One billion mark-The remarkable story of India’s vaccination drive

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Jaspreet Tuteja, Officer, Centre for Healthcare, IIM Udaipur and Prof. Vedha Ponnappan, IIM Udaipur shares their views on recently completed one billion vaccination mark by India

India has reached the landmark figure of 100 crore vaccine shots, the only country after China to reach this magical number. For a country that faced many bottlenecks, such as the short supply of vaccines, a surge of the most devastating second wave of COVID, and issues in the supply chain due to lack of cold chains in rural parts, managing to get to this milestone is an achievement worthy of celebration.

The first vaccine doses were administered on 16th January, 2021. The central government made vaccines available to healthcare workers, frontline workers, and the population aged above 45 years for free. Just before making the jabs open for the population between 18-45 years from 1st May, 2021, the prices were deregulated, thus enabling the vaccine producers to self-determine the prices of their product. This led to a situation where there appeared three different price tags for the dosages administered by the central government, the state government, and private hospitals. This phase saw a great dip in the vaccine administration and slowed the drive. Seeing the inequity in the situation, the Government announced free vaccines for all from 21st June 2021.

Though we will be reaching 100 crore vaccine shots, only 30% of our adult population is fully vaccinated. The highest percentage of the fully vaccinated population is in Kerala. There is a huge disparity between the number of people given the first shot (51% of the population, as reported by Bloomberg’s vaccine tracker) and those who have been fully vaccinated. The main reason for this is that after the initial vaccine hesitancy in large parts of the rural population, many government welfare schemes were linked with the first vaccine dose. In order to get the ration, people had to ostensibly produce the first dose certificate; so the number of people taking the first shot soon increased. But as taking a second shot was not made mandatory, there is a striking disparity in these figures. The second reason could be the ebbing fear of COVID striking; as the cases have dipped, so the people have lost their sense of urgency for the vaccine.

No vaccine cover has been deployed for our children, comprising 40% of the population. Hopes are high on the indigenously developed vaccine ZyCov-D (Developed by Zydus Cadila Pharma), which  is in the trial stage and is expected to be available soon for age group 12- 18 years.

As part of the IIM Udaipur’s Centre for Healthcare’s ongoing research on COVID-19, we interviewed some citizens to understand their experience of being part of the biggest vaccination drive in the world and the challenges ahead.

While most of the people took the vaccine for their own safety, some of them realised that they might become the carriers of the disease to their elder family members. One of the migrant workers in a shop said, “my parents and grandparents live in a village, and I work in the city. I didn’t want to be a carrier and infect them, as I am working in the city. If I, being educated, don’t take the vaccine, what will I tell others? Govt. is doing so much to vaccinate the population.”

There is another category who faced social pressure to take the shot, such as a house help who was asked to get the shot or discontinue work. Yet others took the shot in order to return to work. Social media has been a great motivator in this vaccine drive. The younger generation posting their vaccination selfies and stories on social media platforms like Facebook and Instagram, motivated their peer group to adopt. There are many hashtags, gifs and quotes associated with vaccination that have been trending these days.

The government launched a portal and mobile app, CoWin  (Covid Vaccine Intelligence Network), on 16th Jan, 2021 to enable the beneficiaries to register and to keep track of the doses administered. Initially, for every vaccination, an appointment booking on the app was mandatory.  This was the time when there was a shortage of vaccines, and the 18-45 population was also made eligible for the jabs. Many people faced several issues for booking the slots or had to experience a huge waiting time. A young office-going woman in the city shared, “it was very difficult to find a slot. When we used to login, it showed many slots. As soon as we clicked to book one, it showed no slots available. Later on, when the administration intervened, then things got smoother.”

The issue was more severe in rural parts where there were internet connectivity issues and people were not able to access the portal or the app. Many who were not regular internet users faced challenges in booking an appointment for themselves. There were instances where there was a huge crowd for a limited number of jabs.

On the other hand, when vaccines became plentiful and the number of seekers dwindled relatively, the bottleneck became the vaccine vial. One vial can inoculate 10 people as only 0.5 ml is injected in one person. There were instances where when the number of people to be injected were less than ten, the nurses did not open the vial in order to save the vaccine from getting wasted. Though the people waiting for the jab were upset due to the delay, they also appreciated the determination and dedication of the staff in preventing the loss of doses.

Many people in urban parts managed to get an appointment for a paid vaccination in private setups. They had to pay as much as Rs. 750 to Rs. 1,200 for a shot whereas at the govt set up it was free. People choose paid slots since (1) not enough slots were available for bookings for free jabs, (2) there were long wait times at the govt facilities in the initial days, and (3) mismanagement of the crowd leading to a fear of getting infected while going for a vaccine.

Many community organizations came forward to arrange camps at their respective religious centers or community halls. They used social media to spread the message about the vaccination day, but as pre-booking was not allowed, there was mismanagement at some places. Also, at these places the entries of vaccinations were done offline, so people did not get the notification or certificate instantly, a cause of discomfort given the importance of the vaccination.

In rural India, individuals have not adhered to the two-dose regimen due to many deterrents. The distance to be traveled to get the shot and the long three-month wait time between Covishield shots discourages compliance.

All said this feat is a remarkable achievement. India has got an uphill task to vaccinate its entire population with both the doses of vaccines and also to cover its adolescent population and young children. The one billion landmark gives hope that the government and healthcare workers can continue their relentless efforts to overcome this herculean task with the support of their countrymen.

 

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