India has become only the second country after China to administer 1 billion doses of Covid vaccines. The country achieved this feat in 279 days. India started its vaccination drive on January 16 this year and is currently using three two-shot vaccines: Covishield, Covaxin and Sputnik V.
With over 100 crore doses administered so far, the country has achieved another milestone – of vaccinating 75% of its adult individuals with at least one jab.
As per the union health ministry and CoWIN data available, over 71 crore of India’s 94 crore adult individuals have received the first dose of a Covid vaccine. Of these 71 crore, more than 29.5 crore have also got the second dose.
That seems a rapid positive turnover to the vaccination drive in India that was once criticised not just here but across the world for facing vaccine shortage and said have no clear way forward amid the destructive second Covid wave.
But India now, in just four months, looks well-placed to fully vaccinate its entire adult population soon with more than enough stockpile available unlike four months ago when the country was staring at a bleak future. Without vaccines, the drive had to be suspended on multiple occasions in many states.
What has followed since then is a well-formulated action plan that has come as a rescuer against the pandemic that has affected the whole world on an unprecedented scale. India’s Covid vaccination drive, in fact, is a lesson worth learning – about the dangers associated with the coronavirus infection, the pandemic spread, and the kind of steps one should take to stop its severity.
We were not prepared as we did not expect it
After the first Covid wave peak in September 2021, the month that had seen over 26 lakh new cases and the highest number of daily and active cases before the second wave, and over 1 lakh cases a day for the first time in India, we saw a rapid drop in cases and fatalities thereafter. And in February this year, new cases fell to a level between 8,000 and 10,000 on many days.
The five-day moving average of growth of cases came down to 0.20 in January, went to the level of 0.11 and remained below 0.20 until the first two weeks of March. Active cases that touched the level of 10 lakh in September 2020 dipped to around 2-2.5 lakh a day in January 2021 and further reduced to around 1.30-1.40 lakh a day in February. The doubling rate of the cases, in fact, had gone up to over 850 days.
So, when India started its vaccination drive in January, backed with this data, it decided to go with made-in-India Covishield (developed by AstraZeneca-Oxford) and Covaxin vaccines in a phased manner, adopting a sector-wise and age-wise approach to inoculate beneficiaries. The second Covid wave was not anticipated when such decisions were taken as the existing data didn’t indicate any possibility of it.
Most Indian people were in the general mood that the worst was behind them and the country was relatively safe from further spread of the infection and associated dangers. The five months of consistent decline in the rise of new cases and the fall of active cases gave us a foundation to back our planning and thought process on handling Covid further.
It was coupled with common problems like vaccine hesitancy and questions being raised over a vaccine developed in just 10 months. So, the larger public mood about taking vaccines was not totally favourable, especially when Covid was no longer looking like a serious problem to many.
So, even if Pune-based Serum Institute of India (SII) started making stockpiles of Covishield vaccine in 2020 only, the country did not place any advanced orders. By December 2020, the company had already produced around 5 crore doses of the vaccine and expected to increase it to 10 crore doses a month by March 2021. But it clearly said that scaling up the production process depended on the overall demand by the government.
Vaccination drive and orders
India began its vaccination drive on January 16, 2021. The first phase of vaccination in January was for around 1 crore healthcare workers (HCWs). A total of 37.58 lakh vaccines were administered, inoculating on average 2,34,927 HCWs per day. In February, around 2 crore frontline workers (FLWs) were added to the beneficiary list. A total of 1.05 crore doses of vaccines were delivered to HCWs and FLWs — with on average 3,76,515 doses administered per day.
Between January and February, the Government of India placed an order for 6.6 crore doses of Covishield and Covaxin – 5.6 crore doses of Covishield and 1 crore doses of Covaxin – for its 3 crore beneficiary target.
The country began its mass vaccination drive in March 2021. The targeted beneficiary base rose to 30 crore. The exercise administered 5.08 crore doses in March, or on average 16,39,246 vaccine doses a day.
The same month, the Government of India also placed an order for 12 crore doses – 10 crore Covishield and 2 crore Covaxin.
In the next phase of vaccination from April 1, the entire population above 45 years of age, or 34.51 crore people were included. The drive that month administered 8.98 crore vaccine shots, or 29,95,724 doses per day.
Disastrous second Covid wave pushed up demand for vaccines
The same month also saw the disastrous second Covid wave surging with April recording over 66 lakh cases and 45,882 fatalities and the country crossing the 200,000 mark of pandemic deaths.
With these worrisome peaks, the inoculation exercise was opened for all 94 crore adults of the country in the fourth phase of the drive in May, the month that saw the peak of the second Covid wave.
