ONE NATION, ONE BILLION JABS

India's success, against all odds, with the national jabs project could well be the tipping point it is seeking so desperately. EPISODE #45

Dear Reader,

A very Happy Monday to you.

Last week India achieved a terrific milestone when it logged 1 billion vaccines. This takes some serious processing given the multitude of challenges that had to be overcome. Whether it was the misguided politics of outrage, limited vaccine capacity and then last but not the least a creaking health infrastructure, it was almost as though India had one too many hurdles to clear.

If someone told me in April, when India was in the throes of a vicious second wave and there were serious doubts being expressed about the country’s ability to indigenously develop and manufacture the jab, that by end-October one billion Indians would have received one vaccine my response would have been “no way”.

But remarkably India pulled it off. It is among other things a “yes we can” moment, especially given the scale and complexity of the task. Predictably it is the focus topic this week.

The cover picture is of the iconic Brooklyn Bridge in New York and is taken by Vibha Joshi. A personal favourite, the bridge built in 1883 connects two borroughs: Manhattan and Brooklyn. I believe the bridge is a lovely metaphor for how the covid-19 jab together with safety protocols is etching a path out of the global crisis triggered by the SARS-COV2 virus which originated in Wuhan, China.

A big shoutout to Rajit, Gautam, Premasundaran, Vandana, Rahul and Aashish for your informed responses, appreciation and amplification for last week’s column. Apologies to Yugainder for forgetting to acknowledge him last week: Thank you! Gratitude also to all those who responded on Twitter and Linkedin. Reader participation and amplification is key to growing this newsletter community. And, many thanks to readers who hit the like button 😊—a special thanks to Ashish.

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Pix by Vibha Joshi

A BILLION JABS

Last week India logged one billion jabs. The 100th crore jab was delivered by Nurse Christina at the Ram Manohar Lohia hospital in New Delhi.

This number is an incredible achievement, no matter which way we look at it; unless you are a compulsive critic. While 700 million have received one jab, about 300 million are fully vaccinated. And all of this in the six months since the jab project was rolled out in earnest on 1 May. And lest we forget it has provided a key line of defence against future waves of covid-19. Without this a sustained economic recovery, India so desperately needs, is impossible to conceive.

To get a sense of the benchmark, the number of fully vaccinated people in India are just a little less than the population of the United States—also the world’s largest economy. And more than twice that number have received at least one jab.

And all this in a country like India whose calling card is diversity—whether it be language, ethnicity, religion or geography—and a legacy of a sell-past-the-date health infrastructure. This will be my third column celebrating this achievement. Sharing the previous two below:

VACCINATING INDIA: ANOTHER MASTERCLASS IN SCALING

INDIA'S JAB MASTER CLASS REVISITED

You may think I am going overboard. And guess what you may be right. But frankly I believe this is a story that needs to be told and retold.

And here are my reasons:

Make in India

The jab plan initially targeted vaccinating 900 million. And since the approved vaccines require two jabs we are talking about administering 1.8 billion vaccines. If the task was staggering then the controversies were no less. In short not many gave India a chance to pull it off. Yet they did.

First, India evaded vaccine dependency on the West—which predictably (and irresponsibly) cornered most of the initial global supplies, leaving less developed countries vulnerable to the pandemic as it gained in intensity. India did so by backing the domestic production of Covishield vaccine developed by Oxford-AstraZeneca over options offered by MNCs like Pfizer and at the same time also approved the indigenously developed Covaxin.

Second, it announced a staggered jab plan, beginning with preference for the frontline personnel, to pre-empt panic. Later this was relaxed to include those above 60 years and then further to those above 45 years. And finally the jabs were opened up to those above 18 years of age. The government is still weighing its options on including the last cohort of those less than 18 years.

So far the Make In India project has worked brilliantly. If nothing it just told the nation “Yes we can”. This success should work wonders for its mojo.

