The next level

India reached an important milestone on Thursday: One billion vaccinations have been delivered. Given the late start to the vaccination programme and various hiccups about procurement and delivery, the pace that has been set in the past few months is unquestionably an achievement that all concerned, whether health workers, the Union and the state governments, and vaccine manufacturers can be proud of. One continuing issue is that the level of protection provided does not exactly map up with the number of shots delivered. This is because while three quarters of the eligible adults have received.....
India reached an important milestone on Thursday: One billion vaccinations have been delivered. Given the late start to the vaccination programme and various hiccups about procurement and delivery, the pace that has been set in the past few months is unquestionably an achievement that all concerned, whether health workers, the Union and the state governments, and vaccine manufacturers can be proud of. One continuing issue is that the level of protection provided does not exactly map up with the number of shots delivered. This is because while three quarters of the eligible adults have received at least one shot, only about 30 per cent have received both —which are necessary, according to trials and the real-world data, for reasonable protection against the delta variant of Covid-19 in particular.

The latter proportion will increase rapidly in coming months, hopefully, as those many Indians who received their first shots after the opening up of the programme in the summer become eligible for their second shot. India’s decision to expand the gap between the two doses of the AstraZeneca/Covishield vaccine to over eight weeks is partly responsible for this gap between the numbers and overall protection. The increased pace of vaccination has aided in the re-opening and revival of the economy. This pace should be maintained and enhanced over the coming weeks. State governments now reportedly have ample stocks of the Covishield vaccine, produced by Serum Institute of India (SII), in particular. SII has upped its capacity and can now produce 220 million doses of its vaccine a month. The shots handed out average about 5 million a day now, although this is still below the number needed to meet the government’s target of inoculating all eligible Indian adults by the end of the year.

 
Yet complacency would be a mistake. Although 90 per cent of the shots used are of Covishield, Bharat Biotech’s Covaxin is the dominant vaccine in many parts of the country, such as Bhubaneswar. Scientists are still concerned that Covaxin’s full phase III trial data has not been shared. Given that a quarter of the adults are unvaccinated, there are areas of the country where an outbreak could cause a large number of hospitalisations and fatalities. India’s success in reaching this milestone has come at a cost: Vaccine exports were shut down in the wake of the second wave earlier this year, which left many other developing countries high and dry as they waited for the SII-manufactured shots they were promised.

The government must now focus on ensuring that people turn up for their second doses: Many reports, particularly from rural India, indicate that after receiving the first dose and being able to access public services, people are dispensing with the need for the second dose. More publicity, as well as public-policy nudges and even mandates, might be necessary to ensure that full protection is achieved. This must be a priority, alongside planning for booster shots if the real-world data reveals waning protection over time. The government should not be distracted by pressure to, for example, vaccinate children. That can happen after ample demonstration of the vaccines’ safety and efficacy when administered to children, and once the processes to ensure the uptake of second shots are in place.


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