key: cord-1023614-itt7kmkg authors: Sharma, Priyanka; Pardeshi, Geeta title: Contextualization of the trends in number of beneficiaries vaccinated at a COVID-19 vaccination centre in Delhi, India date: 2022-05-10 journal: nan DOI: 10.1016/j.dialog.2022.100012 sha: 02eaa4d45bf0cfb8c2290e151b989f6bc921d4be doc_id: 1023614 cord_uid: itt7kmkg Background and aims India started vaccination against COVID-19 on 16th January 2021. Present study was conducted to describe the trends in the number of beneficiaries vaccinated at a tertiary care hospital in India against the dynamic background of changing contextual factors. Methods This was a descriptive records-based study conducted at one of the COVID vaccination centre from January 2021 to June 2021. Data on dose-wise daily number of beneficiaries in various categories were collected and analyzed using Excel. The website of the Ministry of Health and Family Welfare (MoHFW), India, press releases and news reports of major media houses were reviewed. Results The peaks observed in number of beneficiaries vaccinated were mainly due to opening up of program for new categories of beneficiaries in a phased manner, announcements made to complete the vaccination coverage within a stipulated time for some categories and publication of trial results by vaccine manufacturers. The dips could be attributed to essential requirement of certain documents, major festivals, disastrous second wave and resulting lockdown in state. Conclusion The time-trend may not remain uniform across the course, but can be predicted in advance to some extent by analyzing past trends. Minimizing the avoidable dips and peaks and managing the unavoidable ones will help in improving the service delivery and beneficiary satisfaction. Final approval of the version to be published; AND Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Dr. Priyanka Sharma I confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. India is amongst the few countries which rolled out vaccine against COVID-19 in mid-January 2021 in a phased manner and administered over 130 crore doses till date. However, the trend in vaccination didn't remain same throughout the program owing to various factors including second wave and policies. We have tried to incorporate the timeline of these contexts along with trends observed in vaccination at one of the vaccination centre in the country. Observing the trends can help in future forecasts and better preparedness for increase or decrease in vaccination coverage. This manuscript is suited for your journal as it will help in guiding the policy makers in devising future guidelines for COVID vaccination program and will aid in other similar ventures. This will also be helpful to other low and middle income countries to learn from our experience and implement strategies for successful vaccination program. Coronavirus disease , caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has crippled the countries across the globe. Most commonly identified symptoms of COVID-19 are fever, altered sense of taste and/or smell, cough, sputum, sore throat, dyspnea, myalgia and fatigue. The main modes of transmission for SARS-CoV-2 are through direct contact and droplet route while airborne transmission has been recognized during aerosol generating procedures in healthcare settings. [1] To fight against COVID-19, a race against time started to develop and roll out the vaccines for protection against COVID-19. India started one of the world's largest COVID-19 vaccination program in phased manner from 16 th January 2021. The eligibility criteria were expanded from healthcare workers (HCWs) to first include frontline workers (FLWs), and then elderly and adults. The government issued guidelines regarding the number of beneficiaries to be vaccinated at each site, and infrastructure and manpower requirements [2] . But the immunization programme faced many challenges. The demand supply gap in vaccine production, problems in planning leading to mass gatherings at vaccination centres, technical issues, emergence of new variants of the virus, misinformation and myths about vaccine fueling vaccine hesitancy, etc. were the major challenges and they kept evolving with time. In this paper, we describe the trends in the number of beneficiaries vaccinated at a tertiary care hospital in India against this dynamic background of changing contextual factors. Reviewing the pattern and putting it in context will help us in suggesting recommendations for further expansion of the program and in similar pursuits in future. This could also aid J o u r n a l P r e -p r o o f other low and middle income countries in designing their policies for vaccination of eligible population. This was a descriptive records-based study conducted at one of the COVID-19 vaccination centre (CVC) of Delhi, India from the month of January 2021 to June 2021. We collected data on dose-wise daily number of beneficiaries in the