The Covid Warrior

Yes, the policy stance was important but the big worry was its execution in a complex country like India. The fears proved unfounded.

A large part of the success is because of the medical personnel—not just the doctors, but also the countless number of support staff—who went that extra mile to deliver the jab. And often at grave personal risk, particularly in accessing remote places (as you can see in the clip below shared by ANI on Twitter). So salute to our covid warriors.

ANI @ANI

#WATCH | A team of healthcare workers in Chhattisgarh crosses a river on bamboo boat to hold a Covid-19 vaccination drive in Rajnandgaon's remote village (22.10)

Health Risks

The covid-19 pandemic also elevated the notion of health risks to the centre stage. For long India has buried its health challenge even though it has gotten only worse. The covid-19 pandemic was a grim reminder that the country’s disease burden, now dominated by non-communicable diseases like heart ailments, cancer and so, has reached a tipping point.

The big shock to the economy—when it contracted in the first quarter of last year following the nation-wide lockdown—was a reminder that health is now a key part of the risk matrix.

Exactly the reason that the the union government was forced to advance the roll-out of the National Digital Health Mission. This is a very ambitious programme which seeks to unlock the health data locked away in the silos of hospitals, laboratories and the existing health network. By getting data to talk to each other, NDHM is looking to exploit the health database—within the guardrails of privacy—for the benefit of both consumers and the health ecosystem, particularly public health care.

A Masterclass in Scale

Upfront the union government announced its intent to opt for the strategy of One Nation, One Jab. It meant that all eligible people could take the jab anywhere, any place in India. Yes it was an enormous challenge to the authorities, but at the same time it was an enormous convenience to those seeking jabs.

No doubt that the friction-less delivery also contributed to the success. The medium of delivering this big ask was the Cowin platform. Its open architecture design ensured flexibility to cater to the diverse needs of a One Nation, One Jab strategy.

What helped is that the enabling digital ecosystem to execute such projects of scale is already in place. The foundation of an estimated 1.3 billion (or 130 crore) holders of Aadhaar, the unique 12-digit ID issued to all residents of India is being used to connect One billion (100 crore) plus cell phone connections, 600-800 million (60-80 crore) Internet users and 430 million (43 crore) Jandhan no-frill bank accounts owned by the poor for delivering various public goods digitally.

As they say, thinking in scale opens up the mind, especially in a country like India which has to simultaneously tackle a range of development challenges. The Cowin application is just another such digital public good. The most high-profile one is the Unified Payments Interface (UPI) which is revolutionising the business of payments at scale.

And like in the case of UPI, the jab project has witnessed an exponential growth (see the monthly jump in the graph below) after hitting critical mass. It is similar to the compounding effect of a regular savings habit on your portfolio.

Last Mile

It is clear then that the national jab project is off to a fantastic start. As the cliché goes, anything well begun is half done. But this is exactly the point where India has to ensure that it does not drop the ball in the last mile. Its history is replete with such instances that have gone on to cost the country dearly.

So in the final analysis I can only hope that besides continuing to adhere to covid-19 safety protocols, India stays the course to deliver the remaining jabs. Not only will it restore the country’s mojo it may well turn out to be a tipping point.

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Recommended Viewing

Last week I anchored a webinar for the Public Affairs Forum of India (PAFI) on the occasion of their eighth annual forum. It was a case of serendipity.

The topic decided about a month ago was whether healthcare was poised to see its “UPI moment” with the launch of the NDHM—something I discussed in detail in a previous column and briefly today.

In a happy coincidence it so happened that the day before the webinar India logged its one billion jabs milestone. And to top it all PAFI had lined up the perfect panel which included R S Sharma, who spearheaded Cowin and is now shepherding NDHM, and Dr Randeep Guleria, the director of the All India Institute of Medical Sciences. It was a fantastic (must watch) conversation.

I am sharing the YouTube link below. Do watch.

Till we meet again next week. Stay safe.