6 minute read 15 Dec 2020
COVID-19 vaccination strategy in India

How private healthcare players can contribute to the government’s COVID-19 vaccination plan

By Kaivaan Movdawalla

EY India Healthcare Sector Leader and Partner

A seasoned healthcare and life sciences consulting practitioner. Passionate about re-engineering the healthcare ecosystem through operational transformation.

6 minute read 15 Dec 2020
Related topics Health COVID-19 Life Sciences

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  • Protecting India: Public Private Partnership for vaccinating against COVID-19

Through this strategy paper, FICCI and EY aim to assess the private sector’s capabilities and capacities for distribution and inoculation of the COVID-19 vaccine. 

In brief

  • India may need 1.3 lakh-1.4 lakh vaccination centers, ~1.0 lakh healthcare professionals (as inoculators) and ~2.0 lakh support staff/ volunteers to support government’s mass-inoculation program
  • 81% of survey respondents from private healthcare industry are willing to inoculate front line workers in local areas and 75% are willing to inoculate their local communities,70% are willing to allocate manpower in semi-urban/rural areas for vaccination and 94% are willing to impart training for inoculation
  • Potential engagement model between public and private healthcare players is likely to emerge to bridge capacity gaps across the value chain of COVID-19 vaccination plan

The destruction, disruption and dread unleashed by the unprecedented pandemic of COVID-19 across the world seems to end soon with several vaccine candidates reporting very encouraging results in late-stage trials. While this is a welcoming news that the world has been yearning for, the challenge of producing, distributing and administering the vaccine to the population in the shortest possible time is formidable, more so for a country like India given our population, geographical spread and skewed health infrastructure across urban and rural areas and between the states. The Government of India formed the National Expert Group on Vaccine Administration for COVID-19 (NEGVAC) with Dr. V K Paul, Member, NITI Aayog as the Chair, which is responsible for prioritizing the vaccine and also in its procurement and administration.

In this context, the NEGVAC has invited the Federation of Indian Chambers of Commerce and Industry (FICCI) to help assess the private sector’s capabilities and capacities for inoculation and distribution of the vaccine. FICCI, in partnership with EY, held stakeholder consultations and through this strategy paper aims to highlight the role and extent of private sector participation in supporting the government to accelerate the process of targeted vaccination across the country.

Private hospitals have been the bedrock of capacity and capability serving greater than 70% of bed capacity and ~60% of inpatient care in India. In the wake of the Coronavirus outbreak, private hospitals have dedicated up to 40%-80% of their bed capacity for treating COVID-19 patients and supplemented government efforts of scaling up testing by contributing to 45% of the testing capacity in India. Given the scale, complexity and timeline of the program for mass-inoculation against the SARS-CoV-2 virus, private players can significantly augment government’s capacity across the value chain of vaccine distribution and administration.

To assess the private sector’s role in inoculation of 60%-70% of the population in a two-year timeline with inoculation of prioritized groups (30 crore or 22% of population[1]) in the next eight months, this report focuses on the following:

  1. Assessment of demand and supply of healthcare resources for vaccine administration.
  2. Assessment of capacity and intent of private players in supporting the mass-inoculation program by looking at the findings from the dipstick survey involving 264 private healthcare participants.
  3. Potential engagement models between private and public sector across different stages of the value chain and private sector players’ key role towards the same.
  4. Role of the private sector from the learnings drawn from other countries.

The study estimates that India may need 1.3 lakh-1.4 lakh vaccination centers, ~1.0 lakh  healthcare professionals (as inoculators) and ~2.0 lakh support staff/ volunteers for mass inoculation of prioritized individuals (30 crore people as identified by the government, includes healthcare professionals, frontline workers, people above 50 years and also people with comorbidities) by August 2021 and the entire adult population (80 crore) by the end of 2022. To meet the demand of 1.3 lakh-1.4 lakh centres, ~60% of the existing public health infrastructure will have to house a vaccination center. Against the requirement of 1.0 lakh inoculators, the public sector can potentially provide 60,000-70,000 (10% of the nurse/ANM capacity in public sector) of them. This could lead to a capacity constraint especially in key states such as Odisha, Bihar, Jharkhand, West Bengal, Uttar Pradesh and Madhya Pradesh. Private sector can adequately supplement the physical and human infrastructure supply in key capacity constrained regions, specifically, in urban and semi-urban areas. Additionally, a second line of inoculators among allied health professionals will have to be made available through training and credentialing process to meet the requirement of inoculators.

