India’s ongoing COVID-19 vaccination drive bears an uncanny similarity to scooter rides of the mid-1980s.
No matter how long or short the journey, the scooter needed to be restarted a few times before one could begin. To start, it needed to be tilted at a 45 degree angle, to ensure the petrol was where it should be. Then, while riding, no matter how much one accelerated, the speed did not rise above a certain level. Despite all this, the manufacturer was proud of the scooter and the owners were happy to have one at home.
It is mid-July now and the rate of COVID-19 vaccination has once again slowed down.
In July, India could have achieved a daily vaccination rate of around 7 million doses. However, actual vaccination is hovering around 4 million shots a day, exactly what it was at the beginning of April 2021.
Short on supply, many states are shutting vaccination centres temporarily.
The same tussle goes on between the states and Union government, where the former keep asking for more vaccines and the latter assuring them of enough stock. But the fact remains that people are still struggling to get vaccinated.
Refusal of Vaccines for Frivolous Reasons at Govt Centres
States have found many ‘unique’ ways of rationing and optimising the vaccine supply, some of which keep the needy from getting vaccinated.
For example, in government-run vaccination centres, people are refused vaccines on frivolous grounds.
“You have high blood pressure, come later”.
“Oh, there is an allergy in your hand, come later”.
“Achcha, you have recovered from a fever a few days ago, you should wait for vaccine”.
However, throughout this, the Union government has insisted that there is no shortage.
Yes, there is one setting where there is no shortage of vaccines and that is the private sector.
No Shortage in Private Sector Due to Over-allocation
The private sector, as per the policy announced on 1 May, has been allocated 25% of the total vaccines manufactured in India.
Since then, while there has been regular short supply of the vaccine and non-availability of slots on CoWIN in government vaccination centres, the private sector never suffered.
This is because the proportion of private sector facilities of the total vaccination centres has never been more than 5% but they have been receiving 25% of the total vaccine. This is far more than their capacity to use, even including on-site vaccination sessions for companies and offices.
The shortage of vaccines is eroding the already low level of trust of the people in government health services. People are forced to make multiple visits, and those keen on getting vaccinated have to shell out money to get vaccinated in a private centre.
Above all, while the government's warning of a third wave, their requests to people to get vaccinated appear hollow. People are asking, 'where are the vaccines?' And there doesn't seem to be any answer.
What are the Solutions?
As they say, the first step to solve a problem is to recognise it and that's exactly what the government of India needs to do.
It has been many months of claiming that the vaccine supply will be sufficient but that has not transpired on the ground. The inconvenience that people are facing has the potential to harm their long-term trust and likelihood of utilising government health services.
Therefore, it should consider a few corrective and operational strategies to optimally utilise the limited quantity of vaccines till vaccine supply and demand are equalised.
Change Vaccine Allocation Formula
First, the government needs to urgently revise the 75-25% vaccine sharing formula for the public and private sector. Vaccine sharing should be proportionate to the vaccination centres.
As around 3-4% vaccination centres are in the private sector, if we factor in additional vaccine quantities for offices and factories, the allocation for the private sector should be capped at 10%.
Another alternative, and perhaps better approach, would be to allocate vaccine doses based on the assessment of actual vaccination capacity of the private sector. This would be efficient and it would release additional doses, which would translate into millions for government health facilities. It is a consideration, government should do immediately.
Targeted Use of Vaccines
Second, we have witnessed that the supply of vaccine is not at the pace projected. Therefore, available vaccines should be used in a targeted manner.
The vaccination of healthy adults between 18 to 44 years could be put on hold, till supply is stabilised. Though every time there is a shortage, most states halt the vaccination of the 18 to 44 years age group only, this forces people to search for alternatives such as vaccination in the private sector. It should be done in a more systematic way. The limited supply should be used to vaccinate those aged 45+ years, and the 18 to 44 years high-risk population.
Prioritise Vaccine Dispersal Geographically
Third, the other aspects of such a targeted strategy can be geographical prioritisation. States like Kerala and Maharashtra, districts reporting sustained transmission, and hill stations which are open now, should be considered for higher and priority vaccine allocation to aim for saturation vaccination coverage (with at least one dose).
Special Focus on Vaccinating Women
Fourth, since the vaccination of pregnant women was approved on 2 July and they account for a sizeable section of the population that was refused vaccination earlier, special measures should be taken to prioritise facilities and accelerate the vaccination of pregnant women and lactating mothers.
It has been exactly six months since India started nationwide COVID-19 vaccination and the struggle seems never ending. It is time that challenges are explicitly acknowledged and pragmatic operational strategies are implemented to get the drive on track. It is possible, and that is the way we can delay and minimise the impact of the next wave.
(Dr Chandrakant Lahariya is a medical doctor, epidemiologist, public policy and health systems expert. He is the lead co-author of ‘Till We Win: India’s Fight Against The COVID-19 Pandemic’. He tweets @DrLahariya. This is an opinion piece and the views expressed are the author’s own. The Quint neither endorses nor is responsible for the same.)
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