First, CoWin must be non-mandatory. On-site and pen-and-paper registrations should be allowed. Second, governments need to recognize the private sector has a big role to play here. CoWin data shows there are 34,788 government vaccination sites and just 1,370 private ones. But NSO 2017-18 data reveals that government hospitals accounted for just 33% ailments treated in rural areas and 26% in urban areas. And in private healthcare, general practitioners and small clinics treated more patients than big hospitals. This clearly suggests GoI and states must enlist licensed doctors and small clinics. The US and UK, incidentally, allow family physicians to vaccinate their patients. Neighborhood doctors and clinics people are familiar with will also be better persuaders than officials when it comes to addressing vaccine hesitancy. Also, medical and nursing students should be paid and drafted to be vaccinators.
Third, the dreadful supply deficit of doctors and nurses in villages will still be a constraint, so Covid vaccination should follow the model of India’s mass inoculation efforts. Almost 74% of rural and 45% of urban children are inoculated at health sub-centres/ health and wellness centers and anganwadis. All 1,50,000 HSCs/ HWCs must be used. Each typically serves a population of 3,000, and is staffed by an auxiliary medical nurse, who doubles up as a vaccinator. These centers should coordinate, just as in inoculation programs, with ASHA workers to bring in people.
Fourth, even after such a massive effort, this continent-sized country will need vaccines on wheels – mobile vaccination centers for remote areas and many villages. The Center has mooted near-to-door vaccinations, and opposed door-to-door vaccinations citing risk of adverse events and vaccine wastage. Near-to-door is a useful model, but it will work mostly in urban, semi-urban settings. Therefore, taking a rigid stand against door-to-door jabs or vaccines-on-wheels won’t help. Let states decide on these details. The Center should primarily focus on ensuring the vaccine supply line keeps humming.