Two months since it rolled out the world's largest vaccination programme, India has given 34.9 million vaccine shots, or about 7% of its initial target of 500 million, up from 3% by February 16. India has 4.5 months to achieve the remaining 93% of this target.
India will need to give 3.65 million shots per day for the remaining 137 days until the end of July, in order to achieve its target of vaccinating 250 million people with two doses.
A small number of adverse events, such as hospitalizations and deaths, have been reported following the vaccinations - 51 people have been hospitalized and 46 people have died after taking COVID-19 vaccination, according to the government on February 26, 2021. The government has maintained since 16 January, 2021, that, "No case of serious/severe AEFI/Death is attributable to vaccination, till date."
IndiaSpend reported on the need for more rigorous investigation and transparency on the reporting of these adverse events, which will in turn boost confidence in the vaccination process.
For this second edition of the COVID-19 vaccination update, IndiaSpend visited three vaccination centres-one government and two private - in the national capital, and spoke to practitioners and public health specialists on the current criteria for vaccination.
After initial reports of throngs of people at COVID-19 vaccination centres when it was opened to the private sector on March 1, the footfall appears to have stabilized to a steady pace, we found.
Jeevan Hospital and Nursing Home in south-east Delhi is located in the lower-middle class neighbourhood of Sunlight Colony, on a cramped and potholed road. At 9 a.m. on 15 March, when the vaccination drive opened, only three people were waiting inside the building.
In two hours, 13 people had been vaccinated. All of them were senior citizens, aged 60 or older.
"I was not able to register online. But I live close to the hospital, so I came over and registered my mother who has been very enthusiastic to get the vaccine," said Amit Arora.
Outside the hospital, brothers Khajan Singh Saini and Dhyanchand Singh Saini, both aged above 60 years, were getting their shoes polished from a cobbler. They live close by, but said they did not want to get vaccinated there. "We don't trust private hospitals, and my son has registered for us to take the vaccine at Safdarjung Hospital," said Dhyanchand.
Rajkumar Jaiswal, a senior citizen who works as office staff serving tea and water at a nearby firm, has come to take his vaccination.
In Delhi, there are more vaccination centres in the private sector (136) than the public sector (56). But many people may not know about that, said Debashish Parmar, a doctor at Ram Manohar Lohia (RML) Hospital, a public hospital.
"Most people don't know where to go for vaccination but assume that RML, being an important government hospital, will definitely be providing the vaccine," said Parmar. "We have so far been able to cater to the inflow of people but it would be good if people went to other vaccination centres also, to decrease the load here."
India's COVID-19 vaccination drive that initially covered only registered health and frontline workers opened up March 1 to all citizens over 60 years of age and those above 45 with 20 specific comorbidities.
This is in keeping with the findings of the World Health Organization (WHO) that those with pre-existing health conditions and above 60 are at higher risk of mortality with COVID-19.
Except HIV infection, all the comorbidities included in the government vaccination eligibility list are non-communicable diseases (NCDs) such as heart disease, respiratory disease and diabetes.
A substantial number of Indians have NCDs, according to the 2015 India State Level Disease Burden Initiative. Cardiovascular disease accounted for 28% of deaths in India in 2016, up from 15% in 1990.
Ischaemic heart disease was the leading cause of health-loss in India in 2016, and stroke the fifth. Also, the prevalence of chronic obstructive lung disease increased to 55 million in 2016, from 28 million in 1990.
As of 2019, India had 77 million diabetics--second only to China (116 million)--according to the International Diabetes Federation's Diabetes Atlas 2019. Up to 75% of India's diabetics face higher COVID-19 mortality risk, as IndiaSpendreported in June 2020.
Some comorbidities have to coexist with others for eligibility in this round. For example, those who have had diabetes should also be hypertensive to get vaccinated, and their diabetes should have existed for over 10 years, or should have other complications associated with it.
The current list of eligibility criteria is "pretty good", said Anoop Misra, chairperson of the National Diabetes, Obesity and Cholesterol Foundation, but some of the conditions are restrictive.
"It needs to expand to include even younger people who also have these chronic diseases," said Misra. "In my practice, I can see that chronic diseases are occurring in younger people too. Some of the cut-offs also don't make sense.
For example, asking that people who have had diabetes for 10 years get the vaccine first. Diabetes, whether one has had it for such a long period or less, remains a risk factor for COVID-19."
Prabhakaran Dorairaj, cardiologist and vice president (research and policy) at the Public Health Foundation of India, pointed out that the eligibility list is dynamic and will start to embrace a wide group of comorbidities in the future.
"One can argue that the list should have simply said that anyone with diabetes or hypertension should get the vaccine, but the volume of people would have been staggering for the system to manage it initially," he said.
"As the ability to vaccinate increases, as the availability of vaccines increases, as more vaccines get approved, more people can also be vaccinated and the list of eligible people can increase," said Dorairaj.
The organization also pointed out that those with multiple comorbidities are at a higher risk than others.
WHO asked countries to use local data to figure out their prioritization strategy. As an example, it said, one approach could be "to prioritize individuals who have two or more relevant comorbidities". India's vaccination criteria so far, has been in line with this advice.
In the UK, the priority list for vaccination is divided into nine groups, and "will include around 99% of people at risk of dying from the disease". The first group is of residents in care homes for the elderly, the second, of those older than 80 and also frontline health and social workers.
The remaining groups are largely age-based and of those who are "clinically extremely vulnerable".
In the second, it is opened to frontline workers and those older than 75. In the third phase, it is open to those between 65-74 years of age and also 16 to 64 years of age with underlying medical conditions that increase the risk of severe COVID-19.
"As vaccine availability increases, vaccination recommendations will expand to include more groups," said the US-based Centers for Disease Control and Prevention.
So far, the Indian government has approved two vaccines for COVID-19--COVISHIELD and COVAXIN. The former is manufactured by Serum Institute in Pune, developed by pharmaceutical company AstraZeneca. The latter is manufactured by Bharat Biotech in India.
COVISHIELD's approval was based on safety, immunogenicity and efficacy data from phase 2 and 3 of clinical trials abroad, and some ongoing data on safety and immunogenicity from the same phases in India.
The WHO has said that there is no link yet between the vaccine and the blood clots that people are experiencing, and that people should continue to take the vaccine.
This month, COVAXIN's efficacy results have been published in The Lancet medical journal. The Indian Council of Medical Research said that these results put COVAXIN "at par with other global-front runner vaccines".
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Anoo Bhuyan reports on healthcare at IndiaSpend. She has also reported on issues of law and justice, technology and society and gender. Before IndiaSpend, she worked at The Wire, Outlook Magazine, BBC News and National Public Radio. In 2018, she won Bournemouth University’s ‘Journalist of Change’ award for her reporting on extra judicial killings in Manipur. She also received a scholarship for her postgraduate degree at the School of Oriental and African Studies, University of London. She can be reached on Twitter at www.twitter.com/AnooBhu.
(This article was originally published on IndiaSpend. Read the original article here.)
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