August 2, 2020 ☼ The Intersection ☼ Covid-19
A national vaccination programme is like a general election, but at much lower temperatures.
This is from The Intersection column that appears every other Monday in Mint.
Sometime over the next 12 months, a vaccine against covid-19 is likely to be available. The task of administering it to few hundred million people—perhaps even over a billion—so that India acquires herd immunity appears daunting. That is, until you realise that India routinely carries out a task of the same scale and similar complexity fairly regularly. I’m referring to elections. If you think about it, a national vaccination programme is like a general election, but at much lower temperatures. It is a good idea to approach it as one because our elections involve a combination of administrative machinery, mindsets and behaviours that are ideal for a rapid national vaccination programme.
In conducting elections, the Election Commission assembles an elaborate administrative setup from existing governmental capacity for a single purpose, performs the task on a tight schedule, and then quickly disbands the setup after it is done. It coordinates departments across various levels of governments to schedule, organize and secure elections, and communicates with citizens in a fairly transparent manner. It has systems to enumerate voters, arrange for polling stations near them, inform them of the time and place of voting, and identify those who have voted. A lot of what it does for elections is more stringent than what is needed for vaccination. It would be good to have vaccination stations as close to home as polling booths, queues of manageable length, and priority accorded to senior citizens. But identification requirements for vaccination are less strict and the entire process need not be completed in a single day. The same indelible ink can be used to mark those who’ve received a dose, something that will be especially useful if the vaccine requires two.
India’s administrative performance is often inversely proportional to the time assigned for the task. We do great events, very effective campaigns, and fairly good missions, but are awful at “business as usual”. India’s elections are outstanding, the Swachh Bharat Mission was declared a success, but our public hospitals and government schools are shoddy. In other words, the shorter the time frame, the better the outcome. It follows that if we want an effective vaccination programme, it is better run like an election than any of the health ministry’s regular immunisation programmes.
India does well at elections not merely because of administrative genius, but also because the incentives of various social actors are aligned. Our political leaders excel at polling booth level organization. Almost everywhere in the country, quite a number of people turn up at the doors of voters, informing them of where their booths are, encouraging them to turn up at the appointed time, often arranging for their transport and—let’s face it—offering them other inducements. A lot of this happens because there’s a lot of money flowing around, which will not happen for vaccination. Yet the desire on the part of Indians to get vaccinated might compensate for the absence of competitive political spending.
This much is similar, but unlike elections, a vaccination programme needs a robust cold chain. Many of the vaccines under development and trials require deep freezing or refrigeration. This is a challenge in India, where cold storage and transport facilities are not widely available and electricity supply is patchy. According to a study conducted by AT Kearney and two Indian pharmaceutical trade associations, on average, supply chains can account for as much as 25% of the cost of goods, compared to 10% for their best-in-class international counterparts. It points out that “high operating expenses in cold chain fleets are impeding vendors from investing in newer technology.” According to the Union health ministry’s Immunisation Technical Support Unit, cold chain equipment costs were budgeted at roughly a quarter of the cost of vaccines in 2014-15, but actual spending was lower, perhaps because government procurement tends to be slow and messy.
The good news is that thanks to the Universal Immunisation Programme (UIP) and implementation of the Electronic Vaccine Intelligence Network (eVIN) in 2017, over 21 Indian states have more efficient public vaccine distribution systems. The latest figures are unavailable, but the government intends to cover all states, with over 27,000 vaccine storage points in the country, by year-end. The eVIN has not only been able to make the stocking, cold storage and distribution far more efficient, but has been able to reduce avoidable wastage of vaccine doses.
This is the right time for the Union government to institute the administrative setup for covid vaccine distribution. The health ministry runs the world’s largest immunization programme, reaching over 27 million infants and 30 million pregnant women every year. Against covid-19, India will have to vaccinate more than ten times that number in the space of months. For this, we need something like the Election Commission that would be just as powerful, cross-cutting, single-minded and temporary.
There are many more The Intersection columns here
As we wait for a vaccine, India should urgently extend and strengthen the eVIN and ensure that all storage points are equipped and ready. With a vaccine estimated to cost ₹1,000 per dose, every rupee spent on infrastructure and efficiency would be well worth it. There are a number of policy issues, including prioritization, equity and privacy, that need thoughtful deliberation and public debate. Leaving them for the last minute would be a recipe for avoidable social tensions.
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