Healthcare professionals

In a dipstick survey of 264 private healthcare participants, a high proportion of respondents stated their capacity and willingness to participate in the vaccination drive.

  • Physical infrastructure: 84% have earmarked inoculation facilities in their hospitals/centers and 54% have cold storage facilities to store vaccines on site.
Physical infrastructure - Dipstick survey of private healthcare
  • Manpower allocation: 88% have trained inoculators available for vaccination, 70% are willing to allocate manpower in semi-urban/rural areas for vaccination and 94% are willing to impart training for inoculation. A trained pool of 30,000 inoculators is also available for inoculation from amongst the participants.
Manpower allocation - COVID-19 vaccination survey of private healthcare
  • Coverage of inoculation services: 81% are willing to inoculate front line workers (e.g.,police), teachers, students, etc. in local areas, 75% are willing to inoculate their local communities (within 5km radius).
Coverage of inoculation services

In the early phases of vaccine roll-out, the entire vaccine administration machinery will be controlled for prioritized beneficiary categories. The program will be largely managed by the government, provided their capacity of human resource for vaccination is adequate. With expansion of the program to include general public enabled by ramp-up in vaccine supply, a hybrid model involving resource sharing between public and private players is likely to emerge to bridge capacity gaps across the value chain as per local requirements for augmentation of infrastructure and technical capacity.

  • Some of the key areas for private sector’s participation in this model include the following

    Focus areas of collaboration

    Role of government

    Role of private sector

    A.   Storage, logistics and distribution

    • Define state-wise nodal points, regulatory and monitoring framework /guidelines for storage of vaccines at nodal and inoculation points, infrastructure requirements, private vendor selection and empanelment process
    • Provide seamless customs clearance regulations for COVID-19 vaccines
    • Provide storage infrastructure, freight vehicles and facilities with required technology and undertake capacity augmentation wherever required
    • Develop SOPs on inventory management, safety protocols and fraud management and train existing workforce on the same
    • Undertake operation and maintenance of storage facilities, freight facilities and assets (including both self-owned and government-owned)

    B.    Vaccine center network, human resource for vaccination and outreach for vaccine advocacy

    • Finalize the number of vaccination centers for defined catchment area across public and private health facilities/practitioners
    • Define eligibility criteria in terms of minimum physical infrastructure and human resource required for approval of a vaccination center
    • Establish platform, protocol and guidelines for registration and approval of qualified vaccination centers
    • Create and execute strategic communication plan
    • Design and execute targeted immunization campaigns/drives based on assessment of progress on population coverage 
    • Permit companies to utilize their CSR funds for inoculation of their own employees, while also supporting them for inoculation of population in their vicinity, wherever possible.
    • Allow their facilities to be used as vaccination centers by the government
    • Adopt specific catchment areas for immunization coverage. Various types of vaccination center locations can be opted by private sector such as hospitals, nursing homes and clinics (including private clinics of GPs), path labs, residential welfare associations, factories, post offices, commercial establishments, such as offices, schools and colleges, community centers
    • Enlist participation of various medical bodies, such as IMA, FOGSI, AYUSH and hospital associations such as nursing home associations to encourage maximum enrolment of their members as vaccination centers
    • Leverage the network of service organizations such as Rotary Clubs (1.5 lakh Rotarians and 4,000 Rotary clubs), Lions Clubs, Gymkhana, Grand Lodge of India and other regional clubs for vaccine administration (each Rotary club has 2-3 medical professionals who can extend their services for this cause) and to drive communication campaigns for advocacy. Large government volunteer bodies such as NCC, NSS, Nehru Yuvak Kendra Sangathan, Bharat Scouts and Guides can be used for volunteer support
    • Leverage e-pharmacy players to support with their technology, capable manpower pool and cold storage network
    • Leverage research done by communication specialists at public health academic institutions to create communication for vaccine awareness. Also, private sector organizations being skilled at marketing, may enable design of effective communication and use a gamification approach for greater outreach and awareness
    • Approach large corporates who undertake CSR initiatives to contribute their funds for the administration of COVID-19 vaccine

