When it comes to vaccine supply, India is currently in a comfortable position. However, the coronavirus pandemic is not over yet
The COVID-19 vaccine supply in India has not just exceeded the demand, but by mid-November 2021, about 22 crore of unused shots were available with the state government and another five crore with the private sector. India’s vaccination drive is far from over.
Around 74 crore more COVID-19 vaccine doses are yet to be administered to achieve full adult vaccination. Therefore, the question arises, can India be considered to achieve COVID-19 vaccine sufficiency or are there factors which may unsettle the balance?
There are at least five considerations which include COVID-19 vaccination of children and booster dose for adults, amongst others, which may impact vaccine requirement and availability.
Let’s examine each of those in detail:
First, India has a sizable proportion of 0-to-17-year population. If each of them is to be given two shots of vaccines, it would require around 90 crore vaccine doses. One of the vaccines approved for 12-17 years is three-dose formulation and requirement would be higher.
However, the current evidence does not support vaccination of all children. Limited number of countries which have started vaccination of 12-17 years, most are focusing on high-risk children in this age sub-groups.
India’s decision on COVID-19 vaccination of children should be determined entirely by the scientific and epidemiological evidence and not influenced by external factors such as perceived demand amongst parents. It is very likely that only high-risk children in 12-17-year age group will be considered for vaccination in the beginning.
Irrespectively, as and when COVID-19 vaccination of specific sub-group of children is recommended by National Technical Advisory Group on Immunisation (NTAGI) in India, considering Covishield contributes to majority of supply for adult vaccination and is not approved for children, the decision to open COVID-19 vaccination is unlikely to alter the supply scenario for adult population.
Second, there is ongoing discourse on the need for COVID-19 booster dose for adults. SARS CoV2 is a respiratory virus and in the long run, a booster dose of vaccine may be required. However, at present, there is no consensus on whether it will be needed at all and if yes, at what interval?
Current evidence is that natural infection and vaccines provide sustained protection from severe disease and hospitalisation even after a gap of 12 months. The other aspect is that the proportion of the adult population in India, which has received both shots is relatively small and received their second shot in the last few months.
Therefore, in an unlikely scenario where evidence emerges that a booster shot is needed, it is likely to be recommended after a gap of 9 to 12 months from the second dose. India will not reach that stage before early next year — a time when vaccine supply is likely to be ramped up further.
Third, there is a scientific consensus on the need for an additional shot, as part of primary immunisation for people who are immunosuppressed and likely to not develop sufficient immune response after two shots. This is called ‘extended primary schedule’.
In the weeks ahead, technical experts in India may allow third shots for this population subgroup; however, the number of people eligible for extended primary schedule is likely to be minuscule and unlikely to have any impact on vaccine requirement.
Fourth, a few are arguing to bring down the interval between two shots of Covishield vaccine from 12-16 weeks. Part of this suggestion is from the political consideration as that would make additional population eligible for second shot and India can achieve a higher coverage by the year end.
However, the decision to reduce the gap between two doses of covishield should be based upon technical and scientific evidence. In any case, even such a decision would make only around 4 crore beneficiaries returning for early vaccination, without much effect on vaccine supply.
Fifth, the government has reported that there are 12 crore beneficiaries who are due to return for a second shot for vaccine. The vaccine supplies available with India are far more than this requirement as well.
Factoring in all of the above, it is very unlikely that there would be any shortage of COVID-19 vaccine supply in India and that country has achieved self-sufficiency which is sustainable. Moreover, as a few candidate vaccines are in advanced stages of clinical trials, the supply pipeline is likely to mature and strengthen.
A few days ago, the Union health minister also announced that the government would soon come up with a roadmap for a booster dose of COVID-19 vaccination in the country. It is likely that when preparing such a roadmap, the technical experts would use the available evidence, propose additional scientific studies and lay down the criteria to make a decision on whether (or not) and when COVID-19 booster dose in India can be started.
Such a document will also help in planning vaccine supply and also aligning domestic priorities with ensuring global supply.
Alongside, it is also the time for the Indian government to develop a robust strategy for ‘accelerated vaccine maitri’ to contribute to global COVID-19 vaccine supply in an incremental and sustainable manner.
With two vaccines from India already having been included in the WHO Emergency Use Listing, it is an opportunity for the country to show global leadership and live up to the reputation of global pharmacy and vaccine manufacturing centre for low- and middle-income countries.
It is also a time for caution. When it comes to vaccine supply, India is in a comfortable position. However, the pandemic is not over yet. The performance of a vaccination programme is the outcome of inter-connected functions of policy formulation, vaccine supply and delivery. Vaccine availability is essential but not sufficient.
Only 40 percent of India’s adult population has been fully vaccinated. Nearly 20 percent of adults have not received any shot. People who received the first shot are not returning for the second shot. The vaccine hesitancy is now catching up and the complacency (in those received one shot) is emerging.
It is time for developing operational strategies to increase coverage and getting more people to vaccination centres. The task is half done, progress is sturdy, and we need to continue all the efforts to fight the virus, till the pandemic is declared as over.
Dr Chandrakant Lahariya, a physician-epidemiologist, is India’s leading vaccines and health systems expert. He is founder of ‘Foundation of People Centric Health Systems’, based in New Delhi. Views expressed are personal.