India’s COVID-19 vaccination coverage formidable, but slow boosting policy has many worried

As per official figures, of the nearly 179.48 crore vaccine doses against coronavirus administered in the country so far, 96.8 crore have been the first doses while 80.6 crore have been the second doses.

With nearly 98 percent of the adult population in India covered with at least one COVID-19 vaccine dose and 83 percent having been fully inoculated, India has built a formidable shield against the notorious pathogen that has killed millions globally over the last two years.

Still, the slow pace in coming up with a well-timed boosting policy and expanding the vaccination to younger lots in the country has worried many.

The adult population in India is estimated to be around 94 crore.

Additionally, 1.97 crore precaution or booster doses have been offered to healthcare and frontline workers and those above 60 years with underlying illnesses who have completed 9 months since the administration of the second dose.

Beginning January 3, the jabs against COVID-19 were also offered to 15-17-year-olds who number, according to official records, around 7.5 crore. So far, 8.82 crore doses have been administered to the beneficiaries in this age-group and nearly 76 percent of the adolescents have received at least one dose.

Understandably, as the eligible pool still left out of the extensive vaccination net gets smaller and smaller, the average daily vaccination level has fallen to just about 19 lakh a day from a high of nearly 85 lakh per day last August.

Big basket of vaccines but only a few being used

What has many experts worried is the slow decision making by bodies such as the National Technical Advisory Group on Immunisation (NTAGI) and the National Expert Group for Vaccine Administration on COVID-19 (NEGVAC), which have been entrusted with the task of guiding the country’s vaccination policy.

Virologist Dr Shahid Jameel, who is a fellow at Green Templeton College, University of Oxford, and a visiting professor at Ashoka University, says that boosting should have been allowed to all above 60 years, without any caveat, in line with scientific evidence.

Also, he put a question mark over the delay in deployment of several COVID-19 vaccines that have received regulatory approvals by the Drug Controller General of India but are yet to be used as part of India's vaccination campaign against the coronavirus.

Only three vaccines have been used in India thus far – Covishield, Covaxin and Sputnik V – whereas nine vaccines have received emergency-use authorisation in the country.

The government has even procured vaccines such as ZyCoV-D by Zydus and Corbevax by Biological E and dispatched them to a few states. However, they are yet to be administered to a single beneficiary.

Both of these vaccines have been approved for populations aged 12 and above, apart from Covaxin, which is also the only vaccine being offered to 15-17-year-olds currently.

No shortage of shots

Both government officials and experts say that there is now no dearth of COVID-19 vaccines in India.

Sources in Pune-based Serum Institute of India, the maker of Covishield, said that the firm has a monthly production capacity of nearly 25 crore but over the last two months it has had to ease up on manufacturing owing to the sharp fall in demand.

Bharat Biotech, the maker of Covaxin, the other coronavirus vaccine being used extensively in the country, has now started producing nearly 7.5 crore doses every month and is hoping to touch its maximum capacity of 8 crore jabs a month from the second quarter of the year.

The government has also kept a stock of 5 crore and 1 crore doses, respectively, of Corbevax and ZyCoV-D, but it is not clear when their use will begin.

“I see no crisis of vaccines at all even if vaccinations for younger adolescents and booster doses for all adults are opened now,” said an additional secretary in the ministry.

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Jabs needed for younger ones too?

Citing research findings, Dr Jameel says younger people also need shots, based on vaccine supplies and availability of vaccines for the 12-plus population group.

Public health expert Dr Rajeev Jayadevan explained that the Omicron wave affected substantially more people than the Delta variant in many countries but the true numbers will never be known because testing rates, for many reasons, did not keep up with infection rates.

“In spite of such large infection numbers in a largely unvaccinated paediatric population in India, paediatricians have observed that this wave did not cause complications in children to any significant degree,” he said, adding that specifically, MIS-C (multi inflammatory syndrome in children), a serious complication that rarely follows COVID-19, did not rear its head after Omicron.

This is either because most children had already been naturally infected during the Delta wave, or that children were able to mount an adequate immune response to omicron, which will protect them against severe disease from future infections, Dr Jayadevan argued.

The Centre has procured some vaccines that are yet to be administered to a single beneficiary.

Also read: Explainer: Intranasal vaccine against COVID-19 and why it is awaited so eagerly

“This means that the vast majority of children in India are already naturally immunised. How much a universal vaccination programme will add to this, is unclear. But still, COVID-19 vaccination will definitely be indicated for children in special categories such as immunosuppression, neurological disability and heart disease,” he said.

Shots for the elderly

He also stressed that since older people are at exponentially greater risk of developing complications from COVID-19, they are more likely to benefit from vaccination, and that includes boosters.

Some others, including public health researcher Dr Oommen John of the George Institute of Global Health, meanwhile, insist on using other tools instead of just vaccination, going forward.

Since the transmission has decreased significantly, this period should be leveraged to strengthen capacity for public health surveillance, says John. It is likely that another variant could be on the horizon and unless it is picked up early, an effective public health response may not be feasible.