3 in 4 Indians get at least 1 jab as total doses near the billion mark

A little over nine months since India’s mass vaccination programme against Covid-19 kicked off, the country is on the cusp of two major milestones – nearly three out of every four adults in the country have now received at least one shot of the vaccine, and the total doses administered are nearing a billion.

The vaccination landmarks come at a time when the recession of the second wave has continued, with new infections and active cases in the country at the lowest levels since early March, or in at least seven months.

Till Tuesday night, 990.9 million shots of the vaccine were administered across the country to around 701 million people. Based on current daily vaccination rate, the country’s billionth shot is likely to be delivered as early as Thursday morning.

In absolute numbers, this makes India only the second country in the world (next to China with 2.2 billion shots administered) in terms of Covid-19 vaccine doses administered. Of the 701 million people who have been administered these shots, 411 million have been partially vaccinated, while another 290 million people fully vaccinated. When seen alongside India’s estimated population of 940 million adults, 43.7% of the country’s adults have been partially vaccinated and another 30.8% have been given both jabs.

A cause of concern for the drive, however, is that daily dose administration has now seen a near-consistent decline from the peak levels seen during the second half of September – a factor that Union health ministry officials and experts have attributed to low turnout during the ongoing festive season and the vaccine hesitancy threshold finally being visible.

The seven-day average of daily dose administration, a statistic that evens out the dip generally seen over weekends, touched a peak of 9.7 million for the week ending September 23 when several states increased daily numbers to mark Prime Minister Narendra Modi’s birthday on September 17. Since then, however, it has dropped nearly 60% to around 3.9 million shots a day for the week ending October 19.

An easy way to understand the impact of this drop in vaccination pace is to see it as the required run rate in the final overs of a cricket match. In the race for vaccination, as is the case in a run chase, a slower run rate in the middle of an innings requires heavy slogging in the final few overs. In the case of vaccination, if the country had sustained its administration rate of around 10 million doses a day around the third week of September, then it would have been on course to meet its December 31 target of fully vaccinating all adults. But since this rate has dropped in the 25 days since, the required rate has shot up – now India needs to administer more than 12 million doses every day till the end of the year to meet this target.

At the rate of administration in the past week (3.9 million a day), however, this target will be delayed by more than five months, data shows.

That calculation assumes that the entire adult population of the country will want vaccines, an unlikely proposition. Most experts believe the vaccine drive will hit a ceiling around the 75-80% level.

Senior government officials said that the Union government plans to start a dedicated campaign to create awareness among masses to overcome vaccine hesitancy once the billion dose target is achieved. “After 100 crore (1 billion) Covid-19 vaccine doses are administered in the country, we will work on running a massive campaign for generating awareness about taking the second dose, and also addressing overall vaccine hesitancy,” said a top government functionary who asked not to be named.

“On weekends and festivals we see a slight drop in numbers but overall, the drive is progressing well. We are looking at covering the entire eligible population as soon as possible; there is no point in talking in terms of deadlines, etc. There is a task at hand that we are trying to accomplish to the best of our capabilities. The number that we have achieved in such a short span of time is remarkable and even higher than the population of several countries,” this person added.

The Union health ministry has reviewed the status and progress of Covid vaccination with states, urging them to focus on second dose coverage of vaccination as there is a sizeable chunk of population that is overdue for their second dose.

“Highlighting that the nation is close to administering a billion doses, the health secretary congratulated the states/UTs on their effort to vaccinate all citizens. It was highlighted that a sizeable number of beneficiaries who are eligible have not received their second dose. States and UTs were urged to focus on the second vaccination dose...,” the Union health ministry said in a statement on Tuesday.

The states have also been advised to identify and prioritise districts that are reporting poor coverage for focused action and explore requirement for mobilisation efforts, addressing localised challenges, need for additional vaccination centres or improving access in hard-to-reach areas.

Vaccine hesitancy, which was not apparent in the initial months of the drive due to limited supply of doses and high rush for shots in a country the size of India, is becoming more visible now as coverage has reached high numbers in recent weeks. Experts across the world have warned that any supposed vaccine hesitancy would start showing signs after countries hit a high coverage threshold (say around 70% or so). This is because those who were going to get their shots have now done so, and those who still remain away from vaccination centres are the ones who are hesitant. This has been the reason why even countries such as the United States, which have far better vaccine coverage than countries like India, have been unable to hit 100% coverage.

“Vaccine hesitancy is not that big a problem right now as it was at the start of the vaccination drive, but there is still a section that needs convincing to take the shot. It is also important for everyone who has already taken one dose to take their second shot ... taking both are important for maximum protection,” a second senior government official aware of the matter said on condition of anonymity.

Experts say that Centre needs to draft an evidence based communication strategy to deal with hesitancy.

“The government should hire a professional agency that understands communication to generate data on reasons behind vaccine hesitancy among different age groups as the reasons might be different. And not just age-level, there should also be subgroups such as rural and urban as people in these groups may have different reasons for not coming out to get vaccinated. The data that is generated like this should be used to draft targeted, evidence-based communication strategy for their messaging to be more effective,” said Chandrakant Lahariya, senior public health and vaccine expert, on dealing with vaccine hesitancy.