India’s vaccine policy needs an urgent reset
India has four decades of experience in running a national immunisation programme for children and pregnant women. It has successfully conducted large-scale mass vaccination drives for many years for polio elimination. Therefore, there was every reason to believe it could deliver Covid-19 vaccines efficiently; however, the ongoing drive in India is faltering (and even that is an understatement).
The initial challenge of vaccine hesitancy was soon replaced by that of short supply (from early April onwards); with the opening of Covid-19 vaccination for all adults in the 18-44 age group, everyone, including those above 45 years, is finding it difficult to get vaccinated. The daily vaccination rate has come down to around two million doses, nearly half the vaccination rate at its peak in April.
As per the vaccine distribution formula developed by the Union government and shared with the Supreme Court, for nearly 600 million people in the 18-44 age group, for May, the number of vaccine doses available (to be purchased by the state governments) will be around 20 million (another 20 million will be available to private hospitals). Vaccine manufacturers are not able to supply vaccines to states. The outcome is that many states have either not started vaccinations for those in this age group or have halted it due to a shortage of supply. People are finding it difficult to book a slot on the CoWin portal — the government IT application for vaccination— and there is a real risk of vaccine inequity, where those without access to smartphones and the internet, may not get a shot for a long while.
An elementary measure of performance of a well-functioning vaccination programme (or any health programme) is that the people eligible for vaccination (or health services) get it promptly. This doesn’t seem to be happening at the moment and demands the urgent attention of those at the highest levels of policymaking and implementation.
A successful vaccination drive is the outcome of assured supply, simplified policies and an adaptive delivery approach. An assured vaccine supply is the first and absolute essential before the launch of the programme. If supplies are limited, doses available have to be used for vaccination of the identified priority groups, with phased openings for additional population groups. All countries across the world first secured vaccine supply and then opened up the vaccination in a graded manner for various population groups. The United States, the United Kingdom and the European Union started to secure supplies by the middle of 2020.
India seems to have erred at many steps in this process. It placed the first order with vaccine manufacturers, just a few days before the launch of the vaccination drive on January 16. Nearly 940 million people are eligible for vaccination and the current total vaccine production in India is 70-80 million doses a month. A few weeks ago, the Centre placed fresh orders for a total of 160 million doses for May, June and July, which will be used for the 45-plus age group.
However, between March 16 and April 30, a total of 116 million people received their first shot. Even if we exclude a small fraction of those who received the Covaxin shot between March 15-31 (they may have already received their second shot in April, as the gap, in this case, is four weeks), nearly 110 million people were scheduled to return for their second shot between May and July 2021. It is likely that a small proportion of the 110 million people waiting for their second dose would go to the private sector. Even then, of the secured Union government vaccine supply of 160 million for May to July, only 50-million-odd shots would be available for 45 years and older coming for their first shot.
Can India be assured of increase in vaccine supply by July 2021? It is unlikely to be to the extent of 150 million doses a month as is being suggested. A large manufacturer in India planned to have a monthly production capacity of 100 million doses by January, a timeline which has now been shifted to July. After all, vaccine manufacturing and scaling up are complex processes and an ambitious timeline does not always work. The situation of other manufacturers is likely to be similar. The contribution of vaccine imports will be marginal to the overall supply for India.
In the wake of supply constraints and challenges, the role of vaccination policy and delivery strategy becomes vital to avoid chaos at the vaccination centres. All policy options and delivery strategies should be re-examined and simplified. The increase in the gap between the two doses of Covishield, announced last week, and which was being suggested by many for months, is one such. There are others. Which population group can be safely asked to wait for their vaccine shots? Can vaccination for any age group (18-30 years) be put on hold till assured supply? Some of these are controversial questions – but they need to be addressed.
Part of the problem seems to be the fact that there is political decision-making in the areas that are purely technical. The political leadership should give a free hand to technical experts to decide and implement new strategies. The leaders of opposition parties have written to the government to revise the vaccination policy and strategy. This could make the government harden its stand, which it should not do. In the end, all that should matter is whether any policy decision, even if it is a reversal of an existing position, will help in ensuring vaccines reach people.
For six weeks now, India’s vaccination drive has been struggling. How long must one wait before acknowledging that what was planned is not working? It is often said that Indian policymakers have mastered the art of drafting policies, which, while being perfect on paper, are poorly implemented on the ground. India’s Covid-19 vaccination efforts have areas for improvement, both in policy and implementation. The government should do all that is needed to make it work, here and now.