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India’s biggest challenge: how to vaccinate 1.3billion people against Covid-19?

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India’s claim to fame is staggering scale of its general elections, with 900 million voters mobilised across 1 million polling stations, to choose from 8,000 candidates across a landmass spanning 2,000 miles north to south and pretty much the same east to west.

But now the country has to go one better. India must vaccinate 1.3bn people against Covid-19 – twice and twice as fast. With more than 9 million confirmed cases of coronavirus and a battered economy, how will the country meet this challenge?

Prime minister Narendra Modi is confident. “We have a vast and experienced vaccination network and the country will capitalise on these advantages,” he said recently.

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India already has the distinction of already having the world’s largest vaccination scheme – the universal immunisation programme. Every year, it administers vaccines for diphtheria, polio, measles and other childhood diseases to around 26 million infants, and it immunises about 30 million pregnant women.

India has 27,000 cold chain points (deep freezers and ice-lined refrigerators) to keep vaccines at the right temperature, 700 refrigerated trucks, around 50,000 cold chain technicians and about 2.5 million health workers to administer doses.

But in many places the cold chain system is in a sad state of repair. Fridge temperature gauges don’t work, vaccines are not stored or monitored properly, and power cuts can last hours, leaving vaccines unfit for use.

From the storage centres, the vaccines will be moved by truck, train and in some cases plane, todistrict headquarters, hospitals, health centres, clinics and chemists where once again they must be stored in freezers until administered.

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Although the Modi government wants to act fast, and ministers speak with confidence of managing the logistical nightmare, apart from fuzzy reassurances, the government has provided few details. It has not been clear about when all the refrigerated trucks, storage centres, freezers, coolers, syringes, alcohol swabs and glass vials will arrive. Or how it plans to train the army of healthcare workers to give the vaccines.

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