R S Sharma, Chairman of Empowered Group on Vaccine Administration and CEO of National Health Authority talks about utilizing learnings from Aadhaar to guarantee speed, inclusivity in vaccination, says vaccine wastage is a management situation, notes that provide, capacity, demand will identify vaccine coverage, and explains dangers in residence vaccination. The session was moderated by Senior Correspondent Prabha Raghavan
PRABHA RAGHAVAN: As chairman of the Empowered Group on Vaccine Administration (Co-WIN), what distinct modifications did you make to meet the country’s vaccination objectives?
I was provided this duty on January 8-9 — the honourable Prime Minister launched the vaccination programme on January 16 — and, at that point in time, what I inherited, so to say, was an application. We had been covering healthcare and frontline workers from January 16 to February 1. We had collected the list of all the frontline and healthcare workers from the states and, (by means of the application), we had been primarily slotting these workers for vaccination at distinct wellness facilities. We had been sending them messages saying that you can come to this facility on this date to get oneself vaccinated. But what I observed was that, mainly because the information itself was not really clean — like on a lot of occasions the phone numbers had been not appropriate — a lot of persons had been not acquiring the messages. Also, at occasions, even if the message reached them, they could not come on a distinct day mainly because of the nature of their job, which essential them to travel. So we realised that the provide-driven method resulted in reduce efficiency of vaccination centres. Let’s say a centre had planned for one hundred vaccinations, but only 20 persons turned up, so there is underutilisation of manpower. We decided that this method is not going to work, specially when it is applied to the common public. The very first transform that we created was to make our method demand-driven. That was one basic transform.
Earlier, we had been also saying that the second dose ought to be provided at the identical centre to guarantee that the particular person gets the identical vaccine. But, suppose somebody is in Delhi and has to make a trip to Trivandrum to check out his household. Now, we can not ask him to travel to Delhi only to get his second dose. So, the second transform that we created was to give more flexibility in booking the second appointment at any centre. The only point we stated was that you will be capable to view (on the Co-WIN platform) only these centres which are delivering the identical vaccine which was provided to you the very first time.
Then, we produced open APIs. It’s a future-proof application. Say tomorrow the hospitals choose to have their personal vaccine appointment technique, and (it is felt that there) is no have to have for a centralised appointment technique, then that will be achievable. The hospitals can then develop their personal systems and just plug into this (Co-WIN). So obtaining an open API is the third component. It is an incredibly significant policy mainly because it guarantees innovation on leading of the current technique. We want to connect with a variety of players in this digital space…
And lastly, scalability is really significant. We developed the technique for a scale of 10,000 concurrent customers (per second). Then, the other aspect was producing it simple for persons to register. For that, we let 4 persons register from the identical mobile. It created the technique more inclusive.
PRABHA RAGHAVAN: Are there any learnings from the procedure so far that you want to take forward or enhance upon in the future?
Certainly. The vaccination certificate can likely turn out to be one of your wellness records… With consent, we can situation exclusive wellness IDs to the particular person (acquiring vaccinated), and he has ownership of the record. Going forward, this can turn out to be one of the digital wellness applications.
Another point is about aligning with worldwide requirements. The World Health Organization is basically producing a regular for digital certification of vaccination and we are aligning with them. As quickly as they come up with their requirements, from day one we will be aligned with it. So our certificate will be interoperable and anyplace in the world you can just digitally confirm it.
The other learnings that we applied had been from the Aadhaar days to guarantee speed, inclusivity, interoperability, open APIs, open requirements, and open supply. All these principles have been incorporated to style the vaccination application.
PRABHA RAGHAVAN: How has the public response to vaccination evolved in the previous month?
While more than 80 million registrations and appointments are taking spot on the technique, we are seeing that a majority of the persons are just going to centres and acquiring themselves vaccinated… Now, we are advertising (acquiring registrations and appointments in advance) from the point of view of crowd management and persons not acquiring disappointed… say, a centre has the capacity to vaccinate one hundred persons and 200 persons land up there… Therefore, the appointment technique, in our view, is a superior technique from every single angle, but that is not taking place. However, we have a stroll-in technique and it does not compromise on any attribute… People ought to not consider of it as some type of shortcut.
