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Covid vaccination at doorstep for elderly, those at greater risk

Showing its concern for senior citizens, the Bombay High Court asked the centre if it was possible to inject them at home. It took the example of Los Angeles and Israel.

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On April 22, the Bombay High Court asked the government to relook its policy of not allowing door-to-door vaccination for Covid-19, saying the facility should be considered for senior citizens. The High Court was hearing a petition filed by lawyers Dhruti Kapadia and Kunal Tiwari, seeking a direction to the centre to allow home vaccination. The municipal agency in Mumbai has also asked for this facility to be made available as soon as possible.

The division bench of Chief Justice Dipankar Datta and Justice GS Kulkarni observed that if a policy denies an elderly person home vaccination because of their delicate medical condition, it must be viewed as arbitrary and unreasonable. Further, the Court said that elderly persons and persons with co-morbidities may face more risks if they are asked to step out to get vaccinated. Even at vaccination centres, Covid-19 protocols may be unintentionally compromised as huge crowds gather.

The centre’s affidavit opposing the petition for home vaccination was filed by Health Ministry Undersecretary Satyendra Singh. The affidavit said that in case of any Adverse Event Following Immunisation (AEFI), case management may not be proper and there would be a delay in reaching health facilities. Further there are many challenges in maintaining protocol of observation of the beneficiary for 30 minutes after vaccination. Besides, the vaccine will be taken in and out of the Vaccine Carrier for each vaccination, there­by increasing the chances of contamination and exposure beyond the recommended temperature. This could affect vaccine efficacy and cause AEFI, alleged the affidavit. It also said that there could be high vaccine wastage due to the increased time in going from door to door and following protocols for physical distancing and infection prevention.

However, the Bench observed that new generation ambulances with ICU facilities were now available. “It is difficult to assume that ambulances fitted with refrigerators to maintain the recommended temperature are not available and, therefore, the efficacy of the vaccine would be compromised,” it said. The Court referred to Los Angeles where people were being vaccinated while sitting in their cars and Israel, where a majority of the population had been vaccinated. “Children and old people should be taken care of, they should be are our first priority. It should not be the reverse. We see them being given priority only at the airport, owing to international standards,” the Court said.

Incidentally, on April 21, the Bombay High Court pulled up the Maharashtra government for not complying with its earlier order directing the supply of 10,000 vials of Remdesivir, the anti-viral drug, to Covid-19 hospitals in Nagpur. The Nagpur bench noted that it was ashamed to be a part of this “nasty and evil society” and was unable to do anything for the coronavirus patients of Maharashtra.

On April 19, a meeting chaired by Prime Minister Narendra Modi decided to allow Covid-19 vaccination for everyone above 18 years from May 1. It was also decided that vaccine manufacturers would supply 50 percent of their monthly doses to the centre and be free to supply the remaining doses to state governments and in the open market. Manufacturers were asked to make an advance declaration of the prices for state governments and in the open market before May 1.

The centre has said it will continue to provide free vaccines at government hospitals for healthcare and frontline workers, and those over 45. The vaccines will be provided to states based on criteria such as active cases, delivery speed and wastage.

Former Health Secretary K Sujatha Rao has criticised the government’s decision to permit open market sales of the vaccines before India got sufficient supply of the vaccines. She tweeted on April 20: “The vaccine policy announced yesterday is completely biased towards pharma companies. It has neatly shifted the confusion and chaos that will emerge from May 1 away from itself and towards the state governments to answer. Never seen such abdication of a fundamental duty.”

She said the MEA (Ministry of External Affairs) has to take up this issue on an emergency basis and help companies get over these issues. There will be a time lag before the supply in sufficient quantities kicks in. The worry is that without waiting for the supply, we are creating the demand by making 18+ age groups also eligible, she said.

Rao said the procurement of vaccines by states is not a good idea and the central government must rethink its decision. She feared that states would now tend to divert scanty resources towards funding vaccines, money that could instead have been used for boost up much-needed health infrastructure.

Till now, only healthcare and frontline workers, and those above 45 were eligible for vaccination. The centre has been purchasing vaccines manufactured locally by Serum Institute of India (Covishield) and Bharat Biotech (Covaxin) and was distributing them to states to administer. These vaccines are available free at government hospitals, whereas private hospitals can charge up to Rs 250 per jab.

It is ironic that while on January 2021, UN Secretary-General António Guterres had proclaimed that India’s vaccine production capacity was the best asset the world has, the country itself is running short of vaccines. According to health officials, India has administered 1,41,911,223 vaccine doses across the country as of April 25, 2021.

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According to the MEA, India had exported 66 million doses of vaccines to 94 countries as of April 22. Of this, only 10.61 million were grants; the remainder had been exported by SII. The current vaccine manufacturing strategy relied mainly on manufacturers’ ability to efficiently switch their seasonal influenza vaccine manufacturing capacity into producing Covid-19 vaccines.

—By Shivam Sharma and India Legal News Service

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