Given that a COVID-19 vaccine is expected to become available in limited quantities from >April 2021, India must have a strategy in mind to vaccinate the population in the shortest possible time. We propose that COVID-19 vaccination be carried out in a mission mode " 'National COVID Vaccination Mission' (NCVM) " similar to the exercise of holding the General Election, with a target to cover 5o percent of the population (approximately 70 crore) by December 2021.
The government and other stakeholders are focusing on issues related to vaccine procurement and distribution and cold chain issues. However, despite all this planning, we believe that if there is a shortage of human resources to administer the vaccine, the timeline for vaccinating the desired percentage of the population could get skewed. This will hurt the vaccination campaign. Here we present a simple strategy to secure human resources required to vaccinate people of India in a time-bound manner.
This pandemic has already harmed the Indian healthcare delivery systems including surgical procedures, non-COVID-19 medical Out-Patient (OPD) treatments as well as routine medical checks including regular immunisations. By some accounts, over ten lakh children have >missed routine required immunisations while OPD treatments for all patients, including essential ones for oncology patients, have dropped by more than 80 percent. The numbers for institutional childbirth have dropped sharply. Under-staffed and under-funded, the existing Indian healthcare infrastructure is now under significant pressure and threatening to crack.
Assuming a single vaccination takes 20 minutes and a working period of eight hours per day, a worker would be able to vaccinate around 1,900 patients in about three months and it would require a pool of four lakh members of staff dedicated only to the COVID-19 vaccination to cover the targeted 70 crore population in six months.
In this scenario, we believe that it is not desirable to further stress the existing healthcare system by diverting human resources from there to administer Covid-19 vaccines. We believe, it is better to create a separate pool of human resources for this mission by calling on those students who are in their penultimate and final year of MBBS, BDS, AYUSH doctoral, nursing, pharmacy and other paramedical programs.
This NCVM exercise should be conducted on similar lines as the National General Election with booths being created across the country, with student professionals administering the vaccine, supported by deputed government (non-medical) officials to carry out administrative duties.
Presently, there are 529 medical colleges in India, churning out around 80,000 MBBS doctors every year. Additionally, 26,000 students complete their Bachelor in Dentistry, 55,000 nurses and 30,000 AYUSH doctors graduate annually. If we consider the penultimate and final year students from all the above courses, the total pool will aggregate to >around four lakh (semi) trained medical professionals " without considering other paramedical students as well as pharmacists (who also number around four lakh annually). This would create a workforce that may arise to the task at hand, viz vaccinating 70 crore people in six months.
It is beneficial if these students are roped into the COVID-19 vaccination system for a three-month 'field internship' stint as part of their formal academic curriculum. Besides taking care of their travel logistics, the students could be compensated through an honorarium and/or academic credits for this internship. As an additional incentive, they should also be given priority in the COVID-19 vaccination queue.
A huge advantage in drawing from the medical student population is that they already have undergone the training needed to work with patients and administer intramuscular injections like most vaccines are. Hence, extensive training will not be required, However, it would be useful if they undergo a short course covering the vaccination programme, ethics ,and Standard Operating Procedures (SOPs) for vaccine administration at the participating institutions. Additionally, if they are allocated to the states where they are undergoing their education, cultural and language barriers should not be an issue.
To ensure a sustainable vaccine program against COVID-19 and strengthen other vaccination programs, frontline workers such as ASHA and ANM workers could also be trained/re-trained to administer this vaccine as a part of their training program.
This staffing structure could be a win-win for all the stakeholders " the government by enabling much needed continuity in the backlog of routine non-COVID healthcare activities without hampering the vaccination campaign; Medical students by providing valuable field experience as part of a critical national mission, academic credits and priority in vaccination and the general population by an acceleration of the COVID-19 vaccination campaign.
Of course, the success of such a strategy will depend heavily on the availability of a vaccine proven effective during the clinical trials, and made in enough doses to meet India's needs. Meanwhile, efforts are made to scale up >vaccine production and logistics to ensure a hassle-free >supply and delivery chain for various vaccines that will be coming into the market. While vaccine availability, production and delivery are being worked, we believe it is equally critical to focus on procuring adequate human resources. The government and academic institutions should start planning on having the required personnel trained for vaccine administration and ready to mobilise as and when the vaccine becomes available.
The authors are participants in Takshashila Institution's GCPP Health and Life Science programme