Jesus had it easier than Harsh Vardhan. The miracle of ‘feeding the 5,000’ too was strapped by the limited resources of ‘five loaves and two fish’, but the disciples were told to just go distribute them to the crowd. Christ didn’t need policy, planning or prioritization. The Union health minister does. Making up for the earlier lack of transparency, Dr. Vardhan has begun his own Mantri ki Baat, the Sunday Samvad. Mercifully, it is low on platitudes, high on specifics. More Project Manager than Master-ji, he submits a weekly progress report to the nation. He sounds convincing. How reassured should we be? Arrayed on the plus side are our scientific institutions and an enviable vaccine-manufacturing industry. Every eighth immunised child in the world has the Serum Institute of India to thank. Its Oxford-AstraZeneca vaccine is a global frontrunner. Also sprinting are the fully indigenous ICMR-NIV/ Bharat Biotech inactivated virus vaccine and Zydus Cadila’s unique DNA-based one. Dr. Reddy’s Laboratories has received renewed DCGI permission to conduct late-stage trials of Russia’s Sputnik V. Dr. VK Paul, a member of Niti Aayog says, “Several other companies are in talks with the government because everyone is interested in our huge manufacturing capacity.” Official optimism is endorsed by the likes of Bill Gates and Soumya Swaminathan, WHO’s chief scientist. blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain The big ‘but’ butts into scalability. The usual sticking point of lab-to-arm is hugely multiplied when dealing with a totally new vaccine against a novel virus to be administered in the midst of a raging pandemic. Global cooperation has achieved the unthinkable in terms of science, but delivering it is entirely our baby. Planning is further stymied by uncertainty: Which vaccine will actually breast the tape, and will even combined production live up to Dr. Vardhan’s promise of 20-25 crore people immunised by July 2021? Each of them will need two doses. The race to the targeted population is even more hurdled. Venerable public health expert Dr. Jacob John’s skepticism begins at policy, the prerequisite of planned implementation. The big question here is, ‘Who?’ While we have the pat answer of ‘frontline workers and those with co-morbidities’, the specifics of even these two groups are fuzzier. Moreover, data and the drive will have to come from the states, not all of which are the BFFs of the Centre. A doctor on Mumbai’s Covid response team lashed out at Delhi’s health cabal cornering the decision-making and funds while the responsibility fell to the states. And then there’s the BJP government’s blotched copybook on the matter of lists. ‘Fair and equitable’ is a phrase one hears a lot, but will vaccine recipients really be chosen ‘according to need’ – or according to clout? Dr. Paul says, “We will devise criteria that are as simple as possible, fair, equitable and transparent,” but why are our eyes rolling? The rich and influential have already muscled their way too scarce hospital beds, even reportedly ‘reserved’ these and ventilators. The ‘Whom?’ is a multi-specialty decision that should also involve sociologists, economists, and ethicists. Planning means keeping ready the big data and the details where the devil notoriously lurks. Those with co-morbidities; the IgG antibodies status of the past asymptomatic; archival data of all lab tests and medical records of every state. Digitised India will be a huge tool: Aadhaar and specifically eVIN. This electronic Vaccine Intelligence Network to monitor logistics, stocks and the cold chain was indigenously developed for the universal immunization programme (UIP). The ‘How’ of actual vaccine delivery is a minefield. True, UIP infrastructure has handled 2.5 crore children multiplied by the five shots needed; we boast polio eradication, and Mission Indradhanush (MI) is ranked among the 12 best practices in health (British Medical Journal). But as Dr Naveen Thacker of the International Paediatrics Association points out, all this is “geared for children and pregnant mothers, though we have had some success in delivering adult vaccines such as Japanese Encephalitis. The Covid-19 one will require infrastructural and human resource systems that cater for the elderly and high-risk populations and at a much greater scale.” He cautions, “None of this should be at the cost of the routine UIP for children.” Already, as red-flagged by Bill Gates, “25 years of vaccination progress was wiped out in 25 weeks of the pandemic.” blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain blockchain Dr. Paul throws into the delivery ring our elections experience of setting up booths and getting people to them. The PM publicly endorsed this, adding the disaster management set up (hopefully with a booster shot from PM Cares). Dr. John suggests camps medically staffed, supervised, and equipped to handle side effects. It is universally acknowledged that no vaccine will never create a problem. A communication strategy too must be kept in readiness to prepare the community as well as handle the dreaded AEFI, the ensuing adverse event which ‘does not necessarily have a causal relationship with the immunization’. This damage control must be as honest as it is swift. One shouldn’t diss official planning and preparedness, but genuine hurdles, the high probability of surprises/ setbacks, and that usual suspect, human error, make delivering the Covid vaccine a staggeringly unprecedented challenge. To adapt the metaphysics analogy, the prospect is somewhat akin to ‘being in a dark room and looking for a black cat which, alas, is very much there’.

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