The Daily Star: Inoculating two crore people against Covid-19 every month from October will be extremely challenging if the manpower crisis in the government's regular immunisation campaign is not solved immediately, health officials warn.

They said the workforce and logistics under the Expanded Programme on Immunisation (EPI) are already overstretched mainly for its active engagement in the nationwide Covid-19 vaccination, which came as an additional duty.

Now ramping up the Covid campaign without addressing the manpower issue might hamper both the Covid-19 vaccination and the EPI, the officials said, demanding immediate appointment of at least 11,000 health assistants.

Bangladesh's EPI for children has set a gold standard in the world, health officials pointed out.

Around 15,000 field-level EPI health assistants were assigned for the Covid-19 inoculation on February 7. From ensuring home quarantine in districts to collecting samples for tests, entering data to the system to administrating jabs, these health assistants, along with lab technicians, are also tasked with jabbing 2.5 to 3 crore kids in the country annually under different immunisation campaigns, said health officials.

The government has initially planned to inoculate a maximum 3.5 lakh people daily and around one crore a month through around 11,000 vaccination centres across the country. But it could not fulfill the target due to vaccine supply shortfalls.

The mass inoculation remained suspended for over two months due to the shortage of doses. The country suspended administering the first dose of the vaccine on April 26. Registration of people for vaccination was suspended nine days later.

The government resumed administering the first dose on June 19 on a limited scale and then gradually expanded it.

Due to a smooth flow of vaccine supply over the last couple of months, the government now plans to inoculate massively in the coming months to catch up with the lost time.

Prime Minister Sheikh Hasina on Wednesday told parliament that the government was planning to vaccinate 55 percent of the country's over 163 million people by the end of this year.

She also said six crore Sinopharm vaccine doses would arrive -- two crore each month -- from China between October and December.

Among the over 24.65 crore shots the government is supposed to get, more than 4.4 crore have already arrived in the country as gift or under different bilateral purchase agreements till September 12, the PM informed the House.

Last week, Health Minister Zahid Maleque told The Daily Star, "Initially we are targeting to administer two crore doses of Sinopharm vaccines each month if we get those as per the commitment."

Health officials said the Covid-19 vaccination should be made more systematic and structured to meet the target as only six percent of the country's targeted population has so far been inoculated.

"We are still facing challenges in the mass inoculation drives as the manpower and logistics needed to administer jabs are far from adequate," said an EPI official, preferring anonymity.

And the outstretched manpower and logistics might eventually hamper the regular EPI activities, one of the very few bright spots in the country's healthcare system, he added.

"The EPI was assigned to vaccinate 2.5 to 3 crore kids in the country annually. But as per the government plan, we will now have to administer 25 crore doses apart from carrying out the existing EPI activities. The job has already become burdensome for us," a top official of Directorate General of Health Services (DGHS), told The Daily Star wishing not to be named.

He said around 15,000 health assistants of DGHS looked after the regular EPI activities at the field level although health officials had asked for an additional workforce of 11,000 people in 2018.

"Without increasing the manpower, running the Covid-19 vaccination campaign for a long time is unrealistic. We do not know how it can continue this way," said the official.

Contacted, ABM Khurshid Alam, director general of DGHS, told The Daily Star that they had already sent a proposal to the health ministry on recruiting over 11,000 health assistants.

"It is not feasible to conduct EPI activities with hospital staffers. We have already initiated the process to recruit 11,500 health assistants. We have forwarded the file to the health ministry," he said.

The DG also said that the recruitment would not be made at the local level.

The EPI is also facing a crisis of cold chain technicians.

In every district there should be at least one cold chain engineer but in 30 districts there is no engineer, said EPI officials.

In Dhaka, there are only five cold chain technicians. Whereas, the number should be 20, they said.

Sheikh Rabiul Alam Khokon, president of Bangladesh Health Assistant Association, said their work pressure has mounted since their work starts from ensuring home quarantine to sample collection and from Covid-19 vaccine administration to data entry.

"We are doing these apart from carrying out our regular EPI activities. We are overburdened," said Khokon.

Shamsul Haque, member secretary of the Covid-19 Vaccine Management Taskforce Committee of DGHS, however, said with the existing manpower they can administer a maximum of two crore doses a month.

"If the vaccination campaign is ramped up massively then we will need more manpower to keep the vaccination smooth," Shamsul, also director of EPI, said.

He also said vaccines can be found in the black market and vaccines could be administered privately if the campaign is not regulated by the EPI.

"If the vaccination campaign was supervised solely by the DGHS, such unethical and illegal incidents would not happen. These will continue to happen if other stakeholders are involved in the vaccination."

He said a dedicated Covid-19 cell was required to keep the vaccination programmes smooth as a huge number of people require to be jabbed.

"Currently, we have separated the Covid and EPI activities internally. But they should be brought under a systematic structure," he said.