NEW DELHI—As of 6 p.m. on Jan. 20, the fifth day of its COVID-19 vaccine rollout, India had inoculated a total of 786, 842 people. Over the next few weeks, it aims to inoculate 30 million health and other frontline workers, and by mid-August it plans to have vaccinated another 300 million people with the help of two vaccines—Covishield by Oxford University/AstraZeneca being made in India by the Pune-based Serum Institute, the world’s largest vaccine manufacturer, and Covaxin, a government-backed, homegrown vaccine from Bharat Biotech.
“This scale of vaccination campaign has never been attempted in history and this shows India’s capability,” Prime Minister Narendra Modi had said while opening the vaccine rollout on Jan. 16.
India’s challenges in the run-up to the rollout were twofold—its population size which is second only to China; and the scale of the pandemic in the country, which is second only to the U.S. with 10.5 million people infected and 151,000 dead.
However, it managed to vaccinate 224,301 people in the first two days as compared to China, which had inoculated around 73,000 people in the first two days and aims to vaccinate 50 million people before mid-February. The U.S. had managed to vaccinate a million people in the first 10 days beginning on Dec. 14.
So far, so good—but India is also taking a huge risk.
One of the biggest challenges is a growing anti-vaxx movement in a country which usually leads the world in mass inoculation plans. The Indian government announced in January that one of the two vaccines chosen was Covaxin, that has not yet completed the third phase of its human trials. A plea filed in the Bombay High Court had said the makers of the vaccine have not yet published the findings and data of their trials in any paper.
People who have received the Covaxin so far have had to sign a consent form that says "in phase 1 and phase 2 clinical trials, COVAXIN has demonstrated the ability to produce antibodies against COVID-19. However, the clinical efficacy of COVAXIN is yet to be established and it is still being studied in phase 3 clinical trials. Hence, it is important to appreciate that receiving the vaccine does not mean that other precautions related to Covid-19 need not be followed."
The form also assures that any adverse reaction to the vaccine will be compensated and recipients were handed a form to note down any problems with the vaccine.
“This is crazy—one would understand if there were no other vaccines available, or there was a shortage, but that is not the case,” said Indranil Mukhopadhyay, a New Delhi-based health economist, who teaches at the OP Jindal Global University.
But Modi’s nationalistic government have been vocal about Made in India vaccines ever since the beginning of the pandemic. And if the gamble pays off, India could play an important role in immunizing a large part of the developing world—especially those with weak vaccine logistic networks—with Covaxin, which can be stored at normal refrigeration temperatures of 2 to 8 degrees centigrade.
During his January 16, speech Modi dismissed concerns surrounding the vaccines as “propaganda, rumour and erroneous information,” but it remains a fact that Covaxin is still in clinical trial mode and its inclusion in the vaccination program has meant that while in September around 13 percent of Indians were not willing to be vaccinated—by December that number had swelled to 69 percent.
For the vaccine to be effective nationwide, it is crucial that the majority of the population goes along with the government’s plan to take it.
“It’s a wait-and-watch situation right now. As trust in the vaccines grows, we can overcome the hesitancy,” said Neeraj Jain, Indian country director for PATH, which is part of COVAX, a global effort to ensure equitable access to the COVID-19 vaccines.
But India’s challenges going forward are huge, given that its public health-care system has been in tatters for decades over a lack of resources. Total health spending in the U.S. is 16.9 percent of its GDP, whereas in India it stands at 3.6 percent. There was a shortage of 600,000 doctors and 2 million nurses in the country, as of the latest report in 2019.
But India trumps every other country with its longstanding experience in mass immunization programs, notwithstanding a lack of resources. It runs one of the world’s largest immunization programs that administers vaccines to more than 26 million newborns and 29 million pregnant women.
This program has ensured an established network of cold chains and transport and storage facilities for the vaccines and an army of health workers trained to administer and reach these vaccines to the very last mile. It also successfully ran immunization campaigns against polio and smallpox. Smallpox was eradicated from the country in 1975 with the help of a campaign called Target Zero while the country was declared polio-free in 2014.
Known as the pharmacy of the world, India manufactures more than 60 percent of the vaccines sold worldwide. Pulling on these experiences, India had begun preparations for a countrywide vaccine rollout as far back as in August by setting up a group of experts to oversee vaccine administration for COVID-19. In December, the government published a detailed operational guideline that left nothing to chance—including layout of vaccination centers and specific role of each vaccinator.
In the run up to the launch, more than 100,000 vaccinators were trained with the help of innumerable mock exercises, including three dry runs to identify glitches.
“I think we are ahead of most countries in terms of planning,” Jain told The Daily Beast. “I am looking at the rest of the world and how vaccine rollouts are being handled even in smaller populations, and I think we are doing brilliantly.”
India’s vaccine logistics network—according to this report—comprises 27,000 cold chain points, 76,000 items of cold chain equipment, 700 refrigerated vans, 55,000 cold chain handlers, and 2.5 million health workers. But this network is currently handling around 60 million of the population and will have to be ramped up fast to cover 1.35 billion people in the coming months.
“If you are talking about scale—it’s not that huge as yet but it will get massive when we enter the second and third phase, beyond the health and frontline workers,” said Mukhopadhyay. “And my fear is that they might come at the cost of stalling routine immunization services or other health-care activities.”
When the pandemic broke in India, the government diverted its entire health-care force to focus on curbing the spread of the virus—which disrupted other health-care services and delivery, including existing immunization programs.
The Indian government had anticipated this fallout from the initial months of its handling of the COVID-19 pandemic and in a statement had said that it had ordered states to conduct COVID-19 vaccinations on four days of the week “to minimize disruption of the routine health services.”
But, Mukhopadhyay said, gradually the burden of vaccination will come to rest on the health workers. “The pandemic exposed the limitations of our public health. We have to scale up fast to fill these critical gaps,” he told The Daily Beast.
India is the country best placed to do just that, all Modi has to do now is ensure that the efficacy data for Covaxin is released while there’s still time for him to convince around a billion people to put their faith in India’s homegrown solution.