Injecting certainty

India needs a coherent vaccination plan

Several developments on the Covid-19 vaccination front point to the urgent need for the government to formulate a coherent, long-term policy. The case has become urgent, now that it is becoming clear that the target of fully vaccinating all adults by the end of the year is unlikely to be met. The latest government data shows that less than 10 per cent of the population has received the required two doses and about 34 per cent at least one. One dose does not confer immunity, and the shortage-induced 84-day gap for Covishield, the most used vaccine, implies a sustained risk of infection and transmission for large parts of the population.

The government is now discussing plans to reduce this interval as supplies come on stream. Doing so would go a long way towards accelerating immunity, but the flip-flops on dosage gaps — it started out at the global average of four to six weeks — points to the ad hoc approach. The spectre of shortages arises even as vaccine makers are missing supply targets, and the government has permitted only three vaccine makers — Covishield, Covaxin, and Sputnik — when other robustly tested candidates are available and Indian pharma companies have demonstrated an ability to manufacture them.
 

Given that adequate vaccine supply remains the point of contention fully eight months after the government began its vaccination programme, it is hard to follow the logic of opening the programme for children between 12 and 17, with those suffering co-morbidities given priority. This would have been an unexceptionable step had the vaccine programme for adults of 18 years and above proceeded at pace. But it is now evident that for all Indian adults to be fully vaccinated by the year-end, India needs to deliver 10 million jabs per day, up from roughly 5.9 million right now. Burdening the system with additional cohorts of people will slow this rate even further. There are some 120 million Indians in this 12-17 age cohort and about 1 per cent of them are said to suffer co-morbidities. It is unclear why the government should consider this step: Children and young adults have better immunity levels by virtue of their age. So far, just 8.5 per cent of cases involve children in this age group and the number of deaths has been negligible.

The matter of vaccinating additional numbers arises just as two other issues are being raised over vaccines and the long-term nature of the disease: The need for a third “booster dose” and WHO Chief Scientist Soumya Swaminathan’s observation that instead of devastating waves, the disease may soon become “endemic”. Though the US and Israel have announced booster shots from the fall, there is as yet little evidence for its necessity. But Dr Swaminathan’s observation does suggest a requirement of an annual vaccine, as was the case with small pox and diphtheria. In other words, the government may need to start thinking about ensuring an adequate annual supply of vaccines in the near future, just as it does with TB drugs. Though the dreaded third wave is, fortunately, yet to materialise, the post-Onam surge of cases in Kerala points to the risks in the upcoming north Indian festive season. A better-planned and streamlined vaccination programme would preclude that danger.