VACCINATING INDIA: ANOTHER MASTERCLASS IN SCALING
On 1 May India will unveil the third leg of its jab plan, once again showcasing its amazing ability to pull off projects of scale using indigenous digital tech. EPISODE #20
Hi Everyone,
A Monday of cheer to all of you.
Last week was terrible. Not only did we have to contend with the covid-19 pandemic, which is rapidly gaining ground across the country, but we also had to expend our emotional energy in absorbing outrage. Yes people it is absolutely justified to feel angry (and maybe even to vent), especially since planning could have spared us the worst. But remember this doomscrolling is distracting us from the purpose of dealing with the latest curve ball served by life. If not this there will always be another challenge.
Daisaku Ikeda, one of the great Buddhist philosophers explains it best:
“Adversity gives birth to greatness. The greater the challenges and difficulties we face, the greater opportunity we have to grow and develop as people. A life without adversity, a life of ease and comfort, produces nothing and leaves us with nothing. This is one of the indisputable facts of life.”
The worst kept truth about the ongoing tragedy is that India has a sell-past-the-date health infrastructure. If anything this pandemic is a cruel reminder of its consequences. So any long term fightback or audit of actions/missteps of authorities has to begin with the union and state governments initiating an audit of the existing health assets.
For the moment we should direct our nervous energy in ensuring everyone around us adopts the only proven weapon against covid-19: the mask. Even at this moment, when we are supposed to be in lockdown, I can see people in my neighbourhood walking around and some of them are not sporting a mask. A friend shared a video clip of a band, baaja, baraat in full swing in South Delhi.
Remember that to a large extent, collective safety—especially of our frontline warriors like doctors—is in the hands of all of us. This is a huge responsibility. It is very similar to ensuring safety on the roads. It is not enough that only a few of us follow the rules. Collective safety is guaranteed only if other drivers too adhere to the traffic rules.
This apart, India’s battle against covid-19 got a shot in the arm with the government announcing that even those above 18 years of age are now eligible for vaccines. The bad news is that, immediately, there are not enough vaccines to go around. The demand-supply match is on a knife edge. Exactly why the infrastructure to manage this gigantic programme to vaccinate nearly 1 billion people has to ensure both transparency and equity.
We are off to a good start with the Covid-19 Vaccine Intelligence Network (Co-WIN) platform monitoring and regulating the vaccination programme. In a must read engagement with the Indian Express newspaper, R S Sharma, CEO, National Health Authority of India, explains the architecture of this platform.
Accordingly this week I focus on the ambitious plan to vaccinate India and the lessons it holds out. Among other things it is, I believe, the one note of cheer for India. The silver lining in the cloud as it were.
Thank you Rahul Sharma for this week’s cover photo.
And thank you readers for your support. A big shoutout to Krishnendu, Vandana B, Gautam, Premasundaran and Aashish for your informed comments and amplification. And, many thanks to readers who hit the like button 😊.
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Read on
A BILLION JABS
This Saturday India will launch the third phase of its ambitious vaccination project to protect against the covid-19 pandemic, which originated in Wuhan, China. Under this phase an estimated 600 million in the 18-44 age group will be vaccinated. This is over and above the nearly 300 million above 45 years of age who are already enrolled under the programme in the second phase. Of course the vaccination programme was launched with the frontline covid warriors.
Together they stack up to a staggering 900 million people.
The project estimated to cost about Rs50,000 crore and to conclude in about two years is being billed as the most complex project ever attempted by the country. No matter which way we look at it, the country’s vaccination ambition is remarkable. Most importantly, it is my case that this is yet another masterclass by India on undertaking projects of scale powered by digital technology.
The Jab Plan
In two days, registration for the covid vaccination will begin for those who are 18 years and older. And from 1 May they too will be eligible—based on availability—for the vaccine. The roll-out will be monitored by the Covid-19 Vaccine Intelligence Network (Co-WIN) platform.
According to the Co-WIN dashboard as of now nearly 114 million people have been vaccinated.
The jab project is not going to be easy and would have been insurmountable but for the technology backbone—something that was put in place in January this year.
