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Boosting India’s COVID-19 vaccination drive

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A health worker collects swab samples from a woman for COVID-19 RT-PCR test at the road side in New Delhi (Photo: SIPA/ Naveen Sharma).

In Brief

India is one of the worst affected countries by COVID-19, with an estimated 11.4 million cases and over 160,000 deaths as of 30 March. New Delhi pursued aggressive measures to control the pandemic and the swift implementation of restrictions across the country contained some of the spread.

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India was also one of the earliest countries to test and produce COVID-19 vaccines. The country’s strong manufacturing base, especially in pharmaceuticals, helped accelerate co-patented vaccine production and the manufacturing of new vaccines. India now supplies more than two-thirds of the world’s vaccines.

The Indian government approved two vaccines for use in January 2021 and another six are under consideration. The first is Covishield, a brand of the Oxford University–Astra Zeneca vaccine, with an efficacy rate of 81.3 per cent. Covishield is being manufactured by the world’s largest vaccine manufacturer, the Serum Institute of India.

The second is Covaxin, an Indian vaccine developed by Bharat Biotech in partnership with the Indian government. Covaxin has an efficacy rate of 81 per cent, but the Indian government and the company were criticised for launching the vaccine based on trial data from Brazil and the United Kingdom — with limited bridging study data from India.

To date, India has vaccinated over 60 million people, prioritising healthcare and frontline workers in the first phase of the roll-out. The recent second phase has seen the vaccination of people over 60 years old and those from 45–59 with co-morbidities.

The Indian government set an ambitious target of vaccinating 300 million people by July 2021, having also shipped more than 57 million vaccine doses to 64 countries, including the United Kingdom, Canada, Brazil and Mexico. But while India has the manufacturing prowess to vaccinate its population, the vaccination program itself has been met with serious challenges.

India has an estimated population of 1.38 billion people. Only 60 million Indians (roughly 4.3 per cent of the population) have received their first dose and only 0.6 per cent of the population is fully vaccinated — low compared to the global average of 4 per cent. Countries such as the United States and the United Kingdom have already vaccinated 29 per cent and 46 per cent of their populations, respectively.

A substantial portion of a population needs to be vaccinated to achieve herd immunity. Yet even vaccinating 60 per cent of India’s population translates to nearly 800 million people, which would take over two years to achieve at the current rate.

While over 85 per cent of India’s healthcare services are provided by the private sector, the COVID-19 vaccination program is delivered predominantly through government hospitals, with very few private providers engaged in the campaign.

The two-dose requirement for Covishield and Covaxin — as well as the need to follow up with those who are vaccinated and monitor for adverse reactions — requires a large amount of healthcare staff. But India’s vast network of private healthcare providers remain underutilised.

To date, the Indian government has allocated Rs 35 billion (US$7 billion) for its vaccination campaign. But although New Delhi set the price for private procurement at just Rs 200 (US$3), a significant portion of its population could still be disadvantaged by their economic status.

Nearly one-third of India’s population live on under US$1 per day and another 100 million live in abject poverty. The cost of the vaccine is likely to go up when the government opens the inoculation program to private providers. This would push the poor further back in the vaccination line, ultimately threatening the goal of herd immunity.

While health is usually a state issue in India, the central government runs the country’s existing COVID-19 vaccination programs. Tight central control of the Expanded Programme on Immunisation is a tightly controlled program credited for its wide coverage and implementation. Yet much of this is for paediatric vaccination catering to only 15 per cent of the population. The Indian government needs greater focus on the mammoth challenge of administering COVID-19 vaccines to adults and the elderly.

Vaccines are often wasted because of poor planning and gaps in policy implementation. Added to this is the woeful state of India’s cold chain storage infrastructure — nearly 25 per cent of vaccines are spoiled while being transported from the manufacturing site to the field. Given India’s COVID-19 vaccines need to be maintained at a strict temperature, the country’s cold chain transport infrastructure needs improving.

There is also variation in state vaccination rates due to differences in health infrastructure. States with better facilities are performing better in the vaccination campaign.

India’s vaccine manufacturing heft gives it the opportunity to inoculate its population and achieve herd immunity against COVID-19. But to make the most of this opportunity the Indian government must address the population, private sector participation, cost and logistical challenges that are afflicting its rollout capacity.

Padmanesan Narasimhan is a Lecturer in the School of Public Health and Community Medicine at the University of New South Wales, Sydney.

This article is part of an EAF special feature series on the COVID-19 crisis and its impact.

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