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India’s COVID-19 Vaccine drive: What lies ahead in the next few months?

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In the previous story, we looked at how countries like the US & UK secured vaccine orders more than enough for their population as far as back in 2020. On the other hand, India’s vaccine planning has been tardy, to say the least. Based on the current numbers, what lies ahead for the India COVID-19 vaccine drive? Here is a deep dive.

India is presently battling a massive second wave of COVID-19 pandemic since April 2021 with a record number of infections and deaths being reported every day. Globally, India accounts for 46% of global cases and 25% of global deaths and in the Southeast Asian region, India accounts for over 90% of both cases and deaths, reported in the last week of April, according to WHO’s COVID-19 Weekly Epidemiological Update. Many experts suspect that with low levels of testing and poor record-keeping for the cause of death – and crematoriums overwhelmed in many places – the real numbers of deaths due to COVID-19 could be significantly higher in the country.

As Vaccines are an important part of the fight against COVID-19, the Central Drugs Standard Control Organisation gave approval to two vaccines manufactured in India i.e., Covishield (of Serum Institute of India) and Covaxin (of Bharat Biotech) for emergency and restricted use. India began the administration of these COVID-19 vaccines on 16 January 2021 in phases. Our previous article gives a detailed account of India’s vaccine policy vis-à-vis the US & UK, and how India might have missed the bus in terms of procuring the required number of vaccines in advance for its population. 

Presently, Phase III has been rolled out since 01 May 2021 making those aged 18 years and above eligible for vaccination under the ‘Liberalised Pricing and Accelerated National Covid-19 Vaccination Strategy’. Under this policy, vaccine manufacturers in India will have to sell 50% of their produce to the Centre, which is called the Government of India or GoI share and the rest 50% (other than GoI share) may be sold to State Governments, private hospitals, and industrial establishments.

Status of Data availability on India’s Vaccination Drive

Daily Vaccination Data: The data on vaccination drive in India provides the following major details in various forms. 

  • India’s Cumulative Vaccination Coverage (by age groups, gender, state allocation, etc.)
  • Trends in Adverse Event Following Immunization (AEFI), registration, sessions, and coverage.

Dashboard available on the CoWIN portal, daily/weekly updates from Press Information Bureau (PIB), Ministry of Health & Family Welfare provides these details in varying forms. The COVID-19 Vaccine Intelligence Network (Co-WIN) system is being used to track the enlisted beneficiaries for vaccination and COVID-19 vaccines on a real-time basis.

Export Data: On the other hand, data on the export of the Made-in-India COVID-19 vaccine to different countries, under the Vaccine Maitri initiative is available on the Ministry of External Affairs.

Procurement Data: Details of successive orders placed by the GoI with Serum Institute of India and Bharat Biotech are available via several updates from PIB and RTI responses.

Estimated population: The estimated population of healthcare workers, frontline workers, prioritised population groups and other adults to be vaccinated is available via several updates from PIB. With respect to Phase III, the population between 18-44 years is estimated to be around 59 crores, as detailed by a Supreme Court judgement.

Taking a cue from the sources mentioned above, we will endeavour to understand the status of vaccine administration vis-à-vis the population estimates for each age group and estimate the status of vaccination in the coming three months based on the current supply levels. 

What is the current level of Vaccination among different population groups?

To begin with, let us look at the level of vaccination among different population groups as it stands today. Here, it is important to note that the first two phases of the vaccination drive focussed on healthcare workers (HCWs), frontline workers (FLWs), and people aged above 45 years. The newly launched Phase III has enabled all adults (18+ years) to be eligible for vaccination starting from 01 May 2021. Hence, the difference in the level of vaccination among population groups is also a result of phase-wise strategy and does not convey any disparity among these groups.

  • The high-priority groups of healthcare workers (HCWs) and frontline workers (FLWs) show an overall encouraging trend. With 63.92% population vaccinated and 31.09% awaiting their 2nd dose, only 4.99% of HCWs remain unvaccinated. However, in the case of FLWs, about 31.21% population remains unvaccinated, which means they have not received even a single dose. 
  • With respect to the vulnerable age group i.e., 45+ years, only 7% population is fully vaccinated with 32.85% awaiting the 2nd dose and a majority of 60% still unvaccinated.
  • The trend of vaccination among the age group 18-44 years is a recent phenomenon and the numbers reflect the same, as about 99.8% remain unvaccinated awaiting their first dose. 

What is the estimated requirement?

According to the data given above, we can estimate the number of dosages required to vaccinate the remaining population from different groups, who are either unvaccinated or awaiting their 2nd dose of vaccination.

  • Remaining vaccine dosage requirement for HCWs, FLWs, & age group 45+ years together stands at 43.6 crores.
  • The remaining vaccine dosage requirement for the age group 18-44 years stands at 117.9 or 118 crores.