Keep in mind:
We are talking about a cohort of 900 million people, probably the largest in the world (given the opacity of information about China one can’t say for sure);
Each of them has to be vaccinated twice. In other words we are talking about 1.8 billion vaccines;
And given the current circumstances, there is no guarantee of a person returning to the same location for the second jab. It has to be delivered on the principle of One Nation, One Jab; anywhere, any place;
And the country is logging, at present, about 4-5 million jabs a day.
Addressing a session of the Public Affairs Foundation of India (PAFI) on 9 April, R S Sharma, CEO of the National Health Authority of India, explained that the platform has been created on an open architecture, which renders it flexible enough to adapt to any course corrections—like it happened with the government lifting the cap on the jab brands and bringing in state governments as equal partners.
“Initially we had set it up based on a supply-side strategy wherein doctors and health workers were identified and told to come to specific locations. But people weren’t turning up and the vaccines were being wasted (once taken out of refrigeration the vaccine has to be consumed fully). So we flipped this and made the system demand driven when we moved to the second phase,” Sharma told the PAFI gathering while making his case that the Co-Win platform has in-built flexibility and ability to scale.
The Aadhaar Foundation
This skill of building out an operation that can be scaled has not been acquired overnight. The seeds of this transition were sown way back in 2009 when Nandan Nilekani was entrusted by the Congress-led United Progressive Alliance with the task of rolling out Aadhaar—the 12 digit unique identity for all people residing in India.
Despite some hiccups—one of which nearly killed the project—the Aadhaar experiment was pulled off. And at the end of six years about 1.3 billion people now have an Aadhaar.
Not only did it generate the confidence that India could attempt a project of this scale it also laid the basis for the creation of information highways connecting the nearly 24 crore households in the country with the public delivery system.
Something that made it ideal for the roll out of digital services like UPI or Unified Payments Interface—a system that enables seamless, cost free and inter-operable bank payments (the average number of UPI linked transactions which has been growing exponentially now averages about 3-4 billion a month). In fact, the FinTech revolution which is underway is made possible only because of the UPI backbone and an e-KYC using Aadhaar.
Without Aadhaar the direct benefits transfer or DBTs would never have happened in a seamless manner. Beginning with the subsidy for cooking gas, it was expanded to pensions, payments for the massive rural employment guarantee scheme and most recently to effect the distress transfers to cushion the impact of covid-19 on livelihoods for those at the bottom of the pyramid. Undoubtedly it has reduced leakages by cutting out the corrupt intermediaries.
Delivering these benefits required the creation of bank accounts for a population which was largely unbanked. This process of creating the no-frills Jandhan bank account got a massive push because of Aadhaar. In just six years, the number of Jandhan accounts have grown from 12.5 crore on 31 January 2015 to 42.25 crore on 14 April this year.
By including 300 million people—the size of the US population—in the formal banking system so quickly, India has once again showcased its ability to efficiently implement projects of scale by leveraging a digital backbone.
The Next Steps
Every crisis induces a response. In the Indian context it acts like a force multiplier for policy change.
The devastation caused by the covid-19 pandemic, is forcing the government to bring forward the roll out of the National Digital Health Mission which will provide yet another digital highway connecting the various stakeholders in the healthcare ecosystem.
Sharma informed the PAFI gathering that the project, which was rolled out as a pilot in the union territories of Chandigarh, Ladakh, Dadra and Nagar Haveli and Daman and Diu, Puducherry, Andaman & Nicobar Islands, and Lakshadweep last year, is poised to be unveiled nationally.
“It will be a national grid that will ensure people have access to healthcare in ubiquitous manner. It will enable tele-consultancy, digital delivery of medicines, access to labs, health professionals. Covid-19 has taught us that we can deliver services virtually almost as effectively as we do otherwise,” Sharma said.
Simultaneously, the ongoing vaccination drive is also generating reams of health data about citizens. Provided they give consent and the government guarantees privacy (by fast tracking the pending privacy law through Parliament) this can be the foundation for generating and storing an individual’s health data on a digital platform; something that can be seamlessly accessed whenever-where ever.
