India's health ministry intends to use electoral rolls to trace people above the age of 50 for its plans to vaccinate over 30 crore people in the first phase, as per the ministry's COVID-19 vaccine operational guidelines.
The detailed guidelines highlight that the vaccination drive has been planned and implemented up to the block level. So far, 633 districts have already concluded their district task force meetings, Health Secretary Rajesh Bhushan said in a press briefing on Tuesday.
While five vaccinators will be designated at every site, each site will vaccinate over 100 people in one day. Places that have rooms which could act as vaccinating rooms, waiting rooms, and observation rooms are going to be selected as vaccination sites. The Ministry of Health and Family Welfare (MOHFW) has repeatedly clarified that this vaccination drive which protects adults against COVID-19 will not act as a hindrance to the routine immunization activities.
Focusing on management on any adverse effects following immunization, the government has ensured that every adverse effect whether as minor as a fever, severe with events not requiring non-hospitalisation, and serious events that require hospitalisation be notified in the CO-WIN- the COVID-19 Vaccine Intelligence Network created by the Ministry.
Distribution Of Vaccine At Vaccine Sites
In the first phase, the government intends to vaccinate 30 crore people that include health workers, frontline workers, people over 50 years of age and those under 50 living with co-morbidities.
Health workers include frontline health workers such as ASHAs, ANMs. Multipurpose workers along with nurses, medical officers,administrative posts at health facilities, paramedical staff such as lab technicians, pharmacists.. Scientists and Research Staff, clinical and administrative staff, other health staff, drivers, sanitation workers, as well as all medical, para-medical, and nursing students will be included in this list.
Defence personnel from the Army, Navy, Airforce and Coast Guards along with the special police forces and state police forces will be considered among frontline workers. Permanent as well as contractual municipal workers including sanitation workers, waste collectors, cleaners, engineers, officers, drivers, maintenance staff will be prioritised to receive the vaccine.
Using the latest electoral roll for Lok Sabha and Legislative Assembly election, the ministry will identify persons older than 50 years of age as of January 1, 2021. This group will be further sub-categorised into people over the age of 60 and those between 50 and 60. For identifying people under the age of 50 living with co-morbidities, health workers will go across homes to collect data for the same.
All the data of the eligible candidates will be updated on the CO-WIN dashboard. Only people with prior-registration will be vaccinated. On the spot registrations will not be permitted. Once the data about the eligible candidates is uploaded on the dashboard, officials at the district levels will allocate session sites where the administration process will continue.
While government health facility or private health facilities with more than 100 workers will be designated as fixed session sites, schools, community halls, offices of frontline workers, gram panchayats and municipal offices will also be considered for vaccinating people. Mobile teams will also be formulated for reaching out to eligible people in remote locations.
Vaccination activities will only be undertaken between 9 am to 5 pm at these sites where only 100 people will be permitted in a day. Five vaccinators will assist in the vaccination process. One vaccination officer from the police or other forces will ensure that the person has received the SMS for vaccination on the specific day, check their registration and verify photo ID before escorting them to the waiting room.
Once in the waiting room, the recipients are expected to follow social distancing. A health worker will then cross-check the registration with the CO-WIN system. Next, they will be taken to the vaccinating room wherein a doctor (MBBS/BDS/AYUSH) or a Staff Nurse, Pharmacist, ANM, Lady Health Visitor will administer the vaccine.
Other officers will then check if the person undergoes any adverse reactions when they are waiting for 30 minutes in the observation room. They will be notifying this in a register as well as updating it on the CO-WIN platform.
Communication material explaining the importance of the vaccine and debunking any rumours and false information about the vaccine will be distributed as well as displayed at the vaccination centres. The recipients will then receive a standard SMS on their registered mobile number informing them about when they are supposed to receive the mandatory second dose of the vaccine. Along with the message, the beneficiary can also download a certificate which says that they received the COVID-19 vaccine,
If conducted at health facilities, the vaccination area should be separated so as to not hinder the ongoing curative services. Either the timing could be different or the area for vaccination could be separated. The site selection has thus been left on the district officials.
The Ministry also intends to partner with private facilities, NGOs, and doctor associations to strengthen the process. All of the vaccinators will be provided thorough training. Currently, the training of trainers that will be deployed to States has been completed.
Vaccine Storage
While considering the amount of vaccine that will be required in a particular area, the government intends to calculate the proportion of population and the number of months of the campaign along with even estimating the amount of vaccine that could be wasted in transport and administration.
Currently, the government plans to use over 29,000 cold chain points, 240 walk-in coolers, 70 walk-in freezers, 45,000 ice-lined refrigerators, 41,000 deep freezers and 300 solar refrigerators for vaccine storage and transport.
Management Of Adverse Events Following Immunization (AEFI)
Due to increasing vaccine hesitancy, communication modules will address adverse events beforehand so that the recipients understand what they are signing up for.
The government has put up a surveillance system in place wherein the vaccinators have been trained to identify these events and immediately notify them in the CO-WIN dashboard. If people show any adverse events after leaving the observation room, they are recommended to visit a health facility. The government intends to create AEFI management centres in each block to cater to the needs of the people who received the vaccine.
India currently has three vaccines seeking emergency use. Pfizer's vaccine untested in India has been in the news as few minor adverse events have been reported by participants after taking the vaccine. Bharat Biotech and Serum Institute of India have denied that their vaccine candidates were responsible for the adverse events that were reported in the media.