The present vaccination regime in our country, is it appropriate?

vaccination drive in India is huge and considered to be largest in the world. The govt is permitting the population in a phased manner.
In the initial phase, COVID-19 vaccine provided to the priority group - Health Care and Front-line workers. The second phase vaccinations, starting 1^st March 2021 allocated for all those are above the age of 60 and Indians between the age of 45 and 59 with comorbidities but later included all the people of above 45years of age. The country has huge scarcity and vaccine crunch for the 2phase itself. Even first dose is also not received by many and thinking of 2nd dose is far from reach.

In the midst of this drama, Recently as a third phase, the central government announced that everyone above the age of 18 to be eligible to get vaccine from 1st May 2021.

At this moment when the central govt has announced for 3^rd phase, this has brought utter confusion in to the health care system and the state governments, further how to handle the situation? Some state governments have declared that they will not start the 3^rd phase (vaccination for age of 18years and above) but instead they will first ensure to give the booster (2^nd dose) dose to all those who were already vaccinated under Phase-1 and Phase-2.

If this is the way the vaccination program will be taken up, at least it will take another 12-15 months to cover 50% of population of our country and even that may also be a tough task considering the present production capacities of only 2 vaccine producers.

This theory of vaccinating in phased manner to prioritize the groups which are "age-vulnerable" may work for other countries. But the same strategy which is being followed there may not be appropriate for our country.

In my opinion, considering our huge population and crunch in vaccine production capacity, (instead of prioritizing the vaccination for people vulnerability by age),

Firstly, the govts should target the vaccination to those who are highly moving and active in social life (Employees – Govt, Private, organized, un-organized labor, Taxi drivers, Auto rikshaw, etc.)

Secondly, - prioritize the urban areas and in particularly the metro cities which are connected to direct access with international / national travelers. This including all the population living in the urban cities, Employees, and workers of all levels from Shopping malls to street vendors.

Now, as a case study, I will elaborate this with an example and give the reasons why the present model of vaccination is not appropriate and can be redesigned to strengthen the vaccination drive to give better results with the same available production capacity.

Example1: (Urban population Vs Rural population)

I am staying in Hyderabad, but I belong to a remote village of AP state. I was knowing from my father, many village friends and relatives that as part of the 2nd phase of vaccination program, the govt officials made an arrangement to visit our village (all the rural areas) to figure out the people with eligibility criteria and give the vaccine to some of them depending on the stocks and supply chain.

But in reality, it was very very rare that the people living in those areas to getting infected with covid while the 2nd phase starting date 1st Mar 2021. Instead, the govt should have first concentrated on the urban population irrespective age vulnerability concept. This would have helped containment of covid spread and unnecessary strain on the authorities in logistics of the drugs to scattered locations. The rural population has a chance to get infection only when they visit the nearest urban areas for marketing, shopping etc.

So, if the URBAN POPULATION is vaccinated first, there will be less chances of spreading the infection to the surrounding rural population.

 

Example2: (Age vulnerable people Vs Family responsible people)

Case1: A friend of mine staying in Hyderabad living with family of total 6 members. He is the only person working in the family. He got his parents vaccinated after the 2^nd phase announced but because of his age (<45y) himself and his wife could not get the vaccination yet. Since he is working in a private company, he has to attend to office which is unavoidable. Except him all others of his family are staying at home. If at all they get an infection, that can be only through him. But with the existing phase-wise protocol of vaccination he can’t get the vaccine.

By chance, if he gets the infection and something goes serious with his health, who will take care of his family? Whole family including the vaccinated parents will come on to road. And no doubt in it.

So, the govt should prioritize the working people than the people staying at home. How can you prioritize with age? Some people, even at the age of 60 also live with a good immune system. And some people at 30s suffer lot of comorbid diseases and in high risk with such infections. The biological age of a person can’t be compared with the calendar year age.

 

Case2:

One person was working in Chennai and as he felt few symptoms like fever etc., he immediately got back to his native place which is neighboring village to us. First week the symptoms were on and off, so he didn’t reveal it to anybody in the village, but their family members were in as usual mingling with all others in the village. After a week, his mother got badly infected and showed severe symptoms. Only then, both of them were taken to a nearest covid center for treatment. The boy was recovered but his mother lost her life. Also 25-30 cases reported in the same village in 2 to 3 stages of testing as on date with in 15 days of span. How this will further explode in the village and surrounding villages later on is unpredictable and critical to estimate now.

Now coming to find out the source point of the infection, it is the young man who was returned from Chennai. If had he got the vaccination from his company reference, he wouldn’t have got the infection and wouldn’t have returned to his native place and the situation wouldn’t had been messed up like this.

 

So, the govt and the responsible authorities should first target the Sources of infection. They shall first concentrate on all metro cities where international connectivity is unavoidable due various business reasons, Export and import activities etc. Then next level cities, then towns and then finally the rural and remote rural areas.

Secondly, they should not fix up with a condition like age vulnerability. They should first vaccinate the age vulnerable, people with comorbid conditions though they may be of less than 45years of age and most importantly the working people (because the total family depend on their earnings).

If we streamline this way and structured to a new action plan (with the existing manufacturing capacity of vaccines), the govt can handle easily and successfully the vaccination regime in much better way to contain the corona virus spread in our country.