COVID: Will India be able to meet its vaccination target?

Over 450 million Indians have received one jab of a coronavirus vaccine and 98 million have received both shots — that means just over 7.2% of the country’s 1.3 billion populationare vaccinated.

Based on available data, statisticians say India needs to accelerate its vaccination drive by six to achieve its target of immunizing its entire adult population of 940 million by the end of 2021.

Government exudes optimism

India’s vaccination drive began on January 16. It has been marked by a shortage of vaccines, differential pricing and a bitter struggle between states and the federal government over supply.

Yet the government seems confident of meeting its vaccination target despite major obstructions to procurement.

Last week, Health Minister Bharati Pravin Pawar told parliament that 1.35 billion vaccines would likely be made available across the country between August and December, and that advance payments had already been made to manufacturers.

However, Pawar was quick to point out that while “no fixed timeline” could be indicated in view of the evolving nature of the pandemic, those above 18 would be vaccinated by December 2021.

N K Arora, who heads the National Expert Group on Vaccine Administration, also expressed confidence that the government would be able to meet its target. This was based on the boost in vaccine supply expected over the coming months.

“There has been a gradual increase in the availability of vaccines,” Arora told India’s channel NDTV, adding that the country needs to add between 75 and 100,000 immunization centers to meet its deadline.

The government’s new vaccination policy came into effect on June 21. It shifted to centralized procurement of vaccines after several states faced difficulties in procuring and managing the funding of vaccines. The immunization pace has since picked up again.

In June, India had administered 118 million doses and is likely to administer 124 million doses by the end of this month as it has been vaccinating roughly 4 million people a day, according to government data.

An unfeasible proposition

Critics say there is no clarity on how and when the vaccines will be procured.

“If 1.35 billion vaccines are to be procured, it would mean 270 million doses every month or 8.8 million doses per day on average,” Vikas Bajpai, a social medicine and community health expert, told DW.

Administering 124 million vaccine doses in a month has proved India’s best performance so far, but scaling up to 270 million doses is going to be an arduous task, says Bajpai.

“Vaccinations don’t happen on demand. Has the production capacity increased or have the manufacturers been asked to ramp up?” queries Bajpai.

India’s national network of civil society organizations and health rights activists slammed the deadline as unrealistic.

They point to the government’s failure to involve local communities in their vaccine policy, which has seriously impaired trust among sections of the population and influenced the way they view vaccination.

“There are huge problems of transparency in the vaccine policy apart from logistical issues. Huge swathes of the population both in rural and urban areas have trust issues. It is not going to be easy,” Vandana Prasad, a community pediatrician and public health professional, told DW.

Prasad, who has been involved for over two decades in the Public Health Resource Network, said vaccine hesitancy is becoming more of a problem despite the government’s promise that it would provide states with free vaccines for everyone above the age of 18.

“The questionable basis for emergency authorization approvals and the lack of a robust mechanism to address possible adverse effects will push the deadline,” said Prasad.

Government remains hopeful

Not all experts are on the same page as to whether India was on course to complete its vaccination process by the end of the year.

“Although India’s vaccination rollout has been hampered so far by supply chain constraints, the government is confidently asserting that supplies will improve by August,” Srinath Reddy from the Public Health Foundation of India told DW.

Reddy said that the government’s new-found belief was based on scaled up production and the likely regulatory approval of several new vaccines in advanced stages of clinical trials.

W Shally Awathi, a paediatric pulmonologist from Lucknow says the goal is “doable.”

“I am hopeful that we will be able to meet this target if production is ramped up and we move on a war-footing to inoculate the beneficiaries that are in the cohort group,” Awathi told DW.

Where are the vaccines coming from?

It quickly became clear that the two vaccine manufacturers, the Serum Institute of India (SII) — which produces Covishield — and the Hyderabad-based Bharat Biotech — which produces Covaxin — were not going to be able to meet the demand.

SII officials told DW that the monthly production capacity for Covishield is approximately between 110 and 120 million doses, with no plans to increase it further. Bharat Biotech is also not expected to increase production to expected levels. The company is still producing around 20-25 million doses a month.

The Russian vaccine, Sputnik V, has not been greenlit for everyone, although the government says it plans to produce more than 300 million doses a year. The government is yet to announce when the target might be achieved.

If approved, the Zydus Cadila-developed jabe will become India’s second home-made vaccine against Covid-19. The company has reportedly submitted additional data related to immunogenicity and safety of the vaccine to the Drugs Controller General of India

Supplies of foreign-made vaccines such as Moderna and Pfizer are still facing legal hurdles over the manufacturers’ desire for indemnity protection.

“Unless we know where the vaccines are coming from, how can the government be so confident of meeting a deadline that is so far-fetched? All this will obviously have an impact,” said Bajpai.

With a third wave predicted for India any time between August and December, vaccine protection remains the only way forward against severe infections and hospitalizations, he added.