February 11, 2021

Why India just might pull off ‘the world’s largest vaccination program’

[] Why India just might pull off 'world's largest COVID vaccination program' | Fortune© 2020 Fortune Media IP Limited. All Rights Reserved. Use of this site constitutes acceptance of our u003ca href="https://fortune.com/terms-of-use/">Terms of Useu003c/a> and u003ca href="https://fortune.com/privacy-policy/">Privacy Policyu003c/a> | u003ca href="/california-privacy-policy/#notice">CA Notice at Collection and Privacy Noticeu003c/a> | u003ca href="https://fortune.com/right-to-opt-out/">Do Not Sell My Personal Informationu003c/a> | u003ca href="http://preferences-mgr.trustarc.com/?pid=fortunemedia01&aid=fortunemedia01_pub&type=fortunemedia">Ad Choices u003c/a>u003cbr />nFORTUNE is a trademark of Fortune Media IP Limited, registered in the U.S. and other countries. FORTUNE may receive compensation for some links to products and services on this website. Offers may be subject to change without notice.u003cbr />nQuotes delayed at least 15 minutes. 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To enjoy unlimited access to our journalism, u003c/i>u003ci data-stringify-type="italic">u003ca class="c-link" href="https://bit.ly/2zexcz1" target="_blank" rel="noopener noreferrer" data-stringify-link="https://bit.ly/2zexcz1" data-sk="tooltip_parent">subscribe todayu003c/a>u003c/i>u003ci data-stringify-type="italic">.u003c/i>u003c/p> u003cp>India will launch its nationwide COVID-19 vaccination program on Saturday. Within eight months, it plans to vaccinate 300 million people—nearly equivalent to the entire U.S. population. And that's just the first phase of the country's coronavirus vaccination drive that will eventually extend to India's nearly 1.4 billion people.u003c/p> u003cp>India is the second most populous country in the world, and after the U.S. it has the u003ca href="https://covid19.who.int/?gclid=Cj0KCQiA0fr_BRDaARIsAABw4Esxh_7Mrmy9peSDOHDqgEUM7PvDZMMLaCOyDaHo5kqzPfDxGUClMZQaAiNuEALw_wcB">second-mostu003c/a> coronavirus cases in the world. A successful COVID-19 vaccine rollout will be crucial to lowering India's daily new coronavirus cases and deaths.u003c/p> u003cp>The sheer magnitude of the effortu003cstrong>—u003c/strong>the government is aiming to administer u003ca href="https://www.livemint.com/news/india/govts-aim-to-vaccinate-13-lakh-day-will-help-to-curb-covid-19-spread-quickly-report-11609946303087.html">1.3 millionu003c/a> shots per dayu003cstrong>—u003c/strong>will pose a challenge, as will wrinkles that are somewhat unique to India. The country of nearly 1.4 billion, for instance, has 900 million citizens without regular access to the Internet. u003c/p> u003cp>Still, a December u003ca href="https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/india-can-inoculate-priority-groups-by-june-2021-fitch-solutions/articleshow/79841068.cms?from=mdr">reportu003c/a> by Fitch Solutions said India is well suited to pull off the feat—"The world's largest vaccination program," as Prime Minister Narendra Modi has u003ca href="https://www.livemint.com/news/india/public-representatives-not-part-of-3-cr-covid-warriors-workers-to-be-vaccinated-first-pm-modi-11610364734296.html">called itu003c/a>—even with the weak spots in its health care infrastructure. The report cited India's "good track record" of mass vaccination drives as evidence that it can succeed.u003c/p> u003ch2>Who will get India's vaccine first? u003c/h2> u003cp>India's 10 million health care workers will receive the vaccine first, followed by 20 million frontline workers like police and sanitation staff. Next in line are people over 50 and people under 50 with co-morbidities—diabetes, heart disease, and other conditions that put them at increased risk for a severe case of COVID-19—who number around 270 million. After that, vaccines will become available to the broader population on a voluntary basis.u003c/p> u003cp>In December, India's government released u003ca href="https://m.economictimes.com/industry/healthcare/biotech/healthcare/29000-cold-chain-points-41000-deep-freezers-india-gets-ready-for-covid-19-vaccine-storage/articleshow/79743507.cms">guidelinesu003c/a> for states on how to vaccinate their residents in order to reach the 300 million target—around 20% of India's