A medic prepares a dose of Covaxin vaccine for a beneficiary at Sir J.J. Hospital Hospital, Mumbai, January 27, 2021. Photo: PTI/Mitesh Bhuvad.
India plans to vaccinate 300 million people by July 2021, the government has said. The government has procured 11 million doses of Covishield from Serum institute of India and 5.5 million doses of Covaxin from Bharat Biotech. Both are double-dose vaccines. So the government needs to deliver roughly 3.33 million doses per day.
India’s vaccination drive began on January 16. The current pace of vaccination is around 0.1-0.2 million doses a day – nowhere near the required 3.3 million. Why could this be so?
Unless we rapidly increase vaccination coverage, India’s COVID-19 epidemic may not decline as quickly as desired. To this end, we need to expand the number of vaccination centres. The government needs to activate all vaccination centres currently used to deliver children’s vaccines. In addition, the government should also allow all NGO hospitals and clinics to administer the vaccines.
Each centerer can administer 100 doses a day – which means we need 33,000 centres throughout India. This is not a large number: we already have around 30,000 primary health centres in rural and urban areas, plus NGO hospitals. In densely populated urban areas, the centres could run from 6 am to 11 pm in two or three shifts and offer vaccines to 200-400 people a day.
Of course the supply system needs to keep up such that there is no shortage of vaccines or waste. People working on the supply side should be properly trained and follow all standard operating procedures.
This said, the process of administering the vaccines themselves is not new. A qualified nurse can perform it. The state has to properly allocate recipients so that there is no rush at the centres.
Second, we need to vaccinate all categories of vaccine recipients – healthcare workers, frontline workers, older people and people with comorbidities – in parallel instead of doing so in series. Many healthcare workers are reluctant to take the vaccines, whereas many people in the community are eager to take the vaccines. By vaccinating groups in series, therefore, bottlenecks develop that could keep the vaccines out of reach of those prepared to take it. Making people wait a long time may reduce their enthusiasm, especially if disease numbers go down drastically, which is likely to happen in a month.
The government has not allowed the manufacturers to sell their vaccine candidates in the open market. Serum institute of India has already produced 50 million doses, of which the government has purchased 10 million for now. And of these, only about 2 million have been delivered in the last 12 days.
We hope the speed of vaccination will increase – but if the same rate continues, the government has a long road to 300 million people. So if the government is unlikely to buy more doses soon, it should not prohibit the manufacturers from selling doses in the open market. Doing so will also reduce the government’s burden and ease access.
Serum Institute’s declared open market price of Rs 1,000 per dose of Covishield may be affordable only to 10-20% of the Indian population, likely less. The government can also mandate all organised-sector workers to be vaccinated by their employers. And employers may do so willingly to reduce the risk of COVID-19 in the workplace as well as illness-related absenteeism.
If the government wants to be more entrepreneurial, it can charge Rs 100-200 from people who are not living in poverty, as identified by their ration cards or some other mechanism. It can also sell the vaccine at a higher price, like Rs 500-700 per dose, in government facilities and use the surplus to subsidise vaccines for the poor, which is now being given for free. The paid vaccine can be a way to jump the queue for people who can afford to do so and can justify their need for vaccines. The government of course must manage this without promoting inequity at the same time.
Finally, the government may not need to vaccinate 70% of all Indians to achieve herd immunity. As an emergency measure, it could ensure 70% vaccination in top 50 districts. According to our analysis, these 50 districts have 60% of India’s COVID-19 cases as well as 60% of deaths due to the disease. So achieving herd-immunity by vaccination in these districts will lead to a big drop in the number of cases.
If the country’s COVID-19 epidemic is an emergency situation, the vaccination strategy and pace should reflect that. Going slow won’t hasten the disease’s decline.
Dileep Mavalankar is director, Indian Institute of Public Health, Gandhinagar.