Cluster Vaccination Approach - Uttar Pradesh

Introduction 

As of September 25, 2021, Uttar Pradesh (UP) had emerged as the fastest state in India to administer COVID-19 vaccine doses. On that date it became the first state to have administered 100 million doses, and more than 50 percent of the eligible population in the state had gotten at least their first dose of the COVID-19 vaccine.¹ In September 2021, the state recorded administering an average of 1.2 million COVID-19 vaccine doses per day. The state administered over 3.8 million COVID-19 vaccine doses on September 27, 2021, which is the highest ever vaccination achieved by any state of the country in a day.

By December 12, the state had administered more than 177 million COVID-19 vaccine doses. Across UP, about 119 million people were inoculated with at least one dose and about 58 million people with both doses.²  

Vaccination has been a huge task for the Uttar Pradesh government, with its population of 136 million eligible people – especially because more than 50 percent of them reside in widely dispersed villages rather than more easily reached towns and cities. 

UP launched its COVID-19 vaccination program in January 2021.³ By the end of June, 20.6 million people (15 percent of the population) in the state had received at least one dose, and 4 million people (3 percent of the eligible population) had received both doses.² The pace of vaccination yielded only about 400,000 vaccine doses per day. At this pace, the state could not achieve its target of vaccinating the entire eligible population by December 2021.⁴

Based on this sobering reality, Chief Minister of Uttar Pradesh Yogi Adityanath decided to set a more ambitious target of administering 1 to 1.2 million vaccine doses per day from July 2021 onward. 

To meet this challenge, the government of Uttar Pradesh adopted a cluster vaccination strategy: a unique combination of “near home” vaccine delivery, streamlining registration, and dedicated social mobilization.^4,5 The success of the vaccination drive in UP can be attributed to the cluster vaccination approach adopted by the state health administration.¹

What are the lessons learned from this bright spot? 

Create an efficient environment

The cluster vaccination approach aimed at scaling up the vaccination drive in the state. This strategy intensified vaccination activities in targeted geographical areas. Every block in all 75 districts of the state is divided into clusters based on the number of beneficiaries, geographical spread, and human resources available for vaccination. Each cluster comprises 8 to 10 revenue villages (villages with defined borders). Intensified vaccination activities are conducted in phases, starting with four clusters per district, to saturate each cluster so that nobody gets left behind within each cluster.^4,5,7

“The beauty of this model is that instead of waiting for the people to come forward for vaccination, it will be calling out to the eligible persons on its own. This (strategy) has worked very well with UP on several counts, especially in polio eradication.” — Navneet Sehgal, Additional Chief Secretary, Information⁴

Create an enabling environment

The model has addressed numerous identified concerns such as vaccine hesitancy, logistical issues like distance from home to vaccination centers, dependency on someone for transportation, and lack of trusted sources of information. For example, the state health administration created a communication team to debunk public myths about vaccines and encourage people to get their vaccines.⁴

The model also eases the vaccination experience for villagers. Vaccination camps are held within village centers instead of in a variety of nearby places. The model addresses any digital illiteracy by eliminating online registration steps. Further, arrangements to address adverse events following immunization are put in place, in the form of quick response teams and deployment of advanced life support ambulances for transportation in case of a crisis. The model addressed all the issues such as vaccine hesitancy, logistic issues like distance from home to vaccination centers, dependency on someone for transportation, lack of resources, etc. and was able to pace up the rate of vaccination in the state.⁴

How was this promising practice implemented?

Ran a pilot stage of the program

A preliminary test of the strategy occurred between June 17 and June 26, 2021, in four clusters across one-third of all development blocks in each of the 75 state districts. A team visited each village to vaccinate residents. The list of eligible people was drawn from the electoral list, and each eligible person was given a call slip, including the location and date of vaccination. The outcome of the dry run was reviewed to minimize glitches when the formal drive started in July 2021.^7,8,9

Meanwhile, Sh. Amit Mohan Prasad, Additional Chief Secretary, Health and Family Welfare, Government of UP instructed all districts to earmark clusters and produce required lists, including that of eligible persons, available health staff, and so on, making all necessary preparations to roll out the cluster vaccination strategy across all blocks statewide.⁹

Formulated micro plans to achieve targets 

The strategy prescribed devising micro plans for vaccination at the sub block level to saturate units within given periods of time, using the electoral rolls to obtain lists of the qualified vaccine recipients in a continuation of the phased pilot program. The micro plans included identifying any eligible candidates remaining from earlier rounds and using communication teams to convince them of the benefits of vaccination.^4,10

Addressed vaccine hesitancy and build confidence

Each cluster has a micro-communication plan for spreading awareness. The public awareness campaigns were conducted among villagers for three days before the vaccination days, to address vaccine hesitancy and dispel myths about COVID-19 vaccines. Awareness teams include heads of villages, teachers, and accredited social health activists (ASHAs) and Anganwadi workers. As part of this effort, local influencers who had been vaccinated were asked to encourage people.^4,7

Pooled resources

The health department compiled a list of human resources that were available for immediate deployment. It also constructed a plan to work efficiently in districts with lesser resources.⁴

Eliminated the digital divide

Illiterate people and those unfamiliar with technology found it difficult to register themselves for vaccination. The state administration reduced this digital divide by eliminating registration steps for vaccination by setting up physical registration camps and creating eligibility lists.⁴

 “Earlier, booking a slot was a major concern. But now walking drives are more comfortable for the people. Increasing the number of booths and special camps at the block level have majorly contributed to better performance of the state. The government should now vaccinate everyone as soon as possible.” — Mohammed Irfan, 26-year-old vaccine recipient, Uttar Pradesh¹

Supplementary material

Cluster Vaccination Approach - Uttar Pradesh.pdf

Sources

1. Mishra A. Uttar Pradesh becomes first state to vaccinate 10 crore people. India Today. Updated September 25, 2021. Accessed October 5, 2021. https://www.indiatoday.in/coronavirus-outbreak/story/uttar-pradesh-becomes-first-state-to-vaccinate-10-crore-people-1857247-2021-09-25
2. CoWin Dashboard. Uttar Pradesh. Accessed December 12, 2021. https://dashboard.cowin.gov.in/
3. Statista. Cumulative number of COVID-19 vaccine doses administered across states and union territories in India as of December 5, 2021. Revised December 5, 2021. Accessed December 12, 2021. https://www.statista.com/statistics/1222266/india-cumulative-coverage-of-covid-19-vaccine-across-india/
4. Sharda S. Uttar Pradesh’s Cluster Model promises ease of vaccination in villages. Times of India. Updated June 18, 2021. Accessed September 30, 2021. https://timesofindia.indiatimes.com/city/lucknow/ups-cluster-model-promises-ease-of-vaccination-in-villages/articleshow/83621530.cms
5. TNN. Communication holds the key to last-mile vaccination. Times of India. July 29, 2021. Accessed October 4, 2021. https://timesofindia.indiatimes.com/city/lucknow/communication-holds-the-key-to-last-mile-vaccination/articleshow/84842584.cms
6. United Nations. UN agencies supporting mammoth India COVID-19 vaccine rollout. Published January 19, 2021. Accessed December 13, 2021. https://news.un.org/en/story/2021/01/1082452
7. Mishra A. Uttar Pradesh to begin vaccination using cluster approach in rural areas. India Today. Updated June 18, 2021. Accessed September 30, 2021. https://www.indiatoday.in/india/story/uttar-pradesh-to-begin-vaccination-using-cluster-approach-in-rural-areas-1816373-2021-06-18
8. TNN. Uttar Pradesh: Cluster approach to scale up vaccination drive next month. Times of India. Updated June 15, 2021. Accessed September 30, 2021. https://timesofindia.indiatimes.com/city/lucknow/cluster-approach-to-scale-up-vaccination-drive-next-month/articleshow/83525806.cms
9. TNN. Uttar Pradesh govt begins dry run of new vaccine strategy. Times of India. June 18, 2021. Accessed September 30, 2021. https://timesofindia.indiatimes.com/city/lucknow/uttar-pradesh-govt-begins-dry-run-of-new-vaccine-strategy/articleshow/83624021.cms
10. Sharda S. Uttar Pradesh’s vaccination drive to hit top gear with new plan to reach out to recipients. Times of India. Updated June 12, 2021. Accessed October 4, 2021. https://timesofindia.indiatimes.com/city/lucknow/ups-vax-drive-to-hit-top-gear-with-new-plan-to-reach-out-to-recipients/articleshow/83446377.cms