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Not vaccine supply, distribution by states also the problem in slowing phase one, says govt

Going forward, vaccine allotments will now be on disease burden and performance of states. States that waste more will lose out.

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New Delhi: From 1 May, India will embark on the monstrous task of adding an estimated 50 crore people to its target Covid-19 vaccination group when the process opens up for all adults in the country. But one look at the April report card shows what a challenge it is going to be.

In the first 24 days of April, India administered a total of 7,57,98,521 doses of the Covid-19 vaccine. This in effect meant that on an average, the country administered a little over 31.58 lakh doses of the vaccine every day with the numbers oscillating between 12 lakh and 43 lakh a day. This includes both first doses and second doses.

Since the peak of 43 lakh on 3 April (see chart), the vaccination numbers have drifted significantly lower.

In fact, only twice during the entire month  — on 5 April and on 12 April — did the daily vaccination cross the 40-lakh mark. Even Prime Minister Narendra Modi’s call for a four-day Tika Utsav, a vaccination festival, did not generate the necessary momentum.

As a result, in the over three months after the country launched its vaccination programme on 16 January, only an estimated 8.47 per cent of Indians have received at least one dose of the Covid-19 vaccine (as of 23 April).

In contrast, the comparable figure is 49.36 per cent in the United Kingdom, 41.03 per cent in the United States, 22.64 per cent in Germany and 12.42 per cent in Brazil.

More worryingly, more than 90 days after vaccinations started, the second wave of the pandemic has brought the country to its knees with clamour for oxygen and medical infrastructure rising from every part of the country. A better vaccination rate could have changed that.

“India has an eligible population of about 650 million. At this rate, it will take several months unless we have adequate vaccine supplies and also we should be able to deliver them without long queues,” said former ICMR DG Dr N.K. Ganguly.

“Maybe things will ease when Sputnik V comes in, then J&J is in phase III trial, Zydus is finishing phase III. But we also need the raw materials for the vaccines,” he added.

He cited the examples of Israel, which has just done away with masks, and the UK and US (except Michigan because of vaccine hesitancy) as countries that have successfully bent the curve because of good progress in vaccinations.

In India’s case, there are wide variations even within the country.

Among the big states, Chhattisgarh has managed to vaccinate the highest proportion of its population (16.16 per cent) with at least one dose of the vaccine, followed by Kerala at 16 per cent and Gujarat at 14.53 per cent.

Rajasthan and Delhi, with a population of around 6 crore and 2 crore, respectively, have vaccinated about 12.69 per cent of people.

The capital is currently battling its worst Covid-19 surge until date with about 25,000 cases and over 300 deaths a day.

“Vaccination against Covid-19 must quickly gather speed and scale to reach the many who will be seeking it from 1 May,” said Dr K.S. Reddy, president of the Public Health Foundation of India. “The vulnerable must be prioritised as this happens. More vaccination centres will be needed to add pace  as we step on the accelerator. Centre-state coordination will be a key factor. Vaccine hesitancy too must be reduced through engagement of community-based organisations.”

Graphic: Ramandeep Kaur/ThePrint
Graphic: Ramandeep Kaur/ThePrint

Also read: How pandemic fatigue led India to squander a chance to beat Covid while it was down

Supplies, hesitancy a problem

While states, especially those not ruled by the BJP, have been claiming a vaccine shortage for a long time now, the official Modi government response has always been one of denial.

The issue, according to Union Health Secretary Rajesh Bhushan, is not a supply one but one of equitable distribution of vaccines by states and not a supply issue.

“The problem is not of supply but of planning. We are giving four days supply to the big states and replenishing it every 4-5 days,” Bhushan had said during the Covid briefing on 13 April. “Small states get 7-8 days of vaccine supply that is replenished after that period.. State governments need to see the status of doses on a daily basis just like the exercise we do in the health ministry every day.”

States have been crying foul about the small volumes of vaccines allocated and the frequent need to collect vaccines from depots that is a drain on resources. It is only now that a more “liberal” vaccination programme has been announced that the Modi government has made a clear commitment to allot vaccines to states for 15-day periods.

Going forward, vaccine allotments will now be on disease burden and performance of states. States that waste more will lose out.

Dr Gagandeep Kang, Professor of Microbiology at Christian Medical College, Vellore, however, is clear that the hold-up (in vaccination numbers stagnating) does seem to be in the supplies.

“Had India invested in the companies early on and asked them to ramp up manufacturing, that could have changed. In fact, think about it, the only investment Covishield had before now was from the Gates Foundation,” Kang said. “So had that $100 million not happened, it is possible we would not even have had the vaccines we do now.”

As the 1 May deadline approaches, Dr Kang sees further complications in the central government’s announcement that it would buy 50 per cent of all vaccines, while the other half would be bought by private hospitals and state governments.

“This differential pricing  — how that would work, I would like to understand. I want to see a flow chart. If there are two different rates, then isn’t it possible that the person who is paying the higher rate would buy up all vaccines?” she asked. “How then would a poor person who is say 30 years old and has a serious comorbidity, going to get the vaccine.”

The reference is to the announcements both by Serum Institute of India and by Bharat Biotech to sell vaccines at different rates to state governments and private hospitals.

In the states, meanwhile, with the rise in numbers in the second wave, vaccination centres have started looking more deserted. The fear of infection is keeping people away from the prevention, officials say.

Also read: How govt’s sunny Covid posturing, with some number jugglery, set stage for second wave

‘Should have pre-bought vaccines’

Dr Dileep Mavalankar, director of Indian Institute of Public Health, Gandhinagar, said India should have started moving on vaccines supplies from July last year, pre-bought if necessary like some other countries did given the large population.

“We knew we would require some 200 crore vaccine doses. But that was the past, we cannot change that. Going forward there has to be clarity on vaccine availability, the plan and targets should be set,” he said. “State governments are saying vaccine shortage, Centre is denying it. Why not put up data about vaccine doses available? The hesitancy really seems to be from the government. Early on when SII had vaccines why did we buy in small quantities rather than the entire stockpile?”

He says the need of the hour is for the government to set targets for vaccinations “like Biden did”, and train “vaccine volunteers” to spread awareness.

“Like political parties designate workers to ensure that people under their jurisdiction vote, we should have the same model here to get people to vaccination booths,” he said.

Interestingly, while data on the numbers of 18-45-year-olds in the country is available, the Government of India has in every forum, carefully bypassed mentioning the actual size of the target population in the next phase or the vaccine availability.

“You can do the maths yourself — currently there are just about 2.5 million doses of Covishield and if Bharat is doing about a fifth or a tenth of that then our daily total manufacturing is just about 30 lakh doses,” Dr Kang said.

Even ‘priority’ groups lag in coverage

As of 24 April, a total of 14,09,16,417 vaccine doses have been administered.

These include 92,90,528 healthcare workers who have taken the first dose and 59,95,634 healthcare workers who have taken the second dose.

According to data shared by the ministry of health on 21 April, about 80.43 per cent of healthcare workers in the country, whose vaccinations began three months ago, are fully vaccinated.

In some states, the numbers are lower — in Tamil Nadu, 66.5 per cent are vaccinated while the figure is 72.3 per cent for Maharashtra and 69.1 per cent for Assam.

For frontline workers whose vaccinations began on 1 February, 81.81 per cent have so far been fully vaccinated. Among senior citizens whose vaccinations began on 1 March, about 4.7 crore of the 10 crore people, which is 47 per cent, have so far received at least one dose of the vaccine.

(Edited by Arun Prashanth)

Also read: Vaccination, tracing, lockdown — why India’s ‘one-size-fits-all’ Covid plan hasn’t really helped

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  1. Dr Dileep Mavalankar, makes a lot of sense. I fully agree with his statement, “Like political parties designate workers to ensure that people under their jurisdiction vote, we should have the same model here to get people to vaccination booths,”. The way our political leaders have contemptuously neglected public health and deployed all their resources on campaigning in elections is disgusting. The very top national leaders seem determined to capture power all over teh country, never mind if the poor and weak suffer and die in their millions. The saddest truth is that we do not have a credible national alternative. Perhaps it will take a mass movement to throw up an alternative.

  2. Hyderabad based Central Govt says Union Govt with held permission to Sputnik vaccine makers since Dec 2020. He says Union Govt expecting party fund, so delayed permission to make vaccines in India.

  3. I could read in this article a comparison between the no. of vaccinated in India vs the UK, USA. I would request you to publish the number of persons vaccinated instead of percentages. We can’t compare by percentages as the population in all these countries aren’t the same.

  4. Our enemy within worked overtime to cast doubts in general public mind about the quality of Swadeshi vaccines. This prevented even ideology based frontline workers opting for the early jabs. And one of the reasons why vaccination drive was punctured and shot in the foot, leading to low demand and low supply till date. Too much freedom of speech remains the biggest hurdle in slow developement of our nation since independence. There is concerted effort to defame home grown and encourage import of foreign vaccines by vested interests. Have faith we shall overcome with everyone’s cooperation.

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