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Now or Never: Rethinking India's Covid-19 Vaccination Strategy

As of 2021, India's estimated population stands at 139 Crores. For many, this does not come across as a striking statistic. However, this statistic becomes important in the light of another one: according to the figures available in the Our World In Data's 'Map of Vaccination', only 21.3 Crores of vaccine doses have been administered till date, with only 4.36 Crores of the Indian population being fully vaccinated. This means that only 3.14% of India’s population has been fully vaccinated. In the context of a devastating second wave, it is imperative that the vaccination drive needs to be amped up. Before we understand how this can be done, let's ask another important question: Why has the vaccination drive been slow? 

The answers to the above question are plenty. To begin with, India's massive population is a huge demographic challenge. India's population outnumbers even the population of entire Europe put together. To vaccinate a population of 139 Crores is no easy task, and it is a task that demands an uninterrupted supply chain. Many industry leaders, including the Serum Institute of India's  (SII) CEO, Adar Poonawalla, did not anticipate the severity of the second wave of the pandemic in India. This, coupled with the fact that India imported vaccines to nearly 71 countries before the second wave hit, led to the creation of a shortage in vaccine production. This situation was further aggravated by the shortage in raw materials for producing the vaccines. Further, adding fuel to the injury is the Central Government's policy on vaccination. Recently, the Supreme Court, in a hearing chaired by Justice D.Y. Chandrachud, labelled the Central Government's vaccine policy as "arbitrary" and asked for details regarding the ₹35,000 Crore budget allotment for fighting Covid-19, details on vaccination plan and preparedness, and sought reasons for the differential pricing of jabs. This lack of transparency from the Central Government's end has created a lot of confusion amongst the state governments, causing further delays in the vaccination drive. 

The second wave has been deadly beyond reproach, and it has overwhelmed India's already fragile healthcare system significantly. As a consequence of the same, the healthcare sector has not been able to adequately dedicate itself to the task of vaccinating India's mammoth population. 

Now, let us ask the most pressing question: What can be done to speed up India's vaccination drive? Fortunately, this question, like the previous one, also has many answers. Till the recent arrival of Russia's Sputnik V, Bharat Biotech's Covaxin and Oxford University-AstraZeneca's Covishield were the only two vaccines available to the Indian population. The situation worsened when the Covishield production took a hit. Now, not only do we have Sputnik V, but, very recently, the Moderna and Pfizer vaccines also obtained authorisation. With five different vaccines made available, it is likely that the vaccination drive can be amped up significantly. 

The Covid-19 pandemic has prevented all of us from traveling. In this context, the concept of 'Vaccine Passports' has taken off, with those fully vaccinated with any of the WHO approved vaccines being allowed to travel. This is a huge incentive for people to get vaccinated. However, Bharat Biotech's Covaxin is yet to find a place on the list. If Covaxin gets added, then a greater fraction of the population will be willing to take the jabs. Also, Covaxin production has been more or less consistent, and is likely to keep up the supply pace with the demand. 

Currently, the government hospitals are providing vaccines for free, while the private hospitals are vaccinating people for a fee. A single dose of Covishield is priced at ₹850, a single dose of Covaxin at ₹1200 (at private hospitals) and a single dose of Sputnik V is currently priced at ₹985. With increased production, it is likely that the costs will also come down. If the vaccines are available at private hospitals at a more affordable rate, then, the number of people getting vaccinated will also see a rise. 

As a fourth measure, we need to reconsider the method of booking vaccines. The CoWin app is being used to book vaccines across the country. However, the slots get filled up very quickly. In addition, we must take into consideration the rural and aged population of the country, with the former not having proper access to the internet, and the latter group being prone to ineptness in handling technology. In order to address this issue, we can develop another application for booking vaccines, or even come up with traditional methods of booking, with minimal involvement of technology. In this way, everyone will get an equal shot at booking vaccines, and this will go a long way in encouraging more people to get vaccinated. 

There are still many Indians who are apprehensive about getting vaccinated, primarily because of the influence of rampant misinformation campaigns. Vaccination is absolutely essential for breaking the chain of Covid-19 transmission, and it is crucial that we spread awareness about the importance and safety of vaccines. Social Media can be especially useful in this regard. Considering that Cricket and Bollywood are the two major emotions in India, we could also rope in actors and cricketers to spread awareness regarding vaccines. As awareness spreads, people will be less reluctant to get vaccinated. 

There is a popular saying that goes: "Make the best of what you have". At a time when India is grappling with an acute shortage of vaccines, we cannot afford to waste the supplies that we already have. We need to be more resourceful, and we need to utilize every drop of the vaccine. The Kerala model of vaccination is a good example, as the state managed to vaccinate more people than the number of doses received, by eliminating even the 1.1%  general wastage of vaccines. Efficacy is the key, and it is important for all the states to follow it. 

While the second wave of Covid-19 might be slowly abating in India, many experts have already cautioned about a possible third wave, with children being at particular risk, and India has not yet started vaccinating the under-18 population. We need to fully vaccinate the 18-44 and 45+ age groups as soon as we can, so that the vaccination drive can be extended to include the under-18 population before the supposed third wave hits. 

The worrying rise in the Mucormycosis or Black Fungus cases in India’s post-Covid recovery patients is also proving to be a great public health emergency. Vaccination can also indirectly help in reducing the cases of Mucormycosis, by preventing the occurrence of Covid-19 in people. 

The Covid-19 vaccines are our best chance to fight this devastating pandemic, and it is a chance that we cannot squander at any cost. In the words of William Foege, "Vaccines are the tugboats of preventive health". 


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