Billion vaccine doses: The devil is in the details

India reached the one billion Covid-19 vaccinations milestone on October 21. It is indeed great news and the less paid ordinary health workers in the interiors of India deserve a big salute for this feat.

The government wants all of India's 944 million adults to get vaccinated this year. Around three-quarters of adults in the country of 1.3 billion people have had one shot and around 30% are fully vaccinated, the government says.

The five states that have administered the highest number of doses are Uttar Pradesh, followed by Maharashtra, West Bengal, Gujarat, and Madhya Pradesh.

India's milestone comes months after a huge spike in cases in April and May, when more than 400,000 infections and 4,000 deaths were reported per day and the country's health infrastructure was overwhelmed. 

Cases have now sharply fallen, with fewer than 15,000 infections per day since mid-October, and most activity has returned to normal. Mumbai, where cases peaked in the second surge, reported zero deaths in a day on October 17 for the first time since the pandemic began.

Moving ahead, it is important not to gloat in self-glory and look at some pertinent issues in this context, which will not be raised in a laudatory media.

First, around 250 million adult Indians have not got even a single dose of the vaccine. They are the most marginalised sections of the population, in both urban and rural regions, as well as belonging to tribal regions.

Second, the 100 crores doses include both doses. The government itself says that only 30% of the adult population has been fully vaccinated, and that leaves a whopping 700 million adult Indians unvaccinated.

Third, the children below 18 years, who number almost 400 million, are completely unvaccinated to date, and that has created a situation of education emergency in the country with no physical classes running in the entire country except some pockets as of October 20, 2021. Worse still, there is no declared strategy or policy for children's vaccination. 

Fourth, the media celebration of 1 billion doses calling it as the fastest as well as the placement of India among the top two nations to have achieved the feat is ill-placed. There are only two nations above 1 billion population, and China has already achieved 1 billion doses and is now racing close to 2 billion doses, which they will achieve before December at the current rate.

Fifth, very importantly, we would have crossed this milestone much earlier if the process was started by the government in time in 2020 (and not in January 2021). It was not essential to export a large chunk of vaccines to create a global image and vaccine diplomacy. The focus should have been on the safety of our countrymen first. 

If Covishield and Covaxin were given financial support or advanced bulk orders as done in other vaccine producing nations, and if the WHO-approved foreign vaccines were allowed to be imported in 2020, we could have made more significant progress. 

Around three-quarters of adults of the 1.3 billion people in India have had one shot and around 30% are fully vaccinated. Photo: Reuters

Even the rules and responsibilities of vaccination were not clear and changed several times though, under the Disaster Management Act, the Centre assumes full responsibilities during such crises.

Sixth, a large number of Indians, especially in urban areas, had to buy their vaccine doses, from as low as Rs.300 to as high as Rs.4000 per dose in private hospitals. The polio vaccines were delivered free to the entire population decades back. India as a nation was much poorer then. But 20% of the adult population had to spend for their Covid-19 jabs. 

Seventh, the vaccination process started with two doses with a 28-day-gap between each, which later increased to 42 and now 84 days, and with a scientific basis, glaringly exposing the ill-preparedness even till May 2021. 

The second wave killed officially less than 100,000, but several estimates by the scientific community world-over show it to be more than a million. Now that the production has been ramped up, why cannot we get back to a 28 to 35 days gap between jabs, so that more can be vaccinated and faster? The frontline workers with 28 days gap vaccination have not reported having developed any widespread reaction.

Eighth, September 22 reports in NDTV.com and a few other media outlets have reported and shown images of several vaccination certificates of people who did not receive the jab, as they were given on September 17, PM's birthday to set a record of 2.5 crore vaccines that day, while the daily average till then was around 70 lacs of jabs. Observers have raised questions as to how an infrastructure clocking 70 lacs doses a day could deliver 2.5 crores on a specific day. In at least one case, former Aagar-Malwa district MP Vidya Sharma, the lady who died four months earlier got her vaccination certificate on September 17! In June, several reports were there of 13-14 years old children receiving certificates too without any jab being delivered!

Ninth, recently the government of India has opened up vaccine exports once again in October 2021 while 70% of adults and 100% of children are yet to be fully vaccinated. As of now, there is no way that production can be ramped up enough to cover the entire population and ensure exports at the same time. This may be another challenge brewing ahead.

Tenth and finally, though the number of new cases is much lower now, the ongoing festival season, starting from November 4, with huge gatherings may give rise to infection rates and everyone will need to be careful till mid-November since Diwali is celebrated in the first week of November. We need to learn our lessons from the second surge of April-May, 2021, following Kumbh Mela and elections in five states.

Every pro-people success is important and needs to be rejoiced, but not at the cost of bitter facts. More importantly, that may lead us to believe we no longer need to practise caution which is required for the country not to plunge into another major crisis. 

Professor Ujjwal K Chowdhury is the Secretary of Global Media Education Council, and former Pro Vice-Chancellor of Kolkata based Adamas University. 

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.