Can India inoculate its 900 million adults by December 31?
India’s floundering vaccine policy has been a case of one step forward and two steps back. Last week, amid much fanfare, Prime Minister Narendra Modi, in a televised address, took one step forward when he announced that the Centre will now procure 75 per cent of the available vaccines and distribute them free of cost to the states to vaccinate those who are 18 and above, while the remaining 25 per cent will be made available to the private sector for distribution, with clear pricing guidelines. This was a partial reversal of the earlier policy when, beginning May 1, states were encouraged to procure vaccines directly from the manufacturers and vaccine eligibility was extended to the 18-44 age group, thereby putting the onus on the states to get this group inoculated at the pricing of their choice. This was the time the second wave was in full force.
The immediate consequence of this shift was a disruption in the vaccination drive and a sudden shortage of doses. Mounting criticism from the states, the public and, crucially, the scrutiny of the Supreme Court has probably prompted the current rollback by the prime minister. However, there has been a cost to this zig-zagging vaccine policy and the Centre’s failure to act early to secure sufficient vaccine supply. The death toll from Covid-19 between April 4 and June 5 was 180,000, nearly half the total deaths since the virus struck India last March. In the age of Covid, a delay means death.
Scientists believe that the Covid-19 virus is here to stay, though it could gradually become less dangerous over time. However, in the immediate future, India cannot let its guard down and risk a repeat of what unfolded in May 2021, when an average of 3,900 people died every day as the country faced the onslaught of a lethal second wave. The experience taught us that the virus is still as deadly as it was a year ago. Besides routine surveillance to track any emerging new strains and ensuring that the national infection rate stays well below the WHO-recommended 5 per cent, India needs to vaccinate at least 90 per cent of its population to emerge from this protracted pandemic. The effectiveness of quick mass vaccination can be seen from the example of the US, a country that has vaccinated 42 per cent of its citizens, allowing them to move around without masks in public spaces except in a handful of states where some restrictions remain.
In India, we are still a long way off from achieving mass immunisation, our best shield against another wave causing the kind of devastation the second one did. While the Modi government initially did well to encourage domestic development and manufacture of vaccines, it grossly underestimated the number of inoculations it would need to protect its population, besides failing to anticipate the second wave in time. While the central government proudly claims India has vaccinated 230 million people as of June 8, the damning fact is that only 3 per cent of our population is fully vaccinated so far.
The government made two major blunders in its vaccine policy. First, it relied on domestic manufacturers to meet vaccine needs but was reluctant to place large orders with the companies as the US and Europe did with manufacturers that showed promise. Second, while rightly focusing on vaccinating those 45 and above, as this age group accounted for the highest number of mortalities in the first wave, the second wave brought home the realisation that younger age groups too were vulnerable. As the clamour for vaccinating the young grew, the Centre yielded, despite knowing there was a huge shortage of vaccines. This led to a spurt in the demand for vaccination, resulting in massive shortages and putting the country’s entire vaccine programme in jeopardy.
Now, India has to vaccinate an estimated 900 million people above the age of 18, a daunting task in the absence of any assured supply of the 1.8 billion doses needed by December 31, the date on which the government has promised all of India’s adult population will be vaccinated. Daily vaccinations have picked up pace recently: they now average 2.7 million, up from 1.5 million a month ago. Yet, at this rate, it will take the country 21 months to meet its target. The government urgently needs to administer at least 8.4 million doses daily to achieve ‘herd immunity’ by the end of this year. Incidentally, the highest rate of vaccinations in India was 4.87 million per day on May 20.
In our cover story this week, ‘The Race Against Time’, Group Editorial Director (Publishing) Raj Chengappa considers the possible paths — as well as the many impediments —towards the tantalising prospect of meeting that goal. The Centre seems to have learned its lesson to its credit and is now pursuing the target aggressively and with much-needed urgency. As things stand, the Centre has a plan that could soon bring the daily vaccination rate to 8 million doses. However, everything hinges on securing the production and delivery of 750 million doses of Covishield, 550 million doses of Covaxin, 300 million from Biological E and 150 million of Sputnik V between August and December. If all goes well, then an estimated 1.8 billion doses will be produced in India between August and December.
The country also has to battle vaccine hesitancy, which was one reason India could administer just 140 million doses in the first 100 days of its vaccination programme. After eligibility for a vaccine was extended to include those above 18 years, immunisation gathered some momentum and, in the next 40 days, the country administered 97 million doses. The experience of the Universal Immunisation Programme has shown that India can overcome vaccine hesitancy. While as recently as 2012, only 60 per cent of the population opted for routine immunisation, it has now risen to 90 per cent. A combination of door-to-door outreach and awareness programmes and accessible vaccination sites and affordable vaccines has helped overcome public reservation.
As the second wave begins to subside, India must focus on improving its vaccination supply and administration to forestall a third wave. We cannot indefinitely remain in a lockdown, but we have also learned the cost of premature optimism. Only a combination of continued collective vigilance in maintaining safety protocols and an efficient, well-calibrated vaccination programme can deliver the one thing we all want by the end of the year: to see Covid-19 reduced to an innocuous virus no more harmful than the common cold.
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