While countries, including India, have taken strong measures to contain the spread of COVID-19 through better diagnostics and treatment, vaccines will provide a lasting solution by enhancing immunity and containing disease spread. In response to the pandemic, the vaccine development process has been fast-tracked.

Globally over 274 candidate vaccines are in different stages of development as of 4 December 2020. Most vaccines will require a two-dose schedule to be administered two, three or four weeks apart, and need to be administered through the intramuscular route.

Anticipating that COVID-19 vaccine may soon be available, GoI is preparing for its introduction in the country so that it can be expeditiously rolled out when available.

Government of India’s Vaccination Plan Guidelines:

The government has constituted a National Expert Group on Vaccine Administration for  COVID-19 (NEGVAC). The NEGVAC guides on all aspects of COVID-19 Vaccine introduction in India. High-level coordination at national, state and districts levels will be established for effective cooperation and collaboration among the key departments. Twenty-three ministries/departments and numerous developmental partners will coordinate in planning for COVID-19 vaccine introduction.

TRAINING OF STAFF INVOLVED IN VACCINATION:

1. Enumerators for beneficiary listing,  health  functionaries for vaccination activities, social mobilisers for all mobilisation activities and communication training for all workers involved in the process of vaccination will be given prior training.
2. Initially, all national and state training of trainers may be successfully conducted on virtual platforms.
3. After that, training will be imparted at district and sub-district levels using a mix of virtual and face-to-face pieces of training.
4. The COVID-19 vaccine will be introduced once all training is completed in the district/block/planning unit.
5. Every effort would be made to ensure that everyone in the country has access to timely, accurate and transparent information about the COVID-19 vaccine(s).

PRIORITISATION OF WHO GETS VACCINATED FIRST:

1. The COVID-19 vaccine will be offered first to healthcare workers, frontline workers and to persons above 50 years of age.
2. Second rung of priority will be persons younger than 50 years of age with associated comorbidities based on evolving pandemic situation.
3. The third rung is the remaining population based on the disease epidemiology and vaccine availability.

Further factors that will affect priorities:
The priority group of above 50 years may be further subdivided into those above 60 years of age and those between 50 to 60 years of age for purposes of the phasing of roll out based on pandemic situation and vaccine availability.
Identification of population of  50 years and more will be done basis the latest electoral roll for Lok Sabha and Legislative Assembly elections.

Digital Platform used to enlist beneficiaries:

• One cannot walk into a clinic or vaccination facility and get vaccinated arbitrarily.
• The COVID Vaccine Intelligence Network (Co-WIN) system, a digitalised platform will be used to track the enlisted beneficiaries for vaccination and COVID-19 vaccines on a real-time basis.
• At the vaccination site, only pre-registered beneficiaries will be vaccinated in accordance with the prioritisation, and there will be no provision for on- the-spot registrations.

Vaccination sessions will look like this:

1. One session for 100 beneficiaries
2. While most of the healthcare and frontline workers would be vaccinated at fixed session sites, vaccination of other high-risk populations may require outreach session sites, and mobile sites/teams.
3. State/UT can identify specific days for vaccination.
4. Conduct of the vaccination process similar to the Election process.
    

The vaccination team will consist of five members as follows:

Vaccinator Officer– Doctors (MBBS/BDS), Staff Nurse, Pharmacist, ANM, LHV; anyone legally authorized to give injection may be considered as a potential vaccinator

Vaccination Officer 1: At least one person (Police, home guard, Civil Defence, NCC, NSS, NYK) who will check the registration status of the beneficiary at the entry point and ensure guarded entry to the vaccination session.

Vaccination Officer 2: is the verifier who will authenticate/verify the identification documents;

Vaccination Officer 3 & 4 are the two-support staff who will be responsible for crowd management, IEC/communication and support to vaccinator.

Precautions in terms of storage and transportation:

1. Essential health services including existing routine immunization sessions should not be impacted or interrupted.

2. Vaccine safety needs to be ensured during storage, transportation and delivery of vaccine with sufficient police arrangements so that there are no leakages in the delivery system.

Administration with strict hygiene and safety precautions:

1. SOPs for infection prevention and control practices, safe injection practices and waste disposal, will be followed during the vaccination sessions.
2. As large population groups will be vaccinated over a short period of time with a new vaccine, monitoring the safety of these vaccines will be critical.

Post-Vaccination health-watch:

• The existing Adverse Event Following Immunization (AEFI) surveillance system will be utilized to monitor adverse events and inform the understanding of the safety profile of the vaccines.
• To ensure confidence in the vaccine and the immunization programme during COVID-19 vaccine introduction, states/UTs must rapidly detect and promptly respond to all AEFIs.
• The reporting of AEFI through SAFEVAC is being integrated with Co-WIN software and every AEFI to be reported at the district level and further the referral mechanisms in case of any AEFI needs to be put in place.

Each step-in vaccine introduction will be monitored. This includes:

• Tracking the progress of introduction activities – training, vaccine logistics availability, task forces. This will be supported by partners through tracking mechanisms.
• Readiness assessment prior to vaccine introduction – field visits and desk review of data at national and state levels.
• Concurrent monitoring of vaccination activities – daily evening meetings, standardized monitoring tools, mobile-based app, real-time data from planning unit to the national level.
• Knowledge management- The best practices and innovations at all levels would be shared for improving the implementation in the next phase of scale up.

Roles of different Ministries/Departments in COVID-19 vaccine implementation

Roles expected from different government departments to support COVID-19 vaccination have been defined, however, the list is indicative and task forces may engage with more departments or assign additional roles depending on local needs.