COVID-19 Vaccine Service Delivery Challenges: A Rapid Assessment of Private Health Facilities Providing COVID-19 Vaccination in Maharashtra, India, 2021

COVID-19 a Public Health Emergency of International Concern on January 30, 2020, 1 which coincided with the first laboratory-confirmed COVID-19 case in India. This first reported case in Kerala, India led to the activation of the Strategic Health Operation Centre (SHOC) by the National Centre for Disease Control (NCDC) and was followed by Nation Wide lockdown starting March 25, 2020. During the first wave of COVID-19, cases peaked in September 2020 with 90,000 cases reported daily. The reported cases fell to an all-time low by end of January 2021(10,064 cases being reported on 19 th January) 2 , which was followed by an exponential rise from mid-February 2021 marking the start of the devastating second wave of COVID-19 in India. ] India began its vaccination program against COVID-19 on January 16, 2021, with AstraZeneca Covishield, manufactured by Serum Institute of India. A few weeks later, Covaxin, developed by Bharat Biotech, was added. On April 12, 2021, the Drugs Controller General of India (DGCI) gave the emergency use approval for the third vaccine, Sputnik V (developed by the Gamaleya Research Institute of Epidemiology and Microbiology, in Russia). Vaccination efforts initially focused on health care workers, frontline workers, and those 45 years of age and older. The individuals in age group 18-<45 years were added once additional doses of COVID-19 vaccines were available. The Ministry of Health and Family Welfare, Government of India also released the guidance documents for immunization of pregnant women, lactating mothers, and those with comorbidities, working to ensure that no eligible beneficiary was denied COVID-19 vaccination. To schedule a vaccination, individuals were required to register on a digital platform called the COVID-19 Vaccine Intelligence Network (Co-WIN). The beneficiary could choose whether to take the vaccine at a government public health facility or a private facility. Upon successful registration, the