“India faces a hefty task of immunising over a billion people and with the dangers of a possible third COVID wave looming large, it surely does not enjoy the luxury of time.”
India has recorded over 30 million confirmed positive cases and over 0.4 million deaths since the novel coronavirus pandemic hit the world in late 2019. With these figures due to increase, India currently stands 2nd and 3rd in the list of countries with the highest number of positive cases and deaths from Covid-19, respectively. With a humongous 1.35 billion people, though the number of infected cases and deaths constitute a small percentage of the population . That doesn’t diminish the kind of agony and pain the country has suffered, which is indescribable. Apart from the failure of the health machinery, the country has suffered heavily economically, with several lockdowns halting all movement and activity. Though scenes of mayhem and misery are still etched in the memories of people , India has now left behind the deadly second wave which culminated in the second week of May with a record of over 400 thousand cases in a day.
The only plausible and the most effective solution to its woes lies in vaccinating its population to achieve herd immunity. India faces a hefty task of immunising over a billion people and with the dangers of a possible third covid wave looming large, it surely does not enjoy the luxury of time.
India commenced its vaccination drive with much flare on 16th January,2021 in a phased manner. Indigenously manufactured Covishield by the Serum Institute of India(SII) in partnership with Oxford-Astrazeneca, and Covaxin by the Bharat Biotech(BB) and Indian Council of Medical Research(ICMR) were the first two vaccines to be approved for use. Accordingly, priority groups were chalked out with citizens above 60 years of age and all frontline workers being eligible in the first phase. With an astounding 500 million+ doses of Covid-19 vaccines already administered, India stands much ahead in the tally of absolute population vaccinated, leaving behind early beginners like the US and trailing only behind China. However, it fares much worse when it comes to the percentage terms with only over a mere 8% being fully vaccinated. The 6 month long vaccination campaign can be described as bumpy and shaky, marked by its own crests and troughs.
The first hiccup suffered was in the form of vaccine hesitancy. Vaccine hesitancy refers to the behaviour of people in which they are hesitant or unwilling to get the vaccine administered due to various reasons, but mainly because of their lack of faith in it. The numerous myths and widespread misinformation regarding the vaccines and their side effects have fuelled this phenomenon. Primarily, the unparalleled speed at which vaccines have been developed caused these apprehensions. Although it has been tackled to a large magnitude through mass awareness campaigns and other relevant measures taken by governments and civil society, vaccine hesitancy still persists to some extent.
Another challenge was the lack of urgency among people to get vaccinated due to a waning first wave of the pandemic. By the time India started its vaccination campaign, the peak of the first wave had started to ebb, allowing for a unified rollback of restrictions imposed by the governments. With near normalcy being restored, many people were led to believe that the worst had been overcome. This was reflected in their callous, COVID inappropriate behaviour as well as in the complacency shown in immunising oneself from the virus.
These phenomena resulted in the slow pace of vaccination through January and February, with an abysmal average of approximately 0.3 million doses being administered per day. A domestic surplus in the production of vaccines during these months allowed India to pursue its generous export and donation to other nations. For instance, India shipped 66 million doses of vaccines to as many as 95 countries around the world in Latin America, the Caribbean Islands, Asia and Africa as gifts, commercial agreements, and under the COVAX scheme. Faced with a vast surge in Covid-19 cases within the country beginning late March, the government decided to suspend its Vaccine Maitri program (donation and export of vaccine) citing the domestic need for vaccines as the reason. However, many were of the opinion that India shouldn’t have exported or donated vaccines in the first place without prioritising its own exigencies.
Another striking feature of the Covid-19 immunisation programme has been inconsistency surrounding the policy for vaccine procurement, pricing, distribution, and administration. Uncertainties in supply and demand have caused the lack of a predetermined and comprehensive plan of action since the very beginning. In the first phase, the Central government took it upon itself to procure and distribute vaccines free of cost to the eligible through government-run vaccination centres. However, a sudden increase in demand coupled with calls for decentralisation of the vaccination programme from several state governments, led to the existing scheme of prioritised vaccination being abandoned. Under the resultant new policy, the entire adult population was made eligible to get jabbed starting the 1st of May, 2021.
In this new phase, the state governments took the responsibility of procuring and vaccinating the adult population till 45 years of age. Those above 45 years of age continued to be inoculated free of cost with the vaccines acquired by the central government. Hence, 50% of all vaccine doses made available by SII and BB were earmarked for the centre, and the rest 50% was obtained by the state governments and the private entities. The vaccines were priced differentially for the central and the state governments and this move was highly criticised by the opposition parties.
Within a month of the revised policy coming into effect, the state governments started facing a shortage of vaccines due to not enough of them being made available by SII and BB. With even the international manufacturers ready to deal only with the national governments, the existing policy was tweaked again in the month of June. The central government now retained the charge of immunising the entire population free of cost. Under the new arrangement, 75% of the vaccines produced by the SII And Bharat Biotech were to be reserved for the centre, the remaining 25% free to be procured by private entities. India witnessed a record 8 million+ doses being administered on 21st june, the day this new arrangement kicked in.
Another salient feature has been the digital divide. India developed and used the Cowin App for self-registration and booking of vaccine slots. Though it has been instrumental in increasing participation, in a country with highly uneven internet penetration, it acts as a discriminatory barrier against those who lack access to digital technology and technological know-how. Similarly, vaccine inequity has been another of the major concerns with more vaccination centres being available in urban areas than in rural and backward ones. The lack of awareness about vaccination and its benefits in rural areas has further propelled vaccine inequity.
In times of a humanitarian crisis of such high scale faced worldwide with a colossal demand-supply mismatch, wastage of vaccines during storage, transport and use is something we cannot afford. It is, therefore, an urgent requirement to minimise any such wastage through proper training of all the personnel involved in the process. Furthermore, as astonishing as it may sound, fake vaccination camps have been run by miscreants without being caught. In such camps, other unauthorized substances have been used in the name of vaccines, which pose a great threat to public health at large.
With the centre committing to an ambitious target of inoculating the entire adult population of approximately 0.94 billion by the end of the year, India has a tall task at hand. Given a number of domestically as well as foreign manufactured vaccines in the pipeline, the supply side issue shall not be a hindrance. It is the above mentioned challenges that need to be taken care of urgently. Capacities and infrastructure need to be further improved to handle the logistics adequately. No doubt a mammoth task, it is still achievable given the bright history of India’s immunisation programmes.