population—by late summer. The instructions provided training modules for the health care workers administering the vaccines and handling the cold storage technology. The government will be using a digital platform u003ca href="https://www.reuters.com/article/us-health-coronavirus-india/india-to-start-covid-19-vaccination-drive-from-jan-16-government-idUSKBN29E0G4">calledu003c/a> Co-WIN to track vaccine stocks, storage information, and who gets the dosesu003cstrong>.u003c/strong>u003c/p> u003cfigure class="wp-block-image size-large">u003cimg data-src="https://content.fortune.com/wp-content/uploads/2021/01/GettyImages-1230215395.jpg?w=1024" alt="" class="lazyload wp-image-2939877"/>u003cfigcaption>Indian passengers wait in a queue for a temperature check at Bandra train station in Mumbai on Dec. 19, 2020.u003c/figcaption>u003cdiv class="image-credit">Imtiyaz Shaikh—Anadolu Agency/Getty Imagesu003c/div>u003c/figure> u003cp>Last week, India carried out the last of three vaccination u003ca href="https://www.livemint.com/news/india/nationwide-second-covid-vaccination-dry-run-today-all-you-need-to-know-11610073972642.html">"dry runs."u003c/a> It administered dummy vaccines to health care workers at u003ca href="https://www.timesnownews.com/india/article/india-successfully-conducts-3rd-dry-run-of-covid-19-vaccinations-as-uk-strain-infections-reach-90-nationwide/705024">nearly 5,000u003c/a> sites across the country to catch any blips before the real rollout starts. u003c/p> u003cp>After health care and other frontline workers receive the vaccine, the next high-risk group—people over 50—can register online with their phone number and some form of ID, then receive a text message telling them when and where they will get vaccinated.u003cstrong> u003c/strong>On the day of vaccination, they need to bring their ID for proof of identity. They u003ca href="https://www.mohfw.gov.in/pdf/FAQsonCOVID19VaccineDecember2020.pdf">can verifyu003c/a> their identity with a range of proof, including driver’s licenses, passports, pension documents, and u003ca href="https://zeenews.india.com/personal-finance/big-aadhaar-card-update-is-your-aadhaar-linked-with-your-mobile-know-why-it-becomes-very-important-after-january-16-2335848.html">Aadhaar cards,u003c/a> India's 12-digit national identification system that pulls an individual's u003ca href="https://fortune.com/2018/09/26/india-supreme-court-aadhaar-ruling-biometric-national-id/">biometric datau003c/a> like fingerprints, irises, and photographs.u003c/p> u003cp>Once an individual is vaccinated, he or she will receive a QR code u003ca href="https://www.mohfw.gov.in/pdf/FAQsonCOVID19VaccineDecember2020.pdf">certificateu003c/a> to indicate so. The government u003ca href="https://www.thenationalnews.com/uae/health/coronavirus-how-india-plans-to-vaccinate-300-million-people-in-the-next-six-months-1.1145503">hasn't releasedu003c/a> information on how it plans to reach the hundreds of millions of Indians who don't have Internet access.u003c/p> u003cp>State governments will be in charge of vaccinations within their state, but the central government will bear the cost of the vaccinations, Modi said on Monday.u003c/p> u003ch2>Which vaccines has India approved?u003c/h2> u003cp>Modi has attached the "Made in India" label to both of the vaccines that will be distributed in the government's campaign. One of them, Covaxin, is a homegrown vaccine from Indian pharmaceutical firm Bharat Biotech. The other was developed in the U.K. by Oxford University and pharma multinational AstraZeneca, but it's being made in India by the u003ca href="https://fortune.com/company/serum-institute-of-india/" target="_blank">Serum Institute of Indiau003c/a>, the largest manufacturer of vaccines by volume in the world, so Modi has hailed it as India's own.u003c/p> u003cp>Both vaccines are administered in u003ca href="https://www.livemint.com/news/india/covid19-vaccine-how-many-doses-will-you-need-is-there-any-side-effects-11610514693570.html">twou003c/a> separate doses, 28 days apart, and both can be stored at a normal fridge u003ca href="https://www.businesstoday.in/sectors/pharma/all-indian-covid-19-vaccines-have-to-be-stored-at-2-8-degrees-celsius-dbt/story/427117.html">temperatureu003c/a> of 2 degrees to 8 degrees Celsius, which India's