Together, India would need more than 160 crore vaccine doses to vaccinate its entire adult population. 

What is the status of Vaccine procurement?

Second, let us look at the successive orders of vaccines placed by the Government of India with the Serum Institute of India (for Covishield) and Bharat Biotech (Covaxin) and their consumption as of 06 May 2021. 

India has placed a total order of 35.1 crore doses of Covishield and Covaxin up to 05 May 2021. The entire 2nd and 3rd order is expected to be supplied in the next few months i.e., by July 2021. Most of the vaccines as part of the 2nd order are already delivered while the 3rd order is expected to the fulfilled in the months of May 2021 to July 2021. It is important to note that these numbers represent the quantity supplied to the central government. 

As part of Phase III, an equal share of vaccines is to be supplied to the state governments and private hospitals all over the country, under the ‘Liberalised Pricing and Accelerated National Covid-19 Vaccination Strategy’. Therefore, states and private hospitals will receive an overall 16 crore vaccines in the next few months i.e., by July 2021, which is equal to the number of doses in GoI’s 3rd order. 

What about overall Consumption of the Vaccines?

Third, let us look at the overall consumption of vaccines, either in terms of the export or domestic usage, and estimate the remaining supplies of vaccines for the next few months in India.

As of date, a total of about 6.63 crore vaccine doses were exported from India to 95 different countries. The exports were made under three modes, grant by GoI meaning the Government of India bought them and then donated to various countries, commercial supplies by the manufacturing companies as per agreements made with respective countries, and supply to the COVAX agreement by the respective company. Of these, the GoI exported a total of around 1.07 crore vaccine doses as a grant to different countries, under the Vaccine Maitri initiative. 

On the other hand, the total number of vaccine doses administered in India, as of 06 May 2021, stands at 16.3 crores. Therefore, the total consumption of vaccine doses (out of those procured by the GoI) comes up to 17.3 crores.

By juxtaposing the overall consumption of vaccines with the overall order of vaccines, up to 06 May 2021, we can estimate the total remaining number of available vaccines in India (some of which will be supplied in the next few months) that would be available to GoI as well state governments & private hospitals by July 2021. 

  • As per the present scenario, GoI will have a total of 17.3 crore vaccine supplies by July 2021.
  • In addition to this, the state governments and private hospitals all over the country are to receive a share equal to GoI’s 3rd order for Phase III i.e., 16 crore vaccines, under the ‘Liberalised Pricing and Accelerated National Covid-19 Vaccination Strategy’ by July 2021. 

Therefore, a total of about 33.3 crore vaccine doses of Covishield and Covaxin will be available to be administered in the next few months, up till July 2021. It is possible that other vaccines may be given emergency approval or imported (like Sputnik) in the next three months. Since the projected numbers for these other vaccines are not clear as of date, it is difficult to estimate their availability. 

Projected Vaccine Supply falls short of Requirements.

From the available data, we know that the remaining vaccine dosage requirement for HCWs, FLWs, & age group 45+ years together stands at 43.6 crores and for the age group, 18-44 years stands at 118 crores. However, only a total of about 33.3 crore vaccines will be available to be administered in the next few months, up till July 2021 as things stand today. 

With the current level of vaccine supply, it would not be possible to fully vaccinate the priority groups (HCWs, FLWs, and age group 45+ years), even if the entire supply is exclusively used for them over the next three months. There is a difference of approximately 10 crores between the current requirements and the remaining supply for this group. But since the entire supply is not going to be exclusively used for these groups, we might end up with a shortage of more than 25 crore doses for this group by July 2021. 

In terms of age group 18-44 years, the status of the remaining vaccine supply presents a grim picture, as the estimated requirement of the age group stands as 118 crore vaccines, while the current estimated availability till July 2021 is only 16 crore doses (from the states & private hospital share).

While the vaccination is now technically open to all adults, the supply is not at par to keep up with the demand. Our previous article elucidates how the lack of proactive planning is hurting India’s COVID-19 vaccine drive and how other countries have handled their vaccination drives.

However, it is important to note the vaccine drive in India is still developing. As a recent development, Russia’s Sputnik-V vaccine has been approved for emergency use, in April 2021. Following this, the first consignment of 1.5 lakh Sputnik V doses landed in Hyderabad on 01 May 2021. The estimated availability of the Russian vaccine in the next 3 months is still not clear. It is also being reported that Zydus Cadila is likely to apply for emergency use authorization (EUA) of its COVID-19 vaccine this month, after obtaining the first set of interim efficacy data. 

Whether these developments will help close the gap between supply and demand or the lack of proactive vaccine planning would continue to hurt India’s fight against COVID-19 remains to be seen.

Featured Image: India’s COVID-19 Vaccine drive

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