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Explained: Closing in on 100 crore shots

While India is one of only two countries with a billion-plus population, the landmark comes in the face of several hurdles. A look at how the vaccination drive has progressed since January, and the challenges still ahead.

Getting a jab at a free vaccination camp organised by the Delhi government, on Sunday. (Express photo by Prem Nath Pandey)

In a couple of days or so from now, the number of Covid-19 vaccine doses administered in India will have crossed 100 crore, or 1 billion. Already, India has administered more vaccine doses than any other country in the world apart from China. With no other country having a population of anything close to 500 million, the billion-doses club would consist of only these two countries.

Still, for a country that faced huge supply bottlenecks, and a fair amount of vaccine hesitancy, at least in the initial period, reaching the 100-crore milestone is a no small achievement. Transportation, distribution and storage of vaccines at specific low temperatures posed huge additional hurdles in a country lacking in an elaborate cold-chain network. Add to this the fact that for more than three months during this period, India was in the midst of the worst phase of the pandemic, anywhere in the world, one that had crippled the very same health system that was supposed to administer vaccines as well.

The 100-crore milestone is being achieved in about 275 days — the first vaccine doses were administered on January 16 — which means that, on an average, 27 lakh doses have been given every day through this ten-month period. There have, of course, been wide variations in the daily number of doses administered. On six days, more than 1 crore doses were administered, with a record of 2.18 crore being achieved on September 17. On the other hand, in the initial few days in January and a couple of days in February, less than 50,000 doses were administered.

As on October 16, more than 97.65 crore vaccine doses have been administered to over 69.47 crore people. More than 28.18 crore people are fully vaccinated now. This means that 74%, or close to three-fourths, of the adult population in India have received at least one dose, while 30% have got both doses.

Smaller states, better coverage

Not surprisingly, states with smaller populations have a much better coverage of coverage of Covid-19 vaccination. In states such as Sikkim, Himachal Pradesh, Goa, and in the Union Territories of Jammu and Kashmir, Ladakh, Chandigarh, and Lakshadweep, almost every individual above the age of 18 has already received at least one dose of vaccine. These states also have the highest proportion of fully-vaccinated people — over 40% each in the case of Lakshadweep, Sikkim and Ladakh.

But some of the larger states, with much larger populations, such as Gujarat, Kerala, Delhi, Madhya Pradesh and Uttarakhand have also managed to vaccinate over 90% of their adult population with at least one dose. On the other hand, some low-population northeastern states — Manipur, Meghalaya and Nagaland – and also Puducherry are lagging behind, with less than 60% of their people having beem vaccinated with even a single dose.

Among the higher-population states, Bihar, Uttar Pradesh, Maharashtra, West Bengal, Jharkhand, and Tamil Nadu have all achieved less than 70% coverage for first dose. Between 17% and 25% of their population have received the second dose.

No urban-rural divide

Most of the large urban centres, including the metropolitan cities, have registered fairly good coverage of vaccines. The requirement to get vaccinated in order to attend work or to travel, or even shop, coupled with relatively lower vaccine hesitancy, could have played a role in a large number of people getting the shots. In most major cities, the proportion of people who have received both doses is fairly uniform and, in general, higher than the national average of 30% (see chart, Vaccination in major cities).

In the rural areas, the situation is slightly different. Data exclusively from the rural areas are not available, but numbers from the 243 BRGF (Backward Region Grant Fund) districts, which are primarily rural, present a fairly comprehensive picture. A huge variation in vaccine coverage is visible in these districts. The proportion of fully vaccinated people (out of the adult population as per Census 2011) ranges from less than 8% in districts such as Tiruvannamalai in Tamil Nadu or Balrampur in Chhattisgarh, to close to 80% in Ramban in Jammu and Kashmir, and Raigarh in Chhattisgarh. In reality, these percentages would be slightly lower, because of the increase in population in the last 10 years.

However, there is no evidence to suggest that rural areas, in general, are lagging behind in vaccinations. In fact, data show that these 243 BRGF districts have, on an average, provided over 80% of their populations (Census 2011) with at least one dose of the vaccine, much higher than the national average. The coverage of the second dose is about 30%, at par with national average. There does not seem to be a sharp urban-rural divide in terms of vaccination coverage. Again, the increase in population in the last 10 years would probably bring down these percentages by a few points.

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The road ahead

Despite the phenomenal work in speeding up vaccination in the last two months, there is still a steep climb ahead. India is aiming to fully vaccinate its entire adult population by the end of this year. That means an additional 90 crore doses have to be administered between now and December 31. That is about the same amount of work, as accomplished till now, but in one-fourth of the time.

In September, India administered over 23.5 crore vaccine doses, the highest for any month. It would have to do significantly better than that to achieve full vaccination by the end of the year. Compared to September, the rate of vaccination has been slower in October. With more than half the month gone, only about 8.21 crore doses have been administered.

But for the first time, people getting their second doses are likely to constitute about half the number this month. So far, 48% of the vaccine doses have gone to people getting their second dose. This proportion has not grown steadily, as would be expected. It dropped sharply in June following the increase in the prescribed gap period between the two doses. After a big jump in July, it declined in August again. After that it has been on the rise, as people with the first dose crossed the halfway mark. In fact, in the last four days, second doses have been vastly outnumbering the first dose.

Vaccination may have already played a key role in limiting the spread of the disease. India’s daily count of cases had dropped from a peak of over 4 lakh to 50,000 within 45 days between May and June. However, for the next three months, it remained within a range of 25,000-50,000. It is only now, in October, that this number has finally begun to slide down rapidly. For ten days now, the daily case count has not touched 20,000.

Part of the reason is the vaccination coverage reaching a critical stage. As experts repeatedly point out, vaccination does not offer guaranteed protection against infection, but it does reduce the chances. More significantly, however, it does seem to prevent the disease from taking a serious turn.

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