The active caseload burden touched 37 lakh cases. From 80,000 cases on April 1, the country hit the highest-ever single-day global record of 4.14 lakh new Covid-19 cases on May 6. The recovery rate saw a sharp decline: from more than 97% to less than 80%. Daily death figures were consistently high, in the range of 3,000-4,000 fatalities on many days. It crossed the highest-ever figure of 6,148 deaths on June 9, while the whole month saw 120,770 Covid fatalities.
Vaccine shortage
While the target population base from April to May expanded over 2.7 times with the number of people demanding vaccination increasing manifold after the second wave panic and the fear of another wave in the future, the manufacturing capacity available in the country remained the same: around 7 to 8 crore doses a month with almost no stockpile available. India’s pace of vaccinating its citizens dropped in May because of the lack of availability of vaccines. The month saw just 6.10 crore doses administered that comes to an average of 20.35 lakh doses a day, a fall of 32% from April. Efforts to import vaccines also failed as doses being produced abroad were already booked in advance.
Concerns were raised on vaccine shortage. Governments of states and union territories complained about the non-availability of doses, unfair distribution and differences in pricing between the Centre and the states under the liberalised vaccine policy that sought to decentralise decision-making.
The situation was worsened by vaccine hesitancy in small towns and rural India, the issue of the government’s CoWIN portal being available only in English, a digital divide between urban, small-town and rural India, high vaccine wastage rate in some states and the Centre’s move to supply free vaccines only to the 45+ population base while governments of states and union territories had to make a decision: either bear the cost of vaccines for the 18-44 population age group or make them payable. Faced with these difficulties, they soon realised that it was better if the vaccine drive remained under the control of the central government only.
Corrective measures
The vaccination drive was again back under the central government’s control from June 21. It was followed by corrective measures like requesting Indian manufacturers to increase their production capacity, making CoWIN multilingual and ensuring distribution of vaccines as per caseload demand and vaccine wastage factors that the Government of India said was based on scientific formulation. The Centre also stopped vaccine export to other countries till conditions improved domestically.
Moreover, unlike the previous experience, the government this time went into overdrive to put bulk orders of vaccines, even including the ‘promising but not yet approved’ vaccines, adopting the line taken by countries like the United States and most European nations who put in advance orders even before the vaccination process had begun there. Orders for 16 crore Covishield and Covaxin doses were placed in May followed by 66 crore doses in July.
Also in April, with Russia’s Sputnik V getting approval, agreements were made with some Indian pharma companies to make India its global production hub, with a capacity to generate 85 crore doses annually. It was expected that by August, the local Sputnik V vaccine vials would arrive in the market.
In May, Serum Institute of India and Bharat Biotech promised to raise their production level each to 10 to 12 crore doses by July to meet the increased demand. Though Covaxin failed on this front and India-made Sputnik V was yet to make headway in the Indian market, the government finalised a deal for advanced order with SII as its major partner to provide India at least 136 crore vaccine doses between August and December. 85% of this was Covishield while the rest was Covaxin. Additionally, the government also expected to get 2.5 crores doses each of Zydus Cadila and India-made Sputnik V vaccines.
Also, some additional deals may happen soon. SII is expected to launch the Covavax vaccine, the Indian version of the US vaccine Novavax, this month. According to Serum Institute, it has the capacity to produce 8 crore doses of Covavax a month. India has also paid in advance for 30 crore doses from Hyderabad-based Biological E for its under-development Corbevax vaccine.
And, above all, the central government decided to vaccinate people for free under the drive run by it – a major factor in drawing people across the country to the vaccination drive – in order to overcome vaccine hesitancy and make vaccines available to everyone, even the poorest Indian.
Rapid turnaround
The efforts paid off. People queued up for vaccination. And they got vaccines, unlike the last time, as supply was ensured.
The country that was once staring at an acute deficiency of vaccines just 4 months ago is now repeatedly beating its own targets. The expected supply for June was 11.95 crore Covid vaccine doses. The month saw 11.96 crore vaccinations. A total of 13.50 crore vaccine doses were to be delivered in July. The month recorded 13.45 crore jabs spread over 31 days. In August, the expected target was 15 crore doses. The month saw 22.5% more doses administered with a final figure of 13.38 crore monthly vaccinations.
In September, India was expecting 18 and 22 crore doses of Covid vaccines to be delivered. If we go by the lower limit set in the expected target, at 18 crore, September did better than August, jumping over 31 per cent with 23.60 crore doses. In October, India is expected to see around 27-28 crore doses of Covid vaccines delivered for vaccination.
Though the pace of vaccination has slowed down so far in October, it is not related to vaccine shortage anymore. As Covid cases and fatalities have seen a consistent decline after the second wave peak in May and chances of a third wave, that was once predicted to hit India soon, are now remote as new cases are driven only by the Delta variant and its other strains with no new mutant of concern emerging, registration on the CoWIN website for new vaccinations has steadily dipped. So, it is not about vaccine unavailability this time. It’s about people becoming negligent again in their attitude towards Covid, something that the country witnessed before the second wave.
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