vaccine transport and storage network can sustain. (Other COVID-19 vaccines, like those made by u003ca href="https://fortune.com/company/pfizer/" target="_blank">Pfizeru003c/a> and Moderna, require ultracold storage technology that is u003ca href="https://www.reuters.com/article/health-coronavirus-india-vaccines/india-readies-for-600-million-covid-vaccine-jabs-to-use-standard-cold-storage-top-government-expert-idUSKBN28M01S">more scarceu003c/a> in India.) u003c/p> u003cp>Other countries, like the U.K., have approved and are rolling out the AstraZeneca vaccine, but India's decision to give the green light to the Bharat vaccine has raised a few red flags. u003c/p> u003cfigure class="wp-block-image size-large">u003cimg data-src="https://content.fortune.com/wp-content/uploads/2021/01/GettyImages-1228896803.jpg?w=1024" alt="A woman reacts while a health worker takes a nasal swab" class="lazyload wp-image-2939879"/>u003cfigcaption>A woman in New Delhi reacts while a health worker takes a nasal swab sample during the rapid antigen COVID-19 test drive in October 2020. u003c/figcaption>u003cdiv class="image-credit">Pradeep Gaur—SOPA Images/LightRocket via Getty Imagesu003c/div>u003c/figure> u003cp>India's drug regulator approved Bharat's vaccine for emergency use on Jan. 4 but didn't publish data about the vaccine's efficacy. (Bharat u003ca href="https://www.reuters.com/article/health-coronavirus-india-vaccine/bharat-biotech-says-approved-covid-shot-trials-honest-idUSKBN2991IT">saidu003c/a> it would release its Phase III trial efficacy data by March.) One day earlier, the regulatory panel had asked Bharat for more efficacy data before it approved the shot. The quick reversal prompted u003ca href="https://www.reuters.com/article/us-health-coronavirus-india-vaccine/criticism-mounts-of-indias-abrupt-approval-of-local-vaccine-idUKKBN29B0YM">criticismu003c/a> from some health experts and groups, including the All India Drug Action Network (AIDAN), a health watchdog.u003c/p> u003cp>A Bharat representative and India's Ministry of Health didn't respond to requests for comment. u003c/p> u003cp>Malini Aisola, co-convener of AIDAN, wants more transparency into the panel's decision and the efficacy data, and she also wants the government to establish a publicly available monitoring system to track any adverse events that occur during the vaccine rollout.u003c/p> u003ch2>India’s vaccine advantagesu003c/h2> u003cp>Chandrakant Lahariya, a vaccinologist and public health expert who has researched the history of vaccines in India, says that as far as logistics are concerned, India's u003ca href="https://www.reuters.com/article/health-coronavirus-india-vaccine/india-delivers-covid-19-shots-to-prepare-for-worlds-biggest-vaccination-drive-idUSKBN29H0DX">goalu003c/a> of inoculating 300 million peopleu003cstrong> u003c/strong>in the next six to eight monthsu003cstrong> u003c/strong>is "very much feasible." u003c/p> u003cp>He points to India's universal immunization program, which according to Unicef is the largest public health program u003ca href="https://www.thenationalnews.com/uae/health/coronavirus-how-india-plans-to-vaccinate-300-million-people-in-the-next-six-months-1.1145503">in the world.u003c/a> India vaccinates 26.5 million infants per year for a number of diseases, as well as annual tetanus shots for 29 million pregnant women. The centers used for these vaccinations offer cross-country storage facilities and distribution points for the COVID-19 vaccine, u003ca href="https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/29000-cold-chain-points-41000-deep-freezers-india-gets-ready-for-covid-19-vaccine-storage/articleshow/79743507.cms?from=mdr">includingu003c/a> 29,000 cold-chain points offering precise temperature customization for the doses.u003c/p> u003cp>"A majority of the existing facilities will be used, but a smaller number of makeshift facilities will also be created," Lahariya says.u003c/p> u003cp>India also is known as the "pharmacy of the world" since it u003ca href="https://fortune.com/2020/09/05/covid-vaccine-india-corona-development-manufacturing/">produces halfu003c/a> the world's total vaccine supply. India's vaccine manufacturing ecosystem means that India is unlikely to suffer au003ca