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Why India must vaccinate 80% of population by December 2021 — no matter what the cost

The aim of 80% vaccination is neither too high nor too low.

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Planning for a national Covid-19 vaccination programme has begun to move forward in right earnest in India. Last week Union Health Secretary Rajesh Bhushan wrote to state governments outlining the administrative structures to be put in place to oversee the implementation in their respective jurisdictions. As of now, the Narendra Modi government expects the vaccination programme to take over a year, with healthcare and essential services workers getting the shots before the rest of the population. The Modi government has done well to reject the narrative of low expectations by setting a one-year timeline. As I have argued earlier, this is both necessary and eminently doable if we do not limit ourselves to departmental thinking and processes.

As a multidisciplinary team of my Takshashila colleagues has proposed, India should aim to vaccinate 80 per cent of the population by 31 December 2021 at a cost of Rs 50,000-250,000 crore depending on the type of vaccine. India can not only afford such a programme, it can’t afford not to.

Conversations over our vaccination policy proposals revealed a genuine debate over the number of people who need to be vaccinated. Should it be as high as 80 per cent, as we have proposed? Or is 80 per cent too low? Much of the debate on how many people need to be vaccinated comes from epidemiology — specifically from the notion of “herd immunity”, or more properly “herd protection”. As Christie Aschwanden writes in the excellent article in Nature, “Herd immunity happens when a virus can’t spread because it keeps encountering people who are protected against infection. Once a sufficient proportion of the population is no longer susceptible, any new outbreak peters out.”

Also read: If we want to beat Covid, we have to think like virologists

India’s herd immunity status

Now, herd immunity can happen either when enough people develop natural immunity (after contracting the disease and developing antibodies for it) or when they have been vaccinated.

Using the basic reproduction number R0 (the number of people a single infected person would infect in a susceptible population), for SARS-CoV-19, the herd immunity threshold is between 50 per cent and 67 per cent of the population. On a nationwide level, this means that 65-87 crore people must acquire immunity. However, as epidemiologist T. Jacob John told Science magazine’s Vaishnavi Chandrashekar, a big national epidemic is a “figment of statistical imagination” and it is more correct to see over a 100 smaller epidemics occurring across the country. In other words, 50-67 per cent of various state and local populations must have immunity before their epidemics come to an end.

In the West, there is a political-ideological debate that uses the herd immunity threshold to argue for exposing healthy people to the virus while protecting the vulnerable segments like the elderly and those with co-morbidities. Fortunately, this scientifically questionable, highly risky, practically challenging, ethically problematic and politically charged approach does not find much favour in India as an intentional policy approach. Yet, given the highly variable adoption of masks, hand washing and social distancing, as well as the limitations of the public health machinery across the country, part of the way India is actually coping with the pandemic involves unintentional exposure to infection. As my COBOTE (Cynically Optimistic Back of the Envelope) estimate and the government’s delightfully named Covid-19 India National Supermodel Committee reveal, the real extent of the pandemic in India is likely much higher than what the official numbers show, meaning that crores of people in the country already have antibodies.

Also read: Modi govt mustn’t hesitate to make Covid vaccine free for Indians. It only costs Rs 80,000 cr

Why 80 per cent

Does this mean that the national vaccination targets can be lower because India only needs to vaccinate those who do not have antibodies? Not quite. First, going by the experience of the ordinary flu viruses, post-infection immunity is not permanent, and lasts for a few months to a few years. Second, the cost of testing for antibodies is similar to the cost of vaccination. Therefore, it is necessary to immunise people regardless of whether they have previously suffered Covid-19 infection. This is true even if the vaccine itself offers only temporary protection, and must be taken on an annual basis.

A number of people have wondered why, given that epidemiological calculations indicate a herd immunity threshold of 67 per cent, should we target 80 per cent of the population for vaccination? The answer is that the public policy target is different from the purely epidemiological target for a number of reasons, the first of which is uncertainty. Given that we are not sure at this time if even 67 per cent is enough, it is better to have a safety margin to ensure that the vaccination programme is successful. Second, the fixed costs to immunise 67 per cent and 80 per cent are more or less the same, but the incremental benefits of vaccinating a higher number are higher than the incremental costs. Finally, designing the system to have the capacity to handle 80 per cent of the population allows us to relatively easily extend it to 90 per cent or higher should that become necessary.

As Jacob John’s words remind us, when we say India must vaccinate 80 per cent of its population by the end of 2021, what it should correctly mean is that states, municipalities and district administrations should cover 80 per cent or more of their populations. That is what every administration in India should be planning at this time.

Nitin Pai is the director of the Takshashila Institution, an independent centre for research and education in public policy. Views are personal.

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  1. A laughable piece. Inaccurate as it is, the source of scientific information is also suspect. Herd immunity is achieved at merely 30% infection which India has already achieved. Infection in majority of cases is so mild that even symptoms do not show up. Non-symptomatic spread of disease is a created myth. This created myth is at the root of control and suspension of our democratic rights and freedoms and is giving government unrestricted access at control of citizens by compelling them to wear masks or preventing them from meeting others or shopping freely or exercising and what not. Now vaccination is going to be another tool of coercion of citizens. Perhaps you are sold out to big pharma too.

  2. The concept of herd immunity is a theoretical concept taken from isolated herds of animals ; in humans, because of the greater mobility and low isolation, it may not work. Also, the long term effects of covid, seen in recovered and some asymptomatic people shows that there is long term damage to vital organs of patients. Hence a vaccine is the only solution for protection of the population and it should be on a mass scale in as short a time as possible. The Govt must parallelly allow commercial sale of vaccine and those who can afford, get vaccinated at own cost at a fixed cost. This will reduce the burden on Govt and emphasis on people in far flung areas and the poor can be covered by Govt more easily. CSR to inoculate people should be encouraged besides asking all corporates to inoculate their staff, expenditure to be allowed under health care. Then a return to normalcy can be quick. All existing vaccination programmes can also be resumed. Hopefully, a second generation of vaccines with better and longer lasting immunity will come within 2-3 years.

  3. I was wondering , why same views are not there for diseases which affect the poor ? Its 70 yrs since independence India still not 100% free of TB/Maleria/dengu. And TB KILLS 450,000 PEOPLE EVERY YEAR MAJORITY OF THEM POOR.

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