Sprawling and populous, India presents unique healthcare challenges. Its vast COVID-19 vaccination program offers an example to even rich nations.

India has begun a massive vaccination program aimed at immunizing 300 million people from COVID-19 by August.

The world’s second most populous nation after China, India is calling upon a million doctors and millions of planners and medical staff to target children and adults most in need of protection.

But India no longer needs help from the elephants that hauled vaccines to remote villages in the 1980s when India began to fight polio, measles and other childhood illnesses.

“We now have plenty of roads, even to remote areas,” said a government official at the Indian Embassy in Washington. “We don’t need the elephants for that any more. Trucks have already begun moving to 13 cities.”

Nor does India need donations from foreign aid agencies to deliver more than 300 million doses of vaccine. India boasts the world’s largest vaccine producer, Serum Institute, and the country often provides vaccines and other medicine to developing countries in Asia and Africa, as well as to some developed countries.

In an example of vaccine diplomacy, India will donate 150,000 doses to Bhutan, 100,000 doses to the Maldives and send more to Bangladesh, Myanmar and the Seychelles, India’s Foreign Ministry said last week.

India’s COVID-19 vaccination program is a huge undertaking.

In trips I made across India in the 1970s, I often saw handicapped children on spindly legs, victims of polio, which struck 200,000 children a year.

Starting in 1985, mammoth, well-organized efforts to eliminate polio got underway in India. The World Health Organization (WHO) declared India officially polio-free in 2014 after some 2.3 million medical staff and 155,000 supervisors treated 172 million children.

For decades, millions of Indian health workers, doctors and scientists fighting polio, hepatitis B, measles and now the coronavirus have been working, sometimes using elephants, to reach remote villages and provide vaccine injections to its 1.3 billion people.

One Indian program targets 55 million new mothers and their babies, delivering immunizations for free each year.

India’s healthcare delivery program is instructive to American and European virus-fighters, struggling to organize swiftly and broadly enough to stem the tide of the coronavirus pandemic.

India’s sprawling health program uses a series of more than 25,000 “cold chain” sites where medicine can be kept cool in a tropical country, for both storage and transport. And India is reportedly producing one billion syringes that cannot be reused by drug addicts.

India takes the campaign to inoculate 300 million people very seriously, with newspapers and public reminders that 10 years ago, the country experienced its last case of wild polio virus.

Other countries are taking lessons from India.

India’s system has such vast reach because it piggy-backs on the nation’s electoral system, according to Dr. K Srinath Reddy, president of the Public Health Foundation of India.

India is the world’s biggest democracy. More than 900 million citizens were eligible to vote in the nation’s 2019 general election, and a record two thirds of them, or more than 600 million, cast ballots. An immense electoral system is in place that connects far-flung constituencies and permits the casting and counting of votes.

The infrastructure that underpins elections, including polling stations, is being used in India to administer vaccine doses, and electoral rolls help identify priority age groups.

Reddy also credits the Indian administrative service, which can coordinate work among states and vaccination centers. Typical problems, Reddy said, are “last mile” issues in remote villages, such as keeping vaccines cool and arranging second visits to give the second COVID-19 vaccine.

Countries in Southeast Asia are gearing up for ambitious vaccination campaigns, taking lessons from India’s polio program, according to the WHO.

“We are witnessing unprecedented efforts by member countries to protect their vulnerable population against COVID-19 with vaccines,” said Dr. Poonam Khetrapal Singh, WHO Regional Director for Southeast Asia.

Former U.S. President Donald Trump pulled the United States out of the WHO, but his successor, Joe Biden, restored U.S. membership on his first day in office last month.

New roads and increasing population shifts to cities means that, for now, elephants will not be carrying life-saving vaccine doses to far-flung regions of India, which in many ways is setting a standard for richer countries.

Three questions to consider:

1. What is polio?
2. How is India’s electoral system being used to support its vaccination campaign?
3. Do you think your country can draw lessons from India’s vaccination campaign?

Ben Barber has reported since 1980 from the Middle East, Asia, Africa and Latin America.  He has written for Foreign Affairs, Christian Science Monitor, USA TODAY, Baltimore Sun, Toronto Globe and Mail, American Legion Magazine, Huffington Post and others. He was State Department Bureau Chief for the Washington Times and editor of the newsletter of USAID for seven years.