India is currently facing a shortage of COVID-19 vaccine while there is huge demand for the vaccine which is now technically open to all adults of 18 years and above. But what is the status of vaccination in various states? Here is a review.
Vaccination is one of the most important strategies to combat the further spread of the COVID-19 pandemic. India has so far fully vaccinated (both doses administered) to only around 3.9 crore people, which is 3% of the entire population. Since India began the vaccination drive against COVID-19 in January 2021, as of 13 May 2021, about 13.76 crore persons have received at least one dose. This constitutes 11.4% of the country’s population, as per the 2011 Census. Around 17.83 crore doses have been administered as of 13 May 2021. It is also seen that India’s pace of vaccination has dropped from a weekly average of 2.47 crore doses in the first week of April 2021 to 1.17 crore doses in the second week of May 2021. This drop in pace comes at a time when the country is witnessing a devastating second wave of infections. In this story, we look at the status of vaccination in the country across various parameters. All the data pertaining to vaccination is collated from the government’s CoWIN dashboard. Population figures used in the story are from the 2011 Census.
Tripura has fully vaccinated one-fifth of adult population while UP and Bihar vaccinated less than 3%
With the quick rise in infections, different states have come up with restrictions, partial to complete lockdowns to curb the spread. At the same time, vaccination of the vulnerable and adult is also considered an important step in curbing the spread. However, the proportion of the adult population (those aged 18 and above according to the 2011 Census) that has been given at least one dose of the vaccine shows a huge variation across the states- ranging from 9.87% in Tamil Nadu to 41% in Sikkim.
Among larger states, Chhattisgarh has covered 31.85% of its adult population with at least one dose. Smaller states such as Tripura, Himachal Pradesh, Mizoram, Uttarakhand, and Goa had administered at least the first dose of vaccine to more than 30% of the adult population. Tripura had fully vaccinated (both doses) 20.63% of the adult population, which is the highest in the country. Tripura is followed by Sikkim with 14.57%, and Uttarakhand with 10.7% of the adult population fully vaccinated. On the other side, Bihar and Uttar Pradesh had fully vaccinated only less than 3% of their adult population as of 13 May 2021.
No significant difference in proportion of females and males covered by Vaccination
The proportion of male and female adults who have received at least one dose of vaccine is on par with the overall vaccine coverage in most states. In Jammu and Kashmir, the proportion of adult men who received at least one dose of vaccine was almost 7% more than the proportion of women who received at least one dose. Similarly, in Delhi, the difference was nearly 6%. In 23 states, the proportion of adult men who received at least one dose of the vaccine is more than the proportion of women who received at least one dose. Meanwhile, in Ladakh, Himachal Pradesh, Karnataka, Kerala, and Chhattisgarh, the proportion of women who received at least one dose is slightly higher than the proportion of men with at least one dose. However, the difference between the proportion of male & female population who received at least one dose is not significant in most states and even at the All-India level.
All adults are now eligible to get COVID-19 vaccine shots in India
India’s vaccine strategy initially focused only on registered healthcare workers (HCWs), frontline workers (FLWs), and those above the age of 45, until 30 April 2021. However, since 01 May 2021, those aged above 18 years became eligible for the vaccine. The Centre would continue to procure 50% of manufacturers’ vaccine stocks for vaccinating those aged above 45 years. Manufacturers could sell the remaining 50% of their vaccine stock to state governments and to private hospitals, as per the new policy. The 50% of the stocks bought by the states & private hospitals are to be used for the 18-44 age group.
Population in the 18-45 years age group account for 2/3rds of the Adults
Persons aged between 18 to 45 years constitute nearly two-thirds of the total adult population in the country as per the 2011 Census. However, the percentage of the population who received at least one dose of the vaccine shots in this age group is below 7% in all states except Ladakh, Delhi, and Arunachal Pradesh where 14.79%, 11.56%, and 10% of the population in the age group received at least a dose of the vaccine. Uttar Pradesh (1.95%) and Bihar (2.49%), where vaccine coverage was poor, reported the least proportion of adults in this age group, to have received at least one dose of the vaccine. It has to be noted that most of those in the 18-45 age group who have received at least one dose of the vaccine are the HCWs and FLWs.
Smaller states doing better on Vaccination to the 45+ age group
Among those aged above 45 years, Sikkim, Ladakh, Mizoram, and Himachal Pradesh reported more than 100% of the population in this age group to have received at least one dose. The more than 100% coverage is because we have considered the population as per the 2011 Census which may have increased significantly in the last 10 years and especially in this age group.
On the other hand, only about 23.84% of the 45+ population has been administered with at least one dose of the vaccine in Tamil Nadu. It is followed by Uttar Pradesh (30.46%) and Bihar (36.36%) who also reported less than 40% coverage in this age group, to have received at least one dose of the vaccine. These are also the states which reported high wastage of the vaccine.
