Need to cover 25 crore adults remaining by December, expand second dose coverage, and plan for those below 18 years
The government deserves credit for having administered 100 crore Covid-19 shots within 10 months of kicking off the national vaccination effort. More so, given India has relied, almost entirely, on vaccines produced indigenously. However, amidst this achievement, we must not lose sight of the larger picture. A significant proportion of those currently eligible to receive vaccines—those above 18—remains un-inoculated; more than 25 crore people have not received even a single dose, a fourth of the eligible population.
At the average-rate of first-dose inoculation for the week ended October 20, India will manage to cover less than half of this, or 11.3 crore, people by end-December. To be sure, the pace of vaccinations may have slowed due to the festive season and may recover substantially post Diwali. But building pace will be critical. Data from CoWin also shows that the uptake in the above-45-years age group has been higher than that in the 18-44-years cohort. While this could be attributed to the phased rollout, the vaccination has been open to all for long enough now for the youngsters to have caught up with the older recipients. Given the strong inventory of vaccines with the states—government data shows, this shot up from 46 million to 89 million between mid-September and mid-October—this indicates demand-side problems. With 70% of the adults covered, if indeed a lack of demand is stalling the effort to reach all adults by the end of the year, then it is clear India may have a large vaccine hesitancy problem. To that end, the government must pull all plugs to convince people of the need to get vaccinated; vaccine mandates for certain activity, with strict enforcement, may help.
The other big concern is that full vaccination (two doses)—and Covid taskforce chief DR VK Paul has just reiterated how critical this is to the fight against the pandemic—is still low. Only 21% of the population (less than a third of the eligible population) has received both doses. This will surely pick up as first-dosers complete the mandated minimum gap between the doses. However, as per the ORF Vaccine Tracker, frontline workers—for whom (along with health workers) the vaccination efforts started much earlier—report only a 78% second-dose cover as on October 19. Similarly, the 18-44 years age group, for whom vaccinations were allowed from May 1, report only 18% second dose coverage. While vaccine supply could have been a problem in the early weeks, this hasn’t been an issue for the last couple of months.
What the government also needs to figure out is vaccine coverage for those below 18—constituting 30% of the population. While Covaxin and Zydus Cadilla’s vaccine candidate have been recommended for approval, most experts feel vaccination for a substantial chunk of minors may not be necessary. It could be that the really young—Covaxin trials cover different cohorts in the 2-18-years group—may not need vaccination. However, the older ones in this group, especially 14-years plus, some of whom may even have some form of employment that is associated with high exposure risks, need to be covered. To achieve this, the government needs to strategise well in time. Meanwhile, the second wave showed us the kind of damage that mutations can cause; the Delta variant was more virulent and possessed higher infectivity. To that end, India can’t afford sluggish monitoring of variants; more so, given how such discovery could be crucial to future vaccine-research.