ANIL SASI: How are we bringing down vaccine wastage? It has come down from 13% to 6% now. Also, how considerably of a challenge is the second shot?
Vaccine wastage is definitely one thing which we ought to eradicate as considerably as achievable. Now, let me give you some concept as to why vaccine wastage requires spot. So, let’s say a centre has a capacity for one hundred vaccinations and about 81 persons arrive at the centre, which includes each with appointments and stroll-ins. A vial consists of 10 vaccines. Now immediately after 80 persons get vaccinated, a new vial will have to be opened for the 81st particular person. Now you can either ask the particular person to return, or the healthcare worker thinks that let me give this one shot and then other people may perhaps also trickle in. But what if you give the 81st dose and then no one turns up. So, nine vaccine shots get wasted. Nine out of 81 is primarily about 11% wastage. This is unacceptable, proper?
So, what can be completed? One alternative is to have bigger centres… For instance, if a centre has capacity for 1,000 vaccinations and 991 take spot, then only nine shots will be wasted, which is significantly less than 1%. The situation of wastage is a management type of situation, not so considerably a technologies situation. And management is frequent sense.
Then, there is the second shot challenge. In the case of Covishield, the window is of six to eight weeks… Now, why ought to I restrict a person’s option to only one distinct day in the window by providing him an appointment. So, we stopped that (providing appointment for second dose). We are saying, alright, you got your very first dose, there’s a window of six to eight weeks in which you ought to get the second dose and you can make appointments later. And then say immediately after 5 weeks, we begin sending messages… If the particular person has currently created an appointment someplace, we are fine… If he has not created an appointment, we send a message to him to make one. We send 3 to 4 SMSes to him. We are basically nudging him, once again and once again, to guarantee that he gets vaccinated. But that is all we can do. We cannot force (them)… We will also have a figure as to how a lot of persons did not take the second jab and perhaps we can once again send out a message to them.
TABASSUM BARNAGARWALA: You have spoken about the function of technologies in constructing wellness infrastructure. India relied on a new software program to run an adult mass vaccination programme. In January and February, we saw big delays in administering vaccination due to a number of glitches. Do you consider utilizing the new software program was a significant threat that we took?
On Co-WIN glitches, I can concede that… when we began working on that, there had been currently some applications which had been there and we did not have time to re-engineer or overhaul that application. So, in the initial days when the software program began, we did have some glitches (like OTPs not acquiring delivered). However, we basically plugged these glitches in a couple of days. By January 19 or 20, the software program had turn out to be steady. Also, the dilemma was not with the software program the dilemma was with information. For instance, we had collected the names of frontline and healthcare workers in Excel sheets. Now these names had been there with the phone quantity, and so forth. As the Excel sheet did not have any validation, there had been phone numbers that had nine digits or began with 00 (incorrect phone numbers)… So, mainly because of the information, we could not send messages to these people… So, there had been more complications with the information than with the software program that we had been using… I totally disagree with the hypothesis that Co-WIN delayed the vaccination programme. It has no function to play in delaying or accelerating the vaccination programme. It is only an enabling platform which records the vaccinations and facilitates the vaccination programme. Speed is not definitely in the hands of the software program it is a function of a number of (elements).
SUNNY VERMA: Have you completed any assessment internally or otherwise on how extended it would take for the complete population of the nation to get vaccinated?
I am not definitely in charge of these elements. I consider it will be intriguing to look at dashboard.cowin.gov.in. It provides a actual-time snapshot of the vaccination completed, day, gender, centre, state, district and so forth. It’s a superior overview of the vaccination programme and one can drill down to district or what ever level one desires. It also reports AEFI (Adverse occasion following immunisation), which is generally adverse impact numbers. It’s a extensive info technique. But with regard to the actual estimates — how considerably time it will take (to vaccinate the complete population) — there are 3 variables which basically work in deciding these numbers. The very first variable is the vaccine provide. The second variable is capacity to vaccinate, and the third variable is the demand — how a lot of persons turn up at the centres. The numbers will be a outcome of an interplay of these 3 variables.
SANDEEP SINGH: If there is a rush for vaccination today, will we be capable to manage it?
