India's Citizen Groups, Corporations Step Up To Fight Vaccine Hesitancy

"Most of the elderly people here do not have children around who can help them with getting vaccinated. So we residents had to come together for this," Sinha told IndiaSpend.

With the opening up of vaccination to everyone over 45 years, and with businesses and communities mobilising, India's pace of vaccination has grown from an average of 1.4 million doses in the week ending March 15, 2021, to 3.25 million doses in the week ending April 15.

But three months into the vaccine drive, India still needs to improve its pace of vaccination to reach an average of 3.58 million doses per day and meet the goal of administering 500 million doses to 250 million people by July 2021.

India's vaccination programme might also fall short if the government is unable to ensure an adequate supply of vaccines. The central government has said that "there is no vaccine shortage" but several states, including Maharashtra, Chhattisgarh and Odisha, have reported a shortfall.

All of this is taking place amid India's second wave of COVID-19 infections. India (14 million) now has the second-most confirmed COVID-19 cases in the world, after the United States (31.4 million). India's cases continue to grow, with an average of 163,000 infections reported every day over the past one week ending April 15, compared to 71,282 in the US.

New vaccine approvals unlikely to reduce current shortage

India will have to administer nearly 383 million shots over the next three-and-a-half months, an average of 3.58 million shots daily, to reach 500 million doses administered. On average, over the next three months, India would need more than 109 million doses a month to meet its 500 million target by July 2021. India currently can manufacture about 83-113 million doses of COVID-19 vaccines per month, according to a Rajya Sabha committee report.

Until now, the Indian government had approved only two vaccines--Covishield, developed by Oxford University and the pharmaceutical company AstraZeneca and manufactured by Serum Institute in Pune; and Covaxin, developed and manufactured by Bharat Biotech.

In an attempt to increase the supply of vaccines, India approved a third COVID-19 vaccine, Sputnik-V on April 13, which will be imported by Dr Reddy's Laboratories, which also conducted the clinical trials for the vaccine in India.

The Russian Direct Investment Fund (RDIF, Russia's sovereign wealth fund), has entered into agreements with several Indian pharmaceutical companies to make Sputnik V, and these companies have a capacity to produce more than 850 million doses per year, as per a press release from April 12. But neither RDIF nor the Indian government has publicly stated how many doses of the vaccine will be made available, by when and at what price. Without this information, there is no clarity on whether this vaccine will indeed help India to overcome its current shortage and meet the 500 million doses target of July.

One of the companies, Stelis Biopharma Pvt. Ltd, aims to begin supplying the vaccine by the third quarter of 2021, it said on March 19, 2021.

The government has also said that vaccines which have been approved in other countries, such as the US and the UK, could also be considered for emergency use approval in India.

The government's recent announcement to allow vaccines approved abroad to be quickly approved in India means that "one major barrier to producing and distributing vaccines in India, whether for domestic or for foreign use, has now come down. This is a sensible move," said Gautam Menon, professor of physics and biology at Ashoka University in Haryana. "Manufacturing diverse vaccines in India at scale would be the ultimate solution."

However, the current shortage of vaccines in India can only be addressed by Serum Institute and Bharat Biotech, but their foreign commitments to the World Health Organization's COVAX facility and other exports would clash with this, said Menon. "The current shortage will not be addressed immediately."

In addition, experts have told us that many developed countries have booked more than double and even triple the amount of vaccines that their population needs, which will inhibit India's ability to get these foreign-approved vaccines in the short term. Further, some of these vaccines, such as the ones manufactured by Pfizer and Moderna, might be too expensive for the majority of Indians. The Indian government is buying Covaxin at Rs 206 per dose, and Covishield at Rs 200 per dose. Internationally, Sputnik V has been priced at about Rs 749 ($10). The Pfizer vaccine has to be stored at -70 degrees celsius and costs about $40 for two doses, we reported in December 2020.

Vaccinations, by the numbers

On January 16, 2021, India started what was heralded as the world's largest COVID-19 vaccination drive. Since then, India has administered over 117 million vaccine shots. This includes first and second doses, and shots given to health workers, frontline workers and people above the age of 45 years. On average, about 45,000 vaccination centres operate daily.

The pace of vaccination has grown steadily. By February 15, 2021, India had covered only 3% of its 500 million doses target. By the second month, this grew to 7% and is now, at the close of three months, at 23% of the 500 million doses.

On April 5, 2021, India achieved its highest number of vaccinations in a single day, at 4.3 million.

How the pace of vaccination increased

Initially, the Indian government had allowed vaccinations for only health workers until March 1. Then the government opened up vaccinations for those over the age of 60 years and those who had certain health conditions. From April 1, 2021, the government has allowed anyone over the age of 45 years to take the vaccine.

To boost vaccinations, the government also allowed vaccinations on all days of the week, including on Sundays and holidays. From April 11, the government allowed workplaces, with over 100 people over 45 years, to get vaccinated at the workplace. The government also announced a 'Tika Utsav' (vaccination festival) between April 11 and April 14 to encourage vaccination.

One company that has got on board for these drives is PVR Limited, which runs movie theatres around India. The company plans to cover 7,000 employees and 8,000 family members at all their offices, according to Sunil Kumar, the company's chief human resources officer. "We are organising vaccination drives at our campuses and at the same time motivating employees to proactively get themselves and their family members vaccinated and get the cost of vaccination reimbursed [from the company]", said Kumar, adding that they are also identifying vaccination centres close to their offices/workplaces where employees can get vaccinated.

The Rotary Club of India is using its vast network to carry out vaccination drives. Their national task force works with state governments and has so far handled the logistics for 55 vaccination centres. They have worked with the governments of Kerala, Tamil Nadu, Gujarat, Rajasthan, Maharashtra, Uttar Pradesh, West Bengal, Andhra Pradesh and Karnataka, according to Ashok Mahajan, the chairperson of the task force. "We have organised vaccination programmes in private hospitals and in Rotary's own community centres. We provide and pay for infrastructure, logistics and create awareness about the camps," said Mahajan.

Getting the elderly vaccinated is a priority for HelpAge India, a nonprofit that works for the elderly in care homes, and its partner organisations. "Our mobile health units have gone to remote parts of India to talk about vaccination and inform people about the process to get vaccinated," said Ritu Rana, mission head for health at the organisation. "We also run four homes for the elderly in Punjab and Tamil Nadu. The elderly people residing there were quite apprehensive to get the vaccine. So we got our staff vaccinated first, to build some confidence among the residents, and then got the residents vaccinated," Rana said.

Supply and pace of vaccinations are bottlenecks

Despite all efforts, only 102.2 million people have received COVID-19 vaccination by April 15, 2020, government data show. Only 14.8 million have received both doses while the remaining 87.4 million are yet to take their second dose.

Even while states report shortages, India has already exported 64.5 million doses of vaccines under the 'Vaccine Maitri' (Vaccine friendship) programme. This includes 35.8 million doses exported commercially, 10.4 million as grants, and 18.2 million to 39 countries under the World Health Organization's COVAX facility for poorer countries' access to vaccines.

On April 13, IndiaSpend had reported how the stock of 24 million vaccines and 19 million vaccines in the pipeline would last until April 22. This could deplete faster considering India's average wastage rate of vaccines at 6.5%.

If the rate of vaccination does not exceed the current seven-day average of 3.25 million shots per day, it will take India nine months (until Jan 2022) to vaccinate 40% of its population & 14 months (until June 2022) to vaccinate 60%.

(Shreya Khaitan edited this story.)

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