Six months ago the world was shocked by images and videos of overburdened crematoriums in India and dead bodies floating down the Ganges.
Stories circulated of hospitals running out of oxygen support for critical patients. And on 19 May this year, India broke the record – previously held by the USA – for the number of coronavirus deaths reported on a single day. A total of 4,529 people were recorded as having died that day of covid-related illness.
Today marks a very different landmark in India’s covid story: the country has delivered its 1-billionth dose of the covid-19 vaccine.
31% of the country’s adults are fully vaccinated and another 44% have been partially vaccinated.
The country has made real progress. In this blog I’ll ask, what needs to happen next? But first, let’s look at where we’ve come from.
India’s first Covid wave
India reported first case of COVID-19 on 30 January 2020. Seven week later the government of India implemented a national lockdown.
Daily cases last year peaked in mid-September with more than 90,000 cases reported a day. By January this year, that figure had dropped to below 15,000.
Then the second wave of covid struck.
Devastating second wave
From the first week of March this year, cases again started increasing, signalling the arrival of the second wave of the pandemic. By late April and early May, many hospitals – big or small – were desperately short of beds, medical oxygen and life-saving drugs.
Initially the second wave mainly affected big cities. Then it spread deep into rural regions, where health facilities are often poorly equipped and healthcare workers in short supply. Between March and May this year the share of new cases in rural districts increased from 37% of the national total to 48.5%.
On 6 May 2021 India’s devastating second wave peaked at 414,000 covid cases.
While a decline in the number of new cases (as reported by the government) can be seen, the fear of a third wave lingers.
INDIA’S COVID VACCINATION STORY
One of the few privileged countries to have indigenous covid vaccines, India began its vaccination programme on 16 January this year. Two months before the start of the devastating second wave.
The Drug Controller General of India (DCGI) had approved emergency use of two vaccines: the Oxford–AstraZeneca vaccine (known in India as Covishield) and a domestic vaccine, BBV152 (trade name "Covaxin"), developed by Bharat Biotech in association with the Indian Council of Medical Research and National Institute of Virology.
Since then, appproval has followed for four more vaccines: the Russian Sputnik V, Moderna, Johnson and Johnson, and ZyCoV-D (developed by Zydus Cadila India).
Covaxin has also been approved for 2-18-year-olds. When paediatric covid vaccination starts in India, children with comorbidities will be prioritised.
The rollout consisted of a number of phases, beginning with health and frontline workers, then prioritising groups of people by age and qualifying comorbidities. Until on 1 May eligibility was extended to all residents over the age of 18. And on 13 May, Covaxin was approved for use with children aged 2–18.
To increase the pace of vaccination, the participation of private hospitals was enlisted, giving people who could afford it the option of getting vaccinated at a prescribed rate.
CHALLENGES
The vaccine rollout has posed numerous challenges.
Online registration for vaccines faced initial hiccups, and registration and appointment scheduling remain a challenge in reaching rural and less educated communities. Vaccine hesitancy and resistance persist, especially among people living in slums and rural areas, with fears that the vaccine can cause fever, infertility and death. The National Covid Task Force estimates around 100 million Indians due for the second dose are not taking the vaccine.
Covaxin was initially given interim approval before Phase-3 clinical trials were completed. Concerns over its safety led to state governments choosing to relegate it to a buffer stock and primarily distribute Covishield. Covaxin is still to be included in WHO Emergency Use recommended list of COVID 19 vaccines. Covaxin recipients are therefore prevented from international travel.
Increased demand for vaccines and expanding eligibility to all residents over the age of 18 years led to acute shortages of vaccines. States had to close many vaccination sites and vaccination rates fell. And many States communicated that they are facing difficulties in managing the funding, procurement and logistics of vaccines, impacting the pace of the National COVID Vaccination Program.
PROGRESS
In spite of the challenges, India has made good progress in its vaccine rollout – as signalled by today’s landmark achievement of 1 billion cumulative doses.
The Government of India has committed to vaccinate all of the eligible adults by end of this year. It is looking to:
- increase production of local vaccines
- hasten the process of approval of additional vaccines in pipeline from other domestic manufacturers
- import foreign vaccines (Pfizer, Moderna, Johnson and Johnson) or produce them in India
- minimise vaccine wastage.
Revised government guidelines have reduced the financial burden on states. While the Government of India originally procured 100% of domestically produced vaccines, this was cut to 50% in May. Under the revised guidelines, the Government now procures 75% of the vaccines produced by the manufacturers in India and provides these free of cost to States/Union Territories. These doses will be administered free of cost to all citizens as per priority through government vaccination centres.
Private hospitals are now allowed under the guidelines to purchase 25% of the domestic production (it had been 50%) to serve the section of people who can afford to and prefer to be vaccinated by a private provider.
Vaccine friendship
In January this year, alongside starting the national vaccine rollout, India started a programme of Vaccine Maitri, meaning vaccine friendship. This leverages the capacity of the country's pharmaceutical industry in order to export Indian-manufactured vaccines to other countries.
By 10 March, India had distributed over 58 million vaccine doses to 65 nations through the scheme.
HOW WE’RE RESPONDING
Save the Children India is supporting governments in raising vaccine awareness and motivation in communities. And we’re supporting people from marginalised communities to register for the vaccine.
WHAT NEXT?
India has embarked on a difficult but not impossible journey towards universal vaccination by the end of 2021.
The Government needs to ensure that the three As – availability, affordability and accessibility of the vaccine – are in place.
The government’s revised policy addresses some affordability and availability issues. But the programme needs to reach all areas and all communities.
Vaccine hesitancy and resistance needs to be addressed as a priority. Misinformation and fake messaging on social media needs to tackled. Only an information, education and communication (IEC) campaign can combat vaccine hesitancy.
Ultimately, cooperation between the centre and States/ Union Territories will be the key to success.
Photo shows eight-year-old Sohag* from Hyderabad (* name changed) (photo: Rohit/Save the Children)
