Private healthcare players to augment government’s capacity across the value chain of vaccine distribution and administration: EY-FICCI report
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 vaccine distribution
Private hospitals have been the foundation of serving more than 70% of bed capacity and ~60% of inpatient care in India as per EY-FICCI study titled, “Protecting India: Public Private Partnership for vaccinating against COVID-19,”released by Dr V K Paul - Member, NITI Aayog in the presence of Lord David Prior, Chair, NHS England at FICCI’s AGM ‘Inspired India’. This study aims to highlight the role and extent of private sector participation in supporting the government to accelerate the process of targeted vaccination against COVID-19 across the country.
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 achieve the aspirational goal of inoculating 60%-70% of the population in a two-year timeline with inoculation of prioritized groups (30 crore or 22% of population) in the next eight months, there is a pressing need for potential engagement models between private and public sector across different stages of the vaccine value chain.
Kaivaan Movdawalla, Partner – Healthcare, EY India, says, “Several vaccine candidates are reporting very encouraging results in late-stage trials. While this is a welcome 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. Hence 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.”
Dr Sangita Reddy, President, FICCI and Joint Managing Director, Apollo Hospitals Enterprises, expressed that, “While India has been a powerhouse for vaccine production and distribution, vaccinating over a billion people is a first, and appears to be a daunting task which requires current capacities to be scaled up extremely fast. FICCI and its healthcare industry members have pledged to support the government in its COVID-19 vaccine roll out. FICCI-EY report highlights the key strategies for effective partnerships between the government and industry stakeholders. Additionally, since this is a new vaccine, we all need to collaborate to educate the community about the Need, Safety, Efficacy as well as positive impact of vaccines and why we should not resist getting vaccinated.”
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 co-morbidities) 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.
As per survey carried out by FICCI and EY, in association with NABH, NATHEALTH and other healthcare associations with 264 private healthcare organizations, 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.
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.
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)
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 roles of the government will include:
Finalization of number of vaccination centers for defined catchment area across public and private healthcare set ups based on a defined eligibility criteria in terms of minimum physical infrastructure and human resource requirements
Allowing 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
Defining the categories of healthcare professionals who can be enlisted for inoculation and provide qualification criteria based on which they can be enlisted
Permitting 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
Ensuring interoperability of IT systems of private set ups with public sector IT interfaces (such as COVIN) for seamless automation of (a) vaccine traceability and temperature monitoring across stages of storage and transportation, (b) vaccine stock management, (c) last-mile administration including citizen registration, slot booking, transaction management at vaccine center, adverse event management and feedback management
Investing 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, reducing drop-outs, improving vaccine efficacy across target segments, etc.
Some of the key roles of private players will include:
Adopting 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
Allowing their facilities to be used as vaccination centers by the government
Enlisting 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
Leveraging the network of service organizations such as Rotary Clubs, Lions Clubs, Gymkhana, Grand Lodge of India and other regional clubs for vaccine administration and to drive communication campaigns for advocacy
Approaching large corporates who undertake CSR initiatives to contribute their funds for the administration of COVID-19 vaccine
Creating modules and certification programs for inoculator training and enlisting with the government as a registered training/certification agency. Also extending their digital platforms such as websites and apps to upload training modules for wider dissemination of the content to their networks and associates
Adopting IT systems that provide Track and Trace features to reduce possibility of counterfeit vaccines, augmenting IT systems to integrate with eVIN, setting up COVID mobile app facilitating both citizen and private entities in vaccine administration management, deploying AI and Machine Learning to mine real world data to assess the safety and efficacy of the vaccines and deploying blockchain as an effective tool for privacy and security of personal data.
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.