The Centre has ruled out in the Supreme Court door-to-door vaccination of people and said the inoculation will be done at identified COVID Vaccination Centres (CVC), both government and private, registered on COWIN for “good, germane and rational reasons”. It said that four key requirements of CVC under the COVID-19 vaccination programme are availability of adequate space, adequate cold storage facility, adequate number of vaccinators and medical support staff and adequate arrangements for management of Adverse Event Following Immunization (AEFI).
The Centre’s reply came on the top court’s query whether it plans to undertake nationwide mass awareness campaign for COVID-19 vaccination and ensuring outreach in rural areas and underprivileged sections by using mobile vans, vehicles and railways to vaccinate people near their doorsteps so as to minimize their travel and potential infection with COVID-19. The Centre in its 218-page detailed affidavit said, It is submitted that it may be difficult to timely address AEFI in an adequate manner in the situation of a home or vaccination at the door steps and in case of any adverse event, case management may not be proper and there will be a delay in reaching health facility, even though ambulances are stationed nearby.
It added that beneficiaries can book the slots in identified CVCs through COWIN software based on their residence pin code, for the comfort and convenience of the people, facilitating the vaccination at nearby CVC. It is submitted that maintaining protocol of observation of each and every beneficiary for 30 minutes after vaccination is not possible, as each household may have one or two beneficiaries and it may not be practically possible for the vaccination team to spend more than 30 minutes in each and every household, the government said, adding that this will in fact delay the entire vaccination drive. It said that for administration of vaccines logistically the same need to be stored in special Vaccine Carriers to maintain the requisite temperature and to further prevent contamination.
If the vaccine are administered on a door to door basis, the vaccine carrier box would be required to be opened again and again thereby violating its threshold temperature which is necessary to maintain vaccine efficacy and prevent it from causing AEFI, which may even affect the vaccine confidence and programme performance, it said. The Centre further said that repeated opening of vaccine carriers while giving vaccine at each and every house will expose the vaccine to the temperature beyond recommended range and this may reduce the efficacy of both open and unopened vials kept in the vaccine carrier. Furthermore, there are chances of vaccine wastage due to increased time required visiting door to door for socio-economically and underprivileged sections. As per the guidelines open vial policy is not applicable for COVID-19 vaccine, which means a vial once opened needs to be discarded after 4 hours, it said, adding that it will take time to reach out to each beneficiary and this may lead to vaccine wastage of open vials used for vaccination.
The government pointed out that vaccination at home may expose the healthcare personnel and frontline health workers to undue pressures from the community to vaccinate those other than on due list and hence will need additional security cover as well. Furthermore, the vaccinator will be travelling and delivering the vaccine at various locations and will always be at risk of getting COVID-19 infection. Vaccinators will be exposed to multiple household environments as the COVID vaccine cannot be given at door or outside the home. The vaccination team will require a sitting place at home and would have to spend some time inside the home of the beneficiary, it said. The Centre said that it has formulated SOP on vaccination of persons without any prescribed identity cards under which bulk cohort registration would be possible at designated facilities under special vaccination sessions. The government said that much of India resides in rural areas which are governed by local self-governments at grass root levels like Panchayats and these grassroots level bodies are very successfully representing rural India in all schemes of State Governments as well as Central Government. After the country entered the digital era, almost all these gram Panchayats have established common service centres (CSC) which have a digital platform to be used by the people. These CSCs and its infrastructure is widely and effectively used in rural areas for various purposes and is found to be an effective module taking the development to the grass root levels. This provides access to the internet to a vast variety of persons who may not be adept in using it or may not have direct access to it, it said. The Centre said that Crematorium workers regardless of age, (be they permanent, contractual, outsourced and manpower working with contractors) engaged in working in all cremation grounds are already included under the priority group of municipal workers under frontline workers category. It said that similarly, all Panchayat workers in rural areas involved in COVID-19 activities, regardless of age, are also included in the Frontline workers category.
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