Is India’s Covid vaccination programme the world’s largest or slowest?

The government made grand announcements about the drive in January. Three months on, the reality is different.

WrittenBy:Jammi N Rao
Date:
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On January 11, prime minister Narendra Modi chaired a meeting of chief ministers where he announced that the “world’s biggest vaccination campaign” would start in India on January 16.

According to the announcement, in the first phase, 30 million health, sanitation, police and other front-line essential workers would be covered. In the next phase everyone over 50 and anyone with health conditions that made them vulnerable to Covid would be eligible. The target was to vaccinate 300 million Indians “in the next few months”.

Earlier, on January 3, the Indian drugs regulator had granted emergency use authorisation to Serum Institute’s Covishield and, despite lack of data on efficacy from the on-going phase three trial, Bharat Biotech’s Covaxin.

The early phase of the nationwide programme to vaccinate health workers was mired in reports of “vaccine hesitancy”, particularly to do with the lack of efficacy data on Covaxin. This situation was not helped by crass attempts by official bodies to talk up a paper in the Lancet describing the results of Covaxin’s phase one trial demonstrating immunogenicity and safety. On March 3, Bharat Biotech put out a press release with unpublished results of an interim analysis of data from its Phase 3 trial showing an 81 percent efficacy for Covaxin. I explained these results in a previous column.

To inspire confidence, the prime minister was among the first to take the jab as part of the roll out to those over 50 on March 1. He chose to take Covaxin, and took to Twitter to urge people to get vaccinated.

So how has India’s vaccination programme gone so far?

As of March 31, India’s vaccination programme has given 65.1 million doses of vaccine with 9.3 million Indians having had two doses. These figures look impressive, especially when presented as absolute numbers in lakhs as the press releases from the ministry of Health are wont to do. But how do they stack up in relation to the target set by the prime minister at the start of the year? Remember the “30 crore in the next few months” statement?

International comparisons are always fraught but one useful measure is to express the absolute number of doses as a ratio of the population to be covered. This is the “doses per 100 people” metric published daily for every country by Our World in Data. The top country by this metric is tiny Gibraltar with a population of 34,000 which has given 177 doses per 100 people. As of March 31, India has given 4.7 doses per 100 people, below even the world average of 7.5 and just ahead of Bangladesh’s 3.26.

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That particular metric, doses per 100 people, underestimates India’s performance. India has a relatively high proportion of under-18s, an age group that would not be eligible for the vaccine anyway. To include them in the denominator makes India’s performance look less than it is. But even taking that into account, the chart shows that India’s vaccination programme is sputtering along rather than roaring ahead. This is unacceptable for a country fortunate enough to have companies that boast the potential to manufacture billions of doses of vaccine to export to scores of rich and poor countries alike.

Another way of tracking progress with the task of getting “jabs into arms” is to follow the daily trends. Allowing for early teething problems with the process set up by the ministry of health for registration and appointments using the CoWin app, I decided to look at the daily trends in the month of March. The chart shows a surprising lack of sense of urgency with a dip in the daily numbers every Sunday to 250,000 jabs or lower.

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Putting all the data together, the conclusion is obvious. The prime minister’s vision of 300 million people vaccinated “in the next few months” seems somehow to have been lost in transmission from the video-conference room in New Delhi to the departments of health in the states, and, hence, to the cities, towns and districts where the vaccination centres and clinics are located.

Belatedly, the centre seems to have woken up to this tardiness when it announced on April 1 that all the vaccination centres would be fully operational on every day of the week throughout the month of April.

That may not be enough. To vaccinate 300 million people in say eight months, by the end of August, the government would need 600 million doses. So far, over a 10-week period, India has managed 65 million doses. about 6.5 million doses a week. From April to August, India will need to hit 24 million doses a week to administer 535 million doses in the remaining 22 weeks. And, according to this Reuters report, people aged 45 and over would now be eligible and the target number of Indians to be vaccinated has been raised to 400 million.

It is doable but not with the kind or project management on display so far. An urgent and quick review is needed to identify the bottlenecks that have kept the pace of vaccinations, down to around a million doses a day. Any such review would do well to start with the seven principles I outlined in an earlier column.

If corrective action is not taken soon, the world’s biggest vaccination programme might end up being its slowest.

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