following categories -HCWs, FLWs, senior citizens, and people in age group of 45-59 years. We reviewed the website of the Ministry of Health and Family Welfare (MoHFW), India, press releases and news reports of major media houses to identify the contextual factors. Minister of India urged HCWs and FLWs to take vaccine and not believe myths and misinformation [5] . However, at national level, no peak was observed in first dose trends during same duration. (Supplementary figure 02) [4] The next peak occurred between 6-12 th March mainly due to peak in first dose of HCWs. Therefore, the number of days available for vaccination as well as number of beneficiaries increased causing upsurge in number of beneficiaries between 3 rd to 16 th April. The peak was observed among general population from 3 rd to 9 th April and among HCWs and FLWs from 10 th to 16 th April. (Table 01 and Vaccine supply became erratic and reports of vaccine shortage started surfacing in media. [13, 14] The centres offering vaccination to both 18+ and 45+ must have faced overcrowding. The peaks resulted in increased waiting time for beneficiaries, overcrowding at session sites [17] leading to compromised COVID appropriate behavior, increasing the risk of The first dose was discontinued for all the eligible beneficiaries from 18 th May, causing the dip from 15 th May onwards. [19, 20] The dips in number of beneficiaries resulted in wastage of resources in terms of infrastructure, facilities and manpower deployed. These dips could have been avoided by ensuring regular supply of vaccines, and consistency in guidelines as frequent changes caused confusion about eligibility for vaccination. The trends in first dose vaccination resulted in similar trends for second dose after 28-30 days. (Figure 02 ) Erratic vaccine supply ensuing days with no vaccination is also responsible for the dips observed in second dose trends. The peaks and dips in total doses administered in a day could have been avoided by analyzing the first dose trends and accordingly adjusting dose-wise available slots on Co-WIN portal. ( Figure 03) The trends might not stay similar across the course due to various contextual factors, but can be predicted in advance to some extent by analyzing past trends. Minimizing the avoidable J o u r n a l P r e -p r o o f Tables Table 01. Week-wise distribution of peaks in number of beneficiaries in different subgroups for first dose. Aerosol transmission of SARS-CoV-2: The unresolved paradox Vaccines Operational Guidelines. Ministry of Health and Family Welfare, Government of India India's COVID-19 vaccination drive: key challenges and resolutions Winning over COVID-19. Ministry of Health and Family Welfare, Government of India Dr Harsh Vardhan appeals to the Medical Community and Frontline Workers to come forward and take the COVID19 Vaccine Both the Vaccines cleared by the country's Drugs Controller General are Safe and Immunogenic". Ministry of Health and Family Welfare, Government of India Guidance note for COWIN 2.0. Ministry of Health & Family Welfare, Government of India Bharat Biotech Announces Phase 3 Results of COVAXIN®: India's First COVID-19 Vaccine Demonstrates Interim Clinical Efficacy of 81% Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBV152: interim results from a double-blind, randomised, multicentre, phase 2 trial, and 3-month follow-up of a double-blind, randomised phase 1 trial AstraZeneca blood clotting fear: What's wrong with Covid vaccine? Business Today Update on COVID-19 Vaccination. Vaccination to be offered on ALL DAYS of April month at all Public and Private COVID Vaccination Centres, including gazetted holidays. Ministry of Health and Family Welfare, Government of India AstraZeneca's COVID-19 vaccine: EMA finds possible link to very rare cases of unusual blood clots with low blood platelets. European Medicines Agency MoHFW on clarification of vaccination of HCWs and FLWs. National Health Mission. Department of Health & Family Welfare. Ministry of Health & Family Welfare, Government of India Vaccine shortage dents India's coronavirus adult immunisation drive Vaccine shortages blight India's efforts to contain Covid crisis. The Guardian Smooth sailing to fights in queues: Delhi sees it all as the 18+ turn up for Covid shots. The Print Liberalised Pricing and Accelerated National Covid-19 Vaccination Strategy. Ministry of Health and Family Welfare, Government of India India faces a challenge with its mass vaccination efforts Government of NCT of Delhi Walk-in for 1st dose of Covaxin for 45+ halted in Delhi. The Time of India Vaccination Latest News Today: Delhi government STOPS Covaxin vaccination for those aged 18 to 44 due to shortages, very little stock left for those above 45 years Acknowledgements: None.The manuscript has been read and approved by all the authors, the requirements for authorship have been met, and each author believes that the manuscript represents honest work.