India's vaccine puzzle - Priority versus Reach

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  India's vaccine puzzle - Priority versus Reach

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Read more on - Polity | Economy | Schemes | S&T | Environment

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• Biggest vaccine producer: India is recognised as the world’s largest vaccine producer, but is currently struggling to vaccinate its waiting population during a deadly second wave of Covid. That is costing it both lives and livelihoods, severely impacting the economy that was showing signs of recovery.
• How 2021 started: There was a promising start to the year 2021, and two vaccines were approved and Covid caseload was at an all-time low. Then, India slipped. With the world’s highest number of daily cases, and deaths, the virus started taking young lives, challenging the vaccination strategy. 
• Vaccination policy: The vaccination operation was started in mid-January, with an age-tiered strategy, coupled with inoculating our frontline health workers. 

1. Starting with over 60-year-olds from 1 February, India moved to 45 years and above by 1 March, and announced 18 years and above starting 1 May. 
2. But as it didn’t have the quantum of vaccines necessary to vaccinate the adult population, it didn't work out.
3. The government has shared an estimate of over 2.2 billion doses of vaccines that can be produced between now and December, but many have called this unrealistic. Private sector estimates put this at half or about 1.2 billion doses between Covishield, Covaxin, Sputnik, ZyCov-D, Novavax and J&J’s until December 2021. (Imported vaccines from Pfizer, Sputnik and Moderna could possibly add another 100-200 million doses, but no more)
4. Vaccination rationale: India's challenge is to have a strategy that protects the vulnerable while stopping transmission also.

• Estimated numbers: As per census, approximately 63% of population is over 18 years of age and hence eligible for vaccination. So 82 crore are to be vaccinated. If we assume that 18 crore got one shot, it is now down to 64 crore. Factoring in the need to cover 70% of our population to gain wide-scale protection for all, around 45 crore vaccinations, or 90 crore double doses, are needed. Current production can help reach a very safe place by the end of 2021 and avert a third wave. Starting January 2022, India can start giving booster doses at 200 million doses per month.
• Vaccination prioritization: To ensure every vial and every dose of vaccine is used efficiently, highly streamlined logistics is needed, which can only happen with decentralization at the state level. Today, the central government has announced a model that is split 50% between central procurement and the balance between state governments and the private sector. The science of epidemiology should lead India's vaccination strategies. At a time of vaccine inadequacy, effective impact rather than equitable access ought to drive decision-making. For example, India must prioritize vaccination on a formula of district-wise population density, case load, fatality rate and doubling rates, followed by occupation-based prioritization depending on risk of exposure and infection. So in Karnataka, Bengaluru is the obvious place to start, followed by Mysuru, Bellari, Dakshin Kannada, Dharwad, Hassan Tumakuru, Shivamogga, Belgavi, Gulbarga, etc. Maharashtra would have a graded weightage starting with Mumbai, Pune, Nashik, Aurangabad, etc. Punjab would prioritize Ludhiana, Amritsar, Jalandhar, Patiala, and so on.
• Occupation wise: As for occupation-based prioritization, those most at risk would be delivery service personnel, cab drivers, market vendors, provision shop staff, slum-dwellers, construction workers, and on-site employees, followed by residents of high-rise buildings, gated communities and then single dwellings.
• Summary: Once urban centres are secure, perimeter protection can be deployed through entry-exit protocols, and the focus can then shift to vaccinating the rest of the state. Such a strategy could stop the spread of viral infection in rural areas. A strategy of dealing with vaccine inadequacy through well-targeted priority inoculation is the way forward.

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