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India’s one-billion vaccine mark sparks off celebrations; experts urge restraint

The country needs to give more than 12 million doses a day to fully vaccinate all eligible adults by the end of 2021

October 21, 2021 / 07:05 PM IST
India has been averaging 3.6 million doses a day and needs to ramp it up to 12 million a day REUTERS/Rupak De Chowdhuri

India has been averaging 3.6 million doses a day and needs to ramp it up to 12 million a day REUTERS/Rupak De Chowdhuri

Whether the glass is half empty or half full, depends on who is looking at it.

On Thursday, India administered more than a billion Covid jabs since it began its vaccination drive in January this year. The milestone achieved in 278 days - the first vaccine was given on 16 January – is not without its downsides.

While a billion is an impressive figure by any count, it would be a mistake to overlook the fact that only about 30 percent of the population – or 291 million - is vaccinated two times, while 700 million-plus fellow Indians have just got one jab.

Vineeta BalIndian Institute of Science Education and Research, Pune, says that while reaching the milestone of a billion inoculations is indeed an achievement, it could have been done earlier, as a matter of course, if things had been managed more efficiently. ``Is there any need to celebrate it, or to pat someone’s back?  Vaccinating your own population cannot become a reason to garner praise,” she said.

Rajesh Chandawani, IIM-Ahmedabad faculty, believes more than just the figure, hugely important as it is, is the fact that vaccine supply chains were maintained in 29 states and many union territories and certificates were issued in time and everything happened with clockwork precision. ``That is even more significant than just the number,” he said.

COVID-19 Vaccine

Frequently Asked Questions

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How does a vaccine work?

A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

How many types of vaccines are there?

There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

What does it take to develop a vaccine of this kind?

Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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But the show could only have just begun. India aims to fully vaccinate about a billion people by the end of 2021, but experts say the drive needs to pick up pace further to meet the target.

This milestone makes India the second country to reach the one billion mark - China crossed it in June.

Reaching the one billion mark in 278 days means that India, on an average, administered 3.6 million doses per day, but it is still around 900 million jabs away from a fully vaccinated adult population, with little less than two-and-a-half-months to reach its target.

Experts estimate that the country needs to give more than 12 million doses a day to fully vaccinate all eligible adults by the end of 2021.

The mood is euphoric. Union Health Minister Mansukh Mandaviya will launch a film and song at the capital's Red Fort.

So far, the country has reported more than 34 million Covid cases, second only to the US, and more than 452,000 deaths - behind the US and Brazil.

Biggest challenge ahead

Experts also believe that overcoming hesitancy in the remaining adults and making sure the vaccine reaches the most vulnerable would be the biggest challenge ahead.

Prabhat Jha, founding director of the Centre for Global Health Research at St. Michael’s Hospital in Toronto, says that the billion-mark is remarkable progress after a slow start. ``The challenge will be to ensure the vaccine reaches everyone, especially the rural poor, and double doses are given to maximize the protection against deaths and hospitalizations. I hope that this success will also lead to an adult vaccine programme to match that in place for children. This would vaccinate against common conditions, including flu and serve as a platform for future booster doses.''

On September 17, India administered more than 20 million doses in a day in a record-breaking effort to mark Prime Minister Narendra Modi's 71st birthday.

In October, India administered an average of 5.3 million doses per day. From September 19 to October 19, the average daily doses given slightly improved to six million.

India had a slow start when vaccinations were opened for some 960 million eligible people.

Logistical problems and supply bottlenecks, vaccine hesitancy and a debilitating second wave of Covid-19 during this period made the rollout harder.

Much will depend on levels of vaccine hesitancy and the availability of doses in the coming months.

From a sluggish start, India massively ramped up its vaccination drive, with more than 61,000 public and private health facilities offering the jab. These include the delivery of vaccines by drones to remote far flung areas.

India's daily case count has been dropping - it has been reporting less than 30,000 new daily cases in the past month, and less than 20,000 in the past 10 days.

Time to invest in R&D?

Most countries, especially those in the developing world, have struggled to access vaccines - a challenge that India, as the world's largest vaccine maker, didn't expect to face.

Some others say that with this achievement, the time is ripe for the country to invest in vaccine research and development as well as in vaccine companies. ``India has to be well prepared for the next round of pandemic,” says Dileep Mavalankar, head of the Indian Institute of Public Health, Gandhinagar, Gujarat.

Currently, India is using three vaccines - the Oxford-AstraZeneca jab known locally as Covishield, Covaxin by Indian firm Bharat Biotech, and Russian-made Sputnik V.

India has also approved its first vaccine for those under 18, the three-dose ZyCoV-D, which is also the world's first anti-Covid DNA vaccine.

The government has also authorised Indian Pharma major Cipla to import Moderna’s vaccine, which has shown nearly 95 percent efficacy against Covid-19. But it's not clear yet how many doses will be made available to India.

Malvankar is also aware of the challenges ahead, mainly the 40 percent of the country’s population or 400 million children who are yet to be vaccinated and a festival season, which is bringing out people in droves in the streets and marketplaces.

``I think the chances of a Third Wave have reduced significantly, unless a major mutant comes up now,” he says. The challenge of vaccinating children will be more trying, he predicts.

Ranjit Bhushan is an independent journalist and former Nehru Fellow at Jamia Millia University. In a career spanning more than three decades, he has worked with Outlook, The Times of India, The Indian Express, the Press Trust of India, Associated Press, Financial Chronicle, and DNA.
first published: Oct 21, 2021 07:04 pm