Workers unload a batch of AstraZeneca COVID-19 vaccine on arrival at Benito Juarez’s international airport in Mexico City. Photo: Henry Romero/Reuters
It is the darkest before the dawn. India’s fight against the COVID-19 virus-induced pandemic has been globally applauded. Beginning September 2020, the coronavirus cases in India saw a steady decline. With a steady dip in the cases and the rollout of the first phase of India’s vaccination programme in January 2021, it appeared that the end was near.
However, there has been a sharp uptick in coronavirus cases in March 2021. India recorded 72,108 confirmed cases of coronavirus disease on March 31st, 2021- the highest ever surge in daily cases since October 11, 2020. Due to the nature of the spread of this virus, it is amply clear that the way out of the pandemic is through mass vaccination. The IMF and World Bank have said, “No one is safe until everyone is safe.” The WHO has exhorted the member countries to vaccinate its health care workers and older people within the first 100 days of 2021.
Following this strategy, India launched the world’s largest vaccination drive on January 16, 2021. The inoculation drive has entered its third phase on April 1, 2021, with people over the age of 45 and above eligible for vaccination.
Global equity concerns
Certainly, mass vaccination is the way to beat the pandemic, but it must go hand in hand with equitable distribution of the vaccines. There has been a dominance of the high-income countries in the global vaccination drive. It has been over three months since the high-income countries started their vaccinations but there are still frontline workers in poor countries who have not received a single dose of the vaccine. Glaring vaccination inequities have surfaced within and among countries.
As of March 30, 2021, US has vaccinated about 44 people per 100 populations whereas its neighbour Canada has inoculated only 14 people per 100 populations. Similar inequities in the vaccine’s distribution exist among the countries of Asia, Europe and South America.
For example, while India has vaccinated about 5 people per 100 population, China has inoculated about 8 people per 100 population. As many countries face the fresh onslaught of the third wave of infections because of mutants of the COVID-19 virus, there needs to be an equitable distribution of the vaccine among and within countries.
But there are challenges there. While global equity concerns are acknowledged, can it trump a country’s own domestic vaccine equity concerns? The latter is very difficult to sustain politically and socially too. The murmurs can already be felt in India. While the entire world has acknowledged India’s humane role in supplying vaccine to about 78 countries in the world which has cemented its role as a global leader, some opposition parties are questioning if this was being done at the cost of poor Indians who have limited access to the vaccine.
India’s domestic vaccine equity
India aims to inoculate about 30 crores of people by the end of July 2021 with a target of 70 lakhs vaccinations daily. As of March 31, 2021, the daily vaccinations stood at about 21 lakhs while the total vaccinations were 6.5 crores. The first phase saw the frontline workers being vaccinated while in the second phase people over the age of 60 or people over the age of 45 with co-morbidities were eligible beneficiaries. The third phase now covers all above 45 years of age.
India’s pulse polio immunisation effort has been applauded globally. Even though the scale of the polio vaccination was relatively limited, the lessons from the past have enabled the push for equitable distribution of vaccines. The government has leveraged its institutional networks in the form of ASHA workers, Panchayati Raj institutions and Women’s Self Help Groups (SHG) to mobilise awareness at the grassroots. However, the current challenge is much more difficult as it is a highly transmissive disease and everyone has to be vaccinated not just a target group.
The coronavirus pandemic has had a devastating effect on the Indian economy. The price cap of Rs. 250 in private hospitals and the vaccination being free of cost in government hospitals has ensured that the economic burden of vaccination on individuals is kept to a minimum.
This has enabled individuals from economically weaker sections of the society to get themselves vaccinated. However, barriers in the form of myths surrounding the vaccination, slower rate of vaccination as compared to global standards and availability of vaccines in topographically challenging locations persist. Further, there is an urgent need to open the vaccination across ages in the states like Maharashtra, Punjab which are currently reeling under the third wave of the pandemic.
The vision of equitable distribution of vaccine would falter if it does not account for people with lesser privileges. Irrespective of their age, individuals who cannot work from home or adhere to COVID appropriate behaviour due to the nature of their trade may act as spreaders. It is imperative that the criterion of age is not seen as the sole benchmark for vaccination.
This would only be possible through a granular data-driven approach. This would further safeguard vaccine equity for the vulnerable living in the urban and rural areas. The technical capacity of the urban and rural local bodies across the country should be strengthened to get a complete picture of the vaccinations in their area.
With the sharp spike in cases in March 2021 across the country, it is important to adhere to the principles of smart testing, treatment, tracing, and COVID appropriate behaviour which had helped us tide over the first wave. The government has been cognizant to impress upon the various state governments the need to bolster their health infrastructure in terms of ramping the testing facilities, availability of oxygen, and availability of beds. The second wave of the pandemic can only be mitigated through a combination of equitable distribution of vaccines along with the protocols which have been honed over the last 15 months.
Amar Patnaik is Member of Parliament, Rajya Sabha, from Odisha, a former CAG bureaucrat with a master’s degree in public management from the Lee Kuan Yew School of Public Policy, Singapore, and the Kennedy School of Government, Harvard University. The views expressed are the author’s own.