Six states account for 48% of vaccines allocated by Centre
In terms of vaccine doses allocated for those aged more than 45 years by the Government of India (GoI), Maharashtra is at the top followed by Uttar Pradesh. More than 10% of the vaccine doses so far have been allocated to Maharashtra and 8.4% to Uttar Pradesh. Including the allocation made to Gujarat, Rajasthan, West Bengal, and Karnataka, the six states account for 48% of the vaccine doses allocated by GoI for those aged above 45 years including the HCWs and FLWs.
The criteria used by the central government for allocating the 50% vaccines it would procure are the extent of infection (number of active COVID-19 cases) and performance (speed of administration). Wastage of vaccine is also considered in the criteria and will affect the criteria negatively. The government also announced that state-wise quota would be decided and communicated to the States adequately in advance. The allocated state-wise quota for the second half of May 2021 is not yet made public by the GoI.
Covishield is more abundantly used as compared to Covaxin
So far, only three vaccines have received emergency approval in India. While Russian Sputnik V is yet to be administered, Covishield and Covaxin, both manufactured in India, are being administered in the country. In the north-eastern states and union territories, Covishield was the only vaccine to be administered. In Jharkhand, 51.5% of the vaccine doses used were Covishield and 48.5% were Covaxin. In Delhi, 68% were Covishield, and the rest 32% Covaxin. In Assam, nearly 21% of vaccine doses were of Covaxin. In the rest of the states, Covishield accounted for more than 80% of the vaccine doses used. At an All-India level, nearly 90% of the vaccine doses administered so far are Covishield and the remaining are Covaxin. This is because of the difference in production capacity of these vaccines. So far, GoI has placed an order for 26 crore doses of Covishield of which 15 crores have already been supplied. GoI has also placed orders for a total of 8 crore doses of Covaxin up to April 2021.
Vaccine shortage has slowed down the pace of vaccination
It is clear from the data that India still has a long way to go to cover the entire adult population. It is evident that the vaccines that have been allocated so far for those aged above 45 years themselves are not adequate. In fact, even if India gets the rest of the order placed with Serum Institute of India and Bharath Biotech, around 33.3 crore vaccine doses up till July 2021, and used exclusively for the 45+ age group, it would still not be sufficient to cover this age group.
The pace of vaccination has dropped owing to the supply shortage and limited production capability of the two vaccines being used in the country. Many states have reported shortage and paused vaccination drives for the first dose and those in the 18-44 age group citing shortage. In some states, vaccination is now being extended to only those who are waiting for a second dose. But with the dosing interval for Covishield increased to 12-16 from the current 6-8 weeks, even they are not able to get their second dose.
SC enquired the need for differential pricing for Centre and State
The burden of vaccinating people between 18 to 45 years of age has been placed on the states and private institutions such as hospitals, which are supposed to procure the remaining 50% (after GoI procurement of 50%) of the vaccines manufactured in India. This move will result in additional health expenses for the states as many states have announced free vaccination to this age group as well. Also, the price in private institutions has significantly increased from Rs. 250 per dose that was being charged earlier. Such an increase will make it difficult for a large section of the population to get the vaccine at a private institution.
Recently, during a hearing in the Suo Motu case concerning various aspects of COVID-19, the Supreme Court asked the Centre why it cannot acquire 100% of the vaccines and proceed on the lines of the national immunization programme.
Further, the SC also asked about the rationale behind the differential pricing for vaccine procurement by Centre and State government. The Central Government stated that, that liberty to decide prices on arm’s length basis by and between the State Government and hospitals is based on the concept of creating an incentivized demand for the private vaccine manufacturers in order to instil a competitive market, resulting in increased production of vaccines and market-driven affordable prices for the same. The Centre said it would continue to provide free vaccination for those aged above 45 years. The decision to provide free or subsidized vaccine to the 18 to 45-year-old category is up to the states. As per the GoI, through this approach, pricing, procurement and administration of vaccines more flexible and competitive and would further ensure augmented vaccine production as well as wider availability of vaccines in the country.
Many states including Bihar, Jharkhand, Uttar Pradesh, Andhra Pradesh, Maharashtra, and Kerala have announced free vaccines for 18 to 45 year olds. Andhra Pradesh and Telangana have called for global tenders for procuring COVID-19 vaccines.
As observed earlier, India’s poor planning and delay in vaccine procurement is what has resulted in the current shortage. The only way forward will be through ramping up production through various means and importing vaccines approved elsewhere. However, the issues of shortage are not going to be resolved in the immediate future.
Featured Image: COVID-19 vaccination in States