Co-WIN is an incredibly scalable platform. We are really confident of it and we will be capable to manage the load that comes. Also, the group which has worked tirelessly on this is really competent… We have full ownership of this point (Co-WIN). It’s not as if we have outsourced it to somebody. We are really confident that we will be capable to scale it up.
We have the infrastructure at the backend as properly as security and safety policies in spot. We are also going to release the Co-WIN implementation strategy… The tech backbone is certainly scalable, protected, safe. It has all the attributes of a software program which is simple and inclusive… We have discovered in our 10 years of expertise with Aadhaar, UPI (Unified Payments Interface) and other sorts of frameworks that for any technologies to succeed in our nation, it has to have the following attributes: information collection ought to be minimum — we are not even collecting residential addresses, we are just collecting age, name and gender and it has to be simple and inclusive. This inclusion has been ensured by means of Aarogya Setu… Any smartphone can be applied for it (registration) and you can also do it by means of the portal. And we will be opening it up for other third-party apps also.
We have developed it on open APIs. It also has to serve India’s diversity. So, we are also providing certificates in nearby languages. So, from a tech standpoint, it is a relatively robust solution.
RAJ KAMAL JHA: Given the surge, a lot of more vaccines will have to enter the technique. How ready is the Co-WIN platform to manage that?
Absolutely. Suppose tomorrow we have Sputnik V, and day immediately after tomorrow, we have some other vaccine. We do not have to transform something in the software program. We just add yet another input. They are all information points and you just plug that in… The information points for a vaccine are batch quantity, the vaccine name and of course the encouraged gap (amongst shots) and so forth. These are the information points which you plug into the software program and it begins dispensing… It’s relatively scalable and we are really positive that we will be capable to implement any policy which the government may perhaps choose. It will be compliant… I am really clear that it is the policy which directs technologies and not the other way about. We are following that principle.
KAUSHIK DAS GUPTA: In future, Covid vaccine will be accessible in the open industry. Is the Co-WIN app suited to take care of such an eventuality?
Absolutely… Typically persons consider that this is one thing which has been constructed to serve only the government, it is regulated stuff… Currently, vaccines are in emergency use authorisation. They are not accessible in the industry and they can not be priced and sold in the open industry. But tomorrow, suppose that occurs (availability of vaccines in open industry). Now, the application that we have constructed has elements. One is reservation, which bargains with appointment and scheduling. Now, in an open industry scenario, that is irrelevant. You do not demand that. Similarly, vaccination taking place in an open industry scenario, you are not essential to record that considerably stuff… However, you may perhaps nonetheless demand a certificate… to say that a particular person has been vaccinated with a distinct vaccine. Now, the way in which we have developed these items is that all these elements can work independently in some sense. You can discard the very first element of appointment… and straight connect with the certification model… So the certification elements (of the Co-WIN app) can be valuable for issuing certificates that are digitally verifiable.
SHUBHAJIT ROY: What have we learnt from Covid vaccination programmes from across the world?
Many of these learnings will be replicable and applicable right here, but a lot of of them may perhaps not be. For instance, in the US, when vaccination requires spot, they situation certificates on a piece of paper. Now, in the US, it may perhaps not result in considerably of a dilemma mainly because it has that type of literacy levels and awareness is considerably greater. In India, literacy is low and persons are not that conscious. We have to have to have a option which is acceptable for our diverse atmosphere. If technologies can make the vaccination programme more effective, then I consider we ought to leverage technology… Frankly, I am not conscious of such a digital backbone (like India’s) in any other nation. We are fairly busy in our endeavour to guarantee that our application is steady.
ANURADHA MASCARENHAS: Is residence-based vaccination feasible in the future?
The government has enabled vaccination at workplaces. Wherever you take the vaccination, you ought to guarantee a couple of items. There has to be sufficient space so that the vaccination centre does not turn out to be a point of infection. Most significant is to have a doctor… So that in case of any adverse reaction, you can instantly take care of it. In case there is an adverse reaction and the vaccination is becoming completed at residence, there can be critical problems. So I consider that is one of the factors why we are restricting it to locations exactly where you have simple accessibility or at least you can take care of the adverse reactions in time.