In fact, Sharma hinted at this in his interaction with the Indian Express when he said, “The vaccination certificate can probably become one of your health records… With consent, we can issue unique health IDs to the person (getting vaccinated), and he has ownership of the record. Going forward, this can become one of the digital health applications.”
So at this extremely difficult moment in the country’s history there is some cause for cheer. Yes, it can be safely claimed that we could have avoided this curve ball. True. Yet, it is no small measure that the cup is still half full and not half empty. Which is not a bad place to be in, given the current circumstances.
Recommended Reading
This week also saw NASA pull off their what is being described as their “Wright Brothers moment”.
On 17 December, 1903. Orville Wright covered 120 feet in 12 seconds in an aircraft. Now, 118 years later NASA’s robotic helicopter, Ingenuity, successfully completed the first powered controlled flight on Mars. It was airborne for 59.1 seconds. Once again it was a giant leap for mankind.
In a must read piece published in Mint, Dilip D’Souza explains the enormous challenge of pulling off this feat on Mars and how the origins of this achievement can be traced all the way back to Galileo. As D’Souza explains, on Mars, unlike the Earth, the atmosphere is only about 1% as dense.
“On Earth, a helicopter rises off the surface by, fundamentally, using its rotating blades to move air about. The blades are shaped so that they are curved on top and flatter below. When the blades rotate, the air flows faster over the top of the rotor than the bottom. By Bernoulli’s famous Principle, this means there is lower pressure above the blades than underneath. This produces a suction upwards—or a “lift" to the helicopter. Spin the blades fast enough and that upward force is enough to lift the helicopter into the air. That is, helicopters need air. ”
The theory propounded by Galileo was proven by Brian Cox, the physicist in an experiment conducted in a NASA facility. I am sharing the YouTube video of this breathtaking experiment, which no doubt helped NASA crack the flight code on Mars.
Till we meet again next week. Stay safe.
The blame game and fault finding has gone through the roof. The opposition is attacking the government as if it will be now or never. The government also while defending itself is firing on all cylinders in assigning the blame on the opposition and the states being ruled by them. The acrimonious exchanges appear to be more important than tending to the sick and dying. Fortunately, certain key people are concentrating on planning and executing the required relief. The need of the hour is to pool resources and experience to tackle the situation. I hope it is not too late before good sense prevails and humanitarian feelings prevail over greed for power and money. As usual Anil you have identified the crucial need of the hour. Keep up the good work.
Every newspaper seems to have a slew of commentators who commentate on everything under the Sun. Covid-19 is their current pastime. As usual they point out the flaws in the way the Government and of course the ruling party have handled the pandemic. Somewhere in the narrative is just wee bit of a hint that the ruling party is incompetent and things might have been better under some other dispensation. None has a suggestion how things can be improved from now onwards.
At the risk of joining the same ranks (albeit not being a professional commentator, I may be excused, please) I would like to say the following:
1. It is a fact that the bureaucracy of the country, but for some honourable exceptions, has failed miserably. The fault may lie with the Political leadership in Ministries which possibly tried to play the Chief Executive in every field but more so with the bureaucrat who yielded this space over the past decades and abdicated the responsibility for which they were bred in the system.
2. The sheer disdain for experts that has been visible in every field and the need to dominate all spaces where the Politician does not enter has resulted in our administrative system being woefully ill-equipped to handle such emergencies.
3. It won't be correct to ascribe our inability to handle this pandemic to its once in a century frequency. The administration has to war-game such situations and develop protocols for such events which can be suitably modified around a basic structure of responses and proactivity.
4. While the emergency action on containing the 2nd wave would need to continue apace, the time is more than ripe to create an action plan to prevent, or at the worst, limit the 3rd wave. Enough learning has occurred from the first two waves to develop a strategy and not only tactics for such approach.
5. Relying on Political leadership to provide guidance in what is essentially in administrative domain should be given a go-by. There is enough talent and experience and good intent available in the system to take this initiative on war-footing right now.