Explained: Pulse Polio Vs COVID-19 Vaccination Is A Paper Tiger Being Set Up By Those Who Have Nothing Useful To Say

If only India had launched a universal free vaccination programme in December - like the hugely successful pulse polio programme, reads the tweet of a social media user.

The same sentiment is being expressed in the circles which were not too long ago planting doubts about the efficacy of vaccination against COVID-19.

On Wednesday, the Bombay High Court observed that several lives could have been saved if the Centre had a door-to-door vaccination policy

Those who are fondly remembering the pulse polio and small pox eradication programmes as pointing to them as a proof of failure of the current dispensation are likely not familiar with the facts of the matter.

If we list down the challenges with the COVID-19 vaccination, the following would come up:

• Supply of vaccine to cover large Indian population (around 150 crore doses, given we need two doses per person in the target population)
  
• Easy and equitable availability of the vaccine to people (this is where door-to-door suggestion comes up)
  
• Getting people to agree to get the vaccine (tackling vaccine hesitancy)
  
• Maintaining physical distancing to curb the spread of the virus while vaccination is being scaled up
  
• Monitoring new variants of COVID virus, tracking efficiency of vaccines against them

When we look at the pulse polio or small pox eradication programmes what lessons can we derive that might help up is tackling the above? And the answer is nothing specific, only general lessons derived from the experience of carrying out a vaccination programme.

Both polio and small pox eradication programmes ran for decades, while COVID vaccination is tentatively aiming to cover a substantial population in a few months.

Also the eradication of the former was set as a goal by powerful international agencies which coordinated action across countries. There was substantial involvement of WHO and global support as well as oversight.

Since the developed countries had eradicated these diseases long before the developing countries, 'vaccine nationalism’ was not much of an issue. The vaccine for small pox had been around for almost a century (when India launched its programme), the supply chains were relatively stable and sufficient.

Also, before India conducted the ‘Polio Plus’ programme in 1985, different states like Tamil Nadu had already been running their own vaccination programmes.

None of this is true for the COVID-19 vaccines.

Developed countries, where most of the pharma giants are headquartered, are keeping the vaccines for their own population. Recently, European Commission initiated legal action against AstraZeneca, an Anglo-Swedish company, over the shortfall in vaccine supply to the European Union (EU).

The French President Emmanuel Macron targeted the Anglo-Saxons for hoarding the vaccine for themselves. “Today, the Anglo-Saxons block many of these ingredients and vaccines. Today, 100 per cent of the vaccines produced in the United States are for the American market,” he said.

International mechanisms like COVAX (for global equitable access to COVID-19 vaccines) have largely been ineffective. The first shipment under it was only deployed in February, a month after India launched its vaccination programme on 16 January. India itself banned the exports to COVAX from March onwards to meet domestic demand.

All in all, countries are on their own when it comes to COVID-19 vaccines developed within one year of the pandemic (no mean feat) - starting from acquisition, to the “bridging trial” and emergency-use authorization (which India has fast-tracked), to scaling up the production of the vaccines.

Unlike polio vaccines which were only meant for children, COVID vaccination is supposed to cover all adults - the sheer scale is far higher than previous vaccination drive (small pox vaccine was administered to adults but it was neither a countrywide vaccination programme, nor was it done all-year round).

The union government informed the Supreme Court recently that vaccine production is being gradually ramped up across the country.

The Serum Institute of India (SII) has ramped up production from five crore doses a month to 6.5 crore doses. Similarly, Bharat Biotech Intl Ltd. had hiked production from 90 lakh a month to two crore.

By July 2021, the Russian Sputnik-V is expected to increase production from 30 lakh to 1.2 crore doses a month; Bharat Biotech is expected increase up to 5.5 crore doses per month and SII was also expected to further increase the production.

Remember that the process of vaccine production is quite delicate. Bharat Biotech is commissioning a 10,000L bioreactor for mammalian cell expansion for the vaccine, which will be the largest by global standards.

The next suggestion is for a ‘door-to-door’ vaccination campaign for COVID like polio’s.

Again, this is unrealistic. Unlike, polio vaccine that was orally administered, the COVID vaccine is injected. India is facing shortage of medical personnel in the hospitals and medical centres, how will it arrange for the personnel to go door to door?

Would the public find it acceptable that community health workers like the ASHA, instead of a doctor, are giving an injection (ignoring the time and resources that would have to be spent to train them for the purposes)?

Also, it is relatively risky to give injectable vaccines at home. After giving the vaccine, the person is kept for monitoring for at least 30 minutes. Would the team sit at the house for such a long time? Will the police personnel accompany the teams for safety like they had to for COVID surveillance teams? (There are numerous reports of hospital staff being attacked amidst the pandemic).

And all of this is only if we assume that have a vaccine that can be safely transported in the heat and humidity of India and the logistical means (like freeze vans) to transport it far and wide within a limited time.

Previous door to door vaccination campaigns, like that of the small pox, were also not without problems. Widespread coercion was reported, where police personnel had to sit on people while doctors forcibly injected the vaccine.

The policy of vaccination centres is much more suitable for COVID-19.

Unlike babies who cannot walk to polio vaccination centre themselves, the adults can. The social landscape is also different today and there is higher literacy and less vaccine hesitancy. At vaccination centres, medical personnel feel safer and more at convenience as opposed to going door to door. Vaccines can be conveniently stored.

The vaccination for the priority groups - those above 45 years of age and frontline workers is free and responsibility of the union government. For those in 18-45 age group, state governments are responsible. Almost all state governments have already announced free vaccination for all, and the union government has promised the Supreme Court that it will ensure equitable access to vaccines to all states.

The state governments are also free to design vaccination strategies that account for diverse geographic and socio-cultural determinants. They can mobilise the existing resources in a manner of their liking.

India has never had a mass vaccine program for adults. At least a program that needs to administer jabs to 100 crore adults in 6-8 months.