The Delhi High Court has recently refused to entertain a public interest litigation (PIL) seeking a door-to-door Covid-19 vaccination drive, while the central government has said such a programme using injections are not done even during the universal immunisation campaign for children.
But there is an argument that India, which began its polio immunisation programme in 1995 and recorded its last case in 2011, already has an elaborate network of health care workers that it should tap into. To put things in perspective, about 2 million workers would administer oral polio drops to about 172 million children on an average immunisation day. And the enormity and urgency of the drive scripted India’s success story against polio.
News18 examines why a door-to-door Covid-19 inoculation drive is not feasible.
POSSIBLE ADVERSE EFFECTS
In India, only oral polio vaccine has been administered through door-to-door campaigns. Such a drive for injectable vaccines has not been carried out, as concerns remain over possible adverse events following immunisation. In a door-to-door drive, monitoring of a beneficiary after vaccination is a bottleneck, and there could be a delay in reaching the nearest health facility in case of adverse effects. Anaphylaxis (an allergic reaction) is easy to tackle if the recipient is at a vaccination centre, which are equipped to handle such cases.
The three Covid-19 vaccines approved by India so far (Covishield, Covaxin and Sputnik V) are under emergency use authorisation. While experts say the vaccines are safe (Sputnik V has recently got approval and is not in use yet), the protocol is to observe a beneficiary for 30 minutes after a jab. This can happen only at a vaccination site and under proper supervision.
Once a Covid-19 vaccine vial is opened, all doses in it have to be administered within four hours. Else, they will go waste and have to be destroyed. A Covishield vial has 10 doses in total, while a Covaxin vial contains 20 doses. Each dose is of 0.5 ml, for one person. In case of a door-to-door drive, there will be high vaccine wastage, factoring in the time required for going one house to another.
Going door to door also means the temperature-sensitive vaccines will have to be placed in and out of the carrier before and after each jab. This will, in turn, mean that the temperatures required to store the vaccines are practically impossible to maintain throughout the drive. Eventually, the vaccines will become ineffective due to fluctuating temperatures.
CoWIN is the technological backbone of India’s Covid vaccination drive. It would be tough to update the platform if there is a complex door-to-door campaign.
However, there are certain lessons taught by India’s polio drive that could be used in the inoculation campaign against Covid-19, according to Dr Ashish Sinha, a public health expert.
Detailed micro planning, quality training of health care workers and mobilisation of people to visit session sites could be some of such learnings, according to Sinha, who has worked in the field of immunisation and vaccination with the World Health Organization (WHO) and the United Nations Development Programme (UNDP). ASHA and anganwadi workers may go door to door and bring eligible beneficiaries to vaccination centres, he said.
A weekly review meeting of a district, a state and the Centre should be done, as it was done during the polio campaign. “If we don’t review on regular basis, a lethargic approach could set in, like in many places it has. To speed up vaccinations, a weekly review meeting should be organised,” Sinha said.