    C.  Clinical standards for inoculation- Inoculator capability and training

    • Define the categories of healthcare professionals who can be enlisted for inoculation and provide qualification criteria based on which they can be enlisted
    • Approve and accredit agencies and training programs for inoculation training such as Healthcare Sector Skills Council and National Skill Development Council
    • Allow private sector the flexibility to decide on the degree of participation (such as freedom to restrict participation within urban/non-urban areas, and up to district level and beyond) for vaccine administration, and as trainers to skill inoculators based on their available capacity and capability
    • Create modules and certification programs for inoculator training and enlist with the government as a registered training/certification agency. Training module can include sections on handling of vaccine, injection technique, patient communication and patient counselling
    • Involve participation of medical associations like IMA, specialized association of surgeons and physicians such as OMAG, FOGSI that have a strong state-level presence for dissemination of training as well as monitoring of training program
    • Involve participation of accreditation agencies such as NABH and NABL for imparting training as they have large pool of master trainers/assessors
    • Leverage academic institutions focusing on public health for training people to administer vaccines, in addition to the players in the healthcare sector
    • Extend digital platforms such as websites and apps to upload training modules for wider dissemination of the content to their networks and associates
    • D.    Technology infrastructure and services
    • Existing eVIN network is proposed to track the latest vaccine stock position, temperature at storage facility and geo-tag health centers, and to maintain facility level dashboard for the delivery of the vaccine. Extend the eVIN network to private sector COVID-19 vaccine storage and delivery points as currently it focuses on public health facilities only
    • Issue guidelines for leveraging CO-WIN, and enable private sector to build on and build around CO-WIN
    • Invest in strong analytics engine for not only tracking purposes, but also for planning and predictive analytics related to prioritization of beneficiaries, areas to be targeted, reduce drop-outs, improve vaccine efficacy across target segments, etc.

    Supply side

    • Adopt Track and Trace system to reduce possibility of counterfeit COVID-19 vaccine
    • For manufacturers-Integrate temperature monitoring data of their storage and transportation facilities with the common vaccine platform to lower wastages and ensure better tracking of temperature breaches
    • Leverage drone technology to deliver vaccine at isolated areas

    Vaccine storage and transportation

    • Augment their IT systems to integrate with eVIN. Install temperature loggers (if not already available) in the cold chain equipment and integrate with the Common vaccination platform

    Last mile administration

    • Set up COVID mobile app facilitating both citizen and private entities with following functionalities:
      • Citizen portal
        • Registration, vaccination center selection, slot booking, beneficiary profile, vaccination certification and e-Health records (if opted)
        • Citizen engagement is a critical aspect for active participation. Gamification is an effective way to ensure citizen’s participation
      • Vaccination center enrolment portal
        • Vaccination center enrolment and monitoring, vaccinator registration and authorized vaccinator allocation, vaccination center transaction management system
      • Beneficiary authentication, vaccine payment management, vaccine authenticity verification, administered vaccination details, vaccination certificate management
      • Adverse effects, feedback and grievance redressal mechanism
    • Deploy data platform capabilities coupled with AI and Machine Learning to mine real-world data to assess the safety and efficacy of COVID-19 vaccines and adverse patient monitoring
    • Deploy blockchain as an effective tool for privacy and security of personal data 
It is imperative that the government draws on the commitment, capability and capacity of the private sector to fulfil this national duty in the most effective and efficient manner, for the relief of citizens and in a bid to help the country to return to normalcy as soon as possible.
Kaivaan Movdawalla
EY India Healthcare Sector Leader and Partner

While private healthcare providers have shown willingness to allocate human resources for the vaccination exercise, especially in semi-urban and rural areas, actual execution of the program will be dependent on clear definition of roles and responsibilities of both government and private players as well as agreement on distinctive and well-laid out engagement models for collaboration.

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When it comes COVID-19 vaccination strategy and implementation in India, there is immense scope for collaboration between various private players and public entities across the value chain to augment physical infrastructure, human infrastructure and technology capabilities.

About this article

By Kaivaan Movdawalla

EY India Healthcare Sector Leader and Partner

A seasoned healthcare and life sciences consulting practitioner. Passionate about re-engineering the healthcare ecosystem through operational transformation.

Related topics Health COVID-19 Life Sciences