India’s vaccine roadmap: Will all adults be vaccinated by December end?

In an interview with TNM, health economists and professors — R Ramakumar and Rijo John — break down the daily vaccination numbers India needs to hit to achieve its December target.
A health worker in Jammu vaccinates a young man who exposes his arm while another person holds down his shirt
A health worker in Jammu vaccinates a young man who exposes his arm while another person holds down his shirt
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“India’s vaccination will be completed by December 2021,” Union Minister Prakash Javadekar declared at a press conference on May 28, 2021. That amounts to 108 crore people being fully vaccinated by the end of the year. The Union government now has less than three months to achieve its target to fully vaccinate people who are 18 years old and above.

As on October 4, India has fully vaccinated more than 24 crore people (24,96,89,325). Of this, over 41.36 crore people (41,36,28,156) are yet to receive their second dose. If the Union government intends to achieve its target of fully vaccinating 108 crore people, the remaining 83.03 crore people (83,03,10,675) — over 41.36 crore unvaccinated and over 41.67 crore partially vaccinated — should be administered vaccine doses over the next 87 days. This means, over 1 crore people should be vaccinated per day, and not be restricted to special occasions, as seen on September 17, when over 2.5 crore doses were administered in one day to celebrate Prime Minister Narendra Modi’s birthday

So is the Union government’s target achievable? TNM spoke to two health economists who have been closely following the Union government’s vaccine programme — R Ramakumar, professor at the Centre for Study of Developing Economies, School of Development Studies in TISS, Mumbai; and Rijo John, health economist and adjunct professor at Rajagiri College of Social Sciences, Kochi in Kerala. They share their analysis of India’s vaccine roadmap for 2021. Excerpts from the interview. 

Do you think India will be able to fully vaccinate its complete adult population by December 2021?

Ramakumar: Prakash Javadekar’s argument in May was that India would make available 51 crore doses by July 2021 and an additional 216 crore doses between August and December 2021. By the end-July 2021, India had administered only 46.3 crore doses or 5.3 crore doses less than projected. Later, the government of India itself brought down the target for August-December 2021 from 216 crore to 135 crore doses. If we take August and September, India administered 42.6 crore doses. This was certainly a major improvement over earlier months, and needs to be welcomed. 

The question is if India will be able to sustain this momentum. From October to December 2021, India would need to make available the remaining about 98 crore doses to meet its target (i.e., 5.3 + 135 - 42.6 = 97.7). This implies an average monthly production of 32.6 crore doses. But we produced only 18.9 crore doses in August 2021 and 23.7 crore doses in September 2021. The less we produce in the coming three months, the steeper the target will become for the remaining months of the year.

So, I do not think India will be able to administer two doses for all of its adult population in 2021. I would be happy to be corrected, but as of now, this is what it looks like.

Rijo John: Even after 260 days into the vaccination, India has fully vaccinated only 26% of its adult population, and 70% received only a single dose. At the current pace of vaccination, it will take at least five months more to fully vaccinate all adults in India. This means, the December target will be missed by at least two months, if not more. We need to also factor in the 16-week gap for receiving the second dose of Covishield.

In the seven-day period between September 28 and October 4, India administered 62.56 lakh doses per day on average. Is this pace safe or should the volume of coverage we saw on PM Modi’s birthday be the ideal rate at which India should vaccinate people per day? How many people do you think should be vaccinated per day to achieve the target?  

Ramakumar: The daily vaccination rates have risen. From 42.7 lakh doses per day in July, we gave 61.3 lakh doses per day in August and 78.8 lakh doses per day in September. This was largely because of a sharp rise in the production of Covishield by the Serum Institute of India (SII), which remarkably upped the production in August (16.3 crore doses) and September (21.3 crore doses) from just 11.7 crore doses in July.

If we take the target of 97.7 crore doses to be met between October and December, we get a daily target of 1.08 crore doses. This is much higher than what we are achieving now. In fact, in the first four days of October 2021, we gave only 62.9 lakh doses per day on average. Our numbers have to consistently be above one crore doses per day. Only then can we meet the target set for December 2021.

One key constraint here, in my view, is Covaxin production. The rise in Covishield production from SII has actually been hiding the phenomenal failure of Bharat Biotech in raising Covaxin production. They are still producing just about 2.3 crore doses per month, while they had promised to produce 5.5 crore doses per month by August 2021. This is the case of the so-called “people's vaccine.” The situation can be salvaged if Bharat Biotech produces more Covaxin doses per month, but the question is if they will deliver. As of now, it does not look like it.

Rijo John: To fully vaccinate everyone by the end of the year, we need to do at least 1.1 crore doses every day for the rest of the year. That is less than half the doses given on PM Modi’s birthday on each of the remaining days in the year. But we do have very few vaccinations done on Sundays and many states vaccinate only about four days a week. That would mean the daily targets are even larger.  

India started the Vaccine Maitri programme amid its race to achieve its target. Do you think India will still manage to stay on course and vaccinate its own people? If no, what is the strategy that India needs to adopt before or while it continues its vaccine sharing policy? 

Ramakumar: If India begins to export vaccines before December 2021, its target will only become even tougher to achieve. At the same time, India cannot withdraw from its global commitments. It will have to start exporting vaccines at least by November-December 2021. This means that India's production capacity would have to rise at a much faster rate than would otherwise have sufficed. Only then can domestic needs be met and global commitments be fulfilled. We have to look closely at how the new vaccine candidates are going to come up the regulatory ladder in the next few months, and how the three public sector companies will be able to meet their commitments to produce more of Covaxin.

Rijo John: While ensuring vaccines reach all parts of the world is important, especially to African countries where the rate of vaccination is extremely low, we need to also be able to prioritise our own needs. At the very least, I believe, India should resume exports of vaccines only after at least a single dose reaches all adults in India and that is expected to happen only by the latter half of November. If vaccine exports are resumed in October as announced earlier, it could hamper our own need to provide at least a single dose to all adults as early as possible.

More vaccine candidates will soon be available in India, apart from Covishield and Covaxin. However, given the current climate of vaccine policies adopted by many countries for travel purposes, do you think people will be confident to come forward and trust a new vaccine type? If faced with such a situation, will it impact India’s vaccine target? 

Ramakumar: It is the government of India's duty to ensure that the vaccine candidates that pass the Indian regulatory bodies are concurrently approved by the World Health Organisation (WHO) and other major countries. The delay in getting Covaxin approved by the WHO is one example of delay, and the problems with getting Covishield approved in the United Kingdom is another example of delay. Given these two cases, there will be a tendency among people to demand more vaccines like Covishield over Covaxin or any of the new vaccine candidates. This might actually slow down the rates of vaccination in India. So, the Union government should act fast to ensure harmonious relations with major countries of the world is getting its vaccines approved elsewhere too. However, the unnecessarily harsh engagements with the UK on the Covishield and quarantine issues does not sound promising. I fear that delays may continue and travelling people will be put to more misery if such tit-for-tats become the order of the day.  

What are the challenges you foresee that could potentially delay India’s complete vaccine coverage? 

Ramakumar: First, it is whether India will be able to produce 97.7 crore doses between October and December 2021. Second, it is whether exports would begin before December 2021, in which case we may have to produce more than 97.7 crore doses by end of 2021. Third, it is whether we will be able to improve Covaxin production — both from Bharat Biotech and from the three public sector units. Finally, the more we close in on the target, vaccine hesitancy will set in in a big way and the question would remain if the government can transcend that constraint successfully. So, there are many ifs and buts.

Rijo John: The two major challenges are availability and hesitancy. Given that we have demonstrated the capacity to administer more than 20 million doses on a single day, it appears that lack of availability may be one major limiting factor at the moment to increase the pace of vaccination. As more and more the population gets vaccinated, we should also be expecting hesitancy among at least a smaller proportion of the population. We should find ways to encourage them to get vaccinated too.

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