href="https://inews.co.uk/news/health/boris-johnson-normality-easter-hit-vial-supply-issues-vaccine-roll-out-814248"> shortageu003c/a> of essentials like glass vaccine vials, as the U.K. did. u003ca href="https://www.wsj.com/articles/coronavirus-vaccine-makers-are-hunting-for-vital-equipment-glass-vials-11592317525">Unlike the U.S.,u003c/a> India won't have to import such materials from other countries.u003c/p> u003cp>India’s pharmaceutical manufacturing strength also helped it ramp up COVID-19 testing capacity last year. The government shepherded domestic test-makers into an online marketplace u003ca rel="noreferrer noopener" target="_blank" href="https://www.thehindu.com/sci-tech/health/coronavirus-india-ramps-up-testing-capacity/article31843552.ece">to more efficiently distribute testing supplies across the country.u003c/a> Indian manufacturers also helped the country move from a reliance on imported tests at the start of the outbreak to u003ca rel="noreferrer noopener" target="_blank" href="https://www.financialexpress.com/lifestyle/health/75-of-testing-kits-now-procured-locally/1966060/">producingu003c/a> 75% of its COVID-19 tests domestically by May.u003c/p> u003cp>India u003ca href="https://www.livemint.com/news/india/three-new-facilities-to-help-govt-ramp-up-coronavirus-testing-11595810738079.html">establishedu003c/a> new high-throughput testing facilities that focused on shorter turnaround times for test results and limited exposure to infectious material for lab workers. The efforts helped India accelerate from 75,000 tests per day u003ca href="https://timesofindia.indiatimes.com/india/india-clocks-75000-covid-19-tests-per-day-crosses-1-million-mark/articleshow/75509827.cms">in Mayu003c/a> to 1 million tests a day u003ca href="https://www.livemint.com/news/india/covid-19-india-conducts-over-one-million-tests-conducted-in-a-day-11598067830421.html">in August.u003c/a> The testing capacity scale-up suggests India will be able to carry out a similar increase in vaccination capacity. If India can ramp up COVID-19 vaccinations at the same rate it did testing, it will be able to inoculate 250 million people by June, according to the Fitch report.u003c/p> u003cp>India is also launching its vaccination campaign as its daily COVID-19 caseload declines. u003c/p> u003cp>In the last week, India reported an u003ca rel="noreferrer noopener" href="https://www.nytimes.com/interactive/2020/world/asia/india-coronavirus-cases.html" target="_blank">averageu003c/a> of 17,000 new infections per day, down from a peak of almost 98,000 in mid-September. It had recorded 10.5 million cases in total as of Friday. The government u003ca href="https://www.nytimes.com/2020/11/11/world/asia/india-covid-19-infections.html">creditsu003c/a> its nationwide lockdowns and public awareness campaigns for the dropoff, but health experts caution that people shouldn't let their guard down because a new wave could come at any time.u003c/p> u003cp>Some scientists argue the actual number of people who've contracted the virus is around 200 million people, u003ca href="https://www.nytimes.com/2020/11/11/world/asia/india-covid-19-infections.html">much higher than India's official tallyu003c/a>. One government-backed study used mathematical projections to estimate that almost one-third of people in India had contracted COVID-19.u003c/p> u003cp>Economist Ajay Shah, who researches economic policy and public administration in India, says that pockets of the Indian population may already have achieved herd immunity, which is the aim of the vaccination drive. u003c/p> u003cp>Seroprevalence u003ca href="https://fortune.com/2020/08/21/covid-antibodies-india-pune-survey-herd-immunity/">testsu003c/a> in some u003ca href="https://fortune.com/2020/07/30/herd-immunity-covid-coronavirus-india/">partsu003c/a> of India last year found that a majority of the population in some areas tested positive for coronavirus antibodies—the proteins a person's body produces in response to infection—indicating that those people had contracted and recovered from the virus and were, at least temporarily, immune to it.u003c/p> u003cp>"There is more population-scale seroprevalence in India than probably anywhere else in the world, and the role of immunization at best is to tip the system over into herd immunity if it has not already