On February 19, India became the second-fastest country in the world to reach one crore COVID-19 vaccination mark in 34 days. However, while the number appears significant, the average coverage is only a little above 50% for most Indian states. The vaccination drive across the country had begun on January 16, targeting healthcare and frontline workers in the first phase. The second group to receive the COVID- 19 vaccines will be persons over 60 years of age and persons above 45 years with comorbid conditions, which will begin on March 1. As of 1 pm on February 24, the cumulative coverage for India stands at 1.21 crore. This includes both first and second dosages for the vaccine. But a closer look at the data reveals that even among healthcare workers, the adoption rate is far below the target. Eleven states and Union Territories have achieved less than 60% of their target of registered healthcare workers for the first dose of the vaccines, according to the Union government. Furthermore, more than 10 states and UTs have a vaccine coverage of less than 25% for frontline workers.
This low coverage means that precious vaccine resources could potentially get wasted. According to Union government guidelines, 10% wastage of vaccines is acceptable. Every vial of vaccine contains 10 doses. Once opened, if there are no beneficiaries within the next four hours, the vial is discarded. However, experts believe that on-ground wastage may be higher in some places.
Speaking to TNM, Dr Anant Bhan, bioethics and global health researcher, also emphasised the need to minimise vaccine wastage. “Vaccination is important, especially in light of the new coronavirus variants. Serosurveys seem to indicate that there is still a significant population unexposed to the virus. So, vaccination is an important public health response. We are only focusing on high priority groups now and it will take a long time to reach a level of coverage that will get us herd immunity. However, till that time, vaccination will protect those who are critical and also those who are at most risk.”
According to Girdhar Gyani, who was part of the Prime Minister’s COVID-19 taskforce, “Due to vaccine hesitancy in the priority groups, a significant amount of human resources and time spent on this exercise are being wasted. We have to remember that vaccines, even if they cannot guarantee immunity, will surely decrease the severity of the infection.”
The experts TNM spoke to also said that vaccination needs to be ramped up and extended to other groups of people to ensure better utilisation of resources and increase coverage. “The US is vaccinating more than 10 lakh people per day. We are hardly doing more than 2.5 lakh a day, but 15 lakh a day should be our aim as our population is much higher. Only if more than 50% of the population is vaccinated can we achieve any sort of herd immunity,” Gyani said.
“We have huge capacity and our plan was strong, wherein the first to get the job should be healthcare and frontline workers. But seeing that there is less adoption among health care workers than expected, we have to change the strategy,” he added.
On Wednesday, the Union government announced 2,000 private centres have been roped in for the second phase of the COVID-19 vaccination drive. However, those taking the vaccine from private facilities will have to pay for the vaccination. Dr Bhan said in the open market, private hospitals can start procuring vaccines from the Serum Institute of India (SII) at around Rs 500 (approximately) and possibly charge another Rs 100 for other expenses.
“We are suggesting that this be allowed and carried out on a first-come-first-serve basis to help part of the population get vaccinated quickly. Many private companies may feel that they are ready to sponsor their employees’ vaccination and they can fully start operations, or a private school might decide to do the same for all the staff to safeguard the students,” said Girdhar, the Director-General of the Association of Healthcare Providers (India), in favour of a parallel vaccination drive.
He added, “I do not want to undermine the government. But we have to revisit what happened during the peak crisis time in the pandemic. The government had to reserve beds in private hospitals and that saved lives. In the initial days, lives were lost as we could not arrange oxygen, ICUs (intensive care units) and other critical facilities on time and that increased the mortality rate.”
Gyani and some of his colleagues at the Association of Healthcare Providers (India) have written to the Union Health Minister Dr Harshvardhan that the private medical care players be allowed to sell vaccines under strict government regulation.
While opening up vaccination drive from government monopoly is being advocated even by NITI Aayog and industrialists like Azim Premji, the low coverage is being partly blamed on the centralised scheduling process and the Co-WIN portal.
Speaking with TNM, Mysuru Deputy Commissioner Rohini Sindhuri said that it would have been better district authorities could have entered data in the Co-WIN app retrospectively, since there were technical issues in the app, which delayed registrations and approvals, among other issues.
At present, every beneficiary (frontline/healthcare workers) has to be registered with the Co-WIN app with their mobile number and one registered government identity. Once registered, they will be alerted via SMS a day ahead of their date of getting the vaccine.
“There have been instances where some vaccine beneficiaries would have forgotten to bring their Aadhaar card, so we could not check the number. Also, some persons like some ASHA and Anganwaadi workers, who don’t have phones, had given their family member’s numbers, which led to some confusion over the actual beneficiary. These could have been avoided if we could have entered the data retrospectively. For example, we had to call pourakarmikas to get registered on one day, and then call them again for vaccination on another day, which created a problem,” elucidated the Mysuru Deputy Commissioner.
Pointing out the platform-related issues that are well documented across states, Dr Bhan said that the government should also allow local innovations than the strict centralised system. “If Co-WIN is the way to go, then we need to have all language options and there should also be a system where somebody like a frontline worker can enrol a beneficiary who doesn't have access to technology. So, there should be some systems – like a waiting list – that can be used if the intended beneficiaries do not turn up,” he said.
A senior government official in Karnataka involved with the vaccination exercise said there is too much misinformation doing the rounds, such as “if you take alcohol, the vaccine won’t work or if you are taking blood thinners then those patients should not take the vaccine.” The senior IAS officer, who did not wish to be named, said that none of this is true.
The officer also said that the fear factor could have been countered if the political class had taken the vaccine first as a confidence-building measure.
Dr Bhan also said there has to be a multi-level Information, education and communication strategy in place. “There should be conversations not only at national and state levels but also at institutional levels – such as at hospitals and offices – to address some concerns and reinforce the importance of vaccination,” he said.