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Sunday, June 13, 2021

We can manage the demand for Covid-19 vaccine much better; here’s how

Vaccination in India for months to come will be supply-driven and supply-constrained. Whatever we do with the bands will not lead to more vaccination. 100% vaccination in an age band is only a concept.

Written by Pradeep Bhargava | Pune |
Updated: May 21, 2021 10:37:46 am
As against the total target population of 27 crore Indians (2 doses each) in the 45-plus category, the vaccination till date has been 14 crores, with 4 crores having taken the second dose.

Imagine a setting when you go to an ATM and instead of cash you get a set of “post-dated cheques” from the machine. Well, something similar is happening with the citizens of this country in the age band of 18-44 years with respect to Covid Vaccination. In this case, though, the date when you can encash the cheque is also not assured.

Another disappointing instance. After the announcement that all citizens of the country between the age of 18-44 years can get vaccinated from May 1, 2021, Maharashtra and Karnataka governments have announced on May 13 that they are stopping the vaccination of this age group for want of vaccines.

The population of these states did not go up in the 13 days nor was there a shutdown of the vaccine plants in the country. What emerged was obvious to most when the announcement was made in the last week of April 2021 by GOI about the universalisation of vaccines in India.

The Union government had steered the Covid vaccination programme from January 16, 2021 with great foresight and scientific tenor. It started with health care workers, followed by frontline workers and then senior citizens above 60 years and those above 45 years with comorbidity. A logical sequence then led to all citizens above 45 years. This made complete sense since it factored in the risk profile of the elderly and the most urgent need to protect health workers as they cured the rest of the citizens. As the cumulative vaccination touched nearly 18 crore ( including 4 crore second doses), from the total possible capture of 27 crore population above the age of 45, the government was ready to release the next band. There will always be a certain section of population who will not agree to/ are not able to get vaccinated. Hence moving on to the next band makes sense when a fair percentage of target population is vaccinated.

The announcement came in the last week of April that all between 18-44 years can now register and get in the queue for vaccination. From the average vaccinations of 20 to 25 lakh a day with supplies of 27 lakh a day — 8 crore units a month production between Serum and Biotech — the system was opened for 52 crore more Indians overnight. That is 5 crore just in Maharashtra and about 48 lakh in Pune.

It was a sureshot recipe for disaster. How do you even dream of unleashing all the floodgates of demand when the supply is no way close to it. The wisdom of opening in grades was shelved under huge pressures from stakeholders who advocated that everything should be opened up including age groups/ sourcing/ government controls. And the Centre obliged.

Armchair criticism does not help so let me point towards a possible solution. Here is some context to start:

  • We must remind ourselves that vaccination is the ONLY certain mechanism of ‘preventing damage’ and all other (essential) measures like bed capacity creation / ventilators/ oxygen supply/ medicines are ‘damage control’ actions. Hence this deserves the highest attention. The scale at which our health care workforce has been able to handle the second wave without any major risk to their health / lives is a testimony to the efficacy of vaccination. Remember the many lives that were lost when our warriors attended to patients in the first wave when vaccines did not exist.
  • The country has created an amazing machinery of sites and cadre to vaccinate — 60,000 sites (90% plus in the State sector) who can easily vaccinate on an average 100 shots per day. That corresponds to giving nearly 15 crore shots a month. Twice the number of vaccines we produce today. And this capacity can be easily doubled and hence capacity to vaccinate will not be a constraint for India.
  • Some major announcements were made recently assuring a massive capacity build-up of vaccine supply in the country. The current capacity of nearly 8 crore vaccines per month will go up to nearly 15 crore by July and more than 60 crore by end of this year. This is expected to offer in excess of 200 crore vaccines in the second half of this year, linked to certain approvals.
  • Finally, on the supply side, the process is a lot more complex now as against the past practice where the Centre bought directly from the two manufactures and sold to states and private hospitals at agreed prices. There are three sets of buyers, multiple sets of prices and everyone is free to procure from any source anywhere in the world. Hopefully, the new mechanism will bring in efficiency and scale.
  • We should consider two announcements made by the Centre about increasing the gap between two shots for Covishield (to 12-16 weeks) and extending the period for vaccination after Covid infection to six months as measures which will push demands on vaccination further in time and give some immediate relief.

With this backdrop, I come to a single proposition to make the demand more closely aligned to the supplies.

While the Union government has “permitted” vaccination of all in the age group 18-44 years, it has left it to the states to decide the age slabs depending on the availability of vaccines. The centre is unlikely to change its guidance, and it is now for the states to decide what is right for them.

I am using the following demographic data for India, Maharashtra and Pune for my proposition

Computed from published Census data of 2020 and making certain assumptions.

My suggestions from the above numbers.

India: As against the total target population of 27 crore Indians (2 doses each) in the 45-plus category, the vaccination till date has been 14 crores, with 4 crores having taken the second dose. The additional “candidates” to be vaccinated now are 52 crore Indians with both doses. The challenge is humongous but each state will drive the flow. As mentioned earlier, 100% vaccination in an age band is only a concept.

Maharashtra: Of the 3 crore in the age group of 45 plus, nearly 1.5 crore have been vaccinated (0.5 Crore with second dose). Instead of making the entire age group of 18-44 years (5 crore citizens ) eligible for vaccination, Maharashtra should open up for only the 35-44 age group (1.5 crore citizens ) in the first instance. Those in the 18-34 age bracket (3.5 crore) can be vaccinated post July when supply of vaccines really improves. Even this can be in two tranches of 25-34 followed by18-24.

Pune: Since the direction will be for the whole State, Pune should also open up for the 35-44 age group (15 lakh citizens) rather than the 18-44 band of 48 lacs citizens. This would be so much more manageable.

It is important for me to highlight that vaccination in India for months to come will be supply-driven and supply-constrained. Whatever we do with the bands will not lead to more vaccination. It will only bring in more orderliness and dignity for the citizens for whom today getting a vaccine slot is like winning a lottery. The level of frustration is so high since the state has “reduced” their chance by increasing the lot size so disproportionately. These norms are making more people disappointed and distracted.

Age brackets are accepted as the fairest filters for vaccines the world over. We rushed too fast perhaps imitating other countries which had abundant supplies before they opened. We are still deficient and will stay so for many more months.

Maharashtra still has the opportunity to set right what is flaring up in the form of anger and protests by the citizens who are anxious and frustrated about their chance of getting the vaccine.

Across the state it should permit only the band of 35-44 years to register and get vaccinated in this phase.

The Health Minister of Maharashtra had spoken in favour of this band rather than vaccinating all in one go. He should be able to steer this through the government and bring orderliness in the vaccination drive. We have many other challenges to address and don’t need to added overcrowding and hustling to the mix.

Frankly, all states can opt for the graded entry, if they really want to serve their citizens with efficiency. The multiple channels of vaccinations have to however honour these bands.

(The author is a former president of the Pune-based Mahratta Chambers of Commerce, Industry and Agriculture. Views expressed are personal)

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