COVID-19 vaccination in India: Uneven drive

The government’s obsession with mega events has resulted in a haphazard policy, leading to a record number of doses on certain days, such as Prime Minister Modi’s birthday, and a lack of uniform growth in inoculation across north India.

At a medical camp and vaccination drive organised by BJP leaders in Vizianagaram district in Andhra Pradesh on the occasion of Prime Minister Narendra Modi’s birthday on September 17, 2021.

Crowds have thinned at hospitals and oxygen service centres in Delhi and the lockdown has been lifted for most activities except school education. Mala (name changed), a nurse in a South Delhi pathology laboratory, said that she had jabbed so many people this year that it felt like the entire city had been vaccinated. Apart from such anecdotal evidence, the Delhi High Court’s move to close cases relating to monitoring of health care facilities in the capital in early October indicates that the worst of the second wave of the COVID-19 pandemic may be behind us.

The critical task of achieving full vaccination for the adult population is under way. After some hiccups, the vaccination drive in India began in earnest in January this year. In the first phase of the drive, health care workers were administered their first doses and in February, frontline workers were covered. In March, the second phase was launched targeting enior citizens above 60 years of age and subsequently those above 45 years of age with comorbidities. It was only after July, when the second wave was receding, that the vaccination drive got some momentum with the Centre expanding it to include the eligible adult population.

Haphazard policy

Even then, the drive has not been uniform across north India. The Narendra Modi government’s obsession with mega events and projecting India as an achiever in the vaccine race has reportedly resulted in a haphazard vaccination policy that has led to a record number of doses being administered on particular days, such as Modi’s birthday or International Day of Yoga, and fewer doses on others.

On June 21, the International Day of Yoga, 86 lakh doses were administered across the country, which was a record at the time. But data on the CoWIN app showed that the pace of vaccination had slowed in the preceding days, especially in some BJP-ruled States. During the June 21-27 period, the CoWIN portal recorded a daily average of 61.14 lakh doses. Then, during the June 28-July 4 period, the daily average dropped to 41.92 lakh doses, slipping further to 34.32 lakh doses in the July 5-11 period.

Again, on September 17, Modi’s birthday, India administered 2.5 crore doses, a new record. Several BJP leaders and government functionaries said this was “gift” to Modi on his birthday. Bihar took credit for administering 33.98 lakh doses on that day. The surge in Bihar on September 17 was just a single-day surge. Data on the CoWIN app showed that on September 16, only 86,253 doses were administered and on September 15, 1,45,593 doses. The single-day surge was not repeated in Bihar in the days following Modi’s birthday. The number of doses continued to drop subsequently; on September 21 and 22, the number of doses recorded was 5.26 lakh and 2.36 lakh respectively.

On October 25, India had officially administered over a billion doses, 103 crore to be precise, to become the second highest deliverer of COVID-19 vaccines globally. But according to media reports, the gap between the proportion of population that has received at least one dose and that which has got two doses is the widest in India. According to Bloomberg Tracker, which maps vaccination trends globally, 52.7 per cent of the population got at least one dose and 22.6 per cent received two doses.

In comparison, in China about 82.5 per cent of the population has received at least one dose and 74.8 per cent two doses. In the United States, home to a large group that is against vaccination, 66.5 per cent of the population has received at least one dose while 57.5 per cent is fully vaccinated.

Even Brazil, which is in the eye of a political storm owing to COVID mismanagement, has succeeded in administering the first dose to 75.5 per cent of its population, while 55.3 per cent is fully vaccinated.

On the same day that India crossed one billion doses, the government announced that Uttar Pradesh had administered the highest number of doses, cumulatively at 12.55 crore. This was followed by Maharashtra at 9.53 crore and West Bengal at 7.21 crore. The Modi government had promised to vaccinate 300 million frontline and health care workers by July 2021 and the entire population by the end of 2021, which seems like an uphill task as of now.

In such a scenario, if there is a third wave of the pandemic, there will be a difficult race against time to fully inoculate the population.

Vaccine hesitancy

Vaccine hesitancy widespread and within the same family there are those who are fully vaccinated and those who refuse to take even the first dose. Some alternative medicine proponents are either suggesting non-allopathic treatments or sowing the seeds of doubt around vaccine efficacy and its side effects.

Speaking in Guwahati in early October, Union Minister of State for Petroleum and Natural Gas Rameswar Teli made the unlikely link between the rise in fuel prices and COVID-19 vaccines. According to him, the government had to make money through the fuel price hike to provide free vaccines to the masses. He said: “Our government has aimed to vaccinate 130 crore people of the country at free of cost. The price of each vaccine is around Rs.1,200 and each person will be given two doses. Fuel prices aren’t high but the Centre and States have levied taxes on it. You have taken a free vaccine, where will the money for it come from? You haven’t paid the money, so this is how it will be collected.”

Such statements do nothing to boost the public’s confidence in vaccines and only help in muddying the waters around vaccine efficacy. In another instance, Baba Ramdev, the yoga guru and businessman, was openly promoting his immunity booster Coronil during the pandemic. Resident doctors’ assocations in Rishikesh, Patna, Bhubaneswar, Chandigarh, and Meerut, and junior doctors’ associations in Telangana and Punjab moved the Delhi High Court against Baba Ramdev for confusing people with regards to COVID-19 treatment and vaccines.

They said that since Baba Ramdev was a well-known person, his statements could influence the public and divert them from choosing modern medical treatment, which is prescribed as the standard form of care by the government.

On October 25, Akhil Sibal, appearing for the doctors’ associations, told the court that Baba Ramdev was misleading the public about Coronil tablets being a cure for COVID-19, Justice C. Hari Shankar observed that making profit was neither a public nuisance nor a wrongful act. On a previous hearing, the judge had said, “He may have made some statements against allopathy but that’s an opinion. If you go to any allopathy doctor, they may have adverse views about homeopathy. That does not mean homeopathy practitioners will rise up in arms against allopathy.”

While the Delhi High Court remarked on Baba Ramdev’s right to make profits, on the same day the Supreme Court dismissed a plea to stop the government from administering Covishield and Covaxin doses until all stages of the clinical trials were complete.

The plea in the Supreme Court challenged a Karnataka High Court decision in May that rejected a petition to stop the administering of the two vaccines. While a section of the citizenry is vaccine-hesitant owing to an unscientific worldview, another educated class is pro-vaccine science but hesitant to take these particular vaccines owing to insufficient evidence that they actually work.

While dismissing the special leave petition (SLP), Justice D.Y. Chandrachud said: “We do not want this to be argued at all. The High Court is very right. Let us not cast a doubt on vaccination. It is the key to protecting our population. Even issuing notice on this SLP would subject it to great mischief. We have been through a very critical stage in the history of the pandemic. And India is not the only country in the world where vaccination is happening. Dismissed.”

In May, a Division Bench of Chief Justice Abhay Oka and Justice Aravind Kumar of the Karnataka High Court had maintained that the petition was not in public interest and asked counsel, “If we grant this prayer and people will get infected will you take responsibility?”

The case of the petitioners was that permitting the use of vaccine without completing clinical trials was in violation of rules. They said that the components of the vaccine fell under the category of gene therapy product and thus the guidelines issued by the Union government must be followed. Advocate A.M. Nitin, appearing for the petitioners, submitted that administration of Covaxin and Covishield was not only harmful but also illegal.

In its order, the Karnataka High Court Bench noted: “At the outset, we must note that this court is dealing with various issues arising out of first and second wave of COVID-19. This court has dealt with the issue of the right of migrants, food security, non-availability of oxygen, etc. However, litigants and members of the bar are filing multiple petitions dealing with the same issues. This is a fit case to award exemplary cost as the hearing of the petition has consumed 45 minutes which could have been devoted to many other serious matters like non-availability of oxygen, food security, etc.” The Bench concluded by levying a fine of Rs.50,000 on two of the petitioners.