100-crore jabs a milestone, but bigger challenges await us

Even as early Deepavali celebrations have been triggered by the 100-crore Covid vaccination record achieved on Thursday, senior officials of the Health and Family Welfare Ministry are gearing up for the long haul as India needs nearly 180 crore more doses to achieve universal coverage. 

In other words, what has been done is only one-third and twice the effort is required before India breathes easy from the pandemic. The task is tough and it may take more than a year even if the current momentum is maintained.

Government agencies, both central as well as state, have shouldered 80 per cent of the vaccination load till now and the trend is expected to continue. Though private sector hospitals have been authorised to administration paid vaccinations, only 20 per cent of the jabs so far have been handled by private agencies, including corporates sponsoring inoculation for their employees. Officials expect this trend to continue and the Centre as well as the states have to make significant provision of finances for the vaccination drive during the next financial year too.

Reaching the 100-crore landmark is commendable, but the situation warrants continuation of vaccination on a war-footing, rather than simply gloating.

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First, more than 25 crore adults remain unvaccinated despite nine months of non-stop push. Therefore, 50 crore doses of vaccine are needed to shield them from COVID-19.

Less than 30 crore people have so far managed to get two doses and this means only a little over 21 per cent of the population enjoys full vaccination. Inoculating the remaining 110 crore is a work in progress, either partially or fully since protection from coronavirus is considered adequate only after two doses. Luckily, the third wave of COVID has not reared its head and this has provided more headroom to complete the vaccination process without further delay.  

According to government data, around 71 crore first doses have been administered so far. Out of this 30 crore have received their second dose too. That leaves a requirement of nearly 41 crore doses for those who are done with their first dose, but are yet to receive their second. Unless most of the population is either vaccinated or acquires immunity after recovering from infection, the protective shield against COVID will not be effective enough and the country will continue to be vulnerable to any surge in hospitalisation.

Back-of-the-envelope calculations indicate a requirement of around 91 crore doses of vaccines for completing inoculation of those above 18 years of age. Questions are also being asked about the need for booster doses and if that is approved, then the requirement will only go up. Though it may not be required for the entire population, current trends in countries like the US indicate booster shots for frontline workers, persons with co-morbidities and those who do not develop adequate immunity with the standard two doses.

88 Crore Doses For Children

In the meantime, the Modi government needs to draw up suitable strategies for vaccinating those below 18 years of age – estimated to be around 44 crore. This means another 88 crore doses of vaccines will be needed once approvals for vaccinating children are provided by the authorities after adequate field trials. The total requirement, therefore, works out to at least 180 crore doses if inoculating children also involves the standard two-dose format.

Completing the vaccination mission by next year means maintaining a countrywide logistics system without any letup. The entire vaccine supply chain – production at specialised facilities, clearance of batches, distribution by airlines, storage at state capitals, and finally transportation of vaccination centres – involves temperature controls and other safeguards. 

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At the last count, vaccination is being done at 87,725 centres across the country and these have to be maintained for at least a year. State governments now have nearly 11 crore doses in hand on a daily basis and replenishment is being done at a much quicker pace. The supply pipeline is also strong as the central government has ordered 60 crore Covishield doses to be supplied between now and December.

Hesitancy Challenge

The biggest challenge now is to overcome vaccine hesitancy by convincing unvaccinated people to come forward and receive both doses within the stipulated period. The clamour for vaccines peaked when the second wave struck, leading to unprecedented rush at hospitals and a horrible trail of deaths. The huge queues at vaccination centres have disappeared now and state governments are finding it hard to attract the public. Officials feel that there is no need to worry about adverse side effects as 100 crore doses have been administered with only a few cases of undesirable consequences.

Incentives are also being provided in several parts of the country to lure the public to vaccination centres. However, the real inspiration for people will be the awareness about the benefit of immunity acquired by vaccination and the health risks of not doing so. The other driving force may be the requirement of two doses of vaccination for travel abroad and also for employment in certain sectors that involve regular interaction with the public.

Reopening Schools

School students will be a big beneficiaries when vaccines are approved for those below the age of 18. Once students get inoculated, schools will be less hesitant to reopen. Parents will also feel more confident to send their kids to school. As of now, schools have reopened only for classes IX to XII and even this is only partial. As online education persists even a year-and-half after the first lockdown, students are grappling with various issues ranging from excessive screen-time to obesity.

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Students can go back to their schools once vaccination for those under 18 is done, bringing normalcy back on the strength of confidence. The big question mark in inoculating those under 18 is that only Covaxin has progressed to the final stages of obtaining clearance. The mainstay of the country’s vaccination mission, Covishield, is nowhere close to obtaining approvals for vaccinating them. Therefore, even after approvals by the competent authorities, supply of vaccines for kids would be a cause of concern. The other vaccines on the drawing board have also not made much progress while imported vaccines continue to suffer due to limitations of logistics as well as costs.

Apart from vaccinating the 140-crore population of the country, India is also expected to provide vaccines to neighbouring countries like Nepal, Sri Lanka, Bhutan and Myanmar. Once the domestic demand is met, the focus of the vaccine producers will be on exports as several countries are looking for affordable sources of vaccine supply as the American and European vaccines are considered expensive. Till COVID is contained all over the world, masking and social distancing will be the most important safeguard against the coronavirus, even after two doses of vaccination.