When India crossed a million reported Covid-19 cases on July 16, 2020, I headlined my next column “A Million and a Manifesto”, putting forth suggestions on how to manage the pandemic (back then, testing was the big challenge). With India crossing the 20 million reported cases mark on Monday (May 3), here are some suggestions on how the country’s struggling vaccine drive (currently the big challenge) can be accelerated and universalised. There’s little to be achieved by discussing what India got wrong (most things, actually) in its vaccine strategy, but here’s what the people in charge of India’s vaccine strategy can do to make things better.
The first and immediate task is to enhance supplies — by authorising (after due process) more vaccines for emergency use, exploring voluntary licensing (although manufacturing may pose a bigger challenge than many experts advocating compulsory or voluntary licensing believe), working with local manufacturers to increase capacity, and placing vaccine orders well (preferably months) in advance with both local and foreign companies.
The second is to possess and provide complete clarity on the timing and volume of supplies so that the states and private hospitals know how many vaccines they will have at hand, and when. Ideally, this should be linked to the vaccine registration website so that people seeking shots know this too. In the interests of transparency, the website should display the number of vaccine doses available in each district, and if none is available, the earliest when they will be.
The third is to focus on achieving the primary target. As I have explained before in this column, this is 375 million. That’s the number of people who need to be administered at least one dose of the vaccine for the result to make itself felt on the trajectory of the pandemic. That translates into 40% of the eligible population (those over the age of 18 years). If this means mandatorily extending the gap between doses to 12 weeks to those administered Covishield, the Serum Institute of India’s locally manufactured version of the AstraZeneca/Oxford vaccine, so be it. Research shows that this can be done without any risk and that, in fact, such a hiatus enhances the vaccine’s efficacy. The sooner India hits that number, the better its chances of flattening the infection curve, and staving off a third wave of the pandemic. One expert I spoke to said the results will start becoming evident even at 235 million people (India is currently at 129 million, of which 100 million have been administered only one dose of the vaccine).
The fourth is to remove vaccine hesitancy. This is evident even in some parts of urban India; and it is a big problem in rural India. The closer India gets to universal vaccination, the higher its chances of not witnessing recurring waves of Covid over the next several years. A combination of incentives and punitive measures (preventing those who have not been vaccinated from traveling by rail or air, for instance; or making them ineligible for government jobs and bank loans) may be required.
The fifth is to work with vaccine makers to expedite vaccinations for those under the age of 18. India has around 450 million people under the age of 18. That’s more than the population of the US, the UK, and France combined. There’s no way India can beat back Covid-19 unless this segment of the population is also protected against the disease.
The sixth is to create a unit in government that can estimate demand for Covid vaccines in years to come. It is becoming clear that the first generation of vaccines will provide protection for a limited time — six months to a year at the lower bound, and a year-and-a-half at the higher. This means the country will need billions of doses of vaccines every year till a single-shot vaccine is developed (it’s just a matter of time before one is). And once the annual demand estimation is complete, India’s vaccine drive managers can loop back and focus on the first and the second tasks again.