By Kiran Mazumdar-Shaw
India’s vaccination drive started on 16th January, 2021 in line with WHO prescribed guidelines of sequentially vaccinating its stratified population in three phases. Phase 1 aimed to cover 10 million healthcare workers and 20 million essential frontline workers (police, armed forces, municipal workers) within the government system. Two months later, India has achieved only half the target.
Phase 2 of the vaccination drive was initiated on 1st March, 2021 to cover 100 million people who include those over the age of 60 and those above 45 years with co-morbidities. Till March 18, nearly 15 million first doses have been given to those covered under Phase 2. Cumulatively, over 37 million people in India have received at least one vaccine shot accounting for a little over 2.5% of our population as of March 18.
Ramp Up Vaccination Drive
Meanwhile, India’s COVID-19 caseload has been increasing steadily over the last few weeks, after crossing a peak around September 2020 and dipping to a low in January 2021. The bulk of new cases are being reported from Maharashtra. As on March 18, the cumulative national positivity rate is a notch below 5%.
The rising numbers and the eventuality of the earliest batches of COVID-19 vaccines reaching their expiry dates soon have increased the urgency for the government to be more aggressive in pushing the COVID-19 vaccination drive in the country.
Therefore, the government should look at starting Phase 3, which would include the rest of the population, by end-April. Assuming that we can ramp up to 5 million vaccinations per day from about 2 million doses a day currently, it would allow us to ramp up to 150 million per month and theoretically vaccinate the entire adult population by October 2021.
However, these assumptions are meaningless if we are not willing to be agile and innovative in vaccine deployment. Sequential and stratified vaccination is no doubt logical and stands to reason. However, it is well accepted the world over, that such a logic led decision making process for vaccine deployment is an equitable model but will impede speed and scale. Scientific rationale, on the other hand, might create skewed deployment which may be viewed as inequitable but in effect can stem the spread of infections.
Protecting the elderly and those vulnerable because of co-morbidities is logically undebatable. However, this group is not safe until they receive their second shot. It is therefore imperative that those who live with the elderly also need to be vaccinated to protect and stop transmission. Science will therefore drive decision making in the direction of incidence, rate of infection and demographics. Data driven deployment must necessarily depend on algorithms that factor probability of exposure, vulnerability, infection rates and variants. India can lead the way to develop such paradigms for vaccine deployment. We simply must initiate Phase 3 without further delay. Already, the Ludhiana district administration has extended the ‘frontline workers’ label for vaccination of teachers, bankers, judges, journalists and NGO workers. Why not extend this to the students and the working class to get the economy going.
Time is of the essence and the sooner we initiate Phase 3, the more control over the pandemic we will have. India ought to look at parallel deployment of the Phase 1, 2 and 3 vaccination drives to cover the maximum number of people in the shortest period of time. It is only logical to believe that sequential processing is likely to impede speed and introduce a lag in ramping up. Parallel processing is always a way to introduce speed and scale.
Whilst it is essential to ensure safety when embarking on such a huge scale of immunisation, the first phase ought to have given us adequate assurance and experience. Furthermore, we also require regulatory speed to enable more vaccines to be added to our arsenal. Rather than mandating a bridging trial, it would be better to accord emergency use authorization (EUA) under a trial mode as was done for Covaxin for the vaccines in the pipeline. We have no time to lose and we must ramp up both speed and scale to quell the virus.
A version of this article first appeared in The Times Of India on 23rd March 2021.