Reena Jani got up early, finished her chores in the crisp January cold, and walked uphill to the road that led past her remote tribal hamlet of Pendajam in East India.
The 34-year-old tribal health worker rode a neighbor’s pillion motorcycle for 40 minutes through rice-padded slopes and made his way to the Mathalput Community Health Center.
Jani’s name was at the center of a list of 100 health workers, making her one of the first Indian women to be vaccinated against Covid-19 earlier this month when the country launches a vaccination program the government calls the largest in the world.
But she’d heard rumors of serious side effects and worried about what would happen if she got sick.
“I was scared about my son and daughters. What will you do if something happens to me? “Jani told Reuters, visibly relieved that the injection did not cause any immediate side effects.
The vaccine she received had traveled much further. It was taken by plane, truck, and van approximately 1,700 km from the factory to the Mathalput Community Health Center, where Jani was waiting, and it had to be kept cold all the way.
The safe arrival in Koraput district, where left-wing guerrillas are waging a low-level riot amid rolling hills and thick forests, was evidence of the detailed planning and preparation of the authorities in Odisha state.
But officials acknowledge that this is only the tip of the iceberg.
Just over 1 million vaccine shots given to date, mostly aimed at key workers like Jani, are a tiny first phase of a vaccination program that India hopes will ultimately protect its 1.4 billion people from the coronavirus.
Only when the much larger third phase, which targets 270 million people who are considered at risk, will begin will the government know whether its plan to distribute shots in sometimes hostile terrain and in high temperatures will succeed.
“The problem will start in the third phase when the public comes,” says Madhusudan Mishra, Koraput’s district collector. “It will be a real challenge.”
Delivering vaccines is one thing. Convincing people to take it is another.
Skepticism about the safety and effectiveness of Covid-19 shots is high in India, especially in rural areas, officials say, and misinformation via social media platforms and word of mouth could undermine efforts.
The Covid-19 vaccine Jani was taking was developed by AstraZeneca and Oxford University. India also uses another one developed by Bharat Biotech.
The deployment comes as the number of coronavirus cases in India neared 11 million and the death toll topped 150,000, second only to the US, albeit with a much larger population.
Manufactured in the western city of Pune by the Serum Institute of India, the world’s largest vaccine manufacturer by volume, around 40,800 vials of the AstraZeneca shot were flown to the capital of Odisha on January 12 by a commercial airline.
Five people were killed in a fire last week at the Pune plant, but official figures say that vaccine production will not be affected.
India has distributed 16.5 million doses of the two approved vaccines to its states and territories, distributing them with the help of an army of drivers and infrastructure for existing vaccination programs but strengthening them for the pandemic.
In Odisha, after a late start on Jan. 13, government officials at the vaccine center retrieved vials from a cavernous refrigerator and carefully counted them before placing them in insulated boxes with ice packs to hold for up to 2 to 8 degrees Celsius to three days.
Then it was over with the experienced driver from the Ministry of Health, Lalu Porija. He drove his van all night to reach the site and then had to take the vaccines 500 km back to Koraput with an armed plainclothes policeman to keep company.
“I feel a little tired,” says Porija when he stopped to drink tea late in the evening after a traffic jam had delayed the return journey by several hours.
Porija negotiated cows, rubble, thick fog and hairpin turns, and fought against fatigue. In three days he drove almost 24 hours to collect the vaccine shots and deliver them to Koraput.
On January 15, health care workers at Koraput’s main vaccines store carefully counted, packaged, and loaded smaller quantities for the district’s five vaccine sites, including the Mathalput Community Health Center about 30 km away.
A small white van drove off at noon, blowing up dust on narrow country lanes for delivery to several locations. An armed policeman was inside again.
“The most anticipated vaccine,” a Mathalput health worker told colleagues when a box of shots was unloaded.
India has devised a plan to vaccinate around 300 million people from July to August.
In the first phase, which began earlier this month, the target is 10 million healthcare workers, including Jani. Next come 20 million primary care workers, followed by 270 million people believed to be susceptible to the coronavirus.
Additionally, there is no clear roadmap, although the government says that any Indian who wants or needs the vaccine will get it.
In Koraput, a team of officials spent months creating a local Covid-19 vaccination schedule, officials say.
Since much of the district didn’t have internet access, they chose vaccination sites with good connectivity and ran dry runs, says Koraput’s top health officer Dr. Makaranda Beura.
And where mobile coverage was inconsistent, like in Janis Pendajam Village, health workers were invited to meetings to inform them of vaccination schedules, followed by visits by regulators to people registered for vaccination.
Despite initial problems, particularly with Co-Win – a centralized digital platform to launch and track India’s mammoth vaccination program – officials in Koraput say the current system would be sufficient for the first two phases.
For the much larger third phase, in line with the way elections are being conducted in India, District Collector Mishra expects to deploy all of the local police force to handle the crowds and purchase additional vehicles to assist staff working in work in remote areas.
To get the vaccine deep inside, where Maoist insurgents are known to operate, police must also work with other paramilitary and special forces forces to ensure safety, says Rajesh Pandit, police chief of Odisha in the southwest.
“We have to be extra careful,” says Pandit.
Jani became an Accredited Community Health Worker (ASHA) about seven years ago, a linchpin of the rural health system in India.
She helps monitor pregnant women in her village of 500 people, helps with malaria tests, and distributes basic medicines for fever and diarrhea.
Jani, the main breadwinner in her family of five, earns Rs 3,000 ($ 41) a month to send her two daughters and one son to school.
When she first found out she should be vaccinated, Jani said she was not concerned. Then she heard a rumor.
“Someone told me that people faint, develop a fever and some die after the injection,” she says. “That’s why I was scared.”
In a survey by New Delhi-based online platform LocalCircles, 62 percent of the 17,000 respondents were reluctant to get vaccinated immediately, mainly due to concerns about possible side effects.
Fears are also widespread among health workers, leading India this week to appeal to the frontlines not to reject vaccines after many states failed to meet initial vaccination targets.
Dr. Tapas Rajan Behera, the doctor in charge of the Mathalput Community Health Center, said authorities were aware of the potential reluctance to take the vaccine and had instructed health workers to allay safety fears.
A nervous Jani eventually received her shot that partially vaccinated her against Covid-19: a tiny step in India’s mission to beat the pandemic.