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People stand in a queue as they wait to get a dose of the Covishield vaccine against COVID-19 during a vaccination drive at a civil hospital in Jind, in the northern state of Haryana, on June 1, 2021. Money Sharma/AFP via Getty Images
  • India has recently experienced a devastating second wave of the COVID-19 pandemic.
  • In a new opinion piece, two scientists clarify the failures of vaccine planning and deployment that have contributed to this second wave.
  • The experts make a series of suggestions for how Indian officials should manage and prioritize the country’s vaccine program.
  • Making vaccines freely available for all is one of their key recommendations.

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In a new opinion piece, two scientists lay out the failures in vaccine planning and deployment that have led to the devastating second wave of the COVID-19 pandemic India is currently experiencing.

In the article, which appears in the journal BMJ Global Health, the experts suggest how the Indian national government should rethink its approach to vaccinating the country’s population.

India has recently seen a devastating second wave of the COVID-19 pandemic, with a record high of over 414,000 daily cases on May 6, 2021. Although this figure has since declined, officials are still currently recording over 132,000 cases of COVID-19 every day.

In May, the editors of The Lancet suggested this was partly due to complacency from the Indian national government. For the editors, “the impression from the government was that India had beaten COVID-19 after several months of low case counts, despite repeated warnings of the dangers of a second wave and the emergence of new strains.”

“Modeling [falsely] suggested that India had reached herd immunity, encouraging complacency and insufficient preparation, but a serosurvey by the Indian Council of Medical Research in January suggested that only 21% of the population had antibodies against SARS-CoV-2.”

Dr. Manju Rahi, of the Indian Council of Medical Research, and Dr. Amit Sharma, of the ICMR-National Institute of Malaria Research, both in New Delhi, the authors of the present opinion piece, highlight the key issues surrounding the failure of adequate planning and deployment of COVID-19 vaccines.

For Dr. Rahi and Dr. Sharma, “inadequate vaccination planning coupled with suboptimal pandemic management has led to a large burden of cases and deaths.”

India has authorized three COVID-19 vaccines:

  • Covaxin, developed by Bharat Biotech
  • Covishield, developed by Oxford/AstraZeneca
  • Sputnik V, developed by the Gamaleya Research Institute of Epidemiology and Microbiology, Russia.

Despite this, insufficient production of the vaccines and inadequate planning means the country has a significant shortfall of vaccines. Currently, only around 12.5% of the Indian population has been fully vaccinated by June 2.

In response, the country has authorized vaccines that have received authorization in other countries, even if they have not gone through clinical trials in India. However, more efforts are required if a significant number of the population is to receive the jab.

Dr. Rahi and Dr. Sharma call attention to some of the key issues that have contributed to this low rate of vaccination and, consequently, the significant second wave the country has experienced.

The two experts highlight that the production capacity of the country needs significant improvement. India has a population of 1.3 billion people. However, before May, manufacturers were producing only around 10 million doses of Covaxin and 70 million doses of Covishield per month.

The rollout of Sputnik V will contribute to the number of vaccines available. However, Dr. Rahi and Dr. Sharma say that more vaccine sources will be necessary if India is to vaccinate its population within a year.

The cost of the vaccines has also been a barrier to uptake. Initially, the Indian national government made the vaccines freely available in government hospitals and centers.

However, it then authorized private providers to offer the vaccine, which can cost between $3 and $15 — beyond the means of the majority of the population.

For Dr. Rahi and Dr. Sharma, vaccinations in India should be free for all.

“This differential pricing […] is likely to be detrimental to public health at this time of grave crisis in India,” they warn.

“For India to stem COVID-19, the nation cannot allow any differential approach for its residents,” the authors argue. “Therefore, […] vaccinations must be free for all in India.”

When vaccinating people over the age of 45 years, the Indian national government purchased supplies of the vaccines.

However, for individuals aged 18–44 years, vaccine purchasing has been devolved to state governments. State governments are typically unable to negotiate deals for the vaccines as cheaply as the national government, while private hospitals often pay even more.

With this in mind, Dr. Rahi and Dr. Sharma suggest having a single pricing system for vaccinations for both the state and national governments.

For Dr. Rahi and Dr. Sharma, the priorities for vaccination also need a rethink. They suggest the immediate focus should be hotspots of COVID-19, as well as the most vulnerable individuals — those living in poverty, people with comorbidities, and older adults.

To achieve this, the two authors suggest that health officials need to maintain better health records of the adult population.

They also believe the national government should not rely on digital technologies to record who has received their vaccinations. They highlight that 35% of people, typically in rural areas, do not have reliable internet access, creating a digital divide.

Instead, Dr. Rahi and Dr. Sharma suggest that implementing physical vaccine cards would be more equitable.

The experts also argue that more funding needs allocating to the COVID-19 vaccination effort.

The national government has committed around $120 million for research into COVID-19 vaccines and scaling up production. However, for Dr. Rahi and Dr. Sharma, this is inadequate given the enormity of the vaccination efforts facing the country.

This particularly matters because booster shots may be necessary to protect people against future variants of SARS-CoV-2.

Although the daily cases of COVID-19 in India are reducing, the risk of variants resistant to a person’s immunity is ever-present.

Additionally, the growing crisis of “black fungus” infections following in the wake of many SARS-CoV-2 infections in India offers more impetus to ensure the country’s population is vaccinated as soon as possible.

However, as Dr. Rahi and Dr. Sharma highlight, doing so will require a major change of priorities and a significantly improved approach to vaccine planning and deployment.

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