gone," Shah says. u003c/p> u003ch2>Lessons from the past?u003c/h2> u003cp>India has marshaled its resources for a nationwide vaccination drive in the past, successfully eradicating u003ca href="http://polioeradication.org/news-post/how-india-eradicated-polio-challenges-and-lessons-learned/">poliou003c/a> in 2014 and for its smallpox eradication campaign in the 1970s.u003c/p> u003cp>In the 1960s, around 60% of the world's smallpox cases were reported in India. u003c/p> u003cp>India worked with the World Health Organization in the following decade to train medical staff, organize publicity campaigns, and vaccinate huge numbers of people. The critical technological breakthrough was the development of a smallpox vaccine that remained stable at room temperature, says Shah. Room temperature vaccines could be transported to people in rural areas who lived far from the cold-chain storage facilities that the vaccine previously required.u003c/p> u003cp>In late 1974, 133,000 health workers visited 100 million households across 2,641 cities and more than half a million villages, isolating smallpox patients as well as their family members and neighbors and u003ca href="https://apps.lib.umich.edu/online-exhibits/exhibits/show/smallpox-eradication-india/indian-engages-pandemic">vaccinatingu003c/a> all of them. The last smallpox case in India was recorded in May 1975, four years before smallpox was officially eradicated from the planet.u003c/p> u003cp>While the eradication of smallpox is an example of what Shah u003ca href="http://a href="https://www.ncaer.org/uploads/photo-gallery/files/1609250193Ajay%20Shah.pdf">callsu003c/a> a "population-scale success story" of vaccination in India, its lessons hardly apply to the COVID-19 crisis. Smallpox infections were easy to spot, plus India's population has u003ca href="https://data.worldbank.org/indicator/SP.POP.TOTL?locations=IN">more than doubledu003c/a> since then. u003c/p> u003cp>What's more, Shah says, "the smallpox vaccine was rolled out in India over a total period of six years, and today nobody is going to accept a six-year rollout [of the COVID-19 vaccine]." u003c/p> "},"children":[]},{"name":"html","config":{"content":"u003ch3>u003cspan style="font-weight: 400;">More u003c/span>u003ca href="https://fortune.com/">u003cspan style="font-weight: 400;">must-read storiesu003c/span>u003c/a>u003cspan style="font-weight: 400;"> from u003c/span>u003ci>u003cspan style="font-weight: 400;">Fortuneu003c/span>u003c/i>u003cspan style="font-weight: 400;">:u003c/span>u003c/h3>nu003cul>nu003cli>Elon Musk’s plunge into Bitcoin is a dangerous bet that u003ca href="https://fortune.com/2021/02/08/tesla-buys-bitcoin-elon-musk-tsla-btc/">could saddle Tesla with big lossesu003c/a>u003c/li>nu003cli>Can anyone u003ca href="https://fortune.com/longform/fixing-wells-fargo-charles-scharf-ceo-regulatory-issues-privacy-fake-account-fraud-scandal-covid/">fix Wells Fargou003c/a>?u003c/li>nu003cli>u003ca href="https://fortune.com/2021/02/09/covid-vaccine-sign-up-where-how-when-pharmacies-walgreens-walmart-cvs-rite-aid-publix/">Where to sign up for COVID-19 vaccinationsu003c/a> rolling out at U.S. pharmacies this weeku003c/li>nu003cli>Hawkeye Elegy: u003ca href="https://fortune.com/longform/iowa-covid-derecho-thunderstorm-2020-election-trump-biden-polarization/">A collision of pandemic, disaster, and polarization in the heartlandu003c/a>u003c/li>nu003cli>Will the pandemic finally get Americans to u003ca href="https://fortune.com/2021/02/06/qr-codes-covid-pandemic-do-people-use-them/">embrace QR codesu003c/a>?u003c/li>nu003c/ul>n"},"children":[]}]}]},{"name":"dianomi","config":{"type":"footer"},"children":[]}]}]}]}},"componentData":{},"error":null,"loading":false,"player":{"currentTime":0,"duration":0,"loading":false,"playing":false,"seek":0,"src":"","visible":false,"volume":0.5},"route":{"status":200,"redirectTo":"","redirectStatus":0,"action":"PUSH","pathname":"/2021/01/15/india-covid-vaccine-registration-campaign/","search":"?","hash":""},"visible":{"search":false,"primaryNav":false,"freestar":false,"adminBar":false},"contactForm":{"submitting":false,"submitted":false,"failed":false,"validation":{},"redirect":""},"user":{"isLoggedIn":false,"accessLevel":null}}; ]]> Source

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