As vaccination drive picks up pace, challenges remain

On April 1, India’s Covid-19 vaccination programme received a much-needed boost with the start of the third phase of the inoculation drive which made all Indians above the age of 45 years eligible for coronavirus vaccines. As the country crossed the milestone of 100 million doses on Saturday, data indicates that it will take some doing to maintain a pace that could help India turn the tide against the surging second wave of infections.

The case trajectory of the second wave has long surpassed the first wave peak both nationally and in at least six states, according to HT’s dashboard.

While India’s vaccine programme saw a slow start, relative to the size of the country and the number of people that need to be vaccinated, data shows this has picked up pace in recent days. Part of the reason was vaccine hesitancy, but some of it is also because the Union government has been slow to expand the drive, and state governments are still figuring out how to manage the last mile efficiently.

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The best news for India right now is that the country-wide pace of administering doses is the fastest it has ever been recorded. In the past week, 3.8 million shots have been administered every single day on average. To be sure, this is a rate that has been wildly fluctuating. For instance, just a week ago, the rate of daily doses being administered was less than half the current rate – on average, 1.7 million doses were administered across the country in the final week of March. Vaccination numbers are high right now because India is in the grip of a second wave that is breaking all previous records and has so far not exhibited signs that it may be slowing down any time soon — and people, including those who should have been vaccinated in the first and the second phases are realising the importance of a vaccine.

But despite the fact that this number has not been consistent throughout, the fact that the country can administer close to 4 million doses every day is something that should elicit cheer. Now the challenge is to maintain this rate (or still better, grow it) over a longer period of time in order to give sizeable enough population vaccines to have an impact on the expanding outbreak. This is what makes the next two-three months extremely crucial.

What projections show

As the vaccination drive picks up pace HT’s latest projections show that India is currently on pace to deliver both doses to close to 50 million people by May 13, and over 100 million people by the end of May if the country can keep administering an average of 4 million doses a day.

Until Saturday night, 101.3 million shots have been administered across the country to 88.6 million people, according to data released by the Union health ministry.

HT’s calculations are based on data released by the Union health ministry till Saturday night, and the projections assume that at least 4 million shots will be administered a day, with a second shot being administered at a gap of six weeks after a person receives the first shot. Comparing these numbers to a similar exercise conducted by HT on March 31 shows that while the 50-million target for fully vaccinated people was being hit around the same time (May 13, instead of May 16 in old projection), the recent jump in vaccination rate has given the country a 15-day jump on the 100-million number, which, according to old the old projection was set to be hit on June 16, but will now be reached on May 31.

While these numbers have improved, particularly over the past week or so, the projection shows that the country still remains behind the government’s initial inoculation target – the Centre set a target of fully vaccinating over 300 million people by the end of July, a deadline that has since been extended to August. Based on current projections, around 244 million people would have received both shots by the end of July. To be sure, even after receiving both shots, the full benefits of the vaccination don’t kick in for another two weeks.

The road ahead

The road ahead, however, still carries challenges. The first is that the country will need to ensure there is sufficient supply of vaccines to keep administering at least 4 million shots a day to come even reasonably close to meeting its targets. Based on HT’s calculation, as of Friday night, the country has close to 42 million doses either in stock right now, or in the pipeline. At a rate of administering 4 million doses a day, this is enough for just 10 or 11 days. Ensuring a wider availability in the pipeline is very crucial to maintain this pace of vaccination (leave alone improving it). And doing this will ensure working with manufacturers Serum Institute of India and Bharat Biotech to expand their capacity, and on approving more vaccines.

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The second is tackling hesitancy. So far, the country has seen three phases in its vaccination drive – health care and front-line workers were vaccinated in the first phase between January 16 and February 28; the second phase lasted through March and covered those above 60 years of age or over 45 with a strict list of comorbidities; and the third phase that started in April makes anyone over 45 eligible for a shot. Going by the experience from the first and second phases, towards the end of each phase, daily vaccination numbers start dropping (Chart 1). This appears to be because those who want to get vaccinated generally show up to get shots in the initial weeks of the opening up of norms, and those who are hesitant, remain absent, so the numbers taper off. Whether this happens to the third phase as well, remains to be seen. But should numbers start tapering off, then the only option left with the government may be to expand the eligibility criteria further still (if not throw open the vaccination drive to all adults).