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Young, Indian, unvaccinated

How the ‘world’s largest vaccination campaign’ faltered, leaving 600 million people scrambling for COVID-19 shots.

India began an inoculation drive for its 1.38 billion people in earnest in mid-January. Healthcare, frontline workers and the elderly were the first eligible, followed by people aged over 45 in April and then adults aged 18-45 in May. That last extension, covering around 43% of the population, proved to be a crunch point.

Following a surge in COVID-19 infections across the country in April, Prime Minister Narendra Modi accelerated plans to broaden the programme and opened up vaccinations from May 1 for people aged between 18 and 45 years. The decision led to a rush by people in that age group, who account for 600 million of the population, to sign up to the government’s CoWIN vaccination website. Critically, there was no corresponding increase in vaccine supplies.

Hospitals faced huge shortages and some immunisation centers closed down as vaccine supplies dried up. India’s tech experts, meanwhile, software and websites made to help people book scarce vaccination appointments, giving the middle-class an advantage over the poor.

By June 4, India had provided at least one dose to roughly 50 million people aged between 18 and 44, representing just 8% of that population group.

Adding to the difficulties, a privilege gap emerged in the vaccination rollout, with hospitals charging different prices for the same vaccine since May. Some hospitals in affluent areas have sold the Covishield shot, manufactured in India, for 1,800 rupees ($25) a dose, almost double the 950 rupees charged elsewhere. Data from CoWIN shows that even in poorer regions, the price ranged from 200 to 1,500 rupees. The domestically developed Covaxin shot is costlier than Covishield across the country.

Urban Indians have received shots faster than those living in the countryside. In 114 of India’s least developed districts - home to about 176 million people - authorities have administered 23 million doses in total, a Reuters analysis showed earlier this month. That means vaccines remain unavailable to a large part of the population that cannot afford it or has little or no access to private hospitals.

Modi’s government offered vaccines free of cost to the elderly and frontline workers, but initially left it to state governments and private hospitals to administer doses to adults under 45. After much criticism, Modi reversed that policy on June 7 and said the federal government would offer free COVID-19 shots to all adults from June 21. Private hospitals would still get a quarter of total supplies, which they can sell for 150 rupees over the wholesale cost of a dose.

India - the world’s biggest producer of vaccines for polio, diphtheria and other diseases - sold or donated more than 66 million COVID-19 vaccine shots to 95 countries until the middle of April. But as infections started rising from around mid-March in India, the clamour for vaccines at home also increased. India has now started importing vaccines and also expecting donations from the United States.

Compared to many Western countries, India was late in procuring vaccines. Modi’s government placed the first advance order for an unapproved vaccine only this month, after being criticised for being slow. Countries including the United States and Britain signed orders last year.

The government expects vaccine supplies to improve substantially from June. It is expecting to produce enough shots by December to inoculate all of its estimated 950 million adults, though those between 18 and 45 years will be the last on the priority list.

Several states in India have begun to gradually lift restrictions on travel and businesses, after a fall in cases in recent weeks. However, health experts have warned that cases could surge again once most states re-open, and have called for vaccinations to be sped up.

As of June 8, less than 4% of India’s adult population had been given the required two vaccine doses. Nearly 14% received at least one dose and, of that group, less than one-tenth of 18-45-year-olds have been inoculated.

The State Bank of India warned in a report last week that the third wave of infections could be as bad as the second. Government health officials and independent health experts have said daily vaccinations must jump to keep another surge at bay.

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