Are you vaccinated correctly? - Addressing the concerns surfacing over COVID-19 vaccination in India.

Dear Editor,

With great interest, we read the original article titled “Assessment of the knowledge, preferences and concern regarding the prospective COVID-19 vaccine among adults residing in New Delhi, India–A cross-sectional study” published in your esteemed journal, contributed by Islam et al.[1] in July 2021. We would like to throw light on additional concerns that have surfaced with respect to vaccine administration, and we have proposed a few strategies for the same.

The first problem staring at us is people getting two vaccine shots on the same day by mistake, either with the same or different kind of vaccine. Such incidents have been reported in several states including Bihar and Uttar Pradesh.[2]

Generally, the administration of an extra dose of the same or different kinds of COVID-19 vaccine can occur under several scenarios:

(1) Due to systematic and technical errors (e.g., healthcare providers, inadequate documentation, or patient recall errors).

(2) The rush of patients in a healthcare facility may overwhelm the staff and lead to unwitting administration of extra doses to vaccine recipients.

(3) When vaccinating individuals with a doubtful vaccination history, especially in the case of tribals with missing records and unknown immune status.[3]

Avoidance of such an error is necessary because, in the future, we may have many other vaccines at our disposal. Their composition may vary and there may be complications associated with wrong administration due to the interchanging of vaccines. For instance, in addition to COVAXIN and COVISHIELD vaccines, our government gave the nod to the Sputnik V vaccine for emergency use. It is developed by the Gamaleya Research Institute, part of the Russian Ministry of Health. It is composed of two doses, each with separate adenovirus strains.[4] Any change in this vaccine dosing or interchanging it with another vaccine may lead to lower efficacy.

Additionally, fraudulent COVID-19 vaccination campaigns have surfaced. In June 2021, around 2,000 people from Mumbai and over 500 people from Kolkata have been victims of such fraud. The recipients in both cases were given fake vaccine doses and they did not receive any acknowledgement communication from CoWIN, India's IT platform for the vaccination drive. The Union Health Ministry reached these states and is yet to arrive at a strategy to manage the vaccination of these victims.[5]

Strategies

Separate vaccination centres for different types of vaccines. For example, each centre should have only one type of vaccine, even separate centres for the two doses of Sputnik V.

Separate areas for waiting and observation post-vaccination in each centre. This would ensure that no mix-up can occur among the vaccine recipients.

The vaccine recipient must have a denoting/identification marker. For example, a bandage over the vaccine site on the arm.

Steps to be taken for proper data management and effective internet traffic with CoWIN server capacity upgrade.

Making sure that vaccine recipients do not leave the vaccination centre until they have received the acknowledgement communication from CoWIN.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.