COVID-19 Vaccination Drive: Where’s India Going Wrong?

-Written by Hrithik Raj Gupta

India is one of the world’s largest vaccine manufacturers. It currently has two clinically safe and effective vaccines against COVID-19. But India is still lagging in vaccinating a significant part of its population. India has only administered 5.51 doses per 100 people as of 3rd April, whereas the USA has administered 48.35 doses, China 9.3, and Israel 116.36 doses. It is not like India does not have experience of mass inoculation campaigns. India’s vaccination against Polio and Smallpox was universally praised. Due to these campaigns, India has some of the highest approval ratings for vaccines.

Is the Government deliberately slowing down the vaccination drive by imposing age restrictions?

Now that the second wave has come in India, fast and comprehensive vaccination is of paramount importance. Why, then, despite claiming that India has enough doses to inoculate a large part of its population, is the government deliberately slowing down the vaccination drive by imposing age restrictions?

The answer lies in India’s huge population and how COVID-19 disproportionately affects people of different age groups.

· Let us say the government today universalizes vaccination, and all people above 18 become eligible for vaccines. It would be pandemonium. There would be long queues outside vaccination centers, and social distancing would go out of the window (remember the lines outside liquor shops during lockdown).

· Another factor is that the USA and European countries such as Sweden and Germany are halting exports of crucial raw materials. Serum Institute of India (SII), Biological E, and Bharat Biotech will be adversely affected. They may have to slow down their production. That is why the government is avoiding allowing universal vaccination. It is a genuine concern that it may have to delay second shots if uptake of vaccines increases too dramatically, or countries worldwide enforce stricter restrictions on exports. And a delay in the second shot can lead to increased breakthrough infections, i.e., infection between the first and second doses of the vaccine.

· Another reason is that COVID-19 has a higher mortality rate for people above 45. By the government’s estimate, people above 45 accounted for only 40% of cases until December 2020 but amounted to 88% of all fatalities. This disproportionate behavior of COVID-19 is prompting the government to focus on this age group. Because if the virus continues to surge like this, it is imperative for the government first to vaccinate this age group rather than people below 45.

So, what is the solution to this problem?

The government has the right instinct to vaccinate people above 45, but such low uptake of vaccination is a severe bottleneck. Suppose India continues to administer 30 lakh doses every day. In that case, it will take 2.5 years to vaccinate the entire population or 1.75 years to vaccinate 70% of its population.

First, India needs to approve more vaccines as soon as possible. There are two vaccine candidates Sputnik V and Johnson & Johnson’s single-dose vaccine. Both have published efficacy data in reputed journals and are being administered in other countries with trusted health systems. Both the vaccines have tie-ins with reliable local manufacturers. They can be produced at prices similar to currently approved vaccines and only require standard refrigeration.

J&J vaccine can be a gamechanger in vaccination drive because it is a single-dose vaccine. And India has so far had trouble with people not coming for second dose of vaccines. But Biological E would still have to conduct a bridging trial on Indian test subjects before asking for approval. Even though it has been approved by US FDA and CDC, arguably the world’s most renowned and trusted government health agencies.

What is the point of giving out Emergency Use Authorizations (EUAs) if manufacturers must jump so many bureaucratic hoops?

UPDATE- With daily cases piling up and the government coming under fire for mishandling the vaccine supply, on 13th April, the Indian government decided to fast track approvals for COVID-19 vaccines that have been developed outside India and have been granted the emergency use authorisation (EUA) by other drug regulatory agencies.

Second, the Indian government needs to tackle vaccine hesitancy and misinformation vaccine uptake has been good to moderate in urban areas. It has not been so good in rural areas, mainly because rural India is not experiencing a second wave and due to a relative lack of information. But as more and more states start to experience a surge in cases, it would become necessary for the rural population to get vaccinated. As they have remained unscathed from the first wave. COVID -appropriate behavior is absent in rural communities, making them particularly susceptible to the second wave.

The government needs to run massive information campaigns. To make communities aware of the benefits of these vaccines and needs to normalize adult vaccination as India has never had huge adult vaccination before. Even other programs such as vaccination against Japanese Encephalitis and pneumococcal diseases failed. So, the government needs to communicate that these vaccines are 100% effective in protecting recipients against death.

The central government should collaborate with the state governments to co-opt regional stars and influencers to encourage vaccination. There is an urgent need to communicate minor side-effects of the vaccines as these vaccines were passed in approved in record time. The people, both urban and rural, are not convinced that these vaccines are totally safe. These fears need to be allayed to ensure good uptake of the vaccine.

Finally, the government needs to ensure that 70 lakhs to 1 crore doses are administered every day. If it wants to inoculate more than 70% of its population before the end of the year, some amount of normalcy returns. In case after 1st April still, only 20 to 30 lakh doses are administered every day. Then they need to expand the drive further as this is no less than actually wasting vaccines. India needs to leave behind this snail pace and needs to fully use the vaccine manufacturing capacity it has been blessed with.

India, so far, has managed the pandemic better than most nations, even better than developed nations such as the US and EU countries. India’s vaccination has also started better than the US and EU, but it is still not good enough. India fully needs to focus on vaccinating 70% population as soon as possible. Vaccination is currently the only fool-proof way to control this pandemic. With the top minister’s busy in election campaigning currently, it is not getting the attention from the government it deserves.