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Vaccination is key in controlling the spread of the COVID-19 that is ravaging the world. Getting all people vaccinated is an ideal situation, which might never see daylight in developing economies and low-income countries. Not only there are bottlenecks in obtaining the vaccine for all amid very serious supply issues, but there are also other issues like vaccine hesitancy and huge numbers of anti-vaxxers as well as a need for efficient system to administer, deliver and enable everyone to have access to the vaccine. These are factors for low COVID-19 immunization levels in countries with limited resources.

National Command Operation Centre of Pakistan aims to vaccinate 70 million people by the end of this year; statistics show that 3 million citizens were partially vaccinated, and 1.5 million were fully vaccinated in the country by the end of May 2021. A formidable task lies ahead. While developed countries have resources to test strategies for mass inoculation, they cannot resort to trial-and-error methods because of limited resources and inadequate health facilities. So, what’s needed is a framework and a medium-term strategy (spanning a year or two) to immunize the people against COVID-19.

If Pakistan wants to vaccinate 70 million population, it needs a well thought out plan and government intervention to take the process forward. Identifying what stage of vaccination rollout, a country is at; plays a key role in determining the policy objectives of vaccination drive. These objectives could be inspired by CDC’s Global Immunization Strategic Framework 2021-30 which is based on the vision where everyone in the world is protected from vaccine-preventable diseases (VPD), disability, and death; or more appropriately it could be driven by a mix of global and local objectives to fight the COVID-19 pandemic.

The current situation is very fluid worldwide with many uncertainties and bottlenecks. Limited availability of vaccines is creating unwanted postponement in vaccination drives in countries, while on the other hand, vaccine hesitancy is also creating a blockade in achieving the results. And then, effectiveness and protection from vaccines remains unclear. In such a dynamic environment, vaccination strategies could be more effective if based on what a country wants to achieve at a certain point in time - i.e., highlight its objective.

While there are many discrepancies in the whole vaccine administration and process in Pakistan ranging from unclear supplies in the future to inability to create a demand, the process has very much followed a staggered objective approach. Initially – based on the supplies and the panic COVID-19 had created as well as initially insights of the virus affecting aged people more – the strategy was largely about vaccinating adults. This was updated to a staggered approach moving from adults to a lower age bracket population to reduce the overall reduction of overall COVID-19 mortality and hospitalization rates. Now the government has started vaccination for citizens above 18 where the larger goal is likely the maximum reopening of the society subject to the availability of vaccines. Another reason for the staggered approach adopted by NCOC is reportedly the slow uptake and vaccinations despite the availability of stocks.

With vaccination now open for all age groups above 18 years, the focus of the government and NCOC must be to make immunization drive fast and efficient; and most importantly it must work towards increasing acceptance and demand for vaccines as much as the supplies allow.

Globally, vaccinations campaigns are also offering opportunities for digitizing and documenting tracking and monitoring vaccinations. Pakistan’s performance against this metric is commendable as the digitization of NADRA has played a pivotal role. This could further be enhanced with expertise in accountability in COVID vaccination certificates. There are also some general approaches like iterative planning, community leaders’ engagement, supply chain management, and training of medical staff and nurses etc. However, what is needed is a customized approach that looks at the country’s shortcomings.

The challenge is to address vaccine hesitancy and low demand. PIDE’s Policy Framework for Vaccinating All highlights some important measures that could instill vaccination among the masses. These include linking Ehsaas cash transfer instalment with mandatory vaccination to increase demand for vaccination among rural and poor communities. Then there are recommendations for mandatory 100 percent vaccination of government employees, private sector businesses, and service sector employees. Also, proposals for compulsory vaccination certificate for new entrants in universities; vaccine for international migrant families without proper documents; covering the out-of-pocket expense for the poor and those from far flung rural areas have been mentioned. Also tackling of positive and negative campaigns is a proposed policy action for improving demand for vaccination.

Besides these, the enforcement of vaccination could be based on mandatory requirement for public places and public offices, railway stations and airports – areas that see maximum number of people gathering on a daily basis. Retail sector that has developed some expertise in enforcing masks and other SOPs can play a role in driving vaccination demand as well. A framework must be devised on paper and be put up for stakeholder consultation to gain maximum support.


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