Covid-19 vaccine: Readying for roll-out in cities

By Vahini Aravind & Kala S Sridhar

Covid-19 has devastated more than 7 million lives and their families in this country, second only after the US. The silver lining to the dark cloud is a vaccine, on which several countries, companies and a global alliance are simultaneously working. According to the World Health Organisation (WHO), there are more than 100 vaccine candidates for Covid-19, which are in various stages of development. Once phase-III trials are complete and a vaccine is ready for commercial launch, the immediate question is the distribution of the same amongst vulnerable groups such as healthcare workers and senior citizens in cities that are home to the pandemic.

While the pandemic is centred in cities, and much has been talked about it, not much has, however, been done to actually empower cities. At the minimum, even data on Covid-19 cases is reported only at the district level, not at the city level. Plans for tackling the pandemic and the distribution of a vaccine discuss only the ‘district health action plans’; cities are nowhere to be heard.

While this is the case, how can cities be empowered to administer a vaccine when it becomes ready for launch? Usually, new vaccines are introduced from top-down from the international level to local health departments. However, new vaccine introductions should be based on local needs, proper evaluation of the quality of the product, and its potential impact on disease epidemiology.

Urban local bodies in our country have been severely stressed with the pandemic, doing testing, quarantining, monitoring isolation, contact tracing and providing institutional support to those who need hospitalisation and treatment.

Nonetheless, taking the case of Bengaluru, the data reveals that there is an acute shortage of human resources in the urban local body Bruhat Bengaluru Mahanagara Palike’s health department. Amongst regular doctors, there is 71% vacancy (66 vacancies), 22 vacancies in staff nurse positions, and 475 vacancies in accredited social health activists (ASHA) workers. There are 18 contractual doctors. Amongst doctors there is a high attrition rate, with MBBS doctors not showing interest in Covid-19 contractual positions. At the urban primary health centres, lady health visitor posts are all vacant, and therefore reporting is very difficult and there is no regular supervision or monitoring. At the zonal level, there are no block health education officers, senior health attendants or lady health visitors, and medical officers of health are burdened with other activities. Amongst contractual employees hired by the National Health Mission, there is high attrition rate and vacancies.

If this is the case with a relatively high-income megacity Bengaluru, it is anybody’s guess what the capacity of other city health departments would be.

Staff shortage leads to inadequate delivery of health services through lack of monitoring and periodic evaluation, leading to less accountability. Just like the polio campaign was done where vaccines were taken to the doorstep of the needy, Covid-19 immunisation should be made available at public places such as hospitals, where healthcare workers are based and senior citizens visit.

Given the inadequate human resources in city health departments, resident welfare associations (RWAs), depending on their capacity, should help city and district administrations in identifying priority target groups for the vaccine.

Further, for the success of any health programme, integrating socio-cultural issues with biological issues is necessary. We find that there is less preference to communication in the context of the cosmopolitan culture in a metropolitan area and overemphasis is given to resource allocation and supply chain for vaccines. It is essential to give due importance to communication strategies to improve immunisation programmes’ performance and reach the vulnerable sections of the population who need the vaccine the most.

In all fairness, it should be mentioned that a Covid-19 vaccine would not need as much publicity as rubella, measles or polio needed. Given the manner in which Covid-19 has played havoc with the lives of millions, the common man is anxious to embrace the vaccine. But our urban local bodies and their health departments should be well-equipped in terms of human resources, along with RWAs, to handle the rush when the vaccine comes. Once a strategy is in place, the task would be relatively easy to implement; now is the time to act.

Authors are, respectively, faculty with the Bangalore University and the Institute for Social and Economic Change. Views are personal