Patchy progress in ‘world’s largest vaccination drive’

Having set a daily target of vaccinating 1.3 million people, India has so far managed a daily average of only 325,000 (MIG photos/Aman Kanojiya)

India was rather late off the block in the roll out of the vaccination drive, that began after much dilly dallying only on January 16, almost a month after dozens of other countries had already been immunising their populations against the pandemic.

There was another major difference in the way the vaccination drive was promoted in India. In view of numerous rumours about the safety of the vaccines and large-scale reticence of the people across the world about taking the shot, global leaders tried to boost confidence in the safety of the vaccines by taking the first shot themselves, which were almost all telecast live on national televisions.

Among the first to get vaccinated was Israeli Prime Minister Benjamin Netanyahu, 71, who took the shot on December 19, 2020. Netanyahu was the first Israeli to be innoculated. He was administered the vaccine developed by Pfizer-BioNTech on live TV as the Prime Minister said he wanted to set a “personal example” to encourage other Israelis to follow suit.

He was closely followed by US President Joe Biden, 78 on December 21, 2020. Following the footsteps of Netanyahu, Biden also took the vaccine on live television to counter vaccine hesitancy in the US, which is the worst-affected by the virus in the world with over 535,000 deaths and over 29.5 million cases so far. Down under in Australia, Prime Minister Scott Morrison also launched the drive in the country by taking the first shot of a Pfizer-BioNTech vaccine.

But in India, it was after almost six weeks of launch of the vaccination drive, on March 1 that Indian Prime Minister Narendra Modi decided to join in world leaders to publicly receive the vaccination for the novel coronavirus. And unlike other nations, Modi only shared a picture of a vaccine.

The delay in Prime Minister’s vaccination led to speculation that this was due to concerns over the safety of one of the two vaccines being used in India in the initial phase of the drive, Bharat Biotech’s Covaxin, which had been cleared for use on humans but without clearance of its phase 3 trials results which were due only in March. By allowing the use of a vaccine that had not completed even the expedited and shortened safety tests, the government did severely undermine the confidence of the people in Covaxin.

Almost two months after it had been approved for use and was widely used, the Central Drugs Standard Control Organisation (CDSCO), the nation’s drug regulator, admitted that the vaccine was still in its clinical trial mode. The vaccine apparently has 81 pc efficiency rate, according to initial analysis of phase 3 trial. But Bharat Biotech is yet to submit the relevant data to CDSCO. By allowing mass use even in clinical trial mode, the government, the vaccine maker as well as the drug regulators have passed on the responsibility of any after-effects of the vaccine on the recipient, who has to sign a waiver of responsibility for any side effects.

Slow rollout & low acceptance

The absence of clinical data as well as regulator’s certificate of safety of the vaccine has led to a severe reluctance amongst the users of the target groups, including healthcare personnel themselves to be inoculated with Covaxin. This is one of the reasons that has made the government miss its own targets of vaccine roll out by a wide margin. It had set a target of 300 million people to be vaccinated, with two doses each, by end of July 2021.

However, the details of who these people are and how they would be vaccinated has remained sketchy. In January, the government had announced that in the first phase, the frontline workers, notably healthcare personnel and security officials like police personnel who have to come in contact with a lot of people every day, would receive the shots and the second phase would begin only on March 1, after the first batch of 30 million people had been vaccinated. However, by February 28, the government had been able to vaccinate only 14.30 million persons, missing the target by over 52 pc. Having set a daily target of vaccinating 1.3 million people, it has managed a daily average of only 325,000.

Though by March 4, three days after the launch of phase 2 which included those over 60 years and some between 45-60 years of age and with certain co-morbidities, the daily rate was ramped up to over 700,000 doses, that is still about 40 pc of the daily target rate, if at all India is to get anywhere near vaccinating 300 million by end of July.

By contrast a number of other countries had raced ahead of India, despite its claims of having the world’s largest vaccination drive. On March 4, the United States had administered 82.57 million doses, while China had already completed 52.5 million doses by February 28, the United Kingdom had administered 21.5 million doses by March 3 and on March 4, India’s total count was 18.01 million.

If indeed the government has to meet its 300 million target, it has to almost multiply by 11 times the number of doses being administered daily from the current average of 367,000 and reach 4 million doses a day from March 5 up to July 31. That is a steep target even for a country that produces 60 pc of the world’s vaccines. The healthcare network is not adequately funded or well developed to be able to handle vaccines which need reliable refrigeration every single moment from manufacture to use.

Gifting others but charging at home

One of the reasons behind the slow roll out of vaccination is the so-called Vaccine Maitri (Vaccine Friendship) policy of the government which has seen the country supply over 36.2 million doses of vaccines to over 50 countries. Of this, close to 7 million doses were gifts to friendly as well as strategic partners of India, the government says.

The decision of the Indian government was welcomed broadly by all recipient countries as well as the United Nations, but the decision was sharply criticised in India mainly due to the slow pace of vaccination.

Another policy that has come in for criticism and indeed which can put a big question mark on the principles and practices of the government is pricing of the vaccines. While the government hospitals will continue to administer the vaccines free of cost, the government has allowed private hospitals to charge about INR 250 per dose. This decision has also been criticised widely since most countries, ranging from the United States, EU and United Kingdom to China and Russia have been vaccinating for free.

Moreover, by having dual policy in place, the government may soon run out of people to vaccinate in private hospitals due to the payment of INR 500 per person for two doses.

Even if the government does manage to reach its initial target of 300 million, India is unlikely to top the global list of number of vaccinations. Though China has not declared its target, the country has already administered over 53 million doses and is likely stay far ahead of India in total number of vaccines administered as well the proportion of the population to have been inoculated. Moreover, even the United States, which has a population of 330 million, says it would inoculate all Americans by end of July, putting it marginally ahead of India in total number of doses and at least 4 times as much in per capita terms.

As of now, India’s rate of vaccination lags behind not just the developed countries, but also many developing ones as well. As of March 4, India had administered at least one dose to 1.3 persons for every 100 people, while the global average was thrice as much at 3.6. Israel topped the list with nearly 99 on 100 persons, while UK had covered over 31 and the US about 25. China was at 3.65 on February 28.

Thus, whichever way Indian government presents it as the world’s largest vaccination drive, the numbers just don’t add up.