India can vaccinate swiftly by using ‘mohalla method’
The irony is stark. Millions scramble for oxygen cylinders and hospital beds, oscillating between life and death. Around the same time, several other millions decided the political fortunes of five states/UTs.
Earlier this year, Indians defied a mortal fear of the coronavirus and voted in large numbers, with a turnout of 70 per cent or higher across states. On jabs, though, it was different. A listless rollout plan curtailed the availability of vaccines and people’s tentativeness only hastened the inevitable. In two weeks, a second wave swept India, spiralling into its biggest crisis. An overpowered medical infrastructure burst at its seams.
But that’s not the point. While every life-saving equipment is a survival kit, it’s the pace of vaccinations that will ultimately ensure India’s endurance against the virus. The point is: the secret to winning this war lies in our learning from past experience, including elections.
January 13, 2011 was a historic day for India. A two-year old child in West Bengal was found crippled by polio but was later cured. It was the last time polio would strike here. That day, India became polio-free. Two years earlier, India housed half the world’s polio cases. No one thought the country could ever eradicate it. However, aided by the state, Unicef and others, India’s feverish campaign against polio, led by 2.5 million vaccinators, touched 200 million homes, with 700,000 vaccinations in each round. Despite its challenges of poor infrastructure, India relied on its strengths: a “mohalla”, or community, outreach.
Today, only 12 per cent Indians have got their first dose, against 50 per cent in America. Currently, the vaccination rate is less than half million a day, sometimes falling further, given the shortage of vaccines. At this rate, it may take until summer 2022 to vaccinate 75 per cent of India. Are we prepared for more casualties until then?
A more dynamic and swifter pace of vaccinations is the antidote to arrest fatality numbers, build confidence and encourage a quicker economic revival. The polio experience is a test case. Juxtaposing the polling principle onto the vaccine execution plan gives it the kick it requires. The polling database, with details of citizens and their residences, is a ready master-sheet. In December
2020, Union home secretary Ajay Bhalla asked (then) chief election commissioner Sunil Arora to identify people above 50 at the polling station level. A promising start was made, but the plan ignored key aspects of our election experience. We should replicate our polling expertise, that was used in the polio campaign: the “mohalla method”.
Currently, the approach of using hospitals for vaccinations has proved counterproductive. A sudden desperation and opening up of vaccinations for the
18-44 age group has led to longer queues. This inevitably means a high probability of an infection while on a hospital visit. Using the CoWin platform to register and then showing up with identifiers like PAN or Aadhaar cards at selected jab centres like schools, community halls or sports venues often used as polling booths will decentralise the process. Mumbai and Gurgaon recently started “drive-in” jabs. More such measures must be undertaken across the country. The aim should be to reach people, rather than herding them at overcrowded hospitals.
The “mohalla method” will increase vaccinated numbers in clusters. The knock-on effect is that as neighbourhoods vaccinate, infections will slow down in clusters, creating identifiable safe zones. Earmarked vaccinated zones enable city administrations to loosen lockdowns methodically in areas where jabs have crossed high numbers and infections have fallen.
Using age as the sole criteria for prioritisation, instead of a combination of age, economic status and population density, was always expected to pose challenges. The prioritisation of senior citizens meant most people unlikely to go to work were vaccinated first. Next in line were the 45-plus population, many of whom can afford private vehicles. The most vulnerable population was the 18-45 age group — where more people use public transport. Given India has over 70 per cent people under 45, and most frontline workers including delivery personnel fall in this category, the approach meant most of India was unvaccinated against the second wave.
States with worse Covid numbers could form the bigger focus in this vaccination plan. At a city level, densely populated areas require more vaccine booths -- based on voter lists from elections. Citizens who aren’t on voters’ lists in their neighbourhoods can use Aadhaar cards. This also helps those facing a tech challenge in online registrations.
The “mohalla method” demands deployment of substantial numbers of health workers, logistics, and vaccines. Cynics may say this isn’t possible. But it actually works. India has over 12 lakh medical professionals, 7-8 lakh alternative medicine professionals, around two lakh medical students, diagnostic centre professionals,
We can reach a national jab rate of
10 million (one crore) a day, which means vaccinating the country in 4-5 months. If a third wave were to arrive
in late 2021, most of India would have
been vaccinated. armed forces doctors, nursing assistants to provide jabs, the local police and paramilitary to handle the logistics and the armed forces to provide administrative support. Every neighbourhood can plan 5-6 centres of 25-30 volunteers each. Neighbourhood clusters could be simultaneously vaccinated in around 4560 days (given availability of healthcare resources, vaccine supplies and errors in calculation). We can reach a national jab rate of
10 million (one crore) a day, which means vaccinating the country in 4-5 months. In a worst-case scenario, if a third wave were to arrive in late 2021, most of India would have been vaccinated.
But do we have vaccines? Choosing just two vaccines and then exporting them when just eight per cent of India was vaccinated was bound to lead to shortages. India needs over two billion jabs. Scaling up is a nobrainer. J&J’s Phase 3 trials are set to begin. Russia’s Sputnik V is here and will be distributed by Dr Reddy’s Labs. Bharat Biotech has ramped up its capacity from 200 million to 700 million doses a year. India has asked for a waiver on intellectual property and barriers on vaccines from Europe and America.
It’s taken a catastrophe for us to realise we must speed up vaccinations. To execute the blueprint, the bottom line is to shed lethargic bureaucracy and ensure an efficient supply chain and execution. A crisis taskforce needs to have a crack team of senior experts from amongst medical professionals, the armed forces and civil services. Like the polio campaign earlier, a targeted media campaign involving cricket and movie stars must be the focus. The campaign must be on a war footing and the national leadership has to make this period count. The war isn’t over till we have enough ammunition to fight for our citizens. And we must vaccinate to win.
The writer, a retired Army officer, is the author
of Watershed 1967, based on a forgotten war between
India and China, and a member of the guest faculty at New York’s Columbia
University