The Bhubaneswar Model: Achieving Vaccination Coverage at the City Level

Introduction

The second wave of COVID-19 between April and June 2021 wreaked havoc across India, with the country registering 400,000 cases and 4,000 deaths in total.1 This was almost four times higher than the peak number of cases and deaths in the first wave. In the Odisha city of Bhubaneswar, the number of active cases rose from 75 to 12,852 between March 13 and May 23 2021.2,3 The rapid rise in the number of cases concerned the Bhubaneswar Municipal Corporation (BMC) and put the city’s health infrastructure under considerable stress. 

In March 2021, when the BMC started the vaccination drive for those aged 60 and above, the city had set up 22 vaccination centers.4 Seeing the rise in cases between March and May, however, the government of Odisha and the BMC adopted a more aggressive vaccination strategy to develop herd immunity and protect the citizens. The BMC added a further 31 centers by June, both mobile and drive-in. 

It took four months of dedicated efforts and vaccination drives to numerous vulnerable segments of the population before Bhubaneswar became the first city in India to fully vaccinate its eligible adults ahead of a possible third wave.5 As of August 11, 2021, the BMC had administered 1,993,961 doses against the targeted 1,742,000 across all eligible age groups.6 Pregnant women, elderly people without access to transportation to vaccination centers, bedridden and terminally ill patients, along with other vulnerable groups that were excluded in the initial phases of the vaccination drive, have also been prioritized since July.7

How Can You Replicate or Adapt This Promising Practice?

Plan and implement based on milestones and priority groups

The BMC set periodic benchmarks for vaccination, identified the highest priority groups, and established a task force to drive the accomplishment of targets. They optimally used the national age-based vaccination phases rolled out by the government for maximum vaccination. During March and April 2021, the BMC quickly ramped up vaccination, focusing on the elderly population (aged 60 and above), to maximize coverage. As a result, when people between 18 and 44 years of age became eligible for vaccination in May, the focus could shift to them. The BMC simultaneously conducted special vaccination drives for at-risk populations such as delivery executives, hotel and restaurant staff, homeless people, terminally ill patients, bedridden patients, older adults without access (supplying pick-up and drop-off service), and at-home vaccination facilities. The BMC also planned for contingencies such as monsoons, the Yaas cyclone, and a possible third wave of COVID. 

Use available resources strategically

At the core of the BMC’s success in vaccinating 100 percent of the eligible population is the foresight and preparation with which they leveraged the resources available to them. During the national vaccine shortage in June, after the 18-to-44 age group became eligible for vaccination, the BMC diverted the existing stock of Covaxin sanctioned by the center for people above 45 to those in the 18-to-44 age group. This was possible due to extensive ramp-up of the vaccination during the first phase and reduction in the number of people over 45 years old seeking vaccination. Toward the end of the second wave, they could focus on the 18- to 44-year-olds who were showing up for vaccination.4 The BMC also leveraged the support of all its officials in carrying out daily monitoring of vaccination centers,8,9 mobilizing priority groups for vaccination,10,11 and campaigning to tackle vaccine hesitancy.12 

Create awareness to tackle vaccine hesitancy

The BMC’ communication strategy was to make vaccination-related information straightforward and easy to access. The BMC leveraged social media channels, print media, and electronic media to disseminate vaccination-related information. The civic body also engaged its local officials in their awareness campaigns against vaccine hesitancy and mobilization for vaccination.13,14 These measures helped increase awareness of the vaccination campaign and ensured buy-in from the community. 

What are the lessons learned from this bright spot?

When the BMC started the vaccination drive in March, the second wave of COVID-19 in India had begun. By mid-April, the second wave had hit Bhubaneswar, with an even higher rate of transmission than that of the first wave.15 Bhubaneswar alone was contributing 10 percent of the total caseload in the Khorda district of Odisha.16 The health infrastructure of the city was under considerable stress, despite the government’s efforts to increase available infrastructure, such as ICU facilities and hospital beds.7

The BMC was faced with the difficult mandate of vaccinating 100 percent of the eligible population to avoid the massive surge in COVID-19 cases that was seen in other Indian cities. Their strategy to fully vaccinate its eligible population had five key elements: 

  • Strategic foresight in the planning and use of available resources: Bhubaneswar was among the only cities that decided to rely entirely on Covaxin, a domestically developed vaccine, to vaccinate the eligible population. The BMC opted for Covaxin over Covishield, the locally manufactured version of the AstraZeneca vaccine. Covaxin had a shorter dose gap (28 days) and a steady supply, whereas Covishield had shortage issues and triple the dose gap (84 days). However, the BMC prioritized using Covishield for students moving to overseas universities, given its global approval.17
  • Identification and inoculation of priority population and groups: Alongside vaccinating health care workers and frontline workers, the BMC identified additional priority groups. People who regularly come into contact with consumers are at a higher risk of infection. Groups such as delivery persons and hotel and restaurant staff were rapidly vaccinated in separate facilities set up for them.18 The BMC forged partnerships with businesses that fall under the at-risk category, such as Swiggy, Zomato, Uber, Bluedart, Hotel & Restaurant Association of Odisha, and the Odisha Computer Application Center, to carry out the special vaccination drives.19
  • Use of multiple media and routes to maximize reach: To make vaccines accessible to everyone, the BMC set up various types of vaccination centers. Bhubaneswar had a total of 55 vaccination centers: 30 ward-level primary health centers and community centers, 10 drive-in vaccination centers, and 15 mobile vaccination centers.2 To vaccinate at a consistent speed and also offer suitable options, the BMC set up the drive-in centers at community gathering places such as shopping malls,20,21 schools, and colleges.22 Furthermore, after operating through a registration-only process, in June 2021 BMC opened up walk-in vaccinations for people who had received the first dose but were awaiting the second dose to speed up vaccinations.23 In the following month, walk-in vaccinations for people who had not received their first dose was also initiated.24 This measure was taken particularly to cater to people who could not register or book slots online. 
  • Prioritization of underserved populations: The BMC identified underserved and marginalized populations that required special intervention, setting up special vaccination drives accordingly. The BMC set up specific drives for the transgender community of Bhubaneswar, for people residing in slums, older adults, and persons with disabilities, among others. For the elderly population (those above 80 years of age) and terminally ill patients, at-home vaccination facilities were made available through online or call center registration.25,26  The BMC allocated two days a week especially for vaccinating pregnant women to reduce their risk of contracting the virus at vaccination centers. By June 2021, BMC also started vaccinations at resident welfare associations (RWAs) and apartment complexes for citizens above 45 years of age. The BMC also carried out vaccination for people living in old age homes,27 the homeless population,28 the Odisha Association for the Blind, and other marginalized groups.29 
  • Focused awareness campaigns through online and offline models[cite]: Throughout the vaccination drive, the BMC had a very focused approach toward communication and public awareness campaigns. The BMC established a COVID-19 helpline30 and popularized it through social media31,32 and mass media including news, handouts, and posters. It used its social media handles to provide vaccine-related information pertaining to registration,33 slot booking, available slots, centers, and other special vaccination facilities. Beyond dissemination of COVID-19 information online and offline, BMC staff at primary health centers, community health centers, and wards and blocks mobilized people and promote vaccination. The BMC local authorities also campaigned in the city’s slums and other at-risk locations to raise awareness about vaccination and fight vaccine hesitancy.13,14

How was this promising practice implemented?

The BMC established a task force to undertake their mandate of 100 percent vaccination. The success of this task force in fully vaccinating the city’s eligible population was a result of proactive planning, vigorous execution, and close monitoring of activities pertaining to vaccination. 

Plan ahead

The Government of Odisha formed steering committees ad task forces at the state and district levels . The government planned for special circumstances such as the return of migrant workers to the state and monsoons to ensure smooth and consistent month-to-month vaccination drives across the city. Further, in June, ahead of a possible third wave of Covid-19, the state government ramped up vaccination activities and increased the per-day vaccination rate. 

In parallel, the BMC planned benchmarks and targets for various ages and priority groups at the outset of the vaccination drive. The BMC conducted regular strategy and coordination meetings with the health secretary, the secretary of women and child development,33 the BMC commissioner, and all officials managing the various responsibilities pertaining to vaccination. The civic body also factored in vaccination of underprivileged groups while charting out the vaccination drive. Additionally, the BMC planned in advance for critical situations such as a disaster or a possible third wave. During the Yaas cyclone, for example, people who had booked slots during the days of the cyclone were automatically given slots for the next vaccination drive.34

Execute broadly

The BMC ensured that each ward had vaccination centers, and it set up a helpline to help those who could not register online, providing vaccination slots via their officials. The BMC also allocated different slots for different age groups and undertook special vaccination drives targeted at specific groups of people (e.g., slums, old age homes, RWAs). The special vaccination drives ensured that priority populations were getting vaccinated alongside the regular vaccination drive without burdening the operating centers.

In June, the BMC introduced rapid antigen tests to make the vaccination drive more efficient and avoid vaccine wastage.35

Monitor and evaluate

The BMC followed a stringent monitoring and evaluation process for all activities pertaining to the vaccination drive. Senior officials of BMC and the Bhubaneswar Development Authority, such as the principal secretary of Odisha’s Department of Women and Child Development, the BMC commissioner, and zonal heads conducted periodic checks to ensure smooth operations and monitoring arrangements.7,8 These periodic checks and daily reportage of activities ensured that vaccination protocols and COVID-19 guidelines were followed on a day-to-day basis.

Supplementary material

The Bhubaneswar Model - Achieving Vaccination Coverage at the City Level.pdf

Sources

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  4. Express News Service.  COVID vaccination at 22 hospitals in Bhubaneswar. The New Indian Express. Published February 28th, 2021. Accessed August 11, 2021. https://www.newindianexpress.com/cities/bhubaneswar/2021/feb/28/covid-vaccination-at-22-hospitals-in-bhubaneswar-2270077.html 

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  18. Bhubaneswar Municipal Corporation to ramp up COVID vaccination drive, plans to inoculate 25,000 people a day. New Indian Express. Accessed June 11, 2021. https://www.newindianexpress.com/cities/bhubaneswar/2021/jun/11/bhubaneswar-municipal-corporation-to-ramp-up-vax-drive-plans-to-inoculate-25000-people-a-day-2314654.html
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  24. Bhubaneswar Municipal Corporation Twitter. June 05, 2021. https://twitter.com/bmcbbsr/status/1410936945190920193

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  29. Bhubaneswar Municipal Corporation Twitter. June 18, 2021. https://twitter.com/bmcbbsr/status/1405906403034730496 

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  34. Bhubaneswar Municipal Corporation Twitter. May 26, 2021. https://twitter.com/bmcbbsr/status/1397194359645298688 

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