Dr D N Patil, from Directorate of Health Services, coordinates Maharashtra’s entire vaccine programme — from measles and rubella vaccination for children to regular polio drives. Since the last few months, he has been working on training health workers, registration of beneficiaries, management of vaccination centres and coordinating with districts on storage and capacity building. Excerpts from his interview with The Indian express
The government has experience of mass immunisation with mostly paediatric population. This is the first time adult population will be covered on such a large scale. How is it going to be different?
We have some experience in adult immunisation. We give immunisation shots to pregnant women, tetanus and diphtheria shots are given to many after age of 16 years. We have lessons learnt from measles and rubella vaccination campaign. This time, because the disease and vaccine are both new, this is an entirely new experience for us.
This vaccination has to be given to different groups, like health workers, front line workers and high-risk population. Finding and registering them is a new thing for us. This is also the first time we have to rely on online software (CoWIN ) for registering and vaccinating people.
What are the hurdles you expect?
As such there are going to be no major hurdles because we had a dry run to gain some experience. We anticipate some problems in tribal, hilly and rural areas because network connectivity can be an issue and the entire system is online data based. We have requested the Government of India to allow offline date entry when there is no network. Once network comes that data will be uploaded. The government has agreed to do this.
What is the stock in first batch of vaccine?
We will get 9.63 lakh doses of Covishield from Serum Institute of India and another 20,000 doses of Covaxin from Bharat Biotech in first batch. More doses are expected later from the central government.
How will the vaccine be transported to all centres?
The vaccine stock will first reach our nodal storage facility in Pune from the manufacturing unit. Between Tuesday and Wednesday, it will be distributed by road to nine regional stores in Kolhapur, Mumbai, Pune, Thane, Aurangabad, Latur, Akola, Nagpur and Nashik. From there it will immediately be transported to nearby districts by Wednesday or Thursday. Each district will transport it to their vaccination centres. By January 15, vaccine centres will get their stock. The entire transportation is by road. We will be ready to start immunisation from January 16.
How many vehicles does state have to transport vaccines?
We have three transport vehicles at state level, nine at regional level, 34 at district level and about 20 vehicles at district level. Even PHCs have their own vehicles when needed.
Covaxin is going to be administered under open label trial (unlike in other trials, recipients will know what vaccine they are being given), so what are the norms that will be followed?
We do not have any communication about that from the central government. There is no information given on dosages for Covaxin either. The guidelines are expected today or tomorrow. We are also waiting for them. Once we receive them, we will train our staff in administering it. Since a beneficiary has to receive both doses of the same vaccine, we plan to distribute 20,000 Covaxin doses in limited region in state so that double doses for a beneficiary is possible.
How do you plan to proceed if health workers refuse one of the two vaccines and insist on the other?
This is a voluntary exercise and we can only counsel health workers for vaccination. They are our first beneficiaries. There are no guidelines on how to proceed if say a health worker refuses to take Covaxin and asks for Covishield or vice versa. Let us wait for the guidelines from Centre.
Will beneficiaries be informed about which vaccine they are being administered?
Yes, we will inform them at the time of immunisation shot, but not in the SMS sent to them informing them of date and venue.
What are the preparations for handling adverse events following immunisation (AEFI)?
There are 511 vaccination centres identified, from primary health centre level to hospital level, across Maharashtra. For handling AEFI, we have identified rural hospitals and hospitals at higher level to deal with two types of adverse events. We will provide two types of kits. An anaphylactic kit and AEFI kit will be ready at each centre. Vaccinators have been trained on how to identify adverse event. If there is anaphylaxis seen in a person, the kit can be immediately used to stabilise them. For AEFI, a separate kit is available.
If a person gets Covid-19 before or after first dose, how are they supposed to reschedule their vaccination appointment?
As per guidelines, a health worker must be Covid-19 free for the last 14 days before scheduled date of vaccination. This is to ensure they don’t carry the infection and pose a risk to other beneficiaries at centres. If a health worker gets Covid-19 infection or can’t make it on scheduled date of immunisation, they can later visit the vaccination centre and ask for the next date to be sent via SMS. This exercise of vaccination is not new. During Measles and Rubella immunisation, too, we had to get beneficiaries out from their home for their second dose. Since in first phase we are vaccinating health workers, we don’t anticipate a lot of issues because these workers are all easily accessible. We will strategise solutions as and when issues arise.
Health Minister Rajesh Tope had suggested to ink finger of beneficiaries, just like elections, to identify those who received the shot. Are we going ahead with that procedure?
No, not as of now.