Accessing COVID-19 vaccine is logistically difficult for the old and sick
It was an average day at the vaccination centre at AIIMS in Delhi. There were hundreds of people but they moved around in orderly fashion, directed by the volunteers and the security guards.
Among those waiting for the vaccination, were the elderly who became eligible for the vaccine on March 1. Some of them walked with sticks, others came on wheelchairs. Nearly all were accompanied by a family member. They were lucky.
According to the Longitudinal Ageing Study in India (LASI) report, some 20.3 per cent of people above the age of 60, have no one to take care of them other than their equally aged spouse. Another 5.7 per cent of this age group live totally alone.
It must be very difficult for this group to get vaccinated for two major reasons. One, many of them are not mobile and reaching vaccination centres would be a problem.
The second reason is that the vaccines lead to side effects such as fever, body pain and tiredness for two-three days. For a single person over 80 years of age, for instance, life would be impossible for a few days. It would be difficult even for the couples who would both be sick if they decided to get vaccinated together.
The elderly have been affected the most by the pandemic and have been prioritised for vaccination to reduce mortality. But how do we get these old and vulnerable vaccinated?
There were some talks about door-to-door vaccination in Maharashtra, which is going through a surge in cases, but this idea was discarded as the vaccinated person has to be observed for half an hour for adverse effects.
So, what is the solution?
India’s vaccination drive against the SARS-CoV-2 virus is based on the country’s experience with managing elections. In the last general elections in 2019, some 610 million people voted.
But getting people vaccinated is not exactly similar to voting. For example, during elections, party workers visit each house and often ferry the old to the voting centre in cars and then drop them back. The mobile elderly can easily walk to the centre which is near their houses.
This is what we need to reproduce if we want to get this group vaccinated. This would require a small team of health professionals at the neighbourhood voting centre. The old people can easily wait out the 30 minutes of observation period in a familiar environment. Social workers can be stationed in the area for the rest of the day to help people.
Getting old people vaccinated is a long-standing issue that needs to be addressed. In California, the flu vaccination rate for adults in 2015-16 was only 39 per cent compared to the goal of 70 per cent. The reports from the United States of America for COVID-19 vaccine are disconcerting. Being internet-savvy is prerequisite for booking a slot.
While it is obvious that a better system is needed, it has not been addressed so far. The British Geriatrics Society suggests that people with limited mobility should be vaccinated at home or at their local doctor’s clinic.
In Israel, where around 60 per cent of the population is vaccinated, the responsibility for reaching the elderly was clearly defined. For example, the responsibility for vaccinating nursing home residents was assigned to the country’s national medical emergency services organisation. The recipient knew who was responsible for vaccinating them.
There are lessons for India’s policy makers and the country’s young population. The country’s elderly today did not face environmental triggers for lifestyle diseases as the young face now. They did not consume junk food and were more physically active.
The young have to make the right lifestyle choices to ensure that they are healthy at old age. The policy makers have to facilitate this for the young.
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