and minimising infection, disease, hospitalisation, ICU admission, death, and transmission.

The entire vaccination programme was guided by the National Expert Group on Covid-19 Vaccine Administration (NEGVAC), consisted of various experts from cross-cutting fields and also included representation of five states – Madhya Pradesh, Maharashtra, Uttar Pradesh, Tamil Nadu & Assam, who shared the perspectives on the on-ground implementation of the vaccination programme. Through 31 intensive meetings, the expert group played a vital role in the programme’s journey based on the following guiding principles that laid the foundation of the vaccination programme : 1. Vulnerable groups should be identified and prioritised for early vaccination.

2. Vaccination of ‘Anyone, Anywhere’ should take place i. e.

, without imposing domicile-related restrictions for getting the vaccine. 3. Vaccination must be universal i.

e. , no person should be left behind. 4.

The entire process of vaccination of individuals should be supported in real time with the use of technology. The technical foundation of the programme was stimulated by the lens of the Covid-19 Working Group (CWG) under the National Technical Advisory Group for Immunisation (NTAGI). CWG met 54 times during the pandemic to contribute to critical vaccine-related policy and program challenges.

The Empowered Group for Vaccine Administration for Covid-19 (EGVAC) was constituted to guide the development and evolution of Co-WIN, a ground-breaking cloud-based IT solution that played a pivotal role in this drive. Linked to the existing Electronic Vaccine Intelligence Network (eVIN) platform, Co-WIN enabled equitable and inclusive vaccination access to all citizens and contributed to efficient management and data-driven decision-making. This campaign necessitated a multidimensional approach to provide accurate information, counter misinformation arising due to the ‘infodemic’, address both vaccine eagerness and hesitancy, and promote Covid-appropriate behaviour.

By effectively leveraging a combination of media tools, the programme could build public trust, leading to one of the world’s highest vaccine confidence rates, as recognised by international bodies. This multifaceted media strategy served as a global case study, highlighting the importance of tailored approaches for diverse populations and the power of collaboration between government agencies and media entities. In this grand endeavour, meticulous planning, dynamic training methods, and innovative use of technology-empowered a broad spectrum of health providers, across geographical barriers, to tackle the pandemic.

Initiatives taken to adequately manage the cold chain infrastructure and syringe availability were vital, for which strong foundation was provided by the country’s experience in running the Universal Immunisation Programme (UIP) which was augmented for the Covid-19 vaccination campaign. Similarly, the timely measures taken to navigate the syringe demand, the culmination of which led to the administration of over two billion Covid-19 vaccine doses within two years, exemplifying meticulous planning and adaptability. The case for having a robust, transparent, and responsive Vaccine Safety Surveillance System undertaken by strengthening the existing Adverse Events Following Immunisation (AEFI) Surveillance System during the pandemic is also worth mentioning.

The vaccination campaign in India against Covid-19 bore witness to a spectrum of inventive practices and successful approaches undertaken by the states and Union Territories. The judiciary’s review of the logic, constitutionality, and regulatory decisions surrounding the vaccine approval process, the safety and effectiveness of certain vaccines, and the phased vaccination plan, enabled a just implementation of the programme and lent credibility to the entire processes. Media played a very crucial role in shaping people’s perceptions, particularly during crisis management and in the resultant era of an ‘infodemic’.

Planning and implementation of Covid-19 vaccination was entrusted to the Immunisation Division of MoHFW. To support the division National Health Systems Resource Centre was available with its technical expertise. Similarly, the Immunisation Technical Support Unit (ITSU) of JSI looked after the Supply Chain and Logistics for Covid-19 vaccination.

The role of partner organisations was phenomenal in this entire drive and deserves mention. UNICEF, UNDP, WHO, and ITSU stood by the MoHFW in drafting the entire operational guidelines for Covid-19 vaccination. The UNDP team, supported the development and deployment of the CoWIN platform and also in the management of the Covid-19 vaccine supply chain through the existing eVIN platform.

The WHO team, supported the operational planning, capacity building of human resources, and Adverse Event Following Immunisation (AEFI) surveillance for the Covid-19 vaccine. The ITSU team aided in the daily compilation of coverage reports and AEFI surveillance. With all the tirelessly concerted efforts and strategic interventions leading to the administration of more than 220 crore Covid-19 vaccine doses across the country, India displayed its capability to consistently achieve high levels of vaccination coverage for a sustained period.

This achievement can be attributed on the whole to the amalgamation of the adoption of timely strategised measures, dedicated and efficiently skilled human resources, use of cutting-edge technology, mechanism of periodic reviews, and especially, ‘Jan Andolan’ (people’s participation), over more than two years. More importantly, during a period when the country was grappling with the disastrous effects of the pandemic, Universal Immunisation Programme demonstrated its strength and resilience, which is evident from WUENIC report 2022, which indicates that India’s UIP coverage has not only recovered from the impact of Covid-19 pandemic but has surpassed the coverage of each antigen above 2019 levels. To conclude, the story of India’s National Covid-19 Vaccination Programme is a story of timely decisions and innovations – in policy and regulations, in logistics and supply chain management, in social mobilization, and in good governance.

The programme as a whole has brought about the unparalleled global success of India in the face of the biggest public health challenge, so far. It is a textbook example to guide future generations to face any such crisis and bring a public health revolution. The nation’s efforts and innovative approaches that ultimately led to overcoming various challenges and ensure vaccination for all, echo Nelson Mandela’s words, “It always seems impossible until it is done.

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