Vaccination: Focus on hesitancy, the 12-18 age group, booster shots

Two weeks ago, I wrote in this space that the coronavirus disease in India could soon stop being a pandemic and become endemic, an opinion that has since been aired by experts far more qualified than me. This also means that India could either dodge the third wave of the disease altogether — this is an opinion I have consistently articulated, despite the scare being created by some around a wave that affects young people — or, at worst, see localised flare-ups. This, the pandemic-to-endemic transition, is a big and significant milestone, and it is coming soon.

There is another significant milestone that’s coming too, perhaps as soon as the middle of October. This is the ceiling India will hit in terms of vaccine coverage. There are around 940 million people over the age of 18 in the country. The government has said it will vaccinate all of them by the end of the year — a stretch, but possible as long as supplies keep increasing as rapidly as they did in August.

The problem is that not all of them want vaccines. And short of vaccine mandates — I am all for them, or creating some link between access to benefits such as grains under the public distribution system to vaccines, or even incentives — there is nothing that is likely to make them take the jab. I expect this ceiling at the 75-80% vaccination coverage level. That translates into 705-752 million people. The government, public health workers, employers, media, religious and charity organisations, influencers — all of us have a responsibility in making sure more people get vaccinated, but there are always those who will not.

The experience of the United States (US), where many infections, most hospitalisations, and almost all deaths currently being seen, are among the unvaccinated is a cautionary tale, but there are those who will still not learn from it. This means that India needs to start planning for the next phase of its vaccine drive, which could (and should) start mid-October.

Ideally, this needs to have two legs. The first will have to be vaccines for around 165 million people between the ages of 12 and 18; the Zydus vaccine, ZyCoV-D, which is thus far the only one approved for use in this age group, should be reserved exclusively for people in this age group, with jabs being prioritised for the most vulnerable and also for those in Classes X and XII. There is simply nothing to be achieved by making this vaccine another in India’s portfolio of vaccines being administered to those over the age of 18. That battle is won (or is in the process of being won).

The second leg will have to be booster shots. It is now clear that people who have never been infected with the virus that causes Covid-19 will need a booster shot. These shots will, again, have to be prioritised for the most vulnerable, people over the age of 60, those over the age of 45, and others, pretty much in the same order in which vaccines were rolled out earlier this year.

In ideal circumstances, those who have suffered a Covid-19 infection should come last, but this information isn’t available on Co-WIN, India’s vaccine platform, which, in turn, isn’t connected to the databases where the information is available. Given that there is no supply constraint, it makes sense to just give the booster shot to everyone.

The two things the country has to watch out for now, as more activities are allowed, and schools open up for physical classes, are localised outbreaks (which have to be crushed through lockdowns; for instance, every district needs to have a school closure protocol ready) and the emergence of mutant strains of the original Sars-CoV-2 virus.

It is important to not just sequence an adequate number of viral genomes, but to also publicise the results widely (perhaps through the regular health ministry briefings) so that everyone knows.