A third wave of coronavirus in India is said to be ‘inevitable’ and according to a recent study by IIT Kanpur, it is set to strike by October 2021.
In the past couple of weeks, top scientists and epidemiologists, as well as public servants have made an active attempt to warn the masses.
There is an urgent need to empirically identify the current trends of vaccine supply and immune profiles. It is imperative to add more nuances to the clamour around the third wave for both public consumption and policy action.
Supply And Demand Dynamics of Vaccination Drives
According to the Chennai-based Institute of Mathematical Sciences, for India to reach mass immunity, at least 50 percent of the population needs to be vaccinated.
However, this can vary depending on the reproduction rate of a population (the number of people one person can infect), which is often a function of density, hygiene and mutations; this rate is variable within the country itself with cities like Mumbai posting reproduction rates of 0.83 to Delhi posting reproduction rates of 0.20.
On the supply side, there are currently three main vaccine providers in the country –Bharat Biotech, Serum Institute of India, and the most recent Dr Reddy’s. SII produces Covishield and had promised to increase production capacity to 100 million doses by May. However, it faced delays and is now planning to produce 65-70 million doses in June-July, which will be increased to 100 million a month by August.
Bharat Biotech is producing Covaxin, which has had a much lower production capacity due to regulatory delays and ongoing Phase-3 trials. It plans to produce 20 million vaccines in June, 6.5 million in July-August, and 100 million from September onwards.
Dr Reddy’s has received approval to produce the Sputnik V in May 2021, but the production capacity will be limited to 12 million doses a month.
Moreover, while the production of Sputnik V is promised to be 850 million doses, the timelines are unclear, and pharmaceutical companies will only begin production in August locally.
By October 2021, it is expected that Covishield will supply 335 million doses, Covaxin will supply 225 million doses, and Sputnik V 36 million doses. There will be a total supply of 621 million doses, which will be available for usage by the population.
On the demand side, the government has made a hefty promise to vaccinate 1 billion people by December 2021, implying an output demand of 2 billion doses.
Given that about 240 million doses have been inoculated and assuming that an equal number of doses are disbursed from now to December, about 1.017 billion doses will be required by October to stay on the government’s vaccination plan.
What the Analysis Shows
Our analysis shows a supply deficit of nearly 400 million doses before the expected third wave in October. This is likely to be an overestimate as we do not consider the average wastage ratio of 6.5 percent across Covishield and Covaxin.
While foreign-produced vaccines, like Pfizer and other locally developed ones, have been moving through the regulatory and expedition approvals, their full approvals only expect a roll out Q4 onwards of 2021, which may be too late for an anticipatory third wave.
It is more pertinent to look at effective demand, ie the actual rate of vaccination in the country which is different from the government’s target vaccination rate.
Using a June-average as a representative rate of future vaccinations rather than using values from January-March (when only essential workers were being vaccinated) yields, the effective demand for the vaccine supply in the country.
By the beginning of October, we forecast that 602 million vaccine doses will be administered given the current vaccination rate.
This indicates that the effective (or constrained) demand will meet the effective supply (based on public domain resources) of vaccinations before the third wave. This might bode well for the vaccination market but in epidemiological terms, it spells disaster as it falls 400 million doses short of the government’s target vaccination rate.
At the current rate, only around 82 million people will be fully vaccinated by October, a mere 8.2 percent of the target population.
While even administering the first dose lowers the severity of the effects of COVID-19, this is significantly lower than the ambitious target set by December.
Hence, the effective vaccine demand in the country is constrained by the suboptimal vaccine roll out. It is with this information that the new vaccine policy being released on 21 June should be amended.
Our forecasting results show that while vaccination in states of all representative profiles of the country is on an upward trend, the proportion of total state populations fully vaccinated (that is, having received their second dose) range from 2.7 percent in Uttar Pradesh to 20 percent in Delhi.
This clearly shows that vaccination efforts need to be highly ramped up to reach the government’s ambitious target.
Third Wave May Not Only Be a Singular National Event
While the spread of the second wave of coronavirus seemed to be coordinated across most states in India, it is useful to remember that it was in contrast to the first wave which was rather scattered among states and Union Territories at different times.
During the second wave too, for instance, Maharashtra was one of the first states to start showing declining trends in transmission rate back in April 2021, while states like Tamil Nadu and Assam, until a few days ago, were still peaking with daily infection rate.
On the other hand, it is reported that Delhi, Mumbai, and Pune, along with many towns and cities in Chhattisgarh, Kerala, and Madhya Pradesh, are in various phases of their third and fourth waves. Therefore, even if the second wave is declining for India as a whole, it is not representative of all the states and districts.
Similarly, with the oncoming third wave, it is imperative to study local trends and spread of the virus which will invariably be a function of COVID appropriate behaviour, reproduction rate, vaccinations, among others.
The idea of a singular distant third wave could lead to false sense of safety among masses and increased rate of non-compliance – a trend observed in the aftermath of the first wave.
There needs to be an active attempt to apprise the citizens of the details pertaining to their specific region.
Rate of Infection is Hard to Determine
Conventional wisdom assumes every fresh wave would be weaker than the previous one. However, this logic seems to have been challenged in various countries across the globe, in the current crisis.
The US witnessed three successively large waves with the deadliest third wave peaking in January this year. Experts on the subject matter have emphasised that the impact of the same cannot be accurately predicted.
A widely cited report states that “we find that if serious cases decline from 20 percent to 5 percent (due to better health infrastructure and rigorous vaccination) in the third wave, then the number of deaths could significantly reduce to 40,000 as compared to the current deaths of more than 0.17 million”. However, it fails to give an empirical reasoning for the decline of a sharp 15 percent.
It is important to highlight that rather than considering a blanket rate of infection rate, a more heterogeneous approach should be adopted by the states. Given various factors like transmission rate, vaccination trends, and lockdown guidelines, more state governments should undertake such crucial studies.
For instance, it is reported that the Delhi government is studying four scenarios of infection rate (lower to second wave, equal to second wave, 30 percent more than the second wave and 60 percent more than the second) and is preparing for health infrastructure accordingly.
A Momentous Task at Hand
India has a momentous task at hand and the impending revised vaccination policy holds utmost significance to ramp up the current trend of vaccination in India.
That being said, the responsibility of state governments is to actively analyse and work on the local trends of the virus spread. We are not sure if the worst is over yet and for which parts of the country.
Meanwhile, the declining trend of the second wave should not trick the citizens into COVID-19 non-compliant behaviour. We can only afford to err on the side of caution.
(Amaani Bashir is a Strategy and Partnership professional at The New Development Bank. She holds an MSc in Development Economics from SOAS, University of London. Anmol Rathore is a Research Consltant at WeGovernance Knowledge Services. She holds a Masters in Regulatory Policy and Governance from Tata Institute of Social Sciences, Mumbai. This is an opinion piece, and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)
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