Disclaimer: This blog only expresses my personal experience as I attended the COVID-19 vaccination drive where my Host Organisation supported the vaccination team at the session site on January 26, 2021. Everyday there are new developments on this issue. To get more information about the COVID-19 vaccine, please visit trusted web sources such as the World Health Organization and updates by the Government of India.
The worldwide pandemic heralded by COVID-19 in the year 2020, caused uncertainty, monotony, and anxiety among people but also built resilience, solidarity and hope. The inauguration of vaccination to fight COVID-19 has rekindled hopes of normalcy. As of now, innovative minds in five countries including India, the United Kingdom, the United States, China and Russia, have come up with the COVID-19 vaccine, making up the V-5 Club. On January 16, 2021, the largest vaccination drive was launched on an equal footing as the election campaign, in over 3000 session sites all across India.
As an AIF Clinton Fellow, I was fortunate to participate in this national event- thanks to my Host Organisation, Seba Jagat, that supported the vaccination drive at M. Rampur Community Health Centre (CHC) as part of their public health, hygiene and nutrition programme, Sampurna Bharta. M. Rampur was one of the Blocks of Kalahandi district where CoviShield, a COVID-19 vaccine by Serum Institute and AstraZeneca, was inoculated to 100 front-line health workers. The drive was carried out under the watchful eye of the Block Development Officer of M. Rampur Block, Ms. Rumana Jafri and several representatives from the National Health Mission.
The Process Followed at the Immunization Site
The CHC had conducted a dry run of all the steps involved in advance in accordance with the COVID-19 Vaccines Operational Guidelines by Ministry of Health and Family Welfare. On the big day, the process involved 5 ‘Vaccination Officers’ beginning from Vaccination Officer 1, a defence/security personnel, at the entry point who checked the registration status and ensured regulated entry to site. The CHC had prepared a list of 100 recipients in advance.
Registration Desk: Seba Jagat’s member, Ms. Jagyanseni Bhoi served as Vaccination Officer 2 at the registration desk who checked their name on the list, verified and authenticated their photo identity documents directing them to the waiting area. The security guards/support staff were responsible to manage any crowding of people at the desk and in the waiting area.
Waiting Area: Once their turn came, the recipient would join the queue outside the immunization room. Here physical distancing was strictly followed. As per the operational Guidelines, this area had to be open and well-aerated. Vaccination Officers 3 and 4 i.e., two support staff, overlooked the process, managed crowd and ensured 20 minutes of observation.
Immunization: As per Dr. Sabyasachi Padhi, Medical Officer In-charge of M. Rampur CHC, inside the immunization room, the Vaccination Officer (an MBBS doctor) was authorized to administer the vaccine after checking the oxygen level and temperature of the recipient.
Getting vaccinated: Dullabha Sahu works as security staff at M Rampur Community Health Centre; during the pandemic he courageously carried out his duty from 8:00 AM to 02:00 PM and additionally sanitized the hands of everyone who entered the premises; he ensured everyone maintained 2 gaz distance and wore their masks properly. All this while, he lived in a quarter 10-15 meters away from his main house to prevent any exposure to his family.
Observation: After being vaccinated, the recipients were directed to stay under observation for 30 minutes. Here, the doctor checked the following:
- Blood pressure
- Pulse rate
- Oxygen saturation (SpO2 level)
On this day, 59 out of 100 people were vaccinated. Dr. Padhi assured that nobody had any adverse effects after the vaccination. Some reported minor reactions such as pain from the needle, dizziness, and mild fever. This was validated through my conversation with one of the Supervisors of the Anganwadis in M. Rampur and a Seba Jagat member in Lanjigarh. The Supervisor said that neither she nor any Anganwadi Worker or ASHA in her knowledge, had any extreme effect. Although, the members from Lanjigarh said the ASHAs and Anganwadi workers she works with, had got fever and they got slightly scared. However, they are all doing well now. From 16th January to 25th January, on 5 days the vaccination drive was carried out at M. Rampur CHC and 290 health workers were vaccinated.
Reminder for new recipients: To send reminders about the date, time-slot and place of the vaccination, the people who had to be vaccinated, received SMS from the Co-WIN (COVID Vaccine Intelligence Network) system. Co-WIN application is a database on which the health centre enters details about the vaccinated individuals. On the first day of vaccination, the system faced some technical glitches which were resolved soon. In case a person does not have a phone, then the ASHAs and Anganwadi workers are to inform the recipient with all the details. Here is a sample of the SMS a recipient had received which has the information about date, time and location along with advice to bring a photo identity proof.
Follow-up and Reminder for the Second Dose: Similarly, after 28 days of receiving the first dose, the recipients were summoned and reminded to get the second dose through SMSs sent from Co-WIN.
Detect, Respond, Report and Investigate Adverse Events Following Immunization (AEFI)
Vaccine hesitancy was among the ‘Ten threats to global health in 2019’ by WHO, which is caused due to lack of confidence, complacency towards immunization and inadequate access. Ipsos and World Economic Forum conducted a 15-country survey in December 2020 with 13500 adults, after the first vaccination drives in United States and United Kingdom. Respondents from China reported the highest intent to get the vaccination if available while the same was the lowest in France. The top rated reason why one would not get the vaccine was a fear of side-effects.
However, as per a research report by Kekst CNC based on data collected in February 2021, there is an upward trend in likelihood to get the jab among middle-aged and older population of European countries, as the vaccine drive expands (KEKST CNC). Through my interactions with people in M. Rampur and Lanjigarh, who were vaccinated, most of them were healthy while some reported mild fever, who received medication. The health workers and older population expressed desire to get vaccinated.
The COVID-19 Vaccines Operational Guidelines by Ministry of Health and Family Welfare acknowledge that there is insufficient “safety data” about COVID-19 vaccine, and any death or hospitalization in high-risk group (such as the elderly, health workers, front-line workers like police, municipal workers) after vaccination can be co-incidental and of temporary nature. In order to boost confidence in the vaccine, the guidelines have laid out a robust Adverse Event Following Immunization (AEFI) surveillance system, to detect, promptly respond, report and investigate such events. The vaccinators and medical officers are to be trained to respond to anxiety reactions among recipients, ensuring separated waiting area. The guidelines recommend the recipients should be counselled about the possibility of adverse events, especially minor ones like local pain, swelling and mild to moderate fever (pg. 107).
The guidelines recommend all health workers (including public, private and individual practitioners) to be sensitized to detect adverse effects, doctors in out-patient department (OPD) should ask for record history of COVID-19 vaccination. The treating doctor shall report the same to the nearest PHC doctor in the prescribed ‘Case Reporting Format’ or telephonically. AEFIs including Minor events (pain, swelling at injection site, fever, malaise), severe events (fever above 102 degree Fahrenheit, anaphylaxis) and serious events (results in death or disability, requires hospitalization) can be reported by Co-WIN application. Since this web-based application is not for public use yet, the reports should be made available in the public domain on a regular basis in a transparent manner to sustain the confidence of people.
Role of Development Partners and Civil Society Organizations
The guidelines seek support of partner agencies such as WHO, UNICEF and UNDP in AEFI surveillance and in developing operational guidelines, training modules and capacity building of personnel involved in cold chain supply and communication; developing social mobilization strategy, community engagement; media engagement to bring forth relevant and easy to understand information to avoid false news and rumors. (pg. 108). Perhaps they can ensure quality of the surveillance arrangements that are mentioned in the guidelines, during the vaccination campaign, like checking the availability of Anaphylaxis kit as well as the AEFI management kit or emergency tray; transportation to ferry anyone in need of hospitalization; sufficient stock of injection Adrenaline; pre-sanitization of the area; ensure that at least one AEFI management centre is identified at the Block level; availability IEC material (poster, banner, leaflet about the vaccine in local language and message to bring identity card) at the site, sensitization of doctors, and so on. Moreover, it is paramount to also generate awareness about the second dose which is to administered 28 days after the first dose. With more people getting vaccinated, the confidence in vaccination shall rise too.
The Operational Guidelines envisage the Civil Society Organizations (CSOs) to support in planning and implementation of the COVID-19 vaccine drive, to make it into a ‘Jan Andolan’ (people’s movement) (pg. 35). The CSOs can lend support in addressing concerns surrounding vaccine hesitancy and vaccine eagerness, fight misinformation and rumors, engage in positive messaging with medical professionals, identify potential recipients of the vaccine. CSOs can also build IEC material suitable to the local context, about the vaccination and the likely effects after immunization so that people can make informed decisions. In addition to this, they can also highlight the importance of getting the second dose of vaccine after 28 days of first immunization.
On March 1, 2021 the phase of second dose of vaccine was rolled out all across India. As on March 18, 2021, over 3.8 crore (38 million) doses of COVID-19 vaccine were administered nationwide. Now, citizens above 60 years and those who are over 45 having co-morbidities, can also voluntarily register themselves on the Co-WIN application here: https://www.cowin.gov.in/home. It is hoped that with time, the COVID-19 vaccines prove to be effective in preventing the coronavirus disease with negligible side-effects, boosting the confidence of people and thus, pushing normalcy to fore.
“COVID-19 Vaccines Operational Guidelines.” mohfw.gov.in. N.p., 2021. Web.
“Ten Health Issues WHO Will Tackle This Year.” https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019. N.p., 2019. Print.
Salyer, Kirsten. “Here’s How Global COVID-19 Vaccine Confidence Has Changed.” https://www.weforum.org/agenda/2020/12/covid-19-vaccine-confidence-world-economic-forum-ipsos-survey/. N.p., 2020.
KEKST CNC. COVID-19 Opinion Tracker – Edition 7. KEKST CNC, 2021. Web. 20 Mar. 2021. COVID-19 Opinion Tracker.