India has undertaken the world’s largest inoculation drive against coronavirus , attempting to vaccinate its 1.36 billion-strong population before a second wave hits the nation, but is the policy to strictly ration the supply of the vaccine the right way to go?

On Thursday, the Delhi High Court raised this questioned, asking the Central Government to explain the rationale behind maintaining strict control over the distribution of vaccines at a time when as many as five states are battling an unrelenting surge in cases.

The worst-hit among them is Maharashtra, which crossed 22 lakh cases on Saturday, with a lakh of cases coming in just the last 13 days.

The Delhi High Court noted that the Central Government was either donating the vaccines or selling them to foreign countries “rather than” inoculating its own people when its approach should, in fact, be to cover more and more base in India.

Earlier, the Congress party had raised a similar question, claiming that the government’s policy to vaccinate the remaining 135 crore Indians is vague and “shrouded in secrecy”.

The Grand Old Party has in the past also asked the Central Government whether it plans to provide free vaccines to all Indians, especially the underprivileged and the poor.

 

The Centre had provided free vaccination in phase 1 to 3 crore healthcare and frontline workers starting 16 January. It has now opened vaccination for the second tier of the population: those aged 60 and above or those above 45 but with comorbidities that are proven to complicate COVID-19 progression.

The phase two instructions also include vaccination at one’s own cost of Rs 250 per dose in private hospitals, but the gap between the national target of vaccinating 30 crore people by August and current stats begs the question if the government should do away with the phase-wise release of vaccines and support an open market approach instead.

Is India’s vaccination drive fast enough?

India’s coronavirus vaccination programme completed 50 days on Saturday, and so far the country has administered 2.06 crore doses.

However, with a 136 crore-strong population and with five states battling an unrelenting wave of fresh cases, the question arises if what was dubbed the ‘fastest vaccination drive‘ only last month is too slow to cover all citizens in time.

With a target to vaccinate 30 crore people till August, India needs to vaccinate at least 5 crore people per month, or more than 16 lakh people each day. But the current rate of inoculation is around 10 to 11 lakh people per day, which is nowhere near the desired target.

On Saturday, India managed to administer nearly 11.4 lakh doses (11,64,422 to be exact), till 7 pm. However, this includes an overlap of the second dose being given to 2,19,503 healthcare and frontline workers.

These numbers are likely to improve as the government has roped in the private sector for vaccine dissemination. Furthermore, media reports of public figures getting their shots is also likely to decrease vaccine hesitancy. However, even if the August target is met, that still leaves over 100 crore Indians exposed.

According to a report in Hindustan Times, some states like Bihar and Uttar Pradesh despite their large population are lagging behind in administering doses under the second phase, while some like Rajasthan are way ahead of others. This type of geographic disparity in vaccination is another problem, which needs to be fixed immediately.

Besides, the pace of vaccination is not going to be the same in well-developed urban centres and in rural areas within the same state where the poorer population will likely depend on the overburdened public healthcare system and free or subsidised jabs being provided by the government. What this means is a balanced approach between the private and public sector will be needed to ensure coverage.

Unless we rapidly increase vaccination coverage, India’s COVID-19 epidemic may not decline as quickly as desired.

Making a case for open, voluntary vaccination

This is not to say that the government should not rationalise the supply of vaccines to ensure equal distribution among states and Union Territories depending on the severity of the spread of infection. The assurance of free vaccination for those who cannot afford the additional burden is also imperative. But creating bottlenecks in the dissemination process while a section of the population — that is both willing to and able to afford the vaccine protection — waits is perhaps a case of overcaution and ‘over governance.

Experts have also reiterated the need to speed up vaccination as the threat of a fresh wave looms.

Speaking to Hindustan Times, Dr SK Sarin, director of the Institute of Liver and Biliary Sciences, debunks the ‘fastest’ immunisation programme claim of the Central Government. Although India was the faster country in the world to inoculate a million people, Sarin points out that in terms of coverage by population, India is far behind.

“So far we have immunised only 1 percent of our population, while Israel has immunised 85 percent and the US 23 percent. At the current pace, we will not be able to achieve the target even by the end of the year. We have to speed up the vaccination drive at least six to 10 times,” he said.

Director of All India Institute of Medical Sciences Dr Randeep Guleria also said that it was more prudent to allow the willing population to get immunised quickly rather than calling a select group and them not turning up on time.

“I think, if we need to achieve our target we need to have vaccination in more places, we have to open it up in a manner that those who are willing to take the vaccine are allowed to come rather than calling people and them not turning up,” Guleria said.

He had also stressed the benefits of immunising the population fast in a previous interview with The Indian Express. He told the newspaper that maximum immunisation will not only arrest the spread of the virus, but will also indirectly decrease the threat of mutations.

“The vaccine will help in decreasing the mortality; it will definitely help in decreasing the severity of illness, and hospitalisation deaths will come down. It will also, to some extent, help in decreasing the number of people getting the infection, and the duration of infection. Therefore, the transmission will also come down,” he said.

He also claimed that the threat of mutant strains can also be indirectly reduced through aggressive vaccination as a lesser number of cases means the chances of mutation also become less.

The case for parallel and prompt vaccination for all is further made stronger by studies showing that coronavirus is mutating faster than before.

According to The Times of India, Indian Institute of Science (IISc) scientists have found that three Bengaluru isolates had 27 mutations in their genomes with more than 11 mutations per sample — more than both the national average (8.4) and the global average (7.3).

Another study by scientists of Hyderabad-based Council for Scientific and Industrial Research Centre for Cellular and Molecular Biology states that there are more than 7,000 mutations of the virus in India, of which some could pose a serious risk

These mutations may or may not amount to a change in the basic structure of the virus, which may, in turn, alter its ability to spread, resist immunological response or treatment.

Read more about the difference between mutation and strain here

Although vaccine manufacturers, including the Hyderabad-based Bharat Biotech which makes the COVAXIN jab, have expressed hope that the vaccines also impart immunogenicity against the new UK strain, the emergence of fresh and more dangerous strains cannot be ruled out.

Furthermore, in absence of immunisation, the thrust of prevention policy lies in motivating the population to maintain COVID-appropriate behaviour. But reports from across the country show that the adherence to social distancing and hygiene norms has fallen down drastically since the lockdown was eased in the country.

A Local Circles survey published on 24 February states that only 30 percent of respondents rate mask compliance as effective in their area while just 12 percent of respondents rate social distancing compliance as effective. The survey was conducted on over 8,000 respondents from 238 districts of India, of which 51 percent respondents were from tier 1, 28 percent from tier 2 and 21 percent respondents were from tier 3, 4 and rural districts.

In fact, on Saturday, PTI reported a case in Gujarat where a health official tested positive five days after he was administered the second dose of the vaccine. The human body takes at least 45 days to develop an immune response after vaccination, experts said.

The upcoming election in five states, which includes Tamil Nadu, one of the states with a high caseload, is almost guaranteed to turn into a logistical nightmare for health authorities as large gatherings and congregations are bound to happen.

Do we have enough vaccines to innoculate all at once?

Apparently, yes.

A report in livemint states that India has the capacity to manufacture 50 crore vaccines per month to cover domestic needs and facilitate export to nations that are dependent on India for vaccine supply. To vaccinate about a quarter of its population till August, India only needs five crore vaccines per month. It needs to develop herd immunity in about 70 percent of its population via immunisation to end the pandemic.

Another study by Credit Suisse released in November 2020 estimated that India has sufficient capacity for vaccine manufacturing (more than 240 crore doses) and various components like vials, stoppers, syringes, gauze, alcohol swabs, etc.

Apart from that, the Centre has also reiterated time and again that there is no shortage of vaccines. “The states and Union territories should not store, reserve, conserve or create a buffer stock of the vaccines. The Central Government has adequate stock and will provide the required vaccine doses to the states and UTs,” the health ministry said in a statement on 2 March.

The Delhi High Court on Thursday also observed that both Serum Institute of India and Bharat Biotech have said they have the capacity, but “it appears” their production was not being exploited fully.

“…We should not have the situation where we are not even utilising their full capacity. They have the capacity to supply and manufacture. You are not utilising it because of a very restrictive kind of controlled approach,” the court said.

SII and Bharat Biotech had told the Delhi high court on Thursday that they have excess stocks but supplies can be made available only upon permission of the Union government.

Opening up vaccination can ease the strain on public healthcare infrastructure

Reports from various parts of the country suggest that despite making arrangement for a prior registration and appointment system for vaccine beneficiaries, the vaccination centres are bursting at the seams due to overcrowding. These are largely government centres, already operating at full capacity.

The roughly 20,000 centres being used for the vaccine drive at the moment are hospitals, private as well as public, while many primary and secondary health centres at present are kept out of the programme.

But by opening up the vaccination for all, the government will be able to tap into the large network of public hospitals and clinics in a more effective way. India’s private companies have also expressed a willingness to cover the cost of vaccination for their employees.

Tata Steel, ArcelorMittal Nippon Steel India (AMNS India), Rashtriya Ispat Nigam Ltd (RINL), ITC, Reliance group, Jindal Steel and Power Limited have all expressed interest in encouraging inoculation among their employees and their family members.