Earlier this week, India commenced the next step in its mammoth undertaking of vaccinating its 136.6 crore citizens against Covid. With healthcare workers and essential workers receiving their doses first, the vaccines are now being made available for those over 60 years of age and those above 45 with comorbidities.

India approved two vaccines for emergency use on January 3 – Oxford-AstraZeneca’s Covishield, produced by Pune’s Serum Institute of India, and Bharat Biotech’s Covaxin. The latter has been at the centre of a controversy because it received emergency use approval while its clinical trials were still underway.

As of March 3, around 1.56 crore people in India have received their Covid vaccines. The government aims to vaccinate 30 crore people in total by August.

This is especially critical considering that India is currently seeing a spike in Covid cases, with an active caseload of 1.7 lakh on March 1. Maharashtra has reported the highest number of daily cases, followed by Kerala and Punjab.

Since January, when the vaccination drive began, India has vaccinated an average of 92 lakh people per month. To hit 30 crore people by August, the government will have to vaccinate approximately five crore people per month March onwards.

Now, it took India six weeks to vaccinate 1.4 crore people. With private hospitals being allowed to administer the vaccine from March, even if two crore people are vaccinated per month, it would take nearly six years to cover the entire population. And this is only taking into consideration the administering of the first dose of the vaccine. The second dose needs to be administered four to six weeks after the first.

Let’s look at the daily number of vaccinations. The first day of inoculation of those aged 60, and those above 45 with comorbidities, saw 1.47 lakh doses being administered. This increased to 3.85 lakh doses the following day. In total, March 1 saw 4.2 lakh vaccinations, followed by 7.68 lakh on March 2.

If the government is able to keep increasing this number, it might hit 50 lakh vaccines per week. This is possible, considering 25 lakh people registered on the government’s CoWin app as of March 1 for the vaccine.

We reached out to experts to ask them what they think.

Issues overlooked

Rajib Dasgupta, chairperson of the Centre of Social Medicine and Community Health at Delhi’s Jawaharlal Nehru University, told this reporter that it’s likely that the government will not meet its initial timeline. However, he pointed out two things that might accelerate the process – the addition of private providers to the vaccine drive, and the capping of prices at Rs 250 a dose.

“The essence of Covid vaccination is two-fold: to protect the more vulnerable population on a priority basis, and slow down the epidemic,” he said. “To that extent, India has so far immunised less than one percent of the population and has a lot of catching up to do.”

Dasgupta added that the Covid vaccine is likely to be an annual requirement, like the flu shot. India would need a “different programme and a different imagination of designing the services as we go along”, he said.

Dr JA Jayalal, the president of the Indian Medical Association, said he backs the government’s decision to add private hospitals to the drive. However, he thinks the government might not have fully thought things through.

For instance, Jayalal said, those over 45 years of age with comorbidities are eligible for the vaccine if they produce a medical certificate confirming their comorbidities. “The medical certificate is going to be a big problem for the common man and those in rural areas,” Jayalal said. “The hospitals where the vaccination will happen could have themselves checked and determined if they are eligible.” He added that it’s also possible for people to produce fake certificates in order to get the vaccine.

Additionally, he said, the government’s CoWin app began registrations for vaccinations on March 1, the same day as the start of the next phase. New hospitals didn’t have the chance to receive training or hold trial runs before their vaccination drives began.

Jayalal also emphasised that while he took a Covishield vaccine, his family took Covaxin. “Both are good,” he said.

Perhaps it was to assuage these doubts that Prime Minister Narendra Modi claimed that he took a Covaxin vaccine too on March1.

Vaccine diplomacy

India’s “vaccine diplomacy” has also been steaming ahead: the government has given the vaccine to 15 countries including Bangladesh, Myanmar, Nepal, Bhutan and Mexico. Until March 3, 440.13 lakh doses of vaccines – mainly Covishield – left India for foreign shores.

The country is also supplying vaccines through Covax – an initiative led by partners like the World Health Organisation and the Coalition for Epidemic Preparedness Innovations to deliver vaccines to countries in need. India’s Serum Institute of India vaccines have so far been sent to Angola, Nigeria, Cambodia, Kenya and Lesotho, among others, under the programme.

But is India’s vaccine diplomacy taking place at the expense of its own people?

Harsh V Pant, the director of the strategic studies programme at the privately funded think tank Observer Research Foundation, said: “The idea is that somehow, within the constraints that the government has, it will also take a more responsible approach in the global pandemic. Also, if you are sending a lot of these vaccines to your neighbouring countries, it helps you. If you only inoculate your own people and the neighbours are suffering, then the sustainability of that entire thing would be in jeopardy. One should not look at it in such a binary term when such a pandemic is around.”

If a political argument does kick in, he added, it would be quite extraordinary. “It’s not like the government has been doing this behind closed doors,” he said. “It has been the policy of the government to work with other countries and help them in meeting their targets.”

The IMA’s Jayalal also rubbished claims that India’s people were losing vaccines to foreign countries. “There’s enough vaccines for people in India,” he said. “Vaccine is being given in a phased manner. Our production capacity is adequate to take care of the needs of the people here.”

This reporter also reached out to Dr VG Somani, the drug controller general of India, for comment, as well as Dr Vinod Paul, chairperson of the national expert group on Covid vaccine administration, and